CAREC: Prepare for SARS virus

Do you have a high fever (over 38 degrees Celsius), any respiratory symptoms like cough, shortness of breath or difficulty breathing, and have you within the past 10 days arrived from Toronto, Canada or certain regions of the Far East?

The Caribbean has not yet found anyone infected by Severe Acute Respiratory Syndrome (SARS) which has caused 62 deaths in 15 countries, but the Caribbean Epidemiology Centre (CAREC) yesterday warned its member states to be alert for any such cases. CAREC, which is a division of the Pan American Health Organisation (PAHO), which is itself the regional office of the World Health Organisation, issued a statement entitled “SARS Multi-Country Outbreak Alert #4”. Despite no reported SARS cases in the Caribbean, CAREC said: “Given the high level of international travel to and from the Caribbean, each country should be prepared for the possible importation of SARS cases. Early detection, isolation and infection control are essential elements for containment of infection”.

The statement said that up to April 1 the WHO had received reports of 1,804 cases of SARS including 62 deaths in 15 countries. The affected areas include Toronto (Canada); Singapore, Guangdong, Hong Kong Special Administrative Region, Shanxi and Taiwan Province (China); and Hanoi (Vietnam). While the outbreak has been stabilised in Vietnam and Singapore, the Guangdong outbreak is the largest and has shown evidence of spread into the wider community and in the Hong Kong Special Administrative Region there continues to be a significant increase in cases.

CAREC said the incubation period for SARS is two to 10 days, with persons being contagious only while ill. It is spread by heavy droplets not aerosolised droplets, and close contact is thought to be an important factor in transmission. “Close contact means having cared for, having lived with, or having direct contact with respiratory secretions and bodily fluids of a person with SARS. Close contact in an aircraft would be sitting next to a case, in the same row, sitting two rows in front or two behind”. WHO has discovered that SARS is caused by a corona virus, although its agent is yet to be identified. CAREC said: “There is no vaccine or other prophylaxis available. The global experience is that infection control methods work well in containing the spread of SARS in hospitals. Ribavirin with or without steroids has been a successful treatment in many cases”.

The prognosis? “Ninety percent of SARS cases seem to recover in six to seven days. Ten percent of cases progress to a more severe form of the syndrome. The indicators for poor prognosis are being over 40 years of age and having previous existing illness such as coronary heart disease, renal impairment or liver disease. Mortality among the 10 percent of cases with poor prognosis is high, though the overall case fatality rate remains at three percent”. CAREC urged regional governments to establish a response plan to the disease.