Faculty Bibliography

The agency's initial intent was to destroy the remaining stocks of smallpox virus after it stopped person-to-person transmission of the disease. But the agency's member states delayed destroying the virus, demanding additional research to find effective drugs, develop safer vaccines and improve diagnostic tests. Such research must be conducted in the highest biosecurity-level laboratories, with scientists wearing elaborate protective gear resembling space suits. The idea of conducting any genetic research on the virus has been a subject of controversy. At the meeting of the international advisory committee last week, its 20 members voted unanimously to allow insertion of the gene, known as GFP for green fluorescent marker protein, into variola virus at the two laboratories in Russia and the United States, said Dr. Daniel Lavanchy, a smallpox expert for the health organization. The U.S. laboratory is at the Centers for Disease Control and Prevention in Atlanta

Canada, particularly in the Toronto area, is the hardest-hit country outside Asia in the worldwide SARS epidemic, which is believed to have begun last November in southern China. As of Thursday, 27 countries and Hong Kong have reported a total of 3,389 cases. The number of cases in the United States was sharply reduced Thursday to 35, from 208, when federal health officials, as expected, adopted the World Health Organization's stricter definition of probable SARS cases. Worldwide, SARS is blamed for 165 deaths, for a death rate of 4.9 percent, the World Health Organization reported

The request is aimed at people who develop any of six symptoms of SARS, or severe acute respiratory syndrome: severe headache, severe fatigue, muscle aches and pains, fever of 100.4 or higher, dry cough and shortness of breath. The request excludes people who have had cough or shortness of breath from pre-existing allergy or lung disease. Canadian health officials said that all the cases in the Toronto area can be traced back to an outbreak at Scarborough Grace Hospital, and they said that SARS is under control, in part because of their isolation policy. The outbreak in Toronto is now in its fourth generation of cases, increasing the complexity of tracing cases. About 7,000 people in the Toronto area had already been asked to stay in isolation since the outbreak began in March, and about 650 remain in isolation. Of the 35 American cases, 33 had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and a household member of a SARS case

In fact, the investigation into part of the Ontario epidemic is now reaching into the United States. On Thursday, the Centers for Disease Control and Prevention in Atlanta sent a team of epidemiologists to Pennsylvania to help investigate a probable SARS case in a hospitalized patient who attended a religious meeting in Toronto on March 28. Canadian health officials have identified 28 other individuals with SARS who attended the Mass, held by members of the Bukas-Loob Sa Diyos Covenant Community, a Roman Catholic group. Health officials are trying to identify the estimated 500 people who attended the meeting and monitor their health. Of the 35 American cases, 33 had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and a household member of a SARS case. Tests, still in the experimental stage, showed that five of the 33 patients were recently infected with the SARS virus, which is a new member of the coronavirus family. So far, infection with the SARS virus has not been documented among other suspect cases

Of the 35 probable cases, 33 had traveled to mainland China, Hong Kong, Singapore or Hanoi, and one was a health care worker who tended to a SARS patient. The request is aimed at people who develop any of six symptoms of SARS, or severe acute respiratory syndrome: severe headache, severe fatigue, muscle aches and pains, fever of 100.4 or higher, dry cough and shortness of breath. The request excludes people who have had cough or shortness of breath from a pre-existing allergy or lung disease

In fact, the investigation into part of the Ontario epidemic is now reaching into the United States. Yesterday, the Centers for Disease Control and Prevention in Atlanta sent a team of epidemiologists to Pennsylvania to help investigate a probable SARS case in a hospitalized patient who attended a religious meeting in Toronto on March 28. Canadian health officials have identified 28 other people with SARS who attended the Mass, held by members of the Bukas-Loob Sa Diyos Covenant Community, a Philippines-based Roman Catholic group. Health officials are trying to identify the estimated 500 people who attended the meeting and monitor their health. Of the 35 American cases, 33 had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and someone in the household of a SARS patient. Tests, still in the experimental stage, showed that 5 of the 33 patients were recently infected with the SARS virus, which is a new member of the coronavirus family. Infection with the SARS virus has not been documented among other suspect cases in this country. The C.D.C. said it would continue to monitor all cases meeting its broader definition because the agency deliberately wants to cast a wide net to minimize the chance of missing a case of SARS. When laboratory tests that can reliably detect the SARS virus are developed, the findings will be included in the case definition, officials said

Of the 35 American cases, 33 of those infected had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and a household member of a SARS case. Tests, still in the experimental stage, showed that five of the 33 patients were recently infected with the SARS virus, which is a new member of the coronavirus family. So far, infection with the SARS virus has not been documented among other suspected cases in this country

Referring to a well-known study of a cold outbreak at the Eagle Heights Apartments in Madison, Wisconsin, and to an early theory that the outbreak of more than 300 SARS cases in Hong Kong's Amoy Gardens apartment complex was spread by cockroaches, he said: 'Don't blame the cockroaches. In Wisconsin, it wasn't the cockroaches, it was the kids.' Whoever put SARS in the Amoy Gardens sewage pipes and one regular visitor was a dialysis patient at the Prince of Wales Hospital while the airport worker was on the nebulizer would be a superspreader, with the help of rusty pipes. A famous tuberculosis superspreader, described in The New England Journal of Medicine in November 1999, was a 9-year-old boy in rural North Dakota, an immigrant from the Marshall Islands, who in 1997 and 1998 infected his family and 56 schoolmates. The boy had deep cavities in his lungs, while his twin brother, who was two inches (5 centimeters) taller and 11 pounds (5 kilograms) heavier, had a mild case and was not infectious

Another participant, Dr. Sylvie van der Werf, a scientist at the Pasteur Institute in Paris who has tested specimens from SARS patients in Vietnam, said that scientists could be expected to develop molecular techniques based on the genetic maps of the SARS virus that would make research to develop blood and other tests easier and safer. Many molecular methods do not require use of the actual virus, which is dangerous and requires nearly the highest level of safety precautions. Scientists still do not know much about the SARS virus. They know that it can be found in sputum, tears, feces, blood and urine. But they do not know whether the form of the virus they now detect can cause disease if it is spread from these materials. About 10 percent of SARS patients develop diarrhea, suggesting that people can become infected by swallowing contaminated food and water, even through sewage. Dr. [Albert Osterhaus] reported that his team inoculated four macaque monkeys with the coronavirus isolated from SARS patients and then noted the appearance of the signs and symptoms of human SARS, like lethargy, a skin rash and severe difficulty breathing. The lungs and tissues of two monkeys euthanized on the fifth and eighth days after onset of symptoms had the same type of damage seen in patients who died of SARS, Dr. Osterhaus said. Blood tests showed that the other two monkeys had SARS

Preliminary findings showed that the monkeys developed an illness resembling SARS after the coronavirus was put in their nostrils. Some monkeys developed pneumonia and examination of their lungs under a microscope showed that the coronavirus caused a pattern of lung damage similar to that in affected humans. Such findings include the formation of syncytia, or giant cells, in the lungs. The monkey experiments are essential in fulfilling the steps, known as Koch's postulates, that are needed to establish proof that a virus or other microbe causes a disease. As part of the postulates in SARS, scientists must determine whether injecting the coronavirus into animals causes similar symptoms to those that humans experience. A principal aim of the Geneva meeting was to discuss how close researchers have come to developing reliable diagnostic tests and to develop a consensus concerning their use in controlling the epidemic. Even if a test is reliable, it is useless in controlling an epidemic if it does not detect the virus that is its cause. So fulfilling Koch's postulates is critical for determining the usefulness of diagnostic tests. [David Heymann] expressed hope that new tests aimed at the coronavirus would help contain SARS