WHO/WPR - Severe Acute Respiratory Syndrome = (SARS)

From: Subject: WHO/WPR - Severe Acute Respiratory Syndrome (SARS) Date: Mon, 12 Jul 2004 16:15:49 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C4682B.7F361630"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1409 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C4682B.7F361630 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.wpro.who.int/sars/docs/update/update_07022004.asp WHO/WPR - Severe Acute Respiratory Syndrome = (SARS) HOME | COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE = | SARS | AVIAN=20 INFLUENZA ------=_NextPart_000_0000_01C4682B.7F361630 Content-Type: application/octet-stream Content-Transfer-Encoding: base64 Content-Location: http://www.wpro.who.int/sars/images/wpro_SARSbanner.jpg /9j/4AAQSkZJRgABAgAAZABkAAD/7AARRHVja3kAAQAEAAAAPAAA/+4ADkFkb2JlAGTAAAAAAf/b 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Investigation into China's recent SARS = outbreak yields=20 important lessons for global public health
2 July=20 2004

It has been more than two months since the Ministry of = Health of China notified WHO and the world about an outbreak of = SARS in=20 Beijing and Anhui Province. Since then, WHO experts have been = supporting=20 the Chinese authorities in their investigation into the cause of = the=20 laboratory-acquired cases, and in assessing the effectiveness of = measures taken to control the outbreak.

On July 1 2004, = the=20 Ministry of Health of China released its status report on the=20 investigation.

While the outbreak has now been = successfully=20 contained, initial findings from the investigation and the = assessment of=20 control measures have raised several important lessons for = global public=20 health.

Investigation into the source of the=20 outbreak

During the course of the investigation, a=20 significant amount of information was gathered, although all the = practices within the National Institute of Virology in Beijing = have yet=20 to be thoroughly assessed. Although not all detailed information = has=20 been made available to WHO, the following conclusions have been = made=20 about the source of the outbreak:

The National Institute of Virology in Beijing was the most = likely=20 source of the outbreak.=20
At least four individuals may have been infected with SARS = at the=20 Institute. These include the two laboratory workers reported = in April,=20 and two additional laboratory workers. These two additional = laboratory=20 workers appear to have suffered from SARS-like illnesses in = early=20 February 2004. Recent laboratory tests performed at a national = reference laboratory were positive for SARS antibodies.=20
The use of inactivated SARS coronavirus, which was not = tested to=20 determine the effectiveness of the inactivation, in a general=20 laboratory at the Institute appears the most likely cause of = the=20 outbreak.
During the investigation, it became = apparent that all=20 the positive laboratory workers worked in the same general = laboratory at=20 the Institute. Although no research involving live SARS viruses = was=20 known to have taken place in this laboratory, SARS coronavirus = that had=20 been inactivated in a Biosafety Level 3 laboratory in the = Institute was=20 used on several occasions during the early months of 2004 in = experiments=20 carried out in this area. The timing of the use of inactivated = SARS=20 coronavirus in the general laboratory coincides with the = presence there=20 of all the positive workers and with their likely incubation=20 periods.

WHO recommends that further work is needed to = verify the=20 effectiveness of the method used to inactivate the live SARS = virus. At=20 the same time, other possible explanations of the cause of the = outbreak=20 cannot be fully excluded.

Biosafety concerns raised by = the=20 outbreak

The incident at the National Institute of = Virology=20 in Beijing has raised concerns about biosafety in general, and = the way=20 in which inactivated viral material is handled in = particular.

"In=20 light of the investigation, WHO believes that Member States = should=20 carefully review biosafety standards and strengthen them to = avoid=20 further incidents," said Dr Shigeru Omi, Regional Director of = WHO's=20 Western Pacific Region.

WHO will be working with Member = States=20 and expert groups to develop country and regional strategies to=20 strengthen biosafety. Core components of such biosafety = programmes at=20 country level are likely to include:

A containment policy to reduce the number of laboratories = storing=20 and working on SARS coronavirus.=20
A legislative framework and independent advisory body to = assist in=20 the development, implementation and evaluation of a national = biosafety=20 programme and in the investigation of biohazard incidents and = the=20 dissemination of lessons learned to the global scientific = community.=20
A laboratory accreditation system based on standardized = biosafety=20 criteria.=20
An occupational health service to monitor the well being = of=20 laboratory workers.=20
Comprehensive biosafety and training programmes in all = diagnostic=20 and research institutes supported by a management framework = that=20 facilitates compliance with evidence-based guidelines and the = adoption=20 of a positive biosafety culture.
WHO also emphasizes = that=20 scientists working with highly pathogenic viruses such as SARS = need to=20 handle inactivated material with the utmost caution. In = particular, WHO=20 recommends that:

Researchers use appropriate and internationally accepted = methods=20 for validating the inactivation of live viruses.=20
Inactivated material should be handled only in = laboratories at=20 biosafety level (BSL) 2 or above.=20
Researchers handling inactivated material should wear = appropriate=20 personal protective equipment.=20
New methods for inactivation should be adopted only after = rigorous=20 testing.=20
Clear and comprehensive protocols should be available for = all=20 inactivation techniques.
Assessment of = effectiveness of=20 outbreak control measures

In addition to supporting = the=20 investigation into the possible source of the outbreak, WHO has = worked=20 with Chinese authorities to evaluate the effectiveness of the = outbreak=20 control measures.

Joint WHO-Ministry of Health teams have = visited=20 all the hospitals where the recent cases were treated before = they were=20 admitted to designated SARS facilities. In addition, WHO experts = have=20 reviewed data on contact tracing and other control=20 measures.

"Overall," said Dr Omi, "WHO believes that the = Chinese=20 authorities acted swiftly and effectively to control the = outbreak once=20 the alarm had been raised. Extensive contact tracing was = undertaken in a=20 matter of hours, and the effective isolation of cases and = identification=20 of contacts appears to have ensured that the outbreak was = contained with=20 remarkable speed."

However, there was a delay in = detecting the=20 initial cases. As a consequence, two generations of transmission = occurred and the application of effective hospital and community = control=20 measures took place late in the outbreak. The Ministry of Health = of=20 China has acknowledged this and is looking to strengthen further = the=20 current detection and response system.

There are a number = of=20 lessons from this outbreak that are important globally, for = Member=20 States and for WHO itself:

Health care workers, laboratory workers and people in = close=20 contact with certain animals are at risk of contracting a = range of=20 infectious diseases with outbreak potential. Disease detection = systems=20 need to be designed to take these risk factors, as well as = clinical=20 information, into account - and to be robust enough to ensure = that=20 nobody slips through the net and evades detection.=20
Health care workers need to be aware of the risks = associated with=20 certain occupations (including their own) and to be able to = take a=20 detailed occupational history from a patient.=20
Health care workers also need to be aware of the = importance of=20 asking about the health of close contacts of anyone with a = potentially=20 contagious respiratory illness. Quickly identifying possible = clusters=20 of respiratory illness is important in the control of such = diseases=20 and the detection of new or rare infectious diseases.=20
All health care workers should be empowered to initiate = effective=20 measures to protect themselves and others from potentially = contagious=20 diseases, in a "safety first" approach. This means that health = care=20 workers should be aware of potential clinical and = epidemiological risk=20 factors; have ready access to the equipment and knowledge = needed to=20 protect themselves and others; and be allowed to initiate the = most=20 appropriate infection-control measures immediately - with = validation=20 and approval from senior members of staff later.
This = recent=20 outbreak has demonstrated once again that SARS is a containable = disease.=20 WHO commends the Chinese authorities for taking swift action to = control=20 the latest outbreak. WHO will be working closely with the = Chinese=20 authorities to assist in the strengthening of biosafety, and to = build a=20 long-term strategy for strengthening laboratory research and = diagnosis=20 in China.

WHO looks forward to working with China in its = efforts=20 to tackle SARS and other public health issues in the=20 future.

Chinese=20 Ministry of Health SARS Investigation Summary
http://www.wpro.who.int/sars/docs/update/update_07022004_rev= isedfinal.asp

_____

For more information, please=20 contact:
Mr Roy Wadia at (86 10) 6532 5687; mobile (86) 1361 = 117=20 4072; email wadiar@chn.wpro.who.int
Mr=20 Peter Cordingley at (63 2) 528 9991 to 93, mobile (63 917) 844 = 3688;=20 email cordingleyp@wpro.who.int
=
Mr=20 Dick Thompson at (41 22) 791 2684; mobile (41 79) 475 5475;email = thompsond@who.int or Ms = Maria Cheng=20 at (41 22) 791 3982; mobile (41 79) 500 6576; email chengm@who.int =

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