Group 3

I.

Introduction
A. What is SARS?
B. History C. Trends

II.
III.

Cause the Genetics of SARS Detection How it Spreads Prevention and Treatment Latest News

A. Signs and Symptoms

IV.
V. VI.

Severe Acute Respiratory Syndrome A viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV) A contagious respiratory illness that can cause a fatal form of pneumonia Was first reported in Asia in February 2003

SARS Fear Chinese newlyweds wear face masks to ward off infection from severe acute respiratory syndrome (SARS) as they cross a street in Wuhan, the capital of Hubei province, China. SARS, which can cause a deadly form of pneumonia, first appeared in southern China in November 2002. Encarta Encyclopedia China Photo/REUTERS

Over 8,000 SARS cases were reported in 32 countries It caused almost 800 deaths by the time the outbreak was declared contained in July 2003

16 Nov 2002 Outbreak of a mystery flu type virus in Guangdong, South China 26 Feb 2003 1st reported case of a flu-type virus Atypical Pneumonia in Hong Kong 12 Mar 2003 WHO issues 1st global alert about SARS

14 Mar 2003 spreads to Canada, Singapore and Vietnam 15 Mar 2003 WHO issues first SARS-related travel advisory 17 Mar 2003 .WHO coordinates an international effort to identify and treat SARS

Cumulative number of cases Areas Australia Canada China China, Hong Kong Special Administrative Region China, Macao Special Administrative Region China, Taiwan France Female 4 151 2674 Male 2 100 2607 Total 6 251 5327^b Median age (range) 15 (1-45) 49 (1-98) Not available Number of Case fatality deaths ratio (%) 0 43 349 0 17 7

977

778

1755

40 (0-100)

299

17

28

218 1

128 6

346^c 7

42 (0-93) 49 (26 - 61)

37 1

11 14

Germany

44 (4-73)

Cumulative number of cases Areas Female Male Total Median age (range) Number of Case fatality deaths ratio (%)

India Indonesia Italy Kuwait Malaysia Mongolia New Zealand Philippines Republic of Ireland Republic of Korea Romania Russian Federation Singapore

0 0 1 1 1 8 1 8 0 0 0 0 161

3 2 3 0 4 1 0 6 1 3 1 1 77

3 2 4 1 5 9 1 14 1 3 1 1 238

25 (25-30) 56 (47-65) 30.5 (25-54) 50 30 (26-84) 32 (17-63) 67 41 (29-73) 56 40 (20-80) 52 25 35 (1-90)

0 0 0 0 2 0 0 2 0 0 0 0 33

0 0 0 0 40 0 0 14 0 0 0 0 14

Cumulative number of cases Areas Female Male Total Median age (range) Number of Case fatality deaths ratio (%)

South Africa Spain Sweden Switzerland Thailand

0 0 3 0 5

1 1 2 1 4

1 1 5 1 9

62 33 43 (33-55) 35 42 (2-79)

1 0 0 0 2

100 0 0 0 22

United Kingdom
United States Viet Nam

2
13 39

2
14 24

4
27 63

59 (28-74)
36 (0-83) 43 (20-76)

0
0 5

0
0 8

Total

8096

774

9.6

http://www.dizzyboy.com/jokes/funnypictures/swineflubras.jpg

Coronavirus

Apparent crown structure, hence the name Enveloped viruses with a single positive-sense RNA strand genome Primarily infects respiratory and gastrointestinal tract of mammals and birds Has the spike, envelope, membrane and nucleocapsid

http://www.wpro.who.int/NR/rdonlyres/464C8256-9D58-44B3-B292-DB3518117CA8/0/SchematicdrawingsofSARS.jpg

Animals! -Civets and bats How did it jump to humans? RNA viruses are highly prone to mutation (instability of RNA replication)

Cough
Difficulty in breathing Fever (>38C or 100.4F)

Chills and shaking

Dry Cough Fever (>38C or 100.4F)

Headache and/or muscle ache

Cough with phlegm Diarrhea

Dizziness
Nausea and vomiting Runny nose and sore throat

Hypoxia ARDS

Low Platelet Count

Low WBC Count Pneumonia

A SARS case is laboratory-confirmed if one of the ff. is met: 1. detection of the SARS-CoV antibody by indirect fluorescent antibody (IFA) or enzyme-linked immunosorbent assay (ELISA) 2. isolation of SARS-CoV in tissue culture 3. detection of SARS-CoV RNA by reverse transcriptase- polymerase chain reaction (RTPCR), which must be confirmed by a second PCR test

Negative laboratory results for PCR, viral culture, or antibody tests obtained within 21 days of illness do not rule out coronavirus infection. In these cases, an antibody test of a specimen obtained more than 21 days after the onset of illness is needed to determine infection.

Suspect case
Fever + Cough + close contact w/ someone positive w/

SARS and/or travel and/or residence in area positive of SARS transmission

Probable case
(Dead) unexplained respiratory illness + contact and/or

travel and/or residence in area positive of SARS transmission

Exclusion
If alternative diagnosis can fully explain the condition

Laboratory Tests: Serologic Testing

RT-PCR (specific for SARS)

Viral Culture and Isolation

But..
No instances of SARS-CoV infection have been detected in persons who are asymptomatic. Absence of SARS-CoV antibody in serum obtained <21 days after illness onset, a negative PCR test, or a negative viral culture does not exclude coronavirus infection.

Clinical Criteria:

Asymptomatic

Moderate
Severe

Epidemiologic Criteria:

Travel (w/in 10days)

Close contact w/ someone SARS positive

Laboratory Criteria:

Confirmed

+-?

Negative
Unconfirmed

Case Classification:

Probable case

Suspect case

droplets that are shed from the respiratory secretions of infected persons. Fecal or airborne transmission seem to be less frequent. close contacts of patients, such as household members, healthcare workers, or other patients

 Case Detection

Isolation
Contact Tracing

International Measures

WHO Travel advisories Designations of SARS hospitals Efficient quarantine measures Legislation

General Measures
Proper attire N95 masks Gloves Body suit Limit the time with the infected All surgeries are cancelled Regular temperature check Daily disinfections

Antibiotic Therapy Anti-viral Therapy

Ribavirin broad-spectrum antiviral activity against many DNA and RNA viruses commonly used with corticosteroids and has since become the most frequently administered antiviral agent for SARS Unproven Ribavirin at non-toxic concentrations has no direct in vitro activity against SARS-CoV

 High doses often result in more adverse effects, such as hemolytic anemia, elevated transaminase levels and bradycardia

Neuraminidase inhibitor Common treatment for influenza A and B Prescribed together with other SARS therapies in China Proven to be ineffective against SARS-CoV

 Protease inhibitor Used to treat HIV Administered with Ribavirin and Corticosteroids Proven to reduce mortality rates especially when administered early

Immunomodulatory Therapy
Drugs that affect the immune system
Corticosteroids Only effective when used in a timely manner Reduced fever and better oxygenation

Assisted ventilation for later stages of SARS when there is respiratory failure
Non-invasive ventilation Face or nasal mask
Invasive Insertion of tube at the trachea Risky for health workers

Vaccine
First vaccine against SARS Sinovac Biotech Ltd. 2004 Needs more testing

HOW? 1. Inactivated SARS-CoV - inactivation of the virus using formaldehyde, UV light and -propiolactone - risky - inactivated vaccine must be replaced by vaccine based on fragments of the virus.

2. S protein based vaccines - responsible for the binding, fusion and entry - major inducer of neutralizing antibodies

3. Vaccine based on Fragments containing neutralizing features

Other Vaccines
Vaccines from modified tobacco and tomato Contains the S protein of SARS-CoV Still under tests

NDV vaccine Newcastle Disease Virus

An avian virus Does not harm humans

NDV as a vector Inserted SARS-CoV gene to the sequence of the NDV

Project leaders Zhongwu Chou and Mark Thompson of USC point out that the basic nanotube and nanowire biosensors consist of a piece of synthetic antibody attached to a nanowire that's attached to an electrical base, immersed in liquid.

A recent study has found that mice treated with the protein, Griffithsin (GRFT), had a 100 percent survival rate after exposure to the SARS coronavirus (SARS-CoV), as compared to a 30 percent survival for untreated mice.

The molecular inhibitor developed is very potent against the SARS virus by binding to and blocking the use of a specific protein, called papain-like protease, or PLpro, involved in viral replication and evasion of the immune system. This is the first design and discovery of an inhibitor for this class of proteins.

Developed by VRC, NIAID, NIH, and Vical Vaccine was well-tolerated, induced neutralizing antibody responses in 80% of the vaccines and T-cell immune responses in all vaccines Side effects are mild and no serious adverse events reported

One of the antibodies was discovered from the blood sample of a patient who recovered from SARS, and another m396 was identified from the library of human antibodies developed from the blood of ten healthy volunteers.

http://www.sarsreference.com/ http://www.who.int/csr/sars/en/ http://www.nlm.nih.gov/medlineplus/severeacuterespiratory syndrome.html http://www.cdc.gov/ncidod/eid/vol10no2/03-1038.htm http://www.cdc.gov/ncidod/sars/factsheetcc.htm http://www.cdc.gov/ncidod/sars/guidance/f/app2.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5217a5. htm

http://en.wikipedia.org/wiki/Coronavirus http://en.wikipedia.org/wiki/Severe_acute_respiratory_syn drome http://en.wikipedia.org/wiki/SARS_coronavirus http://evolution.berkeley.edu/evolibrary/news/060101_bat sars