SARS: Confirmed Cases in Pennsylvania: SARS: Confirmed Cases in Pennsylvania Oct. 2003 André Weltman, M.D., M.Sc.
Division of Infectious Disease Epidemiology,
Pennsylvania Department of Health, Harrisburg
SARS in Pennsylvania: SARS in Pennsylvania >42 persons investigated, & many calls
17 “suspect” cases, reduced to 7 (no final labs)
One “probable” PA resident -- lab (+)
One ill traveler later reported lab (+) in Canada
SARS in Pennsylvania - 1: SARS in Pennsylvania - 1 52 year old man, resident of northeast PA
Exposure in Toronto: “BLD” religious event
Travel to/from Canada by private automobile
Almost 2 weeks in community increasingly ill
Continued work, other activities (trip to NJ!)
Unprotected exposure at 2 hospitals & private M.D.
First suspicion of SARS: hospital E.R., day 11
Intensive investigation by hospital, CDC and DoH
PA - 1: EpiAid: PA - 1: EpiAid Epidemiologic Investigation of Exposures to the First SARS Case-Patient Imported into the US from Canada
Angela J. Peck, M.D. 1,2, E. Claire Newbern, M.D., M.P.H.2,3, Daniel R. Feikin1, Elmira T. Isakbaeva1,2, Benjamin J. Park1,2, Jason Fehr4, Ashley C. LaMonte1, Thong P. Le5, Terry L. Burger6, Luther P. Rhodes6,7, Andre Weltman8, Thomas G. Ksiazek1, Jairam R. Lingappa1, and the SARS PA Case Investigation Team*
PA - 1: Clinical Timeline: PA - 1: Clinical Timeline Days -4 and -5: visit to Toronto for religious event
Day 0: fatigue, myalgia, subjective fever/chills/sweats
Days 2-3: mild diarrhea, Tmax 38.2° (100.7°)
First medical visit day 3 (E.R. of hospital A)
Continued office job days 3 and 6 (home sick days 4-5)
Cough onset day 6, diarrhea worse day 7
Day 7: CXR normal (private M.D., & outpt hospital B)
Day 11: Admit hospital B (ill; infiltrates; labs c/w SARS)
Never intubated, did well on supplemental O2
Discharge to home day 18, mild cough for 9 more days
PA - 1: Index Patient Labs: PA - 1: Index Patient Labs Index patient serum from day 11: antibody (+) for SARS-CoV by CDC
Stool: PCR (+) on days 14, 18, 21, 26
Multiple sputa and one urine: PCR (-)
All clinical viral cultures: (-)
Environmental wet swabs :
hospital room, day 17 (6 days post-admit) x 20 (-)
home bedroom and bathroom, day 21 x 12 (-)
PA - 1: Contact Investigation: PA - 1: Contact Investigation Close contact: any time @ <3 ft or 30 min @ 3-10 ft
26 close contacts, including 17 HCWs
2.5 hours in hospital B E.R. without special precautions
One HCW & one family member: “suspect” SARS
Additional 10 persons with mild respiratory sxs
Medical furlough for 7 exposed HCWs
Numerous clinical samples, incl. weekly x 3 from ill or “unprotected exposed” persons, all (-)
Public message via newspapers, press conference: “No reason to fear high risk to general community”
PA - 1: Why No Transmission?: PA - 1: Why No Transmission? “Despite significant contact with many persons, this patient did not transmit SARS-CoV to any other person, in contrast to events [elsewhere], where even limited contact, in some cases, led to many secondary infections. This underscores that, in some situations, even prolonged close exposures may not result in SARS transmission.” Before own dx, index patient knew of SARS in other BLD attendees (but did not mention it!)
tried some infection control on his own (e.g. mask at home, “stayed away” from co-workers)
No cough early in illness
No “high-risk” procedures (e.g. intubation, nebulizer)
PCR negative sputum, implying low/no viral load
Masks for everyone, everywhere??? (The new normal? What’s practical and what’s not?): Masks for everyone, everywhere??? (The new normal? What’s practical and what’s not?) “Paramedics wearing SARS protective clothing, unload a masked patient from their ambulance at Toronto General Hospital.”
Slide11: “Despite no recent suspected cases of SARS reported in the rural Hubei Province of China, a groom, bride and her attendant took no chances as they crossed a street in Wuhan.”
PA - 2: Unrecognized Case: PA - 2: Unrecognized Case Traveler from Canada, onset while transiting PA
HCW from Toronto area
not aware of exposure to a SARS patient there
visited neighboring state for social event
travel by private auto with one family member
on return, stopped at Shippensburg PA motel
overnight onset of sore throat, mild fever
sought care next day at local “doc in a box”
SARS not considered -- incomplete hx, no sxs
PA - 2 continued: PA - 2 continued Overnight stay in Williamsport (2nd day of illness)
Continued on to Canada next day
Hospitalized there, later lab (+) for SARS-CoV
communication w/ CDC & PA occurred at end of likely incubation of secondary cases
State HAN, newspapers, active E.R. surveillance
No worrisome reports of illness in cachement areas
No illness among family members or hotel staff
We did not attempt to contact other hotel guests
PA Health Alert #54 (May 29, 2003): Investigation of SARS patient who traveled in Pennsylvania …The patient traveled by private automobile in the U.S. between May 16 and May 20. The traveler was in Shippensburg, Pennsylvania on May 18, sought brief outpatient medical care in Shippensburg on May 19, and then returned to Canada by private automobile by May 20… …Because she was in the prodromal stages of illness, it is likely that she was not especially infectious during the time she spent in Shippensburg. Also, the incubation period for SARS is 2-10 days and no unexplained illness consistent with SARS has been reported from the area in the past 10 days. Nonetheless, the Pennsylvania Department of Health asks clinicians in the Shippensburg medical catchment area to consider whether any patients seen since May 16 could have had SARS… : PA Health Alert #54 (May 29, 2003): Investigation of SARS patient who traveled in Pennsylvania …The patient traveled by private automobile in the U.S. between May 16 and May 20. The traveler was in Shippensburg, Pennsylvania on May 18, sought brief outpatient medical care in Shippensburg on May 19, and then returned to Canada by private automobile by May 20… …Because she was in the prodromal stages of illness, it is likely that she was not especially infectious during the time she spent in Shippensburg. Also, the incubation period for SARS is 2-10 days and no unexplained illness consistent with SARS has been reported from the area in the past 10 days. Nonetheless, the Pennsylvania Department of Health asks clinicians in the Shippensburg medical catchment area to consider whether any patients seen since May 16 could have had SARS…
“Rumination of the Day” from TopFive.com, June 20, 2003: “Rumination of the Day” from TopFive.com, June 20, 2003
“I have a great idea for a children's book about an irrepressibly curious monkey who goes on a journey and along the way meets a West Nile mosquito, a killer African bee, a civet cat, a Gambian rat, a prairie dog and a mad cow. It's called Curious George Repeatedly Goes to the Hospital.” -- Steve Nathans