Lack of SARS Transmission among Public Hospital Workers, Vietnam

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Abstract

The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment.

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A novel coronavirus associated with severe acute respiratory syndrome.

Thomas G Ksiazek, Dean Erdman, Cynthia Goldsmith … (2003)

A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. We conducted studies to identify the etiologic agent of this outbreak. We received clinical specimens from patients in seven countries and tested them, using virus-isolation techniques, electron-microscopical and histologic studies, and molecular and serologic assays, in an attempt to identify a wide range of potential pathogens. None of the previously described respiratory pathogens were consistently identified. However, a novel coronavirus was isolated from patients who met the case definition of SARS. Cytopathological features were noted in Vero E6 cells inoculated with a throat-swab specimen. Electron-microscopical examination revealed ultrastructural features characteristic of coronaviruses. Immunohistochemical and immunofluorescence staining revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coronavirus primers designed to amplify a fragment of the polymerase gene by reverse transcription-polymerase chain reaction (RT-PCR) were used to obtain a sequence that clearly identified the isolate as a unique coronavirus only distantly related to previously sequenced coronaviruses. With specific diagnostic RT-PCR primers we identified several identical nucleotide sequences in 12 patients from several locations, a finding consistent with a point-source outbreak. Indirect fluorescence antibody tests and enzyme-linked immunosorbent assays made with the new isolate have been used to demonstrate a virus-specific serologic response. This virus may never before have circulated in the U.S. population. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Because of the death of Dr. Carlo Urbani, we propose that our first isolate be named the Urbani strain of SARS-associated coronavirus. Copyright 2003 Massachusetts Medical Society

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Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.

J S M Peiris, C M Chu, V Cheng … (2003)

We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.

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Severe acute respiratory syndrome--Singapore, 2003.

Mark Chen (2003)

The Singapore Ministry of Health (MOH), with assistance from the World Health Organization (WHO), has been investigating an outbreak of severe acute respiratory syndrome (SARS). This is a novel condition caused by the SARS-associated coronavirus (SARS-CoV) and is characterized by both an atypical pneumonia and efficient nosocomial transmission. This report summarizes epidemiologic features of this outbreak in Singapore, including the influence of super spreaders and the national prevention and control strategy.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (iso-abbrev): Emerging Infect. Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): February 2004

Volume: 10

Issue: 2

Pages: 265-268

Affiliations

[* ]Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam

[† ]Bach Mai Hospital, Hanoi, Vietnam

[‡ ]Centers for Disease Control and Prevention, Atlanta, Georgia, USA

[§ ]National Institute for Hygiene and Epidemiology, Hanoi, Vietnam

[¶ ]Communicable Disease Surveillance and Response, World Health Organization (WHO), Geneva, Switzerland

[# ]Hanoi Medical University, Hanoi, Vietnam

[** ]Communicable Disease Surveillance and Response, WHO, Hanoi, Vietnam

[†† ]Curtin University of Technology, Perth, Australia

[1 ]Primary coauthor.

Author notes

Address for correspondence: Sharon Bloom, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E61, Atlanta, GA 30333 USA; email: sbloom@ 123456cdc.gov

Article

Publisher ID: 03-0707

DOI: 10.3201/eid1002.030707

PMC ID: 3322918

PubMed ID: 15030695

SO-VID: 88a5c3c6-deae-47e5-9509-62d61c603eb5

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Lack of SARS Transmission among Public Hospital Workers, Vietnam

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Abstract

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Microbiology Society: Coronaviruses

Most cited references 5

A novel coronavirus associated with severe acute respiratory syndrome.

Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.

Severe acute respiratory syndrome--Singapore, 2003.

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Cited by 43

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