Preventing the Spread of SARS

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Preventing the Spread of SARS Overview of CDCs
Laboratory Findings James M. Hughes,
M.D. Director, National Center for Infectious
DiseasesCenters for Disease Control and
Prevention
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CDC SARS Investigation

• CDC Emergency Operations Center activated on
  March 14
• Approximately 30 scientists deployed to assist
  the investigations in Hong Kong, Vietnam, Taiwan,
  Thailand, and Canada
• Nearly 300 CDC staff working at CDC headquarters
  and throughout the United States

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Number of Suspect SARS Cases by Exposure Category
and Date of Illness Onset, United States2003
(N100) as of 4/03/2003
10
8
6
Number
4
2
0
2/5
2/7
2/9
3/1
3/3
3/5
3/7
3/9
2/11
2/13
2/15
2/17
2/19
2/21
2/23
2/25
2/27
3/11
3/13
3/15
3/17
3/19
3/21
3/23
3/25
3/27
3/29
3/31
Date of Onset
Travel to high risk area
Ill contact
HCW
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Coronaviruses

• Single-strand RNA, nonsegmented, enveloped,
  31,000 NTs
• 2 serogroups (229E and OC43) in humans
• 1/3 of common colds
• Reinfections common
• Envelope
• S - spike protein
• M - matrix protein
• HE - hemagglutinin

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Coronaviruses

• Survival
• 229 E- 6 days in suspension- 3 hrs after drying
  on surfaces
• OC43- lt1 hr after drying on surfaces

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Laboratory Evidence as of 4/03/2003
No. pos. patients
Assay
Findings
Culture (Vero E6 cells) EM (cell culture,
BAL) PCR (tissue, swabs) Serology (IFA,
EIA) Histopathology
Viral growth Virus-like particles,
Coronavirus Coronaviral nucleic acid Antibody DAD
(ARDS)
4 2 11 5 4
Results not mutually exclusive
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Coronavirus-infected Vero E6 cells (isolate from
SARS patient) by thin section EM
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Coronavirus particle by negative stain
EM (isolate from patient with SARS)
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Coronavirus-infected cell in BAL of SARS patient
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Lung of patient with fatal SARS showing diffuse
alveolar damage and syncytial giant cells
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Multinucleated syncytial giant cellsin lung of
SARS patient
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Other Laboratory Work in Progress

• Immunohistochemistry
• In situ hybridization
• Virus sequencing

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Emerging Global Microbial Threats Case in point
SARS
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Candidate Factors AffectingEmergence of SARS

• Human demographics and behavior
• Human susceptibility to infection
• Economic development and land use
• Changing ecosystems
• International travel and commerce
• Microbial adaptation and change
• Breakdown of public health measures
• To be determined . . .

IOM Microbial Threats to Health Emergence,
Detection, and Response. March 2003.
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Addressing the Threat of SARS

• Enhancing global response capacity
• Improving global infectious disease surveillance
• Rebuilding domestic public health capacity
• Developing diagnostics
• Educating and training multidisciplinary
  workforce
• Vaccine development and production
• Need for new antimicrobial drugs

IOM Microbial Threats to Health Emergence,
Detection, and Response. March 2003.
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SARSWhat we need to know

• Future course of outbreak
• Source of virus
• Mode of transmission in community
• Risk of household transmission
• Risk of transmission on airplanes and ships
• Environmental persistence/decontamination
• Period of infectiousness

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SARSWhat we need to know (cont.)

• Explanation for age distribution
• Importance of hypertransmitters
• Role of co-infection
• Optimal diagnostic test(s)
• Effective therapy
• Vaccine approaches

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http//www.who.int/csr/sars/en/
http//www.cdc.gov/ncidod/sars/
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Emerging Global Microbial ThreatsLessons learned
from SARS

• Importance of strong national and international
  collaborations and partnerships
• Need for planning and practice
• Expect the unexpected