January 5, 2003 -- Results from laboratory tests over the weekend have led the Ministry of Health of China and the World Health Organization (WHO) to upgrade the suspected SARS case in southern China to a laboratory-confirmed case.
The latest results were obtained from virus neutralization antibody tests carried out by two laboratories in Hong Kong SAR, China, that are part of the WHO international laboratory reference network, as well as by a laboratory under the Chinese Centre for Disease Control and Prevention in Beijing.
The virus neutralization tests from all three laboratories indicate that the male patient, a 32-year-old television producer in Guangzhou, Guangdong Province, has recently been exposed to a SARS coronavirus (CoV).
The tests compared the level of SARS neutralizing antibodies in the patient's blood over recent days with levels found early in the course of his disease. The results showed that the level of these antibodies had risen significantly, fitting the laboratory definition of SARS.
The tests in Hong Kong were carried out by teams from Hong Kong University and the Government Virus Unit. The results from the international reference laboratories were conveyed to WHO on Monday 5 January 2004. In turn, WHO informed the Ministry of Health of China in Beijing. At the same time, an international panel of WHO experts - from WHO headquarters in Geneva, the regional office in Manila and the China office - held a teleconference to discuss the results from Hong Kong and Beijing. As a result of this discussion, WHO concluded that the case is indeed a laboratory-confirmed SARS case. This conclusion was then passed to the Ministry of Health of China.
Because of initially inconclusive tests, WHO had recommended to the Ministry of Health of China that it send samples for testing to laboratories within the WHO international laboratory reference network. The Ministry of Health of China selected the two laboratories in Hong Kong SAR, China, as the best choices under the circumstances, given the proximity of these facilities to Guangdong, as well as the fact that these laboratories conducted extensive testing during the SARS outbreak last year.
One case is not an immediate public-health threat, but precautions must continue
WHO said it is important to stress that although this case has now been classified as a SARS case, this does not indicate there is an immediate public-health threat in southern China. It is safe to travel to all areas of China.
SARS can be controlled and contained if there is a system that allows early detection and isolation of cases and timely contact tracing. The Guangdong provincial health authorities are clearly committed to developing such a system and major steps have been taken to achieve this.
The Guangdong provincial authorities have so far identified 81 contacts of the patient, of whom 25 were classified as close contacts, 39 as casual contacts and 17 as healthcare workers. All 25 close contacts and 39 casual contacts have been released from quarantine and are said to be well. The healthcare workers will be kept under observation until 14 days have passed since their last contact with the patient. At this stage all the healthcare workers are well.
A joint Ministry of Health of China and WHO team visited Guangdong Province last week as part of the ongoing investigation into the case. They concluded that the situation in Guangzhou appears to be under control at the present time. Although that assessment was made before the suspect case was upgraded to a confirmed case, it would still appear to hold true. But at the same time WHO has also urged the Ministry of Health of China and Guangdong provincial health authorities to further strengthen the surveillance system and widen the scope of the investigation in the coming days and weeks.
There is a need to ensure that the practices seen in Guangzhou are consistent throughout Guangdong Province, and indeed all other provinces and autonomous regions in China as well.
Other parts of the health care system (e.g., emergency departments and Chinese medicine clinics) need to be better integrated into the current surveillance system, because not all people with fever and cough are reporting to the "fever clinics" that were set up during last year's SARS outbreak.
The joint team in Guangdong Province also found that while current infection control practices in healthcare settings appear to be satisfactory, further refinements should be made. At the invitation of the Ministry of Health of China, more WHO international experts will be heading to Guangdong Province this week to assist in the investigation in this case, including trying to find the possible source of the infection. They will use the earlier WHO team's assessment and review as a guide, and expand upon it as the situation warrants.
Wildlife thought to carry and transmit SARS virus to be slaughtered
Meanwhile, WHO today welcomed a decision by the Chinese authorities to try and minimize contact between humans and the animals thought to be carrying the SARS virus.
"WHO has long maintained that animals could be reservoirs for the SARS CoV, and hence a source of infection," said Dr Hitoshi Oshitani, who leads WHO's response to SARS in the Western Pacific Region. "WHO has repeatedly called for more research to identify which animals are capable of carrying and transmitting the virus to humans, and, very importantly, under what circumstances the virus is able to transmit from animals to humans."
Dr Oshitani cautioned that if wild animals are to be slaughtered, the people carrying out the cull should be protected from infection. "The cull should be done cautiously," he said. He also warned against the danger of the wildlife trade being driven underground, where it could not be monitored.
In addition to research into potential animal sources of infection, further investigation is needed into possible human or environmental sources. "At this stage, there are too many unknowns," Dr Oshitani said.
WHO would like to reiterate the following:
* One confirmed SARS case does not constitute an immediate public-health risk.
* It is perfectly safe for members of the public to travel to Guangdong Province.
* There is no evidence of a spread of infection from the patient to date. All the 81 identified contacts are reported to be well.
* Health authorities in Guangdong Province, together with the Ministry of Health of China and the Chinese Centre for Disease Control and Prevention, have treated this case all along as though it was SARS, using the system established following the outbreak of 2003 (including the tracing, isolation and medical observation of contacts).
* Health authorities in Guangdong Province and Hong Kong have worked together to implement safety measures in the area, in terms of travel, temperature checking and other steps in the wake of this case in Guangzhou.
* Health authorities have been using this case as a way to determine how well the current surveillance system works, and a review of the process so far in this case is already under way.
The Ministry of Health of China has been providing WHO with information daily on this case, and we welcome the opportunity to assist China as it tackles this situation.
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