Outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong The Hong Kong Medical Association

Types of Pneumonia Bacterial Pneumonia Atypical Pneumonia-Mycoplasma Viral Chemical

Severe Acute Respiratory Syndrome (SARS) First recognised in Feb 2003 (case in Hanoi) A form of Atypical Pneumonia characteristics -high fever (>38°C or 100.4° F) -dry cough -breathing difficulties -rapid deterioration

No. of case of SARS worldwide From: 1 Nov 2002 To: 9 Apr 2003, 15:00 GMT+2 Country Cumulative no. of case(s) No. of deathsLocal transmission Brazil20None Canada9710Yes China1,29055Yes China, Hong Kong Special Administrative Region99830Yes China, Taiwan190Yes France40None Germany60None Italy30None Kuwait10None Malaysia31None Republic of Ireland10None Romania10None Singapore1269Yes Spain10None Switzerland10None Thailand72None United Kingdom50None United States1540None Viet Nam624Yes Total2,781111

Figures on Atypical Pneumonia in HK From: The Department of Health website as at 3:00 pm, 7 April 2003 NatureTotal Admission (The numbers in bracket are those with pneumonia symptoms) Health care workers of Hospitals/Clinics and medical students 208 (208) 69 of the patients were discharged Patients, family members & visitors 675 (675) 58 of the patients were discharged Total admission883 (883) 127 were discharged

Epidemiological linkage Metropole Hotel 3 Singapore visitors Outbreak in Singapore 2 Canadian visitors A private hospital outbreak on Hong Kong Island Outbreak in Toronto, Canada 1 American Chinese Hanoi outbreak index case PWH index patient Onset: 21 Feb 03 1 Mainland visitor Onset: 21 Feb 03 Succumbed at KWH

Symptoms of Respiratory Illness SymptomsFrequency Fever100% Chills92% Malaise90% Headache84% Myalgia67% Cough50% Dizziness49% Rigors44% Sore throat43% Runny nose39% Productive cough36%

Known Facts about SARS Less infectious than influenza Incubation 2 to 7 days Infective period? A new virus? Any treatment? Mortality?

How does SARS spread? NOT airborne Droplets - via close contact with an infected person Contaminated working surfaces (e.g. formites, stainless steel) ~ survival up to 6 hours

The wearing of face masks Healthcare workers looking after suspected/confirmed cases of SARS Family members of suspected/ confirmed case Wearing in public area? N95? Surgical mask?

Guideline for wearing facemask 1. Wash hands before wearing a facemask. 2. Follow the instructions on the packet carefully, if available. 3. In general, when wearing a surgical facemask, the following should be noted: the facemask should fit snugly over the face; the coloured side of the facemask should face outside; tie all the strings that keep the facemask in place or fix the rubber bands of the facemask round the ears properly; the facemask should fully cover the nose, mouth as well as the chin; the metallic wire part of the facemask should be fixed securely over the bridge of the nose to prevent leakage; under general circumstances, the surgical mask should be changed daily. posted on the Department of Health website on 28/03/2003

Guideline for wearing facemask 4. Put the facemask into a plastic bag and tie it properly before putting it into a rubbish bin. You may dispose a used facemask concealed in a separate bag with the rest of your domestic wastes. 5. Replace the facemask immediately if it is damaged or soiled. posted on the Department of Health website on 28/03/2003 Wearing a facemask is just one of the ways to prevent respiratory tract infections. The most important thing a person should do is to observe good personal hygiene. For example, wash hands frequently with liquid soap, especially after sneezing, coughing or cleaning the nose.

Prevention of Respiratory Tract Infection (1) Building good body immunity by having a proper diet, regular exercise and adequate rest, reducing stress and avoiding smoking; Maintain good personal hygiene, and wash hands after sneezing, coughing or cleaning the nose; Maintain good ventilation;

Prevention of Respiratory Tract Infection (2) Avoid visiting crowded places with poor ventilation; Put on a mask if taking care of a patient with respiratory symptoms and wash hands thoroughly afterwards; Put on a mask if suffering from respiratory tract infection to reduce the chance of spreading the infection to people around them.

Statistics on community- acquired pneumonia (CAP) There is no unusual rise in the number of CAP The causes of CAP are similar to previous years (50% each of known causes and unknown causes) Disease (till 15/3/2003) Pneumonia24,40018,0003,646

~ The End ~ The Hong Kong Medical Association