*EPF502 01/09/2004
Excerpt: U.S. Braces for SARS Recurrence as New Cases Emerge in China
(Disease prevention chief discusses response and preparedness plan) (1670)

The U.S. Centers for Disease Control and Prevention (CDC) is fine-tuning its response plan for Severe Acute Respiratory Syndrome (SARS) in case the flu-like disease reemerges to become a worldwide epidemic as it did in 2003.

CDC Director Julie Gerberding said during a January 8 press briefing that her agency has updated previously issued recommendations on how health care providers should respond to SARS and improve the capabilities for diagnosing the disease which emerged from China in 2003 as a sometimes fatal respiratory condition unlike any ever seen before.

The rapid spread of the disease from country to country prompted an unprecedented degree of cooperation and collaboration among international and national health agencies. Several Asian nations were most dramatically affected by the outbreak, but SARS appeared ultimately in 29 countries. More than 8,400 people took ill with SARS; almost 1,000 died.

One confirmed case and one suspected case of SARS have occurred in China so far this season. Gerberding said a CDC specialist is in China working with a team of experts attempting to identify the transmission routes for SARS.

"So there's going to be a lot that we'll learn, I think, in the next few weeks about SARS in China," Gerberding said. "We have to remain vigilant; and I think we will continue to take the steps necessary at CDC to be good partners with the international community and to protect our folks here at home."

At the height of the SARS threat, U.S. and international health officials issued warnings urging travelers to avoid trips to certain countries where the disease appeared to be spreading rapidly. Gerberding said current circumstances don't call for such warnings.

The January 8 CDC briefing also dealt with the flu in the United States this season. The full transcript is available at http://www.cdc.gov/od/oc/media/transcripts/t040108.htm

Following are excerpts from the CDC transcript of Gerberding's January 8 briefing.

(begin excerpt)

U.S. Centers for Disease Control and Prevention
CDC News Conference Transcript
January 8, 2004
Influenza Update

[CDC Director Dr. Julie Gerberding opens the briefing with remarks about the influenza outbreak in the United States.]

Gerberding: Let me talk a little bit about another emerging infectious disease that is on our minds again this fall, and that is SARS, this respiratory syndrome. We do know that two SARS cases have been identified in China; one case is documented to have SARS through laboratory testing in a reliable laboratory. The other person, right now is a suspect case, but infection has not confirmed to be SARS. Both individuals are doing well medically and that's certainly good news.

The Chinese health officials have taken all appropriate steps to isolate the patients and to monitor their close contacts for evidence of illness, and so far no secondary cases have been identified, so that's also very good news.

But we are taking many steps here, at CDC, to continue our preparedness effort, as we've been doing all along since the epidemic was first recognized last year.

Today we'll be updating again our preparedness and response plan. This is an ongoing process. We posted this on the Web some time ago. We've gotten a lot of very helpful feedback from experts around the country, actually, around the world, and so we are responding to that and revising our document accordingly, and that will be an ongoing process as we learn the reality of how feasible and how appropriate some of our recommendations are when they go into the front line.

We also have refined the diagnostic for SARS, the diagnostic testing capabilities in our state health laboratories, we've initiated proficiency testing and made sure that the reagents that we're putting out have good quality control, and that our laboratories are fully prepared to do the best job possible at diagnosing the disease if it does emerge.

We've also issued safety guidelines, reminding laboratorians about how to handle SARS or potential SARS specimens, so that we don't have a situation such as occurred in Singapore or Taiwan, where laboratory personnel working with the SARS virus unfortunately contracted the disease.

We also of course continue to collaborate with the NIH on treatment protocols for SARS. We have partnerships with the FDA involving diagnostics and we're continuing to do everything we can to put the latest information out for clinicians, so that those who are responsible for infection control or other SARS case recognition will have the best possible information we have available to assist them.

So two people with SARS in China does not create an indication for travel restrictions. These are unlinked cases and there's no evidence of risk to people other than these individual cases. But of course the Chinese health officials are doing the appropriate things to identify additional cases and they are communicating right and regularly with the World Health Organization.

CDC has one of our top scientists in China, working together with the WHO and the Chinese to evaluate the situation there, and try to understand where the transmission is occurring and how it's occurring. So there's going to be a lot that we'll learn I think in the next few weeks about SARS in China.

But it's just a reminder that we have to remain vigilant and I think we will continue to take the steps necessary at CDC to be good partners with the international community and to protect our folks here at home.

So if there is any news or any change in the level of risk, we would certainly step up to the plate and make those decisions and offer that advice as quickly as it would be indicated. ...

QUESTION: One of the important--in surveillance for SARS, one of the important clues has been to look for clusters of the disease, but these two cases appear to be isolated, and I'm just wondering if this means you're changing your guidance on what to look for, and are there aspects of transmission of this disease that we may not yet know?

Gerberding: SARS is a disease that had a pattern last year that certainly helped us predict where we would look first for a reemergence. But as with any emerging infectious disease, we have to be prepared for the unexpected, and I think what we're seeing here in China is a very vigilant health system that's doing exactly what it should be doing, and that is recognizing patients with fever and unexpected pneumonia, isolating them, thinking about SARS, doing a diagnostic test and so forth.

Every epidemic starts out with an isolated case, and so this is the best way to keep this problem from becoming an epidemic. I think it's way too early to say whether these two will be the only cases, but I think we recognize that new patterns of transmission could evolve, and we'll have to stay on top of that. That's part of the job of the team that's over there right now is to really try to get as much detailed information about potential exposures in most of these people and also to assist in the assessment of animal reservoirs or other sources that virologically could be the ultimate source.

We also have a lot of questions about whether or not there is any carrier state of SARS. We have absolutely no scientific evidence to suggest that at all at this point in time, but that is a phenomenon that has occurred with other viruses, and so that's another thing that people will be watching for very carefully.

So we are taking all of the steps we can right now, but I'm sure there will be emerging information, and we'll do our best to get that out there as quickly as we get it....

QUESTION: ... My question hits on what you just said about the idea of carriers. Can you go into that a little bit more because we're seeing a lot of very extreme reactions in China, all of the Civet cats being drowned, and now there's a big rat hunt. But can you comment about the possibility that somebody who's not really ill is carrying SARS around and perhaps transmitting it to people who are more vulnerable?

DR. GERBERDING: Thank you. We do not have all of the details of the assessment of animals in the Guangdong Province right now, but I think there have been some exaggerated accounts of the steps that the health officials are taking.

They are requesting a ban on the marketing of wild animals in the markets in that province. That's a precautionary step. In addition, animals that are raised domestically, particularly the Civet cats, are being slaughtered so that they don't serve as a reservoir.

Right now, there is no scientific evidence proving that these animals are the source of SARS. They do have Coronavirus infection at times, and the Coronavirus has had some similarity to the SARS Coronavirus, but they are not identical. And so there's a great deal of work to be done to really identify the definite source of SARS. We may not ever be able to identify it for sure, but it's only a hypothesis right now, and I think the officials are taking a precautionary step in the same way that precautionary steps were taken when avian influenza arrived in contaminated poultry farms, et cetera.

Other animals are not the targets of specific programs, although the minister of Health did recommend that individuals use rodenticide to try to reduce the rodent population in the remote possibility that they served as a source of SARS transmission.

So I think that these are steps that are being taken right now as a precaution. The science will hopefully emerge as the investigation evolves, and I'm sure we, and others in the international community, will look forward to being able to make more specific recommendations as we have more information....

(end excerpt)

(Distributed by the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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