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Washington File

07 July 2003

Text: U.N. Health Agency Says SARS is Contained Worldwide

(But threat remains real; disease may recur) (1120)
The World Health Organization (WHO) has declared that the chain of
transmission for severe acute respiratory syndrome (SARS) is broken.
The finding came July 5, when the agency removed Taiwan from its list
of places where recent transmission had occurred. Taiwan had been the
last locale on that list, giving rise to the conclusion that the
five-month old disease outbreak is over.
At the same time, WHO acknowledged in a July 5 press release that
certain cases could have eluded health authorities, and the
sometimes-fatal respiratory illness could quickly reappear.
"This is not the time to relax our vigilance. The world must remain on
high alert for cases of SARS," said WHO Director-General Dr. Gro
Harlem Brundtland.
In their analysis of the previously unknown illness, scientists
discovered that SARS is a coronavirus, member of a family of viruses
that cause other common respiratory ailments. With that knowledge,
scientists speculate that SARS could be seasonal, like other
coronaviruses, and could reappear in winter.
The U.S. Centers for Disease Control still has travel alerts in place,
cautioning travelers of the occurrence of SARS in Beijing, Taiwan,
Hong Kong and Toronto. A travel alert provides particular cautions
about avoiding exposure to disease. Further information is available
at http://www.cdc.gov/ncidod/sars/index.htm.
WHO also offer further information about SARS at
Following is the text of the WHO press release:
(begin text)
World Health Organization
SARS outbreak contained worldwide 
Threat remains and more research needed, says WHO 
5 July 2003 | GENEVA -- Today, the World Health Organization is
removing Taiwan, China, from the list of areas with recent local
transmission of severe acute respiratory syndrome (SARS). Taiwan is
the last area to be removed from the list. It has been 20 days, or two
consecutive 10-day incubation periods, since the last case on June 15.
Based on country surveillance reports, the human chains of SARS virus
transmission appear to have been broken everywhere in the world.
However, due to the many questions remaining about SARS and the
possibility that cases may have slipped through the surveillance net,
WHO warns that continued global vigilance for SARS is crucial for the
foreseeable future. The world is not yet SARS-free.
"We do not mark the end of SARS today, but we observe a milestone: the
global SARS outbreak has been contained," said Dr. Gro Harlem
Brundtland, Director-General of the World Health Organization. "At
this moment, we should all pause and give thanks to scientists, public
health and hospital workers who took risks in the face of a new and
unknown disease. And, we must remember those frontline workers who
died of SARS. Their daily dedication, courage and vigilance averted a
global catastrophe."
From the Guangdong province in China, the SARS virus travelled in
humans to 30 countries and areas of the world but it became deeply
embedded in just six. In these areas, the pattern of transmission was
the same: An imported hospitalized SARS case infected health care
workers and other patients; they infected their close contacts and
then the disease moved into the larger community. In affected areas
approximately 20% of all cases were in health care workers. To date,
8439 people have been affected, and 812 have died from SARS. Now, five
months after SARS began its spread around the world, it is close to
being driven out of humans.
SARS continues to threaten the world. Close to 200 people remain
hospitalized with the disease. And, it is possible that undetected
cases may have slipped through the surveillance network. Thus, while
today we have no reports of local transmission, that may not be the
case tomorrow.
"This is not the time to relax our vigilance. The world must remain on
high alert for cases of SARS." said Brundtland.
SARS will continue to menace the global public health system. It is
possible that new SARS cases will appear. SARS could be a seasonal
disease and return later in the year - a possibility based on what we
know about other members of the coronavirus family. Further, the
original source of this SARS outbreak may still be in the environment
and could ignite a new outbreak in the coming months. For example, it
is possible the virus still circulates in an animal reservoir and may
cross into humans again when conditions are right.
"To answer these and other questions, research into SARS must
continue. Scientific evidence will be crucial for our ability to best
handle another SARS outbreak should there be one," said Dr Brundtland.
The public health research agenda for SARS is long and growing. At the
top of the list is a early diagnostic test, which can detect the
presence of the disease within days of disease onset. This will be
needed to distinguish SARS patients from those suffering from other
respiratory illnesses, especially when the flu season arrives. Without
a diagnostic test, hospitals may be forced to isolate all persons with
respiratory disease fitting the SARS case definition, and this will be
enormously expensive and divert essential resources from other health
needs. WHO is working with it's partners to develop case
investigation, case management and surveillance protocols for SARS in
the post outbreak environment. These will be living documents revised
regularly as our knowledge expands.
Second, intense investigations into a possible animal reservoir are
needed. Only by identifying the original source of this outbreak, and
understanding the way the virus moves from the original source to
humans, can future outbreaks be prevented. Third, a global database is
required to give epidemiologists and clinicians the power of large
numbers to better understand SARS. Also, we need a better
understanding of the advantages of different therapeutic approaches in
the treatment of SARS.
"SARS is a warning," said Dr Brundtland. "SARS pushed even the most
advanced public health systems to the breaking point. Those
protections held, but just barely. Next time, we may not be so lucky.
We have an opportunity now, and we see the need clearly, to rebuild
our public health protections. They will be needed for the next global
outbreak, if it is SARS or another new infection."
Preparing for the next outbreak requires restoring and strengthening
the public health infrastructure. More epidemiologists and other
public health specialists are needed. Better surveillance and response
systems must be established which include strong national, regional
and global linkages in reporting. And governments need to invest more
in hospital infection control.
"SARS is teaching us many lessons," said Dr Brundtland. "Now we must
translate those lessons into action. We may have very little time, and
we must use it wisely."
(end text)
(Distributed by the Bureau of International Information Programs, U.S.
Department of State. Web site: http://usinfo.state.gov)

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