From: Subject: The Scientist :: SARS transmitted via droplets Date: Wed, 28 May 2003 11:01:12 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0025_01C32508.73D375B0"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_0025_01C32508.73D375B0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.biomedcentral.com/news/20030519/02/ =EF=BB=BF The Scientist :: SARS transmitted via = droplets

May 19, = 2003

Previous=20 | Next

SARS transmitted via droplets

Main SARS infection routes, etiology, and control = methods=20 confirmed | By=20 Robert Walgate

The virus last week confirmed as causing severe acute = respiratory=20 syndrome (SARS) is transmitted almost entirely by large = droplets=20 reaching the mucous membranes of nose and lungs and not by = feces or=20 urine reaching the mouth, and the epidemic is coming under = control,=20 a meeting of SARS epidemiologists concluded Saturday (May = 17) at the=20 World Health Organization (WHO) in Geneva. But two mysteries = remain=20 to be solved in China: the reservoir and a possible = alternative=20 transmission route.

The meeting of 16 laboratories and groups concerned with = SARS=20 largely confirmed the existing paradigm of infection and = control,=20 according to a press conference. The sense of relief that = the=20 outbreak was coming under control was palpable. According to = Michael=20 Ryan, coordinator of WHO's Global Alert and Response = Programme, "The=20 control measures we designed at the beginning of the = epidemic have=20 worked, and in country after country we've been able to = break the=20 cycle of transmission=E2=80=A6 and we've seen the number of = secondary cases=20 per case dropping dramatically in so in many places we can = see the=20 epidemic coming to an end."

Margaret Chan, director of Hong Kong's Department of = Health,=20 said, "We see very clearly that the mode of transmission is = droplets=20 as opposed to airborne." And, she told The Scientist, = a=20 Health Canada study will confirm the department's findings = on=20 transmission in Amoy Gardens, the apartment block where 300 = persons=20 were infected. There, feces and urine from SARS patients = with=20 diarrhea were aerosolized through a faulty sewage system and = emerged=20 into apartments=E2=80=94very special circumstances, said = Chan.

Arlene King, director of the Division of Immunization and = Respiratory Diseases, Health Canada, confirmed that "Amoy = Gardens=20 shows that [apart from respiratory droplets] you can = aerosolize=20 other sorts of infectious materials, like feces or urine = that can be=20 inhaled and have contact with mucous membranes." But this is = not=20 what is normally understood as the "oral=E2=80=93fecal" = transmission route=20 typical of enteroviruses and bacteria, like salmonella, Ryan = explained, which requires, for example, the soiling of food = with=20 feces.

A worrying secondary transmission issue remains open, = however, in=20 China. According to Ryan, "The Chinese authorities are = making great=20 strides in identifying contacts of cases, but they can't = always=20 identify the chain of transmission by which that case was = infected.=20 And that is an issue because there are many factors that = might=20 explain that, such as that there might be another infectious = process=20 going on as well as the respiratory route."

The possible original animal source and reservoir of the = virus in=20 China has also still not been identified, and little = research on the=20 issue is in progress. But, said King, "Although the virus = can be=20 sometimes found on animals or in animals, there is no = evidence that=20 animals or insects are spreading the infection in any = country=E2=80=A6" She=20 did not rule out other transmission routes, adding, "There = are=20 certainly things that can be learned about other = [transmission]=20 routes like contaminated articles."

In a separate development, the author of the monkey study = that=20 led WHO to announce on April 16 that coronavirus = causes SARS=20 told The Scientist that the study did not rule out = the=20 possibility that SARS is exacerbated by other = infections.

Albert Osterhaus, head of the Institute of Virology at = Erasmus=20 University and lead author of the paper published last=20 week in Nature (Nature, 423:240, May 15, = 2003),=20 said that although there were only four macaque monkeys in = the=20 experiment, the pathology in the monkeys infected with = coronavirus=20 was "indistinguishable from what we see in SARS cases in = humans."=20 Osterhaus added, "We cannot exclude that the whole thing = might not=20 be exacerbated by other infections, but we have no = indication of=20 that from our limited experiments."

Links for this = article
"Severe acute respiratory syndrome," World = Health=20 Organization Communicable Disease Surveillance and Respose. =
http://www.who.int/csr/sars/en/

R. Walgate, "WHO says coronavirus causes = SARS," The=20 Scientist, April 16, 2003.
http://www.biomedcentral.com/news/20030416/04/ <= BR>
R.A.M. Fouchier et al., "Aetiology: Koch's = postulates=20 fulfilled for SARS virus," Nature, 423:240, May 15,=20 2003.
http://www.nature.com/nature

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