EID Weekly Updates:
Emerging and Reemerging Infectious Diseases, Region of the Americas
Vol. 2, No. 1—8 January 2004
Following the epidemic in Colombia last year, with a total of 82 cases and 35 deaths as of 31 December 2003, the presence of a yellow fever epizootic was confirmed on that same day among monkeys in Los Besotes Ecological Park in the federal Department of Cesar. Also in this Department, four human cases of yellow fever were confirmed during said epidemic; and a previous epizootic occurred in the vicinity of the Maracas River, near the Campo Alegre indigenous reservation, in the city of Becerril.
The isolation of the yellow fever virus in samples from two monkeys in the park brought about an investigation as well as the formation of an interdisciplinary team to elaborate and carry out a contingency plan. Following a visit to the park, the team identified 10 additional dead monkeys from 3 different groups. During this past week, however, there have been no additional deaths.
The measures taken to deal with the situation include broadening vaccination coverage to 100%, to include the entire urban and rural population one year of age and older; vector control in urban areas as well as entomological surveillance studies; strengthening epidemiological surveillance to detect human cases, along with training health-care personnel in adequate techniques for the diagnosis, management, surveillance and control of yellow fever; and educational measures for the population of Velledupar.
The situation has shed considerable light on the importance of active surveillance of this disease in order to activate comprehensive prevention and control measures to prepare for situations of major severity.
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On 5 January 2003, laboratory results confirmed SARS-CoV infection in a 32-year-old male from Guangdong province in Southern China. The patient is currently being treated and remained in isolation at a hospital in the provincial capital of Guangzhou, from 20 December 2003 until his discharge on 8 January 2004.
Since the declaration on 5 July 2003 that the initial outbreak of SARS had been contained, this is the first confirmed case of SARS that is not linked to a laboratory accident. Epidemiological investigations in China have not yet been able to link the patient to exposure to wild animals or to any other known or suspected source of the virus. All the persons who came into close contact with the patient, including health care workers, have remained in good health throughout the observation period, which has now ended.
On 8 January 2004, health authorities in China announced a new suspected case of SARS in Guangdong province, with symptoms starting last 25 December 2003. The patient, who has been undergoing treatment in isolation since 31 December 2003, is a 20-year-old woman from Henan Province who works at a restaurant in Guangzhou.
The diagnosis and classification of this case was carried out following a review by a panel of Chinese SARS experts. Epidemiological investigation and laboratory tests are underway. The patient has been afebrile and stable for the past seven days, and as yet no epidemiological evidence has linked the confirmed case with this suspected case or any other source. The subject’s contacts have been traced and placed under medical observation. At present, neither signs nor symptoms suggestive of SARS have developed in any of these contacts.
Chinese authorities have implemented various preventive and control measures, and a joint team of World Health Organization (WHO) and Chinese experts is investigating possible sources of infection. The components of this investigation are presented online via the WHO Regional Office for the Western Pacific (WHO/WPRO).
SARS symptoms mimic those of several other respiratory diseases, including those frequently seen during the winter months. Thus, it is likely that numerous other suspected cases will be reported over the weeks to come.
The WHO document entitled Alert, Verification and Public-Health Management of SARS in the Post-Outbreak Period describes the mechanisms for ‘SARS alert’ in the post-epidemic period, providing guidance ranging from laboratory confirmation to the quarantine of persons being investigated as possible SARS cases. This document indicates that, during this post-outbreak period, all countries need to remain vigilant for any recurrence of SARS and maintain their capacity to detect and respond to any reemergence of the disease, should it occur. SARS management during this period should be set up by each country after determining the necessary intensity of its surveillance activities by analyzing data taken from a risk assessment. WHO has defined three major possible affected areas, taking into account the experience of the last SARS outbreak and any potential for resurgence. Latin American and Caribbean countries are considered low-risk areas.