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 (1) From: 1 Nov 2002 To: 20 May 2003, 16:00 GMT+2 Country Cumulative no. of case(s) No. of deaths No. recovered Local transmission Australia 6 None Brazil 2 Canada 140 23 106 China 5,248 294 2,254 Yes China, Hong Kong Special Administrative Region 1,718 253 1,229 China, Macao Special Administrative Region 1 China, Taiwan 383 52 63 Colombia Finland France 7 Germany 9 India 3 Indonesia Italy Kuwait Malaysia 5

No. of case of SARS worldwide (2) From: 1 Nov 2002 To: 20 May 2003, 16:00 GMT+2 Country Cumulative no. of case(s) No. of deaths No. recovered Local transmission Mongolia 9 8 Yes New Zealand 1 None Philippines 12 2 Republic of Ireland Republic of Korea 3 Romania Singapore 206 28 161 South Africa Spain Sweden Switzerland Thailand 5 United Kingdom 4 United States 67 34 Viet Nam 63 58 Total 7,919 662 3,984

Figures on Atypical Pneumonia in HK From: The Department of Health website as at 20 May 2003 Nature Cumulative Number Total No. of Discharged Patients Total No. of Deaths No. of Patients in Hospital Health care workers of Hospitals/Clinics and medical students 379 330 (+ 6) 253 (+ 2) 236 (- 14) Recovering patients in convalescene: 58 Active cases: 178 (- 9) Patients, family members & visitors 1,339 (+ 4) 889 (+ 10) Total 1,718 (+ 4) 1,229 (+ 16) Suspected cases 16

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

Symptoms of Respiratory Illness Frequency Fever 94% Chills 65% Malaise 64% Headache 50% Myalgia Cough Rigors 43% Dizziness 30% Diarrhoea 27% Runny nose 24% Sore throat 23%

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 posted on the Department of Health website on 28/03/2003 Wash hands before wearing a facemask. Follow the instructions on the packet carefully, if available. 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.

Guideline for wearing facemask posted on the Department of Health website on 28/03/2003 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. Replace the facemask immediately if it is damaged or soiled. 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) Disease 2001 2002 2003 (till 15/3/2003) Pneumonia 24,400 18,000 3,646 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)

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