Category: General things

Scientists identify new virus: Germ may cause many unexplained infections
June 2 � It isn�t SARS, but infectious disease specialists are trying to learn more about a recently discovered virus that some think may be the culprit in many unexplained respiratory illnesses around the world.
THE EXACT prevalence of human metapneumovirus isn�t known, but Yale University researchers recently found it in 6.4 percent of retested lab samples from 296 children with respiratory symptoms in late 2001 and early 2002, according to a study published Monday in the June edition of Pediatrics.
It was also discovered after the fact in about 4 percent of retested specimens taken from Rochester, N.Y.-area adults in 1999 through 2001, University of Rochester researchers reported in a Journal of Infectious Diseases article earlier this year.
While those sites are the only published evidence of the virus in the United States, it is thought to be far more prevalent and also has been found in Canada, Europe and Australia.

NOT AS INFECTIOUS AS SARS
Like SARS, or severe acute respiratory syndrome, human metapneumovirus has been associated with flu-like infections and pneumonia-like symptoms, but it does not appear to be as infectious as SARS, said Dr. Jeffrey Kahn of Yale University medical school, senior author of the Pediatrics study.
None of the patients in the Yale or Rochester reports died.
Symptoms may include nasal congestion, wheezing, and lung inflammation, and the symptoms may range from mild to serious enough to require hospitalization, Kahn said.
�It can be added to the list of newly emerging human respiratory viruses and really represents another challenge for the medical community,� Kahn said.
It belongs to the paramyxovirus family, which also includes a common bug called respiratory syncytial virus, or RSV. SARS is believed to be caused by a different pathogen.

A CULPRIT IN CHILDHOOD ILLNESSES?
The average child gets about 10 respiratory infections by age 1 and many more throughout childhood. Many are caused by cold viruses, influenza or RSV, but doctors aren�t able to pinpoint a cause in about a third of the cases, Kahn said.
Human metapneumovirus may be the culprit in many such cases, he said.
The virus, nicknamed hMPV, was first identified about two years ago in the Netherlands but likely has been around for a long time, said Dr. Ann Falsey of the University of Rochester.
It has less conspicuous features under the microscope than other viruses and may simply have gone undetected or misdiagnosed before the Dutch discovery, Falsey said.
�This may be one more piece to the puzzle as to what all these respiratory infections are,� she said.
The Yale and Rochester researchers detected the virus in specimens retested after the Dutch discovery.
Early efforts to find a potential vaccine for the virus are under way, said Dr. Larry Anderson, a respiratory disease specialist at the federal Centers for Disease Control and Prevention.
There are no commercially available tests for hMPV; diagnoses can only be made at special research labs, Kahn said.
More research is needed to learn how common it is, whether it occurs seasonally like influenza, and to determine the range of symptoms it can cause and what treatments might help, Kahn said.
�There�s a lot more that we don�t know than we do know right now,� he said.
Source: msnbc.com

More Smallpox Vaccine Concerns
WASHINGTON, D.C., May 27, 2003
There is new concern about the government’s already troubled smallpox vaccination program. Few of the half-million healthcare workers eligible for innoculation under phase one of the program chose to get vaccinated. And some healh experts are warning — not so fast.
Some states, including Florida and Virginia, are already moving ahead with phase two of the government’s smallpox vaccination program, to include as many as three million firefighters, police and paramedics.
But a new report issued by an Institute of Medicine panel says all civilian vaccinations should temporarily stop, and that the federal government should actively get out the word to states, CBS News Correspondent Sharyl Attkisson reports.
The Committee on Smallpox Vaccine Implementation earlier recommended a “pause” in civilian smallpox vaccination, in part due to unexpected adverse events emerging in what was already known to be the most toxic vaccine on the market.
The head of the committee, Dr. Brian Strom, says the Centers for Disease Control, which advises states on their vaccine programs, recently accepted the idea of a pause. Yet, Strom says, the CDC didn’t explicitly notify states of this change of heart. Tuesday’s report encourages the CDC to take more action.
“What we’re asking is one step further � that they go out of their way to make it easy for those states who want to pause to make it easy for them to be able do that,” says Strom.
“We think that it’s better for public health, we think it’s better for the campaign, that all information be learned about to the degree possible before launching into phase two in a large-scale way. We thought that it was very important that people stop, they take stock of where they are, look to learn from the experience gained today before proceeding onward with the rest of the campaign.”
The report says several issues should be resolved “before deciding whether and how to proceed with vaccination.”
On the issue of safety, the report says a “pause” is needed to collect and evaluate adverse event reports. Although every civilian who receives the smallpox vaccine is supposed to be individually tracked, only 34 percent of vaccinees have made it into the surveillance system so far; two-thirds have not.
“Some adverse events might not arouse concern on a state level, but aggregated nationally, new patterns could emerge,” says the report. “Cardiac complications were unexpected adverse events, and there may be others.”
Says Strom: “At this point only about one-third of the civilian patients who’ve gotten the vaccination are in the surveillance system. And one of the things we’d like know about is the outcomes in the other two-thirds of the patients.”
The report also says the consent forms and educational materials should be revised with updated material and information that can be understood clearly by firefighters, police and paramedics instead of the health care workers who were targeted in phase one.
“In many ways, the most important message we have is that maximum preparedness doesn’t require huge numbers; it requires it be done very safely and very carefully. That’s what’s been done so far. The CDC has done a terrific job. And the CDC should use (a pause in the state’s vaccination programs) as an opportunity to learn maximally from the experience to date, in order to be sure that as we launch into phase two it’s given to the right people, it’s the right size and it’s done as safely as possible,” says Strom.
The panel that issued the new report was created by the Institute of Medicine to advise the federal government on implementing the smallpox vaccine program.
But it’s unclear whether the federal government will take the committee’s advice to publicly encourage states to “pause.” Doing so would highlight touchy subjects in some political circles: unexpected adverse events, and what some view as the lackluster response to President Bush’s smallpox vaccine program. Out of roughly 500,000 eligible health care workers, only a small fraction, 30,000, volunteered to receive the vaccine in phase one.
Many who refused the vaccine were concerned about the vaccine’s risks. Some states have already stopped their smallpox vaccination programs on their own, others are “skipping” phase two altogether.
The inherent conflict involved in this issue is apparent. Strom, chair of the committee that wrote the new report, told CBS News it was issued quickly because of its importance and urgency. Yet a spokesman for the Institute of Medicine told reporters, in advance, there would be nothing particularly newsworthy in the committee’s report.
Source: cbsnews.com

Many people struggling to lose weight or eat more healthfully feel discouraged by food cravings that seem to undermine their good intentions. Food cravings are quite common, especially among women, according to a new review of the topic in the Journal of Nutrition. Many factors may create food cravings, although which are the most important and how cravings should be dealt with are far from clear.
FOOD CRAVINGS are at least partly related to the sensory appeal. Foods high in sugar and fat are the most commonly craved foods, especially chocolate. An earlier report in the Journal of the American Dietetic Association notes that, although chocolate cravings are linked with sweet cravings, people who crave chocolate generally report that these cravings are not satisfied by other sweets.

A PHYSIOLOGICAL CAUSE?
Some research has found a physiological basis for cravings, according to the new Journal of Nutrition review. According to some studies, carbohydrates initiate a chain reaction that theoretically can change levels of neurotransmitters influencing mood.
Research with carbohydrate cravers suggests that cravings for sweets may come with negative or depressed feelings that could be relieved as those levels change, but this idea is not universally accepted. Some studies, like one in the International Journal of Obesity and Related Metabolic Disorders, suggest that carbohydrate snacks may not necessarily improve mood.
Uncomfortably low blood sugar may be another physiological cause for a craving for sweets as the body tries to normalize blood sugar levels.
Others propose that cravings may stem from nutritional deficiencies. For example, a lack of adequate magnesium in the diet could be behind a chocolate craving. Chocolate is a good source of magnesium. But avocados and spinach are far more concentrated sources, and we rarely hear of people craving those foods.
Some cravings, especially for chocolate, also seem to fluctuate with hormonal changes before and during women’s menstrual periods.

THOUGHTS AND EMOTIONS
A large body of research shows that thoughts and feelings about food are also strongly influenced by non-physical factors. People who go on diets that forbid certain foods almost always end up craving those foods.
According to a report in the International Journal of Eating Disorders, cravers are often more concerned about their weight than non-cravers. But is this because out-of-control cravings cause undesired weight gain or because excess concern with weight and dieting leads to more cravings?
Not everyone experiences food cravings. But scientists say we should understand that for those who do, their cravings are real and should be respected.

TIPS FOR CONTROLLING CRAVINGS
For people whose cravings seem to be physiological, eating regular meals and not allowing hunger to become overwhelming can help prevent dropping blood sugar from acting as a trigger. Choosing whole grains, fruits, vegetables, and legumes for most of the day’s carbohydrate will supply important nutrients and reduces roller-coaster effects on blood sugars.
For those who seem to crave foods to cope with their feelings, eating only small amounts of less-nutritious craved foods, along with a nutritionally balanced snack or meal, may be appropriate.
Some experts observe that the more we use certain foods to ease emotionally laden times, the more we condition ourselves to crave them in the future. For this reason, efforts to find other ways to ease emotional pain are likely worthwhile. Exercise, for example, has proven to have positive, mood-elevating effects.
Finally, don’t create cravings by making overly strict rules as you aim for healthy eating habits. No food needs to be eliminated to create a healthy diet – it’s how often and in what portion it is eaten that counts.
Source: msnbc.com

Pregnancy Safety Precautions
NEW YORK, May 3, 2003
(CBS) Alisa Kotler-Berkowitz and her son Matan are the picture of health today, but two-thirds of the way through her pregnancy, Kotler-Berkowitz got an unexpected diagnosis. She learned she had gestational diabetes. “I was concerned because I wasn’t sure what it meant, I didn’t know a lot about diabetes,” says Kotler-Berkowitz.
A woman with gestational diabetes produces the right amount of insulin, but the insulin’s effects are blocked by hormones made in her placenta. It’s a condition that affects between 3 and 6 percent of non-diabetic women. Risk factors include a family history of diabetes, high blood pressure, obesity and being over the age of 30.
“It is very important that we screen pregnant women because there are no symptoms,” says Mt. Sinai Hospital’s Dr. Michelle Morgan.
Women are tested for gestational diabetes between the 24th and 28th week of pregnancy. They begin by drinking a sugary solution. After one hour, their blood is drawn to check the glucose level. If it’s too high, the expecting mom will have to undergo further testing. If it is determined a pregnant woman does have gestational diabetes, she must get it under control immediately. Failure to treat the condition can lead to serious problems for the baby, including excessive birth weight, low blood sugar, jaundice, respiratory problems and sometimes death.
In most cases, gestational diabetes is fairly easy to deal with.
“The main stays of treatment generally consist of a program of diet and exercise, and in some cases if the diabetes is not controlled, an addition insulin would be used,” says Morgan.
Kotler-Berkowitz keeps her diabetes in check by following a healthy diet she hopes to maintain. “Lately I’ve rediscovered my love for chocolate so I’m sort of thinking about it, remembering my diabetic diet.”
Dr. Mallika Marshall from WBZ-TV explained on The Saturday Early Show that regular exercise and a healthy diet have been shown to lower the chances of diabetes in people who are at risk. There’s also a medication, called Metformin, that can help prevent diabetes in people who have mildly elevated blood sugar levels high enough for a diagnosis of diabetes.
Another problem some pregnant women may be concerned about is preeclampsia, says Marshall. It is commonly known as toxemia, or pregnancy-induced hypertension. It only occurs during pregnancy and affects about 5 percent of pregnant women in the United States. It usually develops in the second or third trimester.
Women with preeclampsia develop high blood pressure, protein in the urine and swelling of the legs, hands and sometimes the entire body. In rare cases, women can develop seizures and can even die from the condition.
The cause of preeclampsia is unknown, but it results in constriction of the blood vessels in the mother, which can decrease blood flow to placenta and to the fetus. This can slow the baby’s growth.
Marshall says some women may develop swelling, headaches, blurry vision or abdominal pain if they have preeclampsia. But many women don’t develop symptoms at all. That’s why it’s so important that pregnant women get regular prenatal care and have their blood pressure checked throughout their pregnancy.
The only cure for preeclampsia is to deliver the baby, because it resolves itself as soon as the pregnancy is over. If the symptoms are mild and it’s too soon to deliver the baby safely, the woman will usually be put on bed rest and will be monitored closely by doctors and nurses. Sometimes women are hospitalized and treated with intravenous medications. But if symptoms are severe or the woman develops seizures, the baby has to be delivered.
Another problem to be on the lookout for in the later stages on pregnancy is bleeding. Some women may suffer from placenta previa, which happens when the placenta is located in an abnormally low position in the uterus, partially or completely blocking the cervix. In some cases, as the pregnancy progresses, the placenta changes locations and no longer obstructs the cervix. In some cases, a C-section is required for delivery.
In placental abruption another pregnancy-related problem, a part of the placenta detaches from the wall of the uterus, and can cause pain and bleeding. If minor, bed rest may be all that’s required. If severe, the baby may have to be delivered by C-section.
Marshall says pregnant women with asthma are also at high risk of endangering their unborn child. About a third of women with asthma will notice their asthma symptoms worsen during pregnancy. However about a third of women get better during their pregnancy. Severe uncontrolled asthma can reduce the supply of oxygen to the baby and can increase the risk of premature birth.
Source: CBSNews.com

Mutations of the SARS virus and relapses among patients are puzzling scientists trying to understand the disease amid a five-fold increase in deaths in the past month.
Doctors at the Chinese University of Hong Kong said there were two forms of SARS present in the hard-hit Chinese territory, which could complicate efforts to develop a diagnosis and vaccine.
“This rapid evolution is like that of a murderer trying to change his fingertips or even his appearance to try and escape detection,” Dr. Dennis Lo said. Lo added that more research was needed to determine if the virus had become more infectious or deadly.
There were ten new cases and nine deaths reported in Hong Kong on Saturday, bringing to 1621 the total number of infections recorded in the former British colony. A total of 179 people have died from SARS there, while almost 900 have been discharged.
Also, worrying scientists are at least a dozen cases of SARS relapses among discharged patients. The World Health Organization is set to discuss the issue with Hong Kong authorities on Monday. The territory’s health chief has also admitted Hong Kong did not respond quickly enough to the SARS outbreak. This was because little was known about the disease, Health Secretary Dr. Yeoh Eng-kiong said in a radio interview on Saturday. Hong Kong authorities have been criticized for being tardy in imposing quarantines on people who might have been exposed to the virus.
However, recent figures in Hong Kong have backed a declaration from the WHO that the SARS outbreak had peaked there. Across the border in mainland China, SARS cases continued to mount.
There were another 181 new cases and nine more deaths in China on Saturday. Most cases and deaths have been reported in the capital, Beijing. So far, around 1,600 people have been infected with SARS, and 96 have died from it in China’s hardest-hit mainland city to date. The deputy director of Beijing Health Bureau, Liang Wannian, said on Friday he believed the SARS epidemic “was in a stable period with the upward trend contained [in the capital],” China’s official Xinhua news agency reported. Beijing authorities are hoping isolation may help. They have opened a new 1,000-bed hospital to handle patients with the virus and barricaded some roads as patients were being transferred.
The Xiaotangshan Hospital threw open its doors after more than 7,000 builders worked feverishly to erect the structure in just eight days.
China’s central government has also reversed its stance and agreed to allow WHO to send experts to Taiwan to assess the SARS outbreak there. China, which regards Taiwan as a renegade province, has blocked efforts by the island to join the United Nations body as an independent country. Taiwan has complained that its non-membership with the U.N. is behind a lack of response from the WHO to its requests for help against SARS. Taiwan authorities have reported nearly 100 SARS cases. There were five new fatalities Friday.
Globally more than 400 have died, and more than 6,000 have been infected with SARS.

In other developments:
Toronto officials insist the disease is under control in the city after no new SARS cases were reported on Friday. The Canadian city has had the largest virus outbreak outside Asia, with 140 probable cases and 23 SARS deaths.
Singaporean authorities have arrested a man who repeatedly flouted home quarantine. The man, who skipped quarantine and went out drinking on two occasions, was jailed in isolation on Friday. Singapore has put in place strict control measures and has recorded 25 deaths out of 203 cases.
WHO says laboratory tests for SARS in India are inaccurate. So far, India has reported 19 cases of the disease and has quarantined 200 people.
Source: CNN.com

They wear herbal eye masks, sip healthy drinks from the juice bar and rest their necks on warm pillows. They slip their feet into toasty booties, breathe in the sweet aroma of lavender and lemongrass and watch movies through video goggles.
No, Alex isn’t a massage therapist, but the Athens, Ga.-based dentist believes such pampering will make his office seem, well, less like a dentist’s office.
He began creating the spa-like atmosphere — a massage therapist works out of a converted treatment room — about four years ago after the staff brainstormed ways to make dental appointments more appealing.
“It’s changing people’s perception of what it is to have dental treatment,” Alex says. “People are looking forward to coming to the dentist.”
That sums up the goal of a growing number of dentists across the country who have adopted the spa-dentistry concept, with luxuries nobody would have dreamed of in the traditional sterile dental office where the most comfortable thing around was the chair (even if those sitting in it rarely were).
It’s hard to say how many dental offices have combined elements of the spa or other soothing touches with the more typical filling, drilling, root canals, and such. However, anecdotal evidence suggests the idea is spreading in dental care, which federal officials say accounted for a record $65.6 billion in U.S. spending in 2001.
At one of the biggest dental conventions in the country, the Chicago Dental Society will offer a course at its midwinter meeting this weekend that includes tips on how to “create a comfortable spa-like atmosphere for patients and team.”
“We’ve been seeing more and more focus on making our patients comfortable at the dentist’s office, and I think this whole spa-dentist office concept has come out of that,” says Dr. Kimberly Harms, a consumer adviser to the American Dental Association (ADA). “And given the positive response from patients, I think you’re going to see more and more of a trend in that direction.”
Harms and her husband, James, both dentists, have an office in Farmington, Minn. She likes pampering in the dentist’s office partly because she empathizes with dental-phobic patients.
“We don’t have a good reputation in public,” she concedes. And her view on getting dental care? “I’m a big baby. I hate going to the dentist.”
However, Harms dreads it much less nowadays. After all, she’s not only a dentist but a patient at her practice. And slipping on goggles to watch a movie somehow made getting a root canal much easier to bear.
That’s but one of the plush features at the Harms’ practice, which they renovated extensively after moving in a decade ago. Today, patients settle into couches, and easy chairs in a reception area painted in soothing pastels, read books or magazines from the library, nibble cookies and drink juice or coffee.
In treatment rooms, patients sit on chairs with back massagers and snuggle in warm blankets beneath ceilings with flowers painted on them. Instead of watching the needle or drill, they can take in a movie or gaze out the large picture windows at a garden with evergreen trees, flowers in summer, and heated bird baths.
Harms says she and her husband don’t charge additional fees for their non-dental services.
Other practices, such as the Imagemax Dental Day Spa in Houston, charge separately for each service. Along with dentistry, Imagemax offers Swedish body massage, massage with hot stones, “body polishes” with sea salts, body wraps for weight loss, facials, and Botox treatments, among other options.
The ADA, Harms says, considers quality dental care the top priority but welcomes the meshing of luxury and dentistry for a simple reason.
“What will happen is patients will be more comfortable going to the dentist, and that will cause them to go more often,” she says. “The ADA’s main concern is the health and safety of our patients, and anything that can bring them into the office and improve their oral health is a darn good thing.”
Harms sums up the boom in spa dentistry this way: “It all relates to what the patients want, and we’re not only dentists, we’re small businesspeople. It’s fun to practice in an arena where you’re giving patients what they want. I think it’s a nicer way to practice dentistry, improving our lifestyle and patients’ lifestyles.”

Source: HealthScoutNews

Mystery Virus Ravages Hong Kong, Hopes on Vaccine
April 14, 2003 3:08 a.m. ET
HONG KONG (Reuters) – Hong Kong’s leader said SARS has not yet been brought under control, as the mystery virus that has been dubbed the “21st century disease” claimed more victims and took a mounting economic toll.
A Canadian lab offered a ray of hope that a vaccine could be developed for the virus that has now killed 132 people and infected 3,200 across the world — but health experts say it may be months, even years away.
Hong Kong leader Tung Chee-hwa told his boss, Chinese President Hu Jintao, in China’s Shenzen city that the virus had yet to be “brought under effective control” in the territory of seven million, although the nature of the disease and how to treat it was better understood, a government statement said late on Sunday.
Hu’s low-profile visit to southern Guangdong province was the strongest indication yet of how seriously the Chinese leadership views the worsening health crisis in Hong Kong.
The number of Severe Acute Respiratory Syndrome cases in Hong Kong has soared to 1,150 and its death toll to 40 with five more announced on Sunday — the largest jump in weeks. The flu-like virus, which often deteriorates into pneumonia, has been carried by travelers to about 20 countries in the past six weeks after first showing up in Guangdong in November. In a weekend statement released one month after issuing its first alert on the disease, the World Health Organization (WHO) sounded a warning that SARS could become a global epidemic.
“If the SARS maintains its present pathogenicity and transmissibility, SARS could become the first severe new disease of the 21st century with global epidemic potential,” David Heymann, the agency’s executive director of communicable diseases, wrote on the WHO Web Site (www.who.int/csr/sars/en/).
The ways SARS is emerging suggests great potential for rapid spread in a highly mobile, interconnected world, Heymann said.

QUARANTINE MEASURES
Singapore reported three new deaths from the virus on Sunday, taking its toll to 12. It announced the quarantining of 400 staff and patients at its biggest hospital. The virus, which is new to science and has no known cure, has hit hospital staff the hardest, putting healthcare systems under strain. Health officials say they are not sure how the virus spreads, although close contact with an infected person appears to be the main method of transmission Its impact on business has been merciless. The WHO Web Site notes the disease has already caused an estimated $30 billion in losses, which could rapidly mount in a globalized economy. The illness has crippled tourism in Asia and forced airlines to cuts flights sharply. Economists say the longer the crisis lasts the deeper it will eat into the region’s economies and it could push some, including Hong Kong, back into recession.
On Sunday, Asia’s fourth-largest carrier, Cathay Pacific Airways, said it would not rule out grounding its entire passenger fleet next month if passenger numbers continue to fall. Hong Kong-based Cathay, which is carrying only a third of its usual traffic volume, said in an internal memo the company was losing US$3 million a day. “If demand falls still further, we will have to respond accordingly,” said Tony Tyler, director of corporate development.
A Canadian laboratory said on Sunday it had broken the genetic sequence behind the SARS virus.
The Michael Smith Genome Sciences Center in British Columbia said this could help speed development of a reliable diagnostic test and eventually an effective vaccine.
Canada, which has the third-largest number of SARS cases, said its death toll had risen to 13 with more than 270 probable or suspected cases of infection. Thousands have been quarantined.

LONG HAUL
Singapore reopened secondary schools on Monday after shutting all classes three weeks ago to contain the virus and university classes resumed in Hong Kong. But life in SARS-affected countries was far from normal. “We are in this for the long haul,” Singapore Health Minister Lim Hng Kian said when asked if the virus was under control. Singapore air force paramedics in camouflage fatigues, gloves and surgical face masks greet air passengers from SARS-afflicted Hong Kong and China’s Guangdong province, taking temperatures, giving a chilling appearance to one of Asia’s biggest air hubs. The 608 people under home quarantine in Singapore have closed-circuit TV cameras installed outside their doors, and must regularly respond when called on. Those who don’t risk getting an electronic tag slapped around their wrist that beeps authorities when worn outside the home, or when tampered with, after 12 people broke quarantine since late March. The first such tag was issued over the weekend.
WHO has advised against travel to southern China and Hong Kong, which has further cut arrivals in Hong Kong, one of Asia’s main financial centers and top tourist destinations.
Cathay’s warning about grounding its passenger fleet spooked other Asian airline stocks, which were down between two and four percent on Monday. Singapore Airlines, Asia’s most profitable carrier, has cut flights by 20 percent.
Source: Reuters

INDONESIA AND the Philippines on Friday reported their first cases of the severe acute respiratory syndrome, both of them foreigners who had traveled to Hong Kong or Singapore, bringing the number of nations with reported cases to 20.
Redoubling precautions, Hong Kong ordered members of 70 to 80 households with known victims of the disease to stay in their homes for ten days in case they have been infected. Police were making spot inspections, and violators faced fines, imprisonment, or confinement in quarantine camps.
On Thursday, the U.S. State Department advised Americans not to travel to China unless necessary. It also alerted travelers to a new Chinese government policy requiring hospitalization of anyone, including foreigners, who shows SARS symptoms until the contagious phase passes.
The State Department said that under the new Chinese policy, patients would not be allowed to see family members, personal physicians or U.S. consular officials.

55 DEATHS IN CHINA
Beijing has reported four of China, 55 deaths from SARS and 22 cases of infection. Experts believe the disease started in southern China late last year and then spread to other parts of the country and worldwide.
A Chinese health official and the U.S. Consulate in Shanghai confirmed that at least seven foreign nationals, including two Americans, were being treated in that city. None of the foreigners at Shanghai�s Pulmonary Disease Hospital has been confirmed to have SARS, said an official of the Shanghai Center for Disease Control who would give only his surname, Jiang. But on Wednesday, an American teacher was pronounced dead after falling ill in the hard-hit province of Guangdong. The teacher was taken to Hong Kong for treatment in what a friend contended was an attempt by Chinese authorities to avoid the embarrassment of another foreigner’s death on the mainland.
James Salisbury, a 52-year-old English instructor at a polytechnic institute in China, already appeared dead when he was wheeled into an ambulance in the southern Chinese city of Shenzhen, according to the friend, David Westbrook, who was with Salisbury and had been in contact with doctors about his condition.
Meanwhile, researchers released evidence suggesting SARS may be caused by a new coronavirus, a bug that ordinarily causes common colds. But scientists were checking whether some other microbe might make SARS more severe or easier to catch.

ALMOST 3,000 INFECTED
Worldwide, SARS has claimed at least 111 lives and sickened more than 2,700 people. Symptoms include fever, shortness of breath, coughing, chills, and body aches. Mainland China and Hong Kong have reported the highest numbers of infections and deaths. Canada, Singapore, Vietnam, Thailand, and Malaysia also have reported fatalities.
Indonesia’s first confirmed SARS case was a 47-year-old British businessman hospitalized Wednesday. He had visited Hong Kong and Singapore before arriving in Indonesia, said Mariani Reksoprodjo, a health ministry spokeswoman. She said the country had nine other people with SARS-like symptoms under observation.
The Philippines reported its first probable case in a 64-year-old foreigner who frequently travels between Manila and Hong Kong. The patient sought treatment immediately after his symptoms started and did not appear to have infected anyone else, said President Gloria Macapagal Arroyo.
Canada has seen the largest outbreak of SARS outside of Asia, with ten people killed among more than 200 probable or suspected cases, the first a woman returning from Hong Kong. Ethnic Chinese in Canada say they’ve been stigmatized as carriers and that their businesses have suffered.
Seeking to ease concern, Prime Minister Jean Chretien dined in Toronto’s Chinatown and urged others to do the same.

IN U.S., WORKPLACE SARS
The United States has reported its first SARS case suspected of spreading in a workplace. The United States has had no deaths, but 166 suspected cases, most of the people falling ill after traveling in Asia.
In Hong Kong, health officials were making daily phone calls to the 150 people affected by the territory’s new quarantine order to ask about their health. They would be visited by health workers for home medical checks, said Health Department spokeswoman Elaine Wong. The government has promised to provide the quarantined households with food and other necessities. Police were to drop by the homes unannounced to check on compliance with the order, announced Thursday as Hong Kong reported it had almost 1,000 cases and 30 deaths from SARS. The government also said it would post on the Internet a list of buildings where SARS cases had been found.

IN RELATED DEVELOPMENTS:
– Malaysia announced it would deny visas to most Hong Kong people. On Wednesday, Malaysia said it would begin barring all tourists from China while those from other places badly hit by SARS will need to obtain health certificates before entering.
– German airline Lufthansa said Thursday it had been informed by Hong Kong health authorities that one of its passengers had been diagnosed with SARS. The passenger, a 48-year-old Chinese man, had traveled with Lufthansa between March 30 and April 4.
– Taiwan said medical staff would quarantine all arriving travelers with a fever.
– In Singapore, Manpower Minister Lee Boon Yang said that over the next month, all foreign workers arriving from SARS-stricken areas would be quarantined for ten days.
– SilkAir flew home a Singaporean in an empty plane after he was turned back in Thailand on suspicion of being infected with SARS. A battery of tests later showed the man was free of the virus.
– Australia declared itself free of SARS, with health authorities saying the one suspected case detected on Australian soil was a false alarm. A British tourist, who had been declared a probable SARS case but had recovered and left the country, had been suffering from influenza, test results had found, health authorities said.
Source: MSNBC.com

Coronavirus Confirmed as SARS Agent
Laurie Barclay, MD
April 9, 2003 � Within just two months, investigators have found what may be the causative agent of severe acute respiratory syndrome (SARS), according to a report published online April 8 by The Lancet. A coronavirus that has never been described before was isolated from two patients and then confirmed through polymerase chain reaction (PCR) in 45 of 50 patients but in no controls. According to the commentators, the progress is truly “remarkable and unprecedented.” A separate article in The Lancet also provides guidelines for management.
“This report provides evidence that a virus in the coronavirus family is the etiological agent of SARS,” lead author Malik Peiris, from the University of Hong Kong, says in a news release. “However, it remains possible that other viruses act as opportunistic secondary invaders to enhance the disease progression, a hypothesis that needs to be investigated further.”
The Hong Kong University SARS Study Group reviewed records and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters, and ranging in age from 23 to 74 years. Evaluation included chest radiography and double-blinded laboratory testing of nasopharyngeal aspirates and serum samples.
The most frequent symptoms were fever, chills, myalgia, and cough. Fewer than 25% of patients had upper respiratory tract symptoms, but 10% had gastrointestinal symptoms. Respiratory symptoms and auscultatory findings were milder than would be expected from chest x-ray findings.
Predictors of severity were household contact with other infected individuals, older age, lymphopenia, and liver dysfunction. In two patients, a virus belonging to the family Coronaviridae was isolated. Serological and reverse-transcriptase PCR specific for this virus was positive in 45 of 50 patients with SARS, but in no controls. Of 32 patients from whom acute and convalescent sera were available, all had rising antibody titers to this coronavirus.
Because this virus is not one of the two known human coronaviruses, nor is it exactly like any of the known animal coronaviruses, the investigators believe that it may be a new virus which may have originated from animals. Additional genetic analysis may confirm this hypothesis.
“The high incidence of altered liver function, leukopenia, severe lymphopenia, thrombocytopenia, and subsequent evolution into adult respiratory distress syndrome suggests a severe systemic inflammatory damage induced by this human pneumonia-associated coronavirus,” they write. “Thus immunomodulation by steroid treatment may be important to complement the empirical antiviral treatment with ribavirin.”
They describe a “window of opportunity” of around eight days from symptom onset to respiratory failure, and they note that severe complicated cases are associated with underlying disease and delayed use of ribavirin and steroid treatment. The epidemiologic data suggest that spread is by droplets or by direct and indirect contact, although airborne spread and fecal-oral transmission cannot be ruled out.
“These findings significantly strengthen the tentative etiological association reported by other investigators who have also isolated a novel coronavirus from patients with SARS,” Ann Falsey and Edward Walsh, from the University of Rochester in New York, write in an accompanying commentary. “As other pathogens, such as human metapneumovirus and Chlamydia spp, are identified in SARS patients, it will be important to use control groups to determine their role in causality or as cofactors for severe disease.”
They note that nearly 40% of the patients developed respiratory failure requiring assisted ventilation, and that the lack of untreated control patients prevents definite conclusions about the efficacy of treatment.
In a second commentary, William Ho, from the Hospital Authority Building in Kowloon, Hong Kong, reports that the first index case in Hong Kong was admitted on Feb. 22, 2003. As of April 6, 842 cases with 22 deaths were identified in Hong Kong. The Hospital Authority of Hong Kong and the Department of Health have implemented public health measures and hospital policies for diagnosis and management of patients with SARS, which are available online at http://www.ha.org.hk.
Algorithms consider whether a suspected case has had close or social contact with a patient with SARS, whether there are classic symptoms of fever, cough, and shortness of breath, and whether chest x-ray reveals a new pulmonary infiltrate. Management may consist of outpatient monitoring or admission to hospital or designated medical center.
Source: Medscape.com

SARS Not a Disease of Asians
April 08, 2003 4:28 p.m. ET
WASHINGTON (Reuters) – As Chinese-Canadians complained they were being victimized for the spread of the respiratory illness SARS, a top U.S. health official said on Tuesday it is not a disease unique to Asians. Dr. Julie Gerberding, head of the U.S. Centers for Disease Control and Prevention, warned against such discrimination. She also said U.S. authorities were so far controlling any threat of an epidemic here in the United States. But in China, doctors said the government was under-reporting the number of cases and said many hospital wards were full.Hong Kong doctors also published some of the first journal reports on SARS that give clues about why some patients die and others do not.
At least 103 people have died worldwide from SARS and 2,750 have been infected in about 20 countries — nearly half of them in China. Doctors believe the epidemic began in China’s southern Guangdong province in November. The older the patient, the more likely they are to die of SARS, Dr. Joseph Sung and colleagues in the medical team at Hong Kong’s Prince of Wales Hospital reported in a study published by the New England Journal of Medicine. Those who died also had high levels of an enzyme suggesting lung damage called lactate dehydrogenase, the team reported. In addition, patients who died had high levels of immune cells called neutrophils, which the body releases to fight invading bacteria or viruses. Although all five patients who died in Sung’s study had some other illness, such as congestive heart failure, liver cirrhosis or hepatitis, being ill with something besides SARS did not put patients at special risk of dying, they reported.
Canada is one of the countries hardest hit by SARS, with some 226 people infected and 10 reported deaths. The virus was carried to Canada by people flying on airliners from Asia.

WORKERS QUARANTINED
Thousands of Canadians, many of them health care workers, have been quarantined in their homes, while others are wearing masks to work for fear that they might have been exposed to the virus and might infect others. Chinese-Canadians said they were being treated like monsters. Ming Tat Cheung, president of Toronto’s Chinese Cultural Center, said shoppers were staying away from normally bustling Chinatown, and sales were down by up to 70 percent. “We have people calling here saying that Canadians are telling them ‘You dirty Chinese, you eat everything, that’s why you bring diseases’,” Cheung told Reuters. “Chinese Canadians are the victims, not the instigators.” Gerberding said such reactions were illogical. “This is not an illness of Asians,” Gerberding told a U.S. Senate hearing. “This is an illness of people in a particular part of the world where the virus is spreading.” But one Toronto cab driver said he was not picking up passengers from hospitals or from the Chinatown area. “It’s not racism — it’s a precaution. I have to protect my family,” said the cab driver, who refused to give his name.
In China’s Guangdong province, officials said the rate of new infections was down sharply and the outbreak was under control. At least three more people died in Beijing from SARS than officially reported, doctors in the Chinese capital said on Tuesday, as fears spread and hospitals disclosed suspected cases not previously revealed.

HOSPITAL INUNDATED
“It’s impossible there are only 19 SARS cases in Beijing,” said a doctor at the Beijing University No. 1 Hospital. “There are no beds left in our epidemic ward.” Beijing has reported 19 cases and four deaths out of 1,279 infections and 53 deaths nationwide, most of them in Guangdong, where the virus first appeared last November.
More than 40 people in Hong Kong’s Ngau Tau Kok district in Kowloon and Tuen Mun in the New Territories caught the disease in the last 10 days, said a health department spokesman and a district lawmaker in Tuen Mun, raising fears it is far from contained.
Two more deaths and 45 new infections were reported on Tuesday in Hong Kong, where the disease has already killed 25 people.
Deputy Director of Health Leung Pak-yin told a radio program cockroaches might have carried infected waste from sewage pipes into apartments in a huge housing complex, Amoy Gardens, which has had a quarter of the city’s 928 infections.
CDC officials had no immediate comment on such reports. Gerberding told the Senate appropriations committee hearing that the CDC had enough resources to deal with SARS. She said the CDC was meeting with the airline industry to help find ways to prevent SARS from spreading even more.
Source: Reuters