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Emerging Infections: Is SARS Reemerging?Author(s): Barbara A. GoldrickSource: The American Journal of Nursing, Vol. 104, No. 7 (Jul., 2004), pp. 28-29Published by: Lippincott Williams & WilkinsStable URL: http://www.jstor.org/stable/29746055 .

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-o By Barbora A. Goldrick, PhD, MPH, RN, CIC

EMERGING Infections

Is SARS Reemerging? New cases of a global microbial threat

When the World Health

Organization (WHO) announced the end of

the outbreak of severe acute res?

piratory syndrome (SARS) on

July 5,2003, some scientists feared that the SARS coronavirus

would reemerge. They were right to be wary. Between November 2003 and January 2004, five new SARS cases were confirmed in China. Fortunately, none of these cases resulted in further transmis? sion of the SARS coronavirus.

And in May nine new con? firmed cases of SARS were

reported in China, all linked to an accident at the National Institute of Virology in Beijing,

where research on the SARS coronavirus was being con

Barbara A. Goldrick is a consultant and certified nurse epidemiologist in Chatham,

MA, and coordinates Emerging Infections: bagoldrick@comcast.net.

Km

Suxiang Tong, PhD, of the Division of Virol and RickeHsial Diseases at the Centers for Disease Control and Prevention, conduc?s genomic research into the coronavirus that causes severe acute respiratory syndrome (SARS). Reversefranscription polymerase chain reaction may help researchers develop a diagnostic test for SARS.

ducted. According to the WHO, the index patient, a postgraduate

medical student working at the

institute, developed SARS-like

symptoms and was hospitalized. A nurse who attended the index

patient in the Beijing hospital developed the second confirmed case. Another person with con?

firmed SARS also worked in the

virology laboratory. Unfortunately, SARS was not

suspected for several days after the first two cases appeared, delaying the institution of appro? priate infection-control measures that could have minimized the

spread of the coronavirus to contacts. Chinese authorities have closed the virology insti?

tute, and several contacts have been released from observation for SARS-like symptoms. SARS has developed only in patients in close contact with the first two

patients, and there has been no evidence of wider transmission of SARS in China during this outbreak. For more information see the WHO Web site at

www.who.int/en.

Lessons learned in 2003.

During last year's outbreak, sci? entists learned, among other

things, that SARS can spread rapidly around the world. In its

early stages, SARS is hard to dif? ferentiate from other viral infec?

tions, and delays in diagnosis can allow the coronavirus to spread. Diagnosis should be guided by a

patient's history of possible expo? sure (such as travel history), since there are no laboratory tests that

reliably detect the virus early in the course of the illness. And the

screening and quarantine of close contacts of SARS patients are effective in controlling the spread of the disease.

If SARS reemerges as a major health problem, rapid case iden?

tification, infection control, and

reporting by nurses and other health care providers will be nec?

essary to control another out?

break. A U.S. nurse must be

suspicious whenever a patient with pneumonia confirmed on chest X-ray is seen. Patients should be asked the following questions, and if the answer to

any of them is "yes," SARS should be suspected and appro? priate infection-control measures

implemented. ? In the past 10 days, have you

traveled to mainland China, Hong Kong, or Taiwan or been in close contact with other ill persons who have?

? Are you employed as a health care provider with direct

patient contact?

28 AJN ?July 2004 ? Vol. 104, No. 7 http://www.nursingcenter.com

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? Do you have close contacts who have been told they have

pneumonia? It's important to remember

that SARS can be controlled

through basic infection-control measures and that although air? borne transmission of the virus

may be possible, most cases of SARS are spread from person to

person. In those cases in which airborne transmission has been

suspected, aerosolized droplets appear to have been involved (for instance, nebulized droplets of the SARS coronavirus emitted during patient ventilation or airborne, virus-laden aerosols dispersed into the community through inade?

quate plumbing or ventilation sys? tems). Laboratory exposure to the

SARS coronavirus is also a risk.

Although the SARS corona? virus is transmitted primarily through close contact with respi? ratory secretions and aerosols, its presence has been detected in other body fluids such as saliva, tears, urine, and feces.

Nurses and other providers can protect themselves and their

patients by practicing good hand

hygiene; using respiratory pro? tection, including an N95 mask; and using appropriate personal protective attire when patients are in contact isolation. For fur? ther updates and guidelines on

protection from SARS, see the Web site of the Centers for Disease Control and Prevention, at www.cdc.gov/ncidod/sars.

Measles Among US. Adoptees ?t continues to be introduced from other countries.

Although

no longer endemic in the United States, measles is a potentially fatal infectious disease that

can cause diarrhea, pneumonia, and encephalitis. Because it can be introduced from abroad, vigilant surveil?

lance and vaccination in this country are vital. Between

1997 and 2001 the number of cases of measles reported annually in the United States ranged from 86 to 138, and imported cases accounted for 26% to 47% of the total number. The percentage of imported cases of measles

among children adopted from other countries increased

from 2% in 1997 to 20% in 2001, which places others who are susceptible at risk.

Because of measles outbreaks in other parts of the world, nurses and other clinicians should be on the lookout for measles in children adopted recently from abroad. Several cases of measles in the United States have recently been seen in children who were adopted in China. The presumed origin was an orphanage in China at which an outbreak of measles had been reported. MultiState investigation of measles among adoptees from China?April 9, 2004. MMWR Morb Mortal Wkly Rep 2004;53(14):309-10.

Ebola Southern Sudan ̂ ^^^^^^^^^^^^^^^^^^H Seven have died, but for now. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^|

An

outbreak of Ebola hemor

rhagic fever in extreme south? ern Sudan is not, as reported in

mid-May, a new strain of the viru? lent virus, which has reemerged

with frightening regularity across central Africa over the last 28

years, according to the World Health Organization. This out? break?of the Sudan subtype of Ebola virus first identified in 1976?has so far been less

deadly than previous outbreaks. At press time, seven of the 30

people infected with Ebola in Sudan in recent months have died. Since 1976 the four Ebola

subtypes have killed between 50% and 90% of those infected with the hemorrhagic fever. (Of the 1,850 people infected with Ebola worldwide since 1976, more than 1,200 have died.) Three of the four known variants of Ebola virus cause the disease and hide in an unknown reser?

voir?perhaps in monkeys, bats, or other rainforest creatures?

throughout central Africa. With an incubation period of two to 21

days, Ebola hemorrhagic fever is difficult to track, especially since its victims don't live long enough to become hosts. Direct contact with blood and other body fluids transmits the disease, which mani? fests as fever, intense weakness, vomiting, and internal and exter? nal bleeding. Victims often bleed to death through orifices. (See "Ebola," AIN, December 2002.)

In a country devastated by a humanitarian crisis centered in the vast Saharan plains in the

west (see "Crisis in Darfur, Sudan/' Correspondence from

Abroad, page 54), large num? bers of infected patients would be almost impossible to treat because health care access is so limited. This outbreak is isolated to Yambio, near the southwestern border with Congo, in a tropical region typical of climates in

which the virus has thrived. Ebola first emerged in Sudan

and Congo in 1976. Subsequent outbreaks have been contained to

Congo and the Democratic

Republic of Congo (the two coun? tries were known as Zaire until

1997) and three neighboring countries (Gabon, Uganda, and

Sudan), except for one human case hundreds of miles to the west in C?te d'Ivoire in 1994. A fourth Ebola subtype was found in 1989 in a lab in Reston, Virginia, and

was traced to monkeys imported from the Philippines. Its origin has never been determined, and the four infected people survived. However, a Russian scientist died

May 5 after accidentally pricking herself with an Ebola-infected nee?

dle, and earlier this year a U.S. scientist did the same thing at a

Maryland lab but didn't contract the disease, according to the New York Times in its May 25 issue.

?David B?cher, associate editor

wona neaiRi vflganizanon. cook? noMnor

rhagk fever. Fad sheet, No. 103. May 2004. www.who.int/ar/diseoie/ebola/en. ?

ajn&ww.com AJN ?

July 2004 ? Vol. 104, No. 7 29

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