18 March 2003
U.S. Disease Center "Working Around the Clock" on Fast-Moving Illness
(Health Secretary Thompson Says China Accepts U.S. Help) (5960)
Health researchers at the U.S. Centers for Disease Control and
Prevention (CDC) are "working around the clock" to identify the cause
and nature of a rapidly-spreading illness, according to U.S. Health
and Human Services Secretary Tommy G. Thompson.
In a March 17 telebriefing, Thompson said that Chinese health
officials have now agreed to accept international assistance in
studying the estimated 300 cases that have occurred in the Guangdong
Province, the greatest concentration of cases in the eight nations
where confirmed or suspected cases have been identified.
CDC Director Julie Gerberding fielded most of the reporters' questions
in the briefing, describing her agency's contribution to the
international effort to understand the disease. She called it an
"emerging threat," reminding health officials worldwide that a
"problem in one corner of the world will soon be an emerging problem
for all of us."
The symptoms of disease, dubbed Severe Acute Respiratory Syndrome
(SARS), include a fever greater than 38 degrees Celsius (100.4 degrees
Fahrenheit) and respiratory symptoms, such as a cough or shortness of
breath.
Hong Kong and Viet Nam report the greatest number of current cases.
Germany, Canada, Singapore, Slovenia, Thailand and the United Kingdom
report a handful of cases, all of which involve a person who has
recently traveled in the most affected areas, or lives with such a
person.
Aside from the several hundred cases in China's Guangdong province
that appeared predominantly from November to February, the World
Health Organization reports 219 cases of SARS as of March 18 with four
deaths.
"The most important thing that we need to do is to prevent spread of
this infection," said Gerberding. "The second most important thing is
to figure out what's causing (it)."
Though she cautions that all findings are preliminary, the CDC
director said it seems that the disease is only transmitted in close,
face-to-face contact. The spread of the illness doesn't seem to
indicate that the disease will pass from one person to the next in a
crowded room, or on a bus, for instance.
The analysis conducted so far doesn't reveal the cause of the illness
to be a common organism. "We are looking at bacteria. We're looking at
viruses," Gerberding said. "We're looking at atypical bacteria. We are
checking for absolutely everything."
The unknown cause of the disease and its rapid spread among health
care workers in contact with the first patients are two factors that
motivate the intense international search for answers, Gerberding
said. "One issue was the high degree of contagion to health care
workers, and the other was the rapidity and severity of the pneumonia
in the case patients," the CDC director said. "That signaled something
unusual."
Further information is available at http://www.cdc.gov/ncidod/sars/
Following is the excerpted version of the CDC telebriefing transcript:
(begin excerpt)
U.S. Centers for Disease Control and Prevention
CDC Telebriefing Transcript
March 17, 2003
CDC's Response to Severe Acute Respiratory Syndrome
CDC MODERATOR: Let me quickly explain how today's briefing will work
and our plans for keeping you up to date on this emerging epidemic. .
.
We're very privileged today to have the Secretary of the Department of
Health and Human Services joining us by telephone. Following Secretary
Thompson's remarks, Dr. Julie Gerberding, Director of the Centers for
Disease Control and Prevention, will provide information about our
response to the epidemic. Then we'll open to your questions.
Secretary Thompson, welcome to the briefing, sir.
SECRETARY THOMPSON: Thank you so very much, and let me just thank
everybody for being here today, and thank CDC for doing such a
wonderful job. I know how many of the doctors and researchers spent
all week working on this because I was in communication on almost an
hourly basis with Dr. Gerberding, who is just doing an outstanding
job, and I want to publicly thank her for what she's doing.
I would just like to say that the Department is working with CDC as
well as the World Health Organization. We are having a teleconference
with the World Health Organization tomorrow morning, and we're all
aggressively responding to and we're trying to monitor all the cases
of SARS.
Experts at their labs, not only at our own CDC but also at the World
Health Organization, are actively analyzing specimens to identify the
cause for this illness. To date, however, we have not been able to
identify any agent that could be linked to the outbreak, and none has
been identified as such.
First and foremost, I want to reiterate that I, as well as all of us
here at HHS and CDC are taking the situation very seriously. I just
left a representative of the Vice President of the White House and
discussed this issue with them. We're all taking the prudent steps
needed to ensure the maximum safety and the health of all Americans.
The current outbreak of this unknown infectious agent is of concern to
everybody.
I met with the Chinese officials about 10 days ago, and I asked them
at that time to allow CDC to go in and work with them. We were not
able to successfully negotiate that at that time, but subsequently we
have been able to, and we have been working with the CDC in China
along with our CDC, and we're making some progress.
The staff at the CDC have been doing a fantastic job of working around
the clock to monitor this situation and marshaling all the resources
necessary to deal with the outbreak as it unfolds. Our experts at CDC
are keeping me and my staff here at HHS informed throughout the day,
and I thank them for that, and I appreciate that very much.
As you all know, the centers of this outbreak so far have been in Hong
Kong and in Hanoi, and it was started in the Guangdong Province in
China. The individuals who have been infected all have recently
traveled in these areas or had contact with individuals who had
traveled there. There have been no cases reported to date that have
not followed this pattern. However, with the ease of international
travel, it is a possibility that there may be some cases that appear
in the United States, most likely in individuals who probably fall
into the pattern of transmission that we've seen so far.
Officials at CDC are working very closely with the State Department,
the Defense Department, which we had a meeting with yesterday
afternoon and this morning, the Transportation Security Agency, and
other federal and state partners to monitor the situation.
CDC has regular conference calls with state and local public health
officials, and earlier this afternoon CDC had a call with major U.S.
health organizations to share the latest information we have on the
outbreak. We're also in constant communication with the World Health
Organization, and we'll have a teleconference with them tomorrow
morning.
All I would like to say is thank you for the press for covering this
issue. It's very important to get the information out. And also I want
to thank CDC and Julie Gerberding for the great job they're doing.
With that, I'll turn it over to Dr. Gerberding to give you her
statement and also to answer your questions.
Thank you, Julie.
DR. GERBERDING: Thank you, sir. Very glad you could join us for this.
And thank you for taking time out of a busy afternoon to be here and
cover this situation. What I wanted to do was first tell you a little
bit about what we know is going on, tell you some of the things that
we still have to work out, and then describe for you the steps we're
taking and the kind of operating procedure we've instigated here to
deal with this situation.
The Severe Acute Respiratory Syndrome is an emerging infection,
primarily in Asia, but we do see evidence that it can spread to other
countries, in particular we already know there are cases in Canada,
and we're evaluating individuals who are currently present in Germany
and in other parts of the country. It will not be surprising to us if
we identify cases in the United States, but we have not identified
cases here yet. We have received reports of at least 14 persons who
meet some of the WHO criteria for a diagnosis. These individuals are
in active investigation by state and local health agencies, and if any
of them does turn out to actually have this syndrome, we will be
issuing an update.
We know that the disease is so far limited to people who have had very
close contact with cases. Most of the individuals are health care
personnel who have been in direct contact with either the patient or
body fluids from the patient. We also know that household contacts are
at risk, particularly if they've had direct and sustained contact with
sick individuals.
So far the cases are limited, as Secretary Thompson said, to
individuals who have either lived in parts of Asia that are affected,
or who have recently traveled from those areas.
We believe the incubation period is approximately 2 to 7 days,
although as new information unfolds, that may be updated. So the
travel advisories that have been issued stipulate that individuals
returning from those areas with fever and respiratory symptoms within
7 days of their departure should seek medical attention to be sure
that they are not in the early stages of this syndrome.
We also know that there is no evidence so far that persons not in
direct contact with suspect cases are at risk. We have not identified
any people with casual contact or indirect contact. I think we were
reassured by the investigation here in Georgia, where there was an
individual who acquired this infection presumably from family members,
was here in this city while sick, was involved in activities that
involved exposure to others in a workplace setting, and there is no
evidence of spread from that kind of contact in the workplace.
Nevertheless, I stress again this is an ongoing investigation. We
certainly don't have all the information we need to know to have
certainty about any of these issues, and we will just simply have to
update you as we go forward.
The most important thing that we need to do is to prevent spread of
this infection, and I'll tell you some of the things we're doing about
that right now. But the second most important thing is to figure out
what's causing (it). This appears to be a contagious infectious
disease, and as I said, limited to health care personnel and close
household contacts. That suggests spread by the droplet route, and
that's why our infection control precautions emphasize prevention of
droplet spread through the use of face shields and gowns and gloves.
But since we can't be 100 percent sure that there isn't an airborne
component, at least in close quarters, we're also recommending that
masks be worn to protect health care personnel who are treating these
individuals.
Our laboratories here at CDC are literally working around the clock on
the specimens that we've received. They're working in collaboration
with WHO and reference laboratories internationally to try to identify
the pathogen.
We are not suspicious that this is a common organism, or we would have
found it by now. So that leads us to conclude that it's either a
difficult-to-grow organism or one that we have less experience with.
But here at CDC we have reference laboratories that really have the
wealth of the world's reagents and technologies and capacities, and we
are confident that we will be able to identify the cause.
The rate-limiting step for us at this point has been access to
specimens from the patients that are affected with the illness in
Asia, and I'm very pleased to say that we now have taken important
strides toward getting those specimens here. Some are en route and we
expect others to follow this week. So that will be helpful to all of
the laboratories internationally who are collaborating on identifying
this agent.
Some of the things that we're doing right now are probably obvious to
you. We're making a huge effort to communicate about what we know and
what we don't know to the public. But we're also taking steps to
communicate with the involved stakeholders, particularly here in the
United States, where we have yet to identify a case, but we want to
make sure we don't miss one.
We have established a website that contains all of the information
that we have available to us, and the WHO will be issuing morning
updates on the number of cases that have been identified around the
world. You may see some wobble in numbers over time. The case
definition here is very broad: fever, respiratory symptoms in someone
who's been in Asia. And as these cases are investigated, many
individuals may turn out to have other conditions, and they will be
taken off the list. So be prepared for some uncertainties in the
actual number as we go forward one day at a time.
We have activated our emergency response center here to manage this
international outbreak that allows us to have the expert logistic
support for our teams. Right now we have 12 individuals deployed to
various locations internationally to support this, but also it allows
us to take information in real time and transform it into guidance,
isolation recommendations, and public information to help ensure that
we've got the information out in a timely manner.
I just got off the telephone with a number of clinician organizations
from around the country to make sure that they have the updated
information. Dr. John Jernigan, who's here, is leading our clinician
team. We are making 24-hour-a-day services available to clinicians who
have questions about this illness so that they can get
state-of-the-art information, and you can also follow up with us
because we have a public information hotline to help provide people
information as well.
Finally, we really appreciate the efforts of our state and local
health partners across the country who have also been briefed by
telephone and are participating in ongoing updates about this illness.
They, too, along with clinicians, are the front line of detecting
initial cases here, and we know that they will be called to
investigate suspicious patients as they come forward and will be the
first to take steps to prevent further spread.
We have issued guidance to clinicians that says one very important
thing, and that is, when an individual presents to medical care with
fever and respiratory symptoms, it's important to take a travel
history and know if that person has recently left, within the last
seven days, one of the countries in Asia where these cases are being
reported; and if so, the individual should be isolated until
additional information is available to be sure that we're not dealing
with a case patient. And that means that people who have fever and
this travel history and are developing respiratory symptoms, when they
go to the doctor it's very important to let the clinicians know that
you have this travel history and that you've been in this area so that
the appropriate precautions can be taken.
With that, let me just stop and open this up for questions and
answers.
QUESTION: [inaudible].
DR. GERBERDING: The question is what can I say about the 14 reports
we've received in the United States where there's a suspicion of this
syndrome.
Our initial information that of the 14,10 are almost certainly not
people with the syndrome. They don't meet any of the relevant history,
and four are under a little bit more scrutiny just because they have
at least some of the characteristics of the illness that WHO has
defined. But we haven't confirmed any cases here, and so we'll update
you as we go forward . . . .
AT&T OPERATOR: We have a question from Robert Bazell (ph) with NBC
News. Please go ahead.
QUESTION: Dr. Gerberding, you have had some samples from the Canadian
cases, I believe, for several days now, and you mentioned the
difficulty you're having. Can you tell us a bit more about what that
means, the fact that some of these things you've had in your lab there
for three or four days now and you haven't been able to culture out
anything. Isn't that highly unusual?
DR. GERBERDING: Let's say that, first of all, in looking at specimens,
the quality of the specimen is important, but also the time in the
illness when the specimen was obtained matters. The specimen we
received from Canada was an autopsy specimen. It was derived from the
patient more than 14 days after the onset of illness, and it's not
uncommon at all for us not to be able to isolate an organism in a
specimen that that's far into the clinical course. That's why we're
putting so much emphasis on trying to obtain early specimens or
respiratory specimens from patients who are recently developing the
signs and symptoms of the disease.
We do look forward to being able to provide more of an update on that
as we go forward. I would also add that the evaluation of the Canadian
specimen is not complete, and whenever we have to do virus culturing,
we expect results to take several days, and sometimes weeks.
QUESTION: [inaudible].
DR. GERBERDING: The question is: What is the validity of reports that
we've ruled out bacteria and that the Hong Kong laboratories have
excluded influenza in the diagnosis?
First of all, at this point we have not ruled out anything. We simply
have insufficient material to draw firm conclusions about any of this.
We do know that the laboratories in Hong Kong, where a large
proportion of the patients are receiving care, are very good at
diagnosing influenza. They developed this capacity and experience in
the context of the previous avian influenza outbreaks there, and the
fact that they haven't been able to diagnose influenza in the patients
is a strong argument against that being the etiology, at least in
those individuals, but it's really too soon to draw firm conclusions.
We are looking at bacteria. We're looking at viruses. We're looking at
atypical bacteria. We are checking for absolutely everything.
AT&T MODERATOR: We have a question from Bill McLaughlin with (?)
Business Magazine. Please go ahead.
QUESTION: Good afternoon. In terms of the method of transmission, you
mentioned droplets. Is there any possibility that droplets on an
inanimate surface, in other words, if someone were to sneeze on
something and someone else down the road at some point would come in
contact with that particular object, is that of any concern? Or is
that really not likely at this point?
DR. GERBERDING: Droplets almost always are infectious when they're
fresh, and so we are most concerned about recent exposure to fresh
body fluids, and the epidemiologic pattern that we understand so far
is very consistent with that. This is sort of a face-to-face
transmission pattern. We're learning that when we look at the patients
in Hanoi and the patients in Hong Kong and the cluster in Canada. But
we are using infection control precautions that go beyond that in
health care settings where there's likely to be concentrated exposure
just to be absolutely certain. We are not seeing, as I said, spread
within the general population by casual contact, and there's no
suggestion that inanimate objects of any sort are playing a role in
transmission at this point in time.
QUESTION: [inaudible].
DR. GERBERDING: The question is: Are there any commonalities among the
people who have acquired the infection other than being in that part
of the world?
The answer is that these kinds of epidemiologic investigations are
ongoing as we speak. The WHO has teams of investigators in all of the
locations, and they are doing exactly what you said. They are trying
to look for clustering in person, place, and time and see if they can
find any additional clues about where the exposures that led to
infection might have occurred. But we don't have any information at
this point to draw conclusions.
A phone question, please?
AT&T MODERATOR: We have a question from Tom Watkins with CNN. Please
go ahead.
QUESTION: Can you update the numbers you gave over the weekend? How
many cases are there so far? How many deaths? What are the--what is
the status of the survivors? Are they getting better? How many are on
ventilators? And do you know anything about the status of the WHO
health worker who was sickened?
DR. GERBERDING: The WHO has reported an update this morning of 167
cases and four deaths. Keep in mind, as I said before, these numbers
are apt to change as additional information becomes available or
additional cases are detected.
In terms of the clinical status of these individuals that are
surviving this illness, we don't have line-by-line information.
There's a great deal of variability in the presentation and outcome.
We have reports of people who are improving. We have not yet
documented that someone who's been on a ventilator has recovered and
gotten off the ventilator, but we're hopeful that that will be the
case.
QUESTION: And any idea how many of them are on ventilators?
DR. GERBERDING: At this point I don't have an update on that.
QUESTION: Okay. Thanks.
[Inaudible comment and question.]
DR. GERBERDING: With respect to the reports of patients that are under
active investigation, I'm going to defer that question until state and
local health offices have had a chance to provide their own individual
updates.
With respect to what does the WHO number mean, 167 cases are cases
that have been diagnosed since the syndrome was recognized following
the index patient, so this is the cumulative total of cases. Of
course, that does not include the cases that have been described
coming out of Guangdong Province in China where we have much less
information and cannot say at this time whether they are related or
unrelated to this current outbreak situation.
I would just like to emphasize that what we're dealing with here is an
emerging infection, and the fact that we live in this global village
makes our need to be able to identify and respond to these infections
so critical. The fact that Hong Kong has a surveillance system and is
very alert to infectious diseases that could be flu has certainly
helped us identify the early cases there. We need that kind of
capacity in every corner of the world.
AT&T MODERATOR: We have a question from Lori Good(?) with Newsday.
Please go ahead.
QUESTION: Okay. Then my question concerns China and the status of
cooperation with China. Clearly they've been sitting on information
for a very long time, and they've been reluctant to cooperate. I
wonder, are we sending a team in? Do we have an actual firm agreement
that would allow the CDC to go to Guangdong? And as a follow-up,
what's the latest from Switzerland and the U.K. on those suspect
cases?
DR. GERBERDING: This morning the WHO reports that the Minister of
Health of China has requested support from an international team and
that the team is being assembled. That's very good news, and I
anticipate that means that we'll be able to get into China very soon,
as soon as folks on the ground get coordinated.
Lori, I forgot your last--the last part of your question.
QUESTION: What's the latest on the suspect cases in the Switzerland
and the U.K.?
DR. GERBERDING: I have no specific information on the suspect cases in
Switzerland other than there are two that are under evaluation. They
are alive and there are no reports of secondary transmission yet. And
in terms of Britain, that was a breaking news item this morning, and I
do not have the follow-up at this point in time.
QUESTION: Thank you.
[Inaudible comment and question.]
DR. GERBERDING: The question is: Why is it difficult to get specimens?
First of all, this is an international effort, and CDC is not the only
partner who has a role to play here. WHO has a whole network of
laboratories that have great expertise and great capacity in this
area. So we are partnering with a number of different agencies, and if
we don't have specimens, some of the other labs in the consortium
certainly do. And we're very respectful of that partnership.
But, in addition, as a problem emerges in a new area, there are issues
of patient consent, family considerations, then as well as scientific
considerations. Just as in this country we defer to state health
departments when there's evolving a problem internationally, we defer
to the Ministers of Health in the implicated country and we also defer
to WHO in countries that are part of the World Health Organization. So
all of those things mean that there are channels and processes that we
follow when we need to acquire specimens.
Secretary Thompson was very helpful in working with Dr. Bruntdland at
WHO and other Ministers of Health in the affected areas to open the
doors to receiving specimens, and I think that's why we have the
optimism we do that we will be able to have more materials here at CDC
to work with in our laboratories.
AT&T MODERATOR: We have a question from John Sattrack (ph) with
Washington (?) . Please go ahead.
QUESTION: Dr. Gerberding, taking note of the previous comments you
made regarding the unlikelihood of this being influenza, we've
nevertheless heard for some time from influenza experts that the world
is overdue for a large-scale pandemic. I'm wondering--they've called
for pre-event and post-event strategies similar to what's going on
right now with smallpox, and I'm wondering if this is going to change
the long-term thinking in terms of the cost/benefit of any kind of
pre- or post-event strategies, either for influenza or whatever this
SARS might turn out to be.
DR. GERBERDING: Thank you. I believe that most people in the health
community recognize the danger that pandemic flu would place in our
society and have been advocating for some time to speed up and scale
up efforts for preparation. This current emerging threat is a wake-up
call. We right now don't believe that it represents influenza, but it
has many of the same characteristics that we would be concerned about
with an emerging influenza illness. That is, it appears to be
contagious with a high degree of efficiency in at least close
quarters. It's emerging in a part of the world where there are great
conditions of crowding and a great deal of international travel. And
certainly it reminds us that we really do live in a global village and
that an emerging problem in one corner of the world will soon be an
emerging problem for all of us.
[Inaudible comment and question.]
DR. GERBERDING: When is the last time we've dealt with a global
emerging infection? We deal with global emerging infections all the
time. For example, we just are in the midst of an Ebola outbreak in
the Congo.
[Inaudible comment and question.]
DR. GERBERDING: Of an unknown agent? I'd have to defer that to Dr.
Hughes, who's the Director of the National Center for Infectious
Diseases and has the historical perspective.
DR. HUGHES: Thank you. The most dramatic recent example perhaps would
be hantavirus pulmonary syndrome back in 1993. Now, that was not
initially a global problem. It appeared to be local. But subsequently
we've learned about hantaviruses present throughout the Western
Hemisphere that were previously unrecognized. You can go back to
Legionnaire's disease in 1976.
I'd remind you, you know, in terms of dealing with an unexplained
illness, those of you who were around in 1976 might recall it took six
months to identify the cause, and that was a bacterium that caused
Legionnaire's disease. We think we'll get to the bottom of this more
quickly, but there are substantial challenges ahead.
DR. GERBERDING: From the phone?
AT&T MODERATOR: We have a question from Seth Bornstein with Knight
Ridder. Please go ahead.
QUESTION: Yes, can you tell us, are you--you've looked at obviously
bacteria and viruses. What about the co-infection, especially with
bacteria that has--allows virus to invade, I know which is something
(?) an issue in the labs but never in the wild. Is that something that
this is a possibility and you are examining that possibility?
DR. GERBERDING: We're not ruling out any possibilities, but right now
I think the pattern of transmission implies fairly direct contact with
an individual infectious agent. We will certainly be looking for DNA
for a whole host of organisms, and if we're dealing with a dual
infection or something that's complicated of that nature, our probes
should be able to figure that out.
[Inaudible comment and question.]
DR. GERBERDING: I will follow up what the Georgia State Health
Department is reporting about the situation here in Georgia. The
person who visited Georgia was a family member of the family in Canada
that has two individuals who have died from this syndrome. This
individual traveled here on business. She was here for a few days, a
relatively short period of time. She was involved in a business
activity, and the health department has done an outstanding job of
investigating the individuals she had contact with in the workplace,
in the place where she stayed, and the restaurants where she ate, and
I think has done an amazing job of tracking back to make sure that
there was no secondary transmission. She was here much earlier in the
month, and it's past that seven-day period that we're defining as, you
know, the best guess of the incubation period. So as time goes on, I
think it's less and less likely that we'll discover that there's been
any transmission. But the health department is vigilant, and certainly
we'll continue to monitor that situation.
AT&T MODERATOR: We have a question from Kevin Finnegan with CBS News.
Please go ahead.
QUESTION: Actually, it's Elizabeth Kaladin (ph). Dr. Gerberding, I'm
just wondering what, if anything, you've learned from the four deaths.
Were these people who received no therapy or no hospitalization? Were
they a certain age group? Is there anything in common in the four
people who didn't survive?
DR. GERBERDING: We are deferring to the investigators in the field to
pull together the clinical information. Dr. Jernigan is here with us,
who heads our clinical team, and I don't believe we have specific
information on all of the deaths. But right now we cannot draw any
conclusions about benefits of any treatments. A few empiric treatments
have been provided. Most of the patients were treated with
conventional antibiotics that you would use for a community-onset
pneumonia. But, you know, even with common garden-variety pneumococcal
pneumonia, and if you treat with penicillin, you don't always cure the
infection.
So we really can't draw any conclusions on that at this point in time,
and we don't want to wish to have bad outcomes for any of our
patients, but I think the numbers right now are just simply too small
for us to make any conclusions about that.
[Inaudible comment and question.]
DR. GERBERDING: Let me emphasize again the timing of the testing is
highly variable depending on the specific test. We have rapid tests
that screen for families of viruses and bacteria. Bacterial cultures
for common-variety bacteria often become positive very quickly. But
some of the viruses that we're looking for either cannot be grown in
culture or take very long times to grow in culture, and some of them
we still are dependent on probes of the DNA to really identify the
agent.
When we have a situation where we can't actually grow the organism and
get a lot of genetic material, we often have to resort to the most
sensitive DNA technology that we have, and if there is not a dense
infection, sometimes we get a false negative from those tests.
So the rapid tests are being completed very quickly. We're doing
special staining of tissue and immunohistochemical staining to really
look at the location of any potential antigens in tissue, and, believe
me, we've got laboratories all over the center working on this around
the clock.
So in terms of when we'll be able to draw any firm conclusions about
what's going on, I can't predict that. I'd just tell you that we're
doing it as fast as we humanly can, and we're prepared to scale up as
we get more specimens.
AT&T MODERATOR: We have a question from Jennifer Colman with KYW-TV.
Please go ahead.
QUESTION: Yes, hi. With respect to the 14 cases, you mentioned that
four of them were more--you know, were more suspicious. Which areas of
the United States are they in?
DR. GERBERDING: I'm not going to comment on the specifics of those
cases right now in deference to state and local health agencies. But I
think that--I checked with Dr. Jernigan just before I came into this
meeting, and we're not highly suspicious of any of these cases, but
under the circumstances, we want to be absolutely certain that we're
not missing the first patient, and so we are giving them a very
careful follow-up and working with the health authorities in those
areas to provide any technical assistance that we can.
We're also working to obtain specimens from the patients so that we
don't miss the opportunity to make a diagnosis if it turns out that
they do, in fact, represent a case.
A last question from the phone?
AT&T MODERATOR: We have a question from Erica Needowsky (ph) with the
Baltimore Sun. Please go ahead.
QUESTION: Hi. Can you explain what it was specifically about this
illness that raised a flag in the first place, perhaps something to
suggest that it was behaving differently?
DR. GERBERDING: There are, I think, two things that sounded the alarm
in this illness. One is that the first patient that was initially in
Hanoi and then transferred back to Hong Kong, in that particular
cluster, seemed to be the source of many health care worker
infections, much more transmission in the health care environment than
we typically see with most infectious diseases.
Now, in that particular hospital, barrier precautions were not in
place so that's somewhat confusing because they're using a different
approach to infection control than we use here.
So one issue was the high degree of contagion to health care workers,
and the other was the rapidity and severity of the pneumonia in the
case patients. Even in influenza, most people have sort of the
systemic fever illness, and it's quite unusual to develop pneumonia.
Here we had a very high proportion of individuals developing
pneumonia. That signaled something unusual, and I'm sure that was one
of the reasons why they took a closer look at what was going on.
CDC MODERATOR: Thank you, Dr. Gerberding, and thank you also,
Secretary Thompson, for joining us today. That concludes our briefing.
We will keep you up to date on the progress that we're making here,
and we will notify you if we're going to be briefing tomorrow or again
this week.
Thank you.
(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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