CDC HEALTH UPDATE
April 29, 2004

China Reports Ninth Recent Possible SARS Case

The Chinese Ministry of Health (MOH) reported one new possible case of severe acute respiratory syndrome (SARS) in Beijing yesterday, bringing the total to nine possible cases. This new possible case was in a person known to have been in close contact with a 20-year-old nurse who was previously reported as a “confirmed” case by the Chinese MOH.

Chinese health authorities also reported that two additional cases that were previously listed as “suspect” now meet the MOH criteria for “confirmed” cases. Of the nine reported cases in China, four are classified by Chinese health authorities as “confirmed” and five are listed as “suspected.” According to World Health Organization (WHO) guidelines for the global surveillance of SARS, classification as a confirmed case at the start of an outbreak requires independent verification of results by an external international reference laboratory. Such procedures are considered by WHO to be necessary in view of the implications that confirmed SARS cases can have for international public health.

Two of the nine patients worked at the National Institute of Virology Laboratory of China’s Center for Disease Control in Beijing. The laboratory is known to conduct research on SARS coronavirus (SARS-CoV). The laboratory has been closed, potentially exposed personnel are being screened, and possible sources of infection for the two laboratory workers are being investigated.

Chinese authorities are currently involved in active surveillance activities to identify other possible cases of SARS, including enhanced surveillance for any flu-like illness and pneumonia of unknown etiology. They have also initiated measures to prevent the spread of SARS among travelers, including health screening of travelers at ports of entry. For additional information on the SARS situation in China, see the WHO website.

Canada is now distributing SARS Health Alert Notices (i.e., health information cards describing SARS) at major ports of entry to arriving passengers from China. The U.S. Centers for Disease Control and Prevention (CDC) is prepared to respond at U.S. ports of entry, including the distribution of SARS Health Alert Notices, if there is an increase in SARS-CoV activity. CDC is closely monitoring the situation in China and neighboring countries and remains in close contact with international partners to determine the timing and type of response required.

According to the Taiwanese Center for Disease Control, an elderly man who developed fever and pneumonia after returning to Taiwan from China on April 24 was evaluated for possible SARS. Testing for SARS-CoV was reported to be negative.

On April 28, CDC sent an email letter to laboratories to which it had previously shipped live SARS-CoV. The letter alerts the laboratories about the possible laboratory-acquired SARS-CoV infections in China; reminds laboratories of the need to strictly adhere to biosafety level 3 procedures while working with the virus; and provides web links to documents that outline laboratory procedures to be followed while working with SARS-CoV.

Additional information about the SARS situation in China will be provided on the CDC SARS website as it becomes available.

Categories of CDC Health Alert messages:
Health Alert: conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: provides important information for a specific incident or situation; may not require immediate action.
Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action.

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