Global SARS Outbreak Contained

GENEVA, Switzerland, July 7, 2003 (ENS) - The human chains of virus transmission for severe acute respiratory syndrome appear to have been broken everywhere in the world, the World Health Organization announced Saturday. The global public health body no longer recommends the restriction of travel to any areas.

Calling for continued global vigilance and more research into severe acute respiratory syndrome (SARS), the health organization removed Taiwan from the list of areas with recent local transmission. Taiwan is the last area to be removed from the list.

To date, 8,439 people have been affected worldwide, and 812 people have died from SARS.

Although it has been 20 days since the last SARS case was diagnosed in Taiwan on June 15, the world is not yet SARS free, said Dr. Gro Harlem Brundtland, director-general of the World Health Organization (WHO).


Dr. Gro Harlem Brundtland, director-general of the World Health Organization (Photo courtesy WHO)
“We do not mark the end of SARS today, but we observe a milestone: the global SARS outbreak has been contained,” she said. “This is not the time to relax our vigilance. The world must remain on high alert for cases of SARS.”

From the Guangdong province in China five months ago, the SARS virus travelled in humans to 30 countries and areas of the world, but it became deeply embedded in just six areas - Toronto and Vancouver, Canada; Philippines; Singapore; Guangdong and Hong Kong, China, and Taiwan; London, United Kingdom; and Hanoi, Vietnam.

In these six 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 about 20 percent of all cases were in health care workers.

“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," Dr. Brundtland said. "And, we must remember those frontline workers who died of SARS. Their daily dedication, courage and vigilance averted a global catastrophe.”

“With the last known chain of transmission interrupted in Taiwan, the whole world can breathe an initial sigh of relief,” said Dr. David Heymann, the WHO executive director for communicable diseases. “At the same time, public health must not let down its guard, as more cases could still surface somewhere in the world. SARS has taught us that a single case is capable of igniting an outbreak.”

SARS continues to threaten the world. Close to 200 people remain hospitalized with the disease. WHO officials say it is possible that undetected cases may have slipped through the surveillance network.


Dr. David Heymann, World Health Organization executive director for communicable diseases (Photo © WHO/Virot)
“Taiwan was unlucky," Dr. Heymann said. "A lapse in infection control in a single hospital allowed the outbreak, which had been under good control, to escalate. But the authorities reacted quickly and appropriately. In doing so, they have also strengthened capacity to deal with any future outbreaks.”

WHO officials say that there is a possibility that SARS could be a seasonal disease and return later in the year - a possibility based on what scientists know about other members of the coronavirus family.

The original source of this SARS outbreak may still be in the environment and could ignite a new outbreak in the coming months. It is possible the virus still circulates in animals and may cross into humans again when conditions are right, WHO says.

“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.

At the top of the public health research agenda for SARS 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, WHO says, hospitals may be forced to isolate all persons with respiratory disease fitting the SARS case definition, and this will be expensive and divert essential resources from other health needs.

WHO is working with its partners to develop case investigation, case management and surveillance protocols for SARS in the post-outbreak environment. These documents will be revised as knowledge expands.

Investigations into a possible animal reservoir are needed, says WHO. 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.


Workers at the World Health Organization in the SARS Alert and Response Operation Room, at WHO Headquarters in Geneva (Photo © WHO/Virot)
A global database is required to give epidemiologists and clinicians the power of large numbers to better understand SARS, and to assess the advantages of different therapeutic approaches in its treatment.

Dr. Brundtland views SARS as a warning. “SARS pushed even the most advanced public health systems to the breaking point," she said. "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.”

“Interruption of the last known chain of person-to-person transmission has come just in time. Health systems at every major outbreak site were strained to the limits of their capacity.” said Dr. Heymann.

The main symptoms of SARS are high fever greater than 38 degrees Celsius, or 100.4 degrees Fahrenheit, dry cough, shortness of breath or breathing difficulties.

Dr. Brundtland, a physician and former Prime Minister of Norway, warns that 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.”