CDC - World Health Organization Global Conference on = Severe Acute Respiratory Syndrome

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Current Issue
3D"

Vol.=20 9, No. 9
September = 2003

PDF=20 Version | Download Adobe = Acrobat | Comments=20 | Email= =20 this article


=95	Can = SARS Be=20 Eradicated?
=95	Are=20 Current Control Measures Effective?
=95	Are=20 Current Alert and Response Systems Robust=20 Enough?

Conference Summary

World Health = Organization=20 Global Conference on Severe Acute Respiratory Syndrome

David Bell,* Philip Jenkins,* and Julie Hall*
*World = Health=20 Organization, Geneva, Switzerland

Suggested=20 citation for this article: Bell D, Jenkins = P, Hall J.=20 Severe acute respiratory syndrome: where do we go from here? = Emerg=20 Infect Dis [serial online] 2003 Sep [date cited]. = Available from:=20 URL:=20 = http://www.cdc.gov/ncidod/EID/vol9no9/03-0559.htm

On June 17=9618, 2003, in Kuala Lumpur, Malaysia, the World = Health=20 Organization (WHO) sponsored a conference entitled SARS: Where Do = We Go=20 From Here? The purpose of the conference, which was attended by = over 900=20 scientific and public health experts from 43 countries, was to = review=20 available knowledge and lessons learned and to identify key = priorities for=20 the future. Three overarching questions were addressed: Can severe = acute=20 respiratory syndrome (SARS) be eradicated? Are current control = measures=20 effective? Are current alert and response systems robust = enough?

The first day included summaries of the history of the = epidemic,=20 global, and regional responses coordinated by WHO through its = headquarters=20 in Geneva and the Western Pacific Regional Office in Manila, = respectively;=20 and national responses in the People=92s Republic of China (PRC), = including=20 in the Hong Kong Special Administrative Region of PRC, Singapore, = Vietnam,=20 Canada, and United States. Nine presentations summarized = scientific,=20 clinical, public health, psychosocial, and communications aspects = of the=20 SARS outbreak. On the second day, breakout groups met and = presented=20 recommendations on the topics of epidemiology and public health, = possible=20 role of animals, environmental issues, modeling the epidemic, = clinical=20 diagnosis and management, reducing transmission in healthcare = settings,=20 blood safety, reducing community transmission, preventing = international=20 spread, surveillance and response coordination, effective = communication,=20 and preparedness. Background materials for the conference, slide=20 presentations at the plenary sessions (including the breakout = group=20 reports), and the text of speeches by the Director General of WHO = and=20 other dignitaries are available on the Web (URL: http://www.cdc.gov/ncidod/EID/vol9no9/disc40.htm).

Beginning in March 2003, after WHO recognized, through its = Global=20 Outbreak Alert and Response Network (GOARN), an outbreak of severe = respiratory illness with high transmissibility in healthcare = settings and=20 international spread through airline travel, WHO issued a series = of global=20 alerts, travel advisories, and recommendations for diagnosis, = clinical=20 management, and prevention of transmission. Evolving information = was=20 discussed by virtual networks of experts, including virologists,=20 clinicians, and epidemiologists. Field teams composed of staff = from GOARN=20 partners were quickly mobilized to assist affected countries in = enhancing=20 surveillance and containment measures, which included isolating = cases,=20 implementing strict infection control measures, identifying and=20 following-up with contacts, and making recommendations to = travelers to=20 prevent international spread.

From a global perspective, the SARS epidemic demonstrated the=20 importance of a worldwide surveillance and response capacity to = address=20 emerging microbial threats through timely reporting, rapid = communication,=20 and evidence-based action. The importance of international = collaboration=20 coordinated by WHO and the need for partnerships among clinical,=20 laboratory, public health, and veterinary communities were = emphasized.=20 From the national perspective, lessons learned included the need = for the=20 following: strong political leadership at the highest levels to = mobilize=20 the entire society; speed of action; improved coordination between = national and district levels in countries with federal systems; = increased=20 investment in public health; updated legislation regarding = surveillance,=20 isolation, and quarantine measures; and improved infection control = in=20 healthcare and long-term-care facilities and at borders.

Can SARS Be=20 Eradicated?

The breakout groups concluded that it is too soon to tell if = SARS can=20 be eradicated, but substantial reasons for concern exist. Chains = of=20 person-to-person transmission can likely be terminated, provided = no=20 reservoir of asymptomatic carriers, chronic infection, or seeding = of new=20 settings (e.g., Africa) exists. But if an animal reservoir = of the=20 SARS coronavirus exists, as suggested by some studies, eradication = would=20 be very difficult. Fecal shedding of virus by infected persons and = apparent virus stability in the environment could pose additional = barriers=20 to eradication, although these circumstances were not major modes = of=20 transmission in the recent epidemic. Research priorities include = better=20 understanding of the epidemiologic and virologic parameters of = infection=20 and transmission, including =93superspreading events=94; the = possible role of=20 animals, including host range and factors leading to emergence; = the=20 environment; and analysis of the effectiveness of specific = interventions=20 in controlling the epidemic. Additional priorities include = standardization=20 of diagnostic assays and reagents, development of a reliable = front-line=20 diagnostic test for use early in illness; facilitating the ability = to ship=20 diagnostic specimens; and development of animal models to improve=20 understanding of pathogenesis and evolution of clinical disease = and to use=20 in vaccine development and antiviral drug testing.

Are Current=20 Control Measures Effective?

Currently recommended measures to prevent transmission in = healthcare=20 settings are generally effective when applied, but require proper=20 infrastructure, training, and consistent practice. Infection = control=20 capacity and practice in many healthcare settings need = improvement. A=20 minimum global level of safe practice (standard precautions, = supplemented=20 by risk-based precautions) should be established. Studies are = needed to=20 determine optimal protective measures (e.g., type of mask) and = when they=20 should be used. Appropriate protective measures (e.g., isolation=20 facilities and masks fit-tested for individual workers) should be = more=20 widely available.

Measures to control community transmission (i.e., outside of = healthcare=20 settings) and prevent international spread require further = evaluation.=20 Such measures include public information campaigns, contact = tracing and=20 sometimes quarantine, hotlines to report fever, temperature = screening in=20 public places, recommendations to travelers, and entry and exit = screening=20 at borders with questionnaires and temperature checks. Control = measures in=20 the community would likely have the greatest yield if focused on = links=20 between healthcare settings and the wider community, with contact = tracing=20 prioritized according to the nature of exposure, but further = evaluation is=20 needed. Home or institutional quarantines, when used, should = ensure=20 financial and psychosocial support and daily needs of the affected = persons. Stigmatization of affected persons and groups was = identified as=20 an important issue. In an attempt to reduce stigmatization, one = country=92s=20 president reportedly proclaimed quarantined persons to be = =93heroes in the=20 nation=92s battle against SARS.=94 Some participants stated that = visible=20 measures to control community and international spread were = important in=20 restoring public and business confidence and as deterrents, = regardless of=20 the yield of SARS cases detected.

Are Current=20 Alert and Response Systems Robust Enough?

Current systems are robust in that SARS is being controlled, = but many=20 processes are not sustainable because of limited capacity. = Surveillance=20 priorities include developing a sensitive =93alert=94 case = definition in areas=20 at greatest risk for recurrence, developing a front-line = laboratory=20 diagnostic test to identify patients with SARS coronavirus = infection=20 during periods of high incidence of other respiratory illnesses, = improving=20 laboratory diagnostic capacity and laboratory-based surveillance, = and=20 developing integrated information tools that allow real time = analysis of=20 clinical, epidemiologic, and laboratory data.

Response coordination priorities include development of = contingency=20 plans, including ensuring coordination and surge capacity at = global,=20 regional, and national levels; development of laboratory and = information=20 technology systems; and the ongoing revision of the international = health=20 regulations to focus on containing emerging infectious = diseases.

Underlying any response is the need to communicate information = in a=20 transparent, accurate, and timely manner. Effective communication = requires=20 training, understanding, and use of a range of different media. = Developing=20 further the current communication systems and our understanding of = risk=20 communication is vital if future outbreaks are to be controlled = quickly=20 and effectively and the health, economic, and psychosocial effects = of=20 major health events are to be=20 minimized.

Comments to the = Authors

Please use=20 the form below to submit correspondence to the authors = or=20 contact them at the following address:

David=20 Bell, Centers for Disease Control and Prevention, = Mailstop=20 C12, Atlanta, Georgia 30333, USA; fax: 404-639-4197; = email: dbell@cdc.gov

<= /TBODY>

Comments to the EID=20 Editors

Please contact the EID Editors at eideditor@cdc.gov

Email this = article

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		This page = posted August 21, 2003 This=20 page last reviewed August 21, 2003=20

		Emerging = Infectious=20 Diseases Journal National Center for = Infectious=20 Diseases Centers for = Disease Control=20 and Prevention

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