Minnesota Department of Health (MDH) Bug Bytes
April 4, 2003
Vol. 4: No. 4
In the last three weeks the World Health Organization (WHO), CDC, and we have been investigating an international outbreak of cases of atypical pneumonia referred to as severe acute respiratory syndrome (SARS). SARS appears to be a new disease that originated in China. Its exact etiology is still unknown but it is thought to be a novel coronavirus. SARS appears to be spread by droplet and contact transmission; however, airborne transmission cannot be ruled out. The case fatality rate is 3% and there is no known treatment at this time.
Patients are reported as suspect SARS cases if they meet
the following criteria:
Respiratory illness of unknown etiology with onset since February 1, 2003, and:
- Measured temperature > 100.5°F (>38° C) AND
- One or more clinical findings of respiratory illness (e.g. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome) AND
- Travel within 10 days of onset of symptoms to an area
with documented or suspected community transmission of SARS
(see list below; excludes areas with secondary cases limited
to healthcare workers or direct household contacts)
Close contact* within 10 days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case.
* Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient known to be a suspect SARS case.
Areas with documented or suspected community transmission
of SARS: Peoples' Republic of China (i.e., mainland China
and Hong Kong Special Administrative Region); Hanoi, Vietnam;
To date, 2,416 suspect or probable cases including 89 deaths have been reported to the WHO. Cases have centered in mainland China, Hong Kong, Hanoi, Singapore, and Toronto. There have been 115 cases (0 deaths) in the U.S. We have investigated dozens of potential cases in Minnesota and we have recorded five suspect SARS cases including three adults, one child, and one infant. All five case-patients have recovered. We urge clinicians to call us immediately if they are seeing a potential SARS patient. A surgical mask should be placed on the patient in whom SARS is suspected, and contact (gloves, gown, and eye protection) and airborne precautions (an isolation room with negative pressure relative to the surrounding area and use of an N-95mask for persons entering the room) should be applied where feasible. Where respirators are not available, healthcare personnel evaluating and caring for suspect SARS patients should wear a surgical mask. We will provide clinical and infection control consultation, and arrange for laboratory testing.
Additional information and updates is at http://www.cdc.gov/ncidod/sars/
2. Smallpox Vaccination Ends (For Now)
This week we will be completing our Phase 1 smallpox vaccinations of selected patient care providers, public health workers, and essential safety personnel as part of our national smallpox preparedness effort. We have vaccinated approximately 1,470 persons. We are evaluating our efforts to determine how better prepared we are to deal with smallpox cases. We will not proceed to Phase 2 until we have fully evaluated Phase 1 and examined all policy and resource implications of Phase 2.
Throughout our program we had a network of clinicians established to evaluate and potentially treat adverse events associated with vaccination. Of note, we recorded a case of myocarditis in a revaccinee and a case of myopericarditis in a revaccinee. Other cardiac adverse events in the civilian and military smallpox vaccination programs lead the Advisory Committee on Immunization Practices to supplement its earlier recommendations for pre-event smallpox vaccination. Persons with underlying heart disease, with or without symptoms, or who have three or more major cardiac risk factors (hypertension, diabetes, hypercholesterolemia, heart disease at age 50 years in a first- degree relative, and smoking) should be excluded from pre-event vaccination.
3. National Medical Laboratory
April 20-26 is National Medical Laboratory Week. This year's theme is "Laboratory Professionals: Exceptional People -- Exceptional Work" (see http://www.ascp.org/general/labweek/). This is a time to recognize 265,000 medical laboratory professionals (including medical technologists, clinical laboratory scientists, medical laboratory technicians, histotechnologists, cytotechnologists, phlebotomy technicians, microbiologists) and 15,000 board certified pathologists who perform and interpret medical laboratory tests. Laboratorians carry out more than 10 billion tests each year, performing meticulous and exacting procedures in order to provide accurate, reliable information for the diagnosis and treatment of disease; all of this in a time of a devastating laboratory workforce shortage. We are especially appreciative of Minnesota laboratorians and the role they play in our Emerging Infections Program (EIP). Laboratorians along with ICPs and clinicians form the alliance that is the base for all of our EIP work.
We would also like to take this opportunity to thank all laboratories that are a part of the Minnesota Laboratory System (MLS), an integrated network of public and private microbiology laboratories working together to protect and improve the health of all Minnesotans. The goal of the MLS is to strive towards increasing the communication and collaboration of all laboratories serving Minnesota residents, and to strengthen the quality of clinical microbiology as a whole.
In addition, we recognize the essential role these medical
professionals play in our state's bioterrorism preparedness
and response capability. Thanks to all 70 clinical laboratories
(60% of MLS labs) that took the time to participate in a day
long Bioterrorism Workshop held here on various days in February
and March. The experience was extremely rewarding for all
participants and faculty involved. We appreciate your dedication
and time commitment to readiness for bioterrorism and microbiology
We couldn't agree with the theme any more, our laboratorians are exceptional!
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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