17 March 2003
U.S. Supporting Search for Cause of Fast-spreading Pneumonia in Asia
("Everything humanly possible" being done, U.S. health secretary says)
(4410)
The U.S. Centers for Disease Control and Prevention (CDC) have joined
international health officials in the search for the cause and
treatment of a pneumonia-like illness that is spreading rapidly
through Asian nations. In a hastily called teleconference briefing
March 15, Secretary of Health and Human Services Tommy G. Thompson
said, "We are doing everything humanly possible to learn what is
causing this outbreak, how to treat patients, and how to prevent the
spread to others."
The centers are among the agencies involved in the international
effort to learn about the disease, Severe Acute Respiratory Syndrome
(SARS). The World Health Organization (WHO) is leading the initiative
to coordinate the work of health officials in ten countries.
"We have as our current priority the detection of new cases," said CDC
Director Dr. Julie Gerberding in the March 15 briefing, describing the
contribution her agency will make to the international effort. At the
time of the briefing, about 150 cases had been identified, most in
Southeast Asia. On March 17, WHO announced that Chinese authorities
now report having seen some 300 other cases of the condition since
late last year.
The disease has been recognized in seven countries so far, with some
cases occurring among travelers who recently visited countries where
SARS has occurred. China and Vietman report the most cases. WHO is
making travelers, airlines and crews aware of the symptoms, but has
not issued a recommendation to avoid travel.
The symptoms include a high fever and respiratory symptoms, such as a
cough or breathing problems. Gerberding said health officials are
assuming SARS is spread person-to-person through close contact.
Further information is available at http://www.cdc.gov/ncidod/sars/
Following is the excerpted version of the teleconference briefing
transcript.
(begin excerpt)
U.S. CENTERS FOR DISEASE CONTROL & PREVENTION
CDC Telebriefing Transcript
CDC's Response to Atypical Pneumonia in
Southeast Asia and Canada
March 15, 2003
MR. SKINNER: Thank you, Gwen, and thank you all for joining us. We're
going to get right to it, and with us on the call is the Secretary of
the Department of Health and Human Services (HHS), Mr. Tommy Thompson,
who's going to deliver some brief remarks, and then he has to run.
We'll then turn the call over to Dr. Julie Gerberding, and then we'll
take your Q's and A's.
So Secretary Thompson, please go, please.
SECRETARY THOMPSON: Thank you very much Tom, and Gwen, and Julie, and
Jerry. Thank you very much for allowing me to come on this
teleconference. I'm at O'Hare Airfield, and I'm going to be on a plane
in six minutes to go back to Washington, D.C. But I want to thank all
of you today for taking time today to join us for this telebriefing
for an update on the outbreak of what we consider a very severe acute
respiratory syndrome in Asia. We decided to have this telebriefing on
Saturday because this is a situation that we wanted to involve you in
very quickly, and we want you to have the most updated information.
Health officials around the world are taking this situation very
seriously. In fact, I had a teleconference with the World Health
Organization on Thursday at early morning, and I'm going to have
another one either tomorrow afternoon or Monday morning with the
people at World Health Organization. But under the great leadership of
Dr. Julie Gerberding at the CDC, the Department of Health and Human
Services is applying a full court press to learn more about this
outbreak and how it might impact on the United States.
Staff in the HHS Department and CDC Emergency Operations Center are
already working around the clock to assist officials from the World
Health Organization, as I mentioned, as they respond to this outbreak.
We've also contacted the Ministry of Health, my counterpart in China,
and I had a face-to-face meeting with the Deputy Minister of Health
about a week ago, a week to 10 days ago, asking them to make sure that
they would cooperate with us because we have to have their willingness
and their access into China to make sure that we can get to the root
causes of this particular disease.
We are doing everything humanly possible to learn what is causing this
outbreak, how to treat patients and how to prevent the spread to
others. I hope we're able to get to the bottom of this as soon as
possible, as I know all of you are and, certainly, the people and the
wonderful efforts at CDC.
Now, I'd like to turn this to Dr. Gerberding to provide you more
specifics on how the department is going to respond to this outbreak
and be able to give you updated information. Thank you very much,
Julie, for giving me this opportunity to address this group, and I
wish you luck, and I'll be talking to you as soon as I land in
Washington, D.C.
ANNOUNCER: Thanks, sir. We really appreciate you joining in. Have a
safe journey home.
MR. SKINNER: Now I'd like to turn it over to Dr. Julie Gerberding,
Director of CDC. The name is spelled G-E-R-B-E-R-D-I-N-G. And she's
going to take just a few moments to talk a little bit about what we
are doing to organize our response to this outbreak.
DR. GERBERDING: Thank you. I wanted to start by explaining why we are
doing this on a Saturday. I'm fully aware this is not the optimal time
to do a media briefing, but as the Secretary said, the situation is
evolving very quickly, and we really do need to get the information
out. And, hopefully, you will appreciate that getting information out
any time is better than no information.
So we're going to tell you what we know today and recognize that this
is ongoing, and we'll be updating you as regularly as we have new
information. You will also be able to find information on the WHO
website, which is their main mechanism for providing international
summaries of these health data. And we will have links and so forth on
our website as we go forward.
The situation today is that WHO has received reports of more than 150
new or suspected cases of a syndrome called Severe Acute Respiratory
Syndrome, which is basically a very severe pneumonia-like illness that
is being reported from a growing list of countries, including China,
Hong Kong, Indonesia, Philippines, Singapore, Thailand and Vietnam. In
addition, the case reports from Canada. No cases have been identified
in the United States, but travelers through the United States who have
been in contact or have traveled to the affected areas are under
investigation to be sure that their time here did not result in
exposure and an opportunity for persons to acquire the illness in this
country.
Obviously, this is a very early stage of the investigation, and given
the high prevalence of travel through Southeast Asia, we are alerting
our public health communities and our clinicians to be on the lookout
for cases, and I'll say in a couple of minutes what some of the other
steps that we are taking are at this point in time.
We have activated CDC's Emergency Operation Center to manage this
complex international multijurisdictional outbreak. Our role is to
assist WHO and health officials in the affected countries, in
particular in the area of epidemiologic investigation, laboratory
diagnosis, and assessment of prevention intervention. We have as our
current priority the detection of new cases using WHO case definition
which I'll just briefly review for you.
WHO is defining a case as someone with a fever greater than 38 degrees
Celsius (Editor's Note: 100.4 degrees Fahrenheit), respiratory
symptoms which could be cough, shortness of breath or difficulty
breathing, and either close contact with someone who's already been
diagnosed with this syndrome or recent travel to areas reporting cases
of the syndrome.
We recognize, because we do not have an etiologic diagnosis or a
laboratory test for this illness right now, that this is a nonspecific
case definition and may include people who really don't have the
syndrome at all, may have some other more common respiratory
illnesses, but it is a starting point for investigation. And as we
either rule in or rule out cases as we go forward, the number of cases
meeting the syndrome is expected to change.
Our priority also is on communication. And you can expect us to be
providing you with regular updates as we go forward. As I mentioned,
the Web sites will be good resources, but we are also taking a number
of steps to put information out to a variety of collaborating
partners. These steps include sending health alerts to the public
health and the medical community. Later today we will be issuing
guidance to clinicians about the case definition, the isolation
recommendation, and what we can say about treatment and prophylaxis at
this point in time.
We assume that this is spread person to person because we're seeing a
large proportion of the cases in Asia among health care workers who
were caring for the ill patients or household contacts of ill
patients. We are recommending precautions to prevent airborne spreads,
droplet spread and direct contact spread until we have further
information. And so that means we're erring on the side of caution
until we can be more specific.
We are also not recommending prophylaxis at this point in time since
we don't have an etiologic agent, and our treatment recommendations
are nonspecific, basically, utilizing the kinds of empiric treatment
that would be appropriate for any patient with an unexplained
pneumonia, including anti-microbials or anti-virals depending on the
clinical judgment of the treating physician and the isolation and
supportive care that I've already mentioned.
We're also preparing a health alert for passengers returning from
areas where SARS has been diagnosed. The health alert basically
advises travelers that if they become ill with fever within seven days
following their return from the affected area, they should consult
their physician. And, likewise, we're advising physicians where to get
information either through our health alerting mechanism, our
hotlines, or our Web sites where we are supporting the clinical
community.
There is no WHO recommendation for travel restriction at this point in
time, but we are advising persons planning nonessential or elective
travel to affected areas that they may wish to postpone their trip
until further notice. So we will provide additional information about
travel advisories at www.cdc.gov/travel, and that will be updated
periodically as we go forward.
So I think again this is an ongoing problem. We're at the very early
stages of the investigation. We have received only a few laboratory
samples at CDC, so we're only in the preliminary stages of looking for
common and atypical organisms that could be contributing. And we're
working with laboratories around the world to give the most
expeditious diagnostic opportunities here a chance to solve this
problem.
MR. SKINNER: All right, Gwen, I think we're ready for questions,
please.
GWEN: . . . . We have a question from Marian Falco with CNN. Please go
ahead.
QUESTION: Hi, Dr. Gerberding. . . . What about the time difference
between infection and severe illness and in the couple of cases that
we know about? Do you have any indication--I mean how quickly are
people getting very, very sick?
DR. GERBERDING: Again, this is very preliminary, but the investigation
in Hong Kong and Hanoi suggests that the incubation period is
somewhere between two and seven days on average. You know, we're right
now probably identifying the most severely ill patients, and so we
want to be open to modifying that if we have better data in the
future.
QUESTION: And just to get this right, you do not know yet if it's
bacterial or viral infection, correct?
DR. GERBERDING: Correct. We do not have information about the etiology
right now.
CALLER: Thank you.
MR. SKINNER: Next question, please.
GWEN: We have a question from the line of Tom Watkins, CNN. Please go
ahead.
QUESTION: Do you know what conference the man in New York was taken
off the plane in Germany was attending, and where he was staying or
any of his contacts?
DR. GERBERDING: That investigation is being coordinated by the New
York City Health Department and New York State Health Department, and
so those details will be forthcoming from them. But I can assure you
that they are aggressively evaluating all potential contacts and
exposures.
MR. SKINNER: Next question, please.
GWEN: We have a question from the line of Marilyn Chase, Wall Street
Journal. Please go ahead.
QUESTION: Hi, Dr. Gerberding. Can you tell us the number of confirmed
deaths, and are you ruling out--are you trying to rule out Avian
influenza?
DR. GERBERDING: With respect to your first question, we know that this
can be a fatal disease, and we have documentation of specific
individuals that died and with an illness attributable to this. But
the exact number of deaths is not confirmed at this point in time.
There are several, and we are, obviously, putting a high priority on
investigating patients in those areas.
With respect to the Avian flu question, you know that earlier this
year there was documentation of two patients in Hong Kong who had H5N1
influenza, and that was confirmed at CDC in our laboratories as well
as other laboratories globally. However, the test for that virus or
for other influenza viruses so far have not been reported to be
positive from the situation that we are investigating now. So we have
no evidence that this is Avian flu.
MR. SKINNER: Next question, please.
GWEN: We have a question from the line of Rob Stein, Washington Post.
Please go ahead.
QUESTION: Yeah, hi, Dr. Gerberding. I understand that one of the
patients from Canada had just returned from a visit to Atlanta, and I
was wondering what was happening there in response to that.
DR. GERBERDING: You are correct. One of the family members of a
patient in--who traveled to Hong Kong did visit Atlanta and is
reported to have developed respiratory symptoms as they were leaving
this country and returning to Canada. The Georgia State Health
Department is investigating the exposure potential here among contacts
and people who were co-workers of the individual.
In addition, we are working with the airlines to assess the passengers
who may have been on the plane when the individual returned to Canada
to be sure that we're not overlooking an opportunity to test illness
or alert them that they need to seek medical attention should they
develop a fever or other symptoms of illness. So that investigation is
being coordinated by the Georgia State Health Department. We're in
touch with them, and they are very aggressively pursuing all of these
lines of investigation.
MR. SKINNER: Next question, please.
GWEN: We have a question from the line of Elizabeth Cohen, CNN. Please
go ahead.
QUESTION: Thanks for having this press conference. Dr. Gerberding, can
you tell us, is there any reason to think that this is or is not
terrorism?
DR. GERBERDING: No, what we know so far about this outbreak is that
the people who appear to be most at risk are either health care
workers taking care of sick people, or family members or household
contacts of those that are affected. That pattern of transmission is
what we would typically expect to see from a contagious respiratory
illness or a flu-like illness. But we have an open mind, and let me
emphasize that we have an open mind and will be keeping an open mind
about this as we go forward. We don't know the cause of this, and
until we have laboratory information to point this in the right
direction, we cannot jump to any conclusions one way or another.
QUESTION: So it sounds like what you're saying is that it's not
necessarily--you don't have any reason to think it's terrorism but you
can't rule out that it's terrorism?
DR. GERBERDING: We're just keeping an open mind.
QUESTION: And also, do we know how contagious? I mean if I was on a
subway car with someone who was ill, could I get it from them, or do
you need to have that close like I'm-taking-care-of-me kind of
contact.
DR. GERBERDING: What we know so far from the investigations in
progress are that it's very close personal contact of the type defined
by WHO as having cared for, having lived with, or having had direct
contact with respiratory secretions and body fluids of a person with
the diagnosis. So there is no evidence to suggest that this can be
spread through breath contact or through assemblages of large people;
it really seems to require a fairly direct and sustained contact with
a symptomatic individual.
GWEN: We have a question from the line of Barbara Garcia, ABC News.
Please go ahead.
QUESTION: Hi, Doctor. I have, actually, two questions. How is this
particular strain responding to the antibiotics? And is there an
emergency response plan, domestically?
DR. GERBERDING: What we can say right now about treatment is that
there is no consistent utilization of antibiotics or antiviral therapy
in the areas that have had the most cases, and so we have no real
information to help tell us whether or not anything is having a
clinical impact. At best we could just provide anecdotal suggestions
and no data or advice.
So as I said before, our recommendation right now is that patients
presenting with severe pneumonia be treated empirically with the same
anti-microbial regimens that we would normally use when we have an
undiagnosed patient with pneumonia. And we would put a great deal of
emphasis on supportive care and isolation precautions to prevent
spread in those environments.
In terms of the domestic situation, as I said, we're taking steps
today to be on the alert throughout the public health and the medical
community for suspicious cases among people who have traveled through
these areas or who have had direct contact with known cases. And we
are also preparing very specific guidance for clinicians and have
assembled our experts here at CDC with Dr. Hughes and the National
Center for Infectious Disease to bring together the individuals with
clinical perspective as well as epidemiologic perspective to
constantly review and update the guidance that we can issue.
So interim guidance today, ongoing advice and information as we know
more.
GWEN: We have a question from Markie Becker, New York Daily News.
Please go ahead.
QUESTION: Hi. Thanks, Doctor. I have a question about the doctor who
was in New York. Can you tell us exactly when he was in New York and
when, exactly, he was taken off the plane? And also, if other--if
anyone else is showing symptoms at this point?
DR. GERBERDING: Let me just emphasize again that we have no cases
under evaluation or suspicion in the United States at this point in
time. That individual is being evaluated by the New York Health
Department, and they really are the best resource for providing that
level of detail.
GWEN: We have a question from the line of Mary Ann Young, AP
Washington.
QUESTION: My question is--it's not a question, Dr. Gerberding. If you
could please, restate those symptoms converting the Celsius degrees of
fever into Fahrenheit.
DR. GERBERDING: The WHO case definition includes a temperature greater
than 38, which is a temperature above 101 degrees (Editor's Note: The
exact conversion from 38 degrees Celsius is 100.4 Fahrenheit), and
cough, shortness of breath, and trouble breathing, and either close
contact with someone who's been diagnosed with this illness or recent
travel to the areas in Asia that are reporting cases.
GWEN: We have a question from the line of Martin Ensurink (ph), Signs
Magazine. Please go ahead.
QUESTION: Hi, and thank you. Dr. Gerberding, do you know how many
agents have been definitively ruled out as the culprit in these
outbreaks?
DR. GERBERDING: As I said, the laboratory assessment is ongoing, and
we are having an open mind. We have not completely excluded any
pathogen at this point in time. It would be too premature to draw any
conclusions until we have the kinds of specimens and blood,
respiratory secretions, and autopsy samples that we need to really be
conclusive.
QUESTION: Does CDC have any of those specimens yet?
DR. GERBERDING: We have a few specimens, and we're in the process of
evaluating them as quickly as we can. But, as you may know, for some
tests--for example, virus cultures that take several days for the
definitive information to become available--and we're working with WHO
to get more specimens. And also the WHO collaborating labs around the
world as well as the Canadian laboratories are in the process of
evaluating samples. We have confidence that these laboratories can do
very sophisticated testing, so, hopefully, information will be coming
forth in the next few days.
GWEN: We have a question from the line of Tom Watkins, CNN. Please go
ahead.
QUESTION: Can you describe the course of the illness? What are the
symptoms that start out, and do people get better or have they all
just remained sick? And do you know how many of those 150 odd cases
are on respirators?
DR. GERBERDING: We're in the process of looking into the entire
clinical spectrum with the CDC scientists who are on the ground in the
various affected areas. Some people have recovered from this illness.
In addition, some people have had a very rapidly deteriorating course,
and others appear to gradually get ill and then stay more or less in a
steady state for a period of time. So what we can say right now is it
appears to be variable, and we'll be able to say more in terms of
numerators and denominators when we have more thorough clinical
assessment.
QUESTION: And did the cases in China, did that initial outbreak in,
what, February, or in China, has that ended?
DR. GERBERDING: We have very little information about the details of
what occurred in the mainland China outbreak during the winter months.
And as per the Chinese government, we understand that that outbreak is
over. . . .
GWEN: We have a question from the line of Mariam Falco, CNN. Please go
ahead.
QUESTION: Thanks for the opportunity for a follow-up. Dr. Gerberding,
Secretary Thompson mentioned that he had been in consultation with
some folks 10 days ago and had a meeting as recently as Thursday. What
has happened in the past three days that made you have this press
conference now and maybe not on Thursday? Has something significantly
transpired in those past three days?
DR. GERBERDING: Yeah, the main urgency for getting information out
today is that the cases are now being reported from a growing number
of countries in Asia, and the case count is going up quite rapidly.
But in addition, we have concerns about movement out of Asia into
North America as we learned about the family in Canada and the
travelers to the U.S. It was important for us to put the domestic
public health system and clinical system on high alert to watch for
cases and take necessary steps.
In addition, the travel alert that WHO has issued, has an impact on
domestic travelers, and people will be having questions, so we felt it
was very important to get this information out so that they would be
able to look at these international events in context and not be
alarmed about an exposure risk if they don't fall into the categories
where we're concerned about potential spread.
GWEN: We do have a question from the line of Carol Kingstahl (ph),
CNN. Please go ahead.
QUESTION: Thank you, Dr. Gerberding. I actually have two questions.
One, you have mentioned that you're investigating people who have come
through Georgia and through New York. Are there other states where you
have things under investigation? Also, I wish you could speak for a
moment about our global society and how disease travels, it seems like
much more quickly now, and who you feel like you're addressing it now
versus how you would have addressed it, previously?
DR. GERBERDING: The investigations of the patients in Georgia and New
York are the only two cases that we are investigating in the United
States at this point in time. So as of this moment those are the only
two situations that we are aware of. We will not be surprised if
additional situations evolve, and that's part of the reason for
putting our system on alert.
With respect to the global village, I actually am sitting here with
Dr. Jim Hughes, who really is the person is the nation's leader of our
global response to emerging infectious diseases, and I'll just ask him
to answer the last question.
DR. HUGHES: Well, that's an excellent question. This is a very good
example of the sort of global threat that infectious diseases can
pose. And you can see just in the information here as it's developing,
you see the rapidity with which patients can move from one geographic
area to another. So this is a wonderful illustration of the importance
of rebuilding the global disease surveillance and response capacity.
MR. SKINNER: Gwen, I think Dr. Gerberding has something to say in
closing, and then we'll end the call. Dr. Gerberding?
DR. GERBERDING: Yes, thank you. I again just appreciate your doing
this on a Saturday afternoon. I think we would all like to be
someplace else today, but I want to make sure I emphasize one point,
and that is that we have not identified any cases in the United States
at this point in time, but we're thoroughly investigating, and we will
be taking aggressive steps to reach those who have traveled to the
affected areas. And if anybody who's traveled to parts of Asia
implicated in this syndrome has a symptom of fever with respiratory
illness, it's very important that they contact their medical care
provider.
MR. SKINNER: Okay. Gwen, this concludes our call. Thank you very much.
(end excerpt)
(Distributed by the Office of International Information Programs, U.S.
Department of State. Web site: http://usinfo.state.gov)
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