SARS Bulletin from Hong Kong
Sherwood L. Gorbach · Clinical Infectious Diseases · 2003
Introduction. The authors of these bulletins are infectious diseases physicians on the front line in the epidemic of severe acute respiratory syndrome (SARS) in Hong Kong. They are affiliated with the Division of Infectious Disease, Department of Microbiology, at Queen Mary Hospital and the University of Hong Kong, and they are also caring for patients in the Pamela Youde Nethersole Eastern Hospital, Princess Margaret Hospital, and Kwong Wah Hospital. Their bulletins are being published in the News section of the electronic edition of Clinical Infectious Diseases within 1–2 days after receipt in our office; below is a condensation of the bulletins for 6–13 April 2003.—Sherwood Gorbach Bulletin. Within a week, >200 residents of the Amoy Garden housing development in Hong Kong came down with SARS. During the initial outbreak, we saw 70 of these patients. Many of them were young and otherwise healthy, and this subgroup tended to have a more complicated clinical course of SARS and required more frequent pulse methylpredisolone therapy than did patients with SARS whom we saw at other regional hospitals. It is suspected that some of them had been exposed to high doses of virus at the time of contact. The mode of transmission may not be simply person-to-person contact; environmental factors may play an important role. However, so far, we have no evidence that rodents or fomites played a part in transmission. There is a debate among clinicians about how to treat SARS-infected pregnant women. We have seen numerous viral particles in type II pneumatocytes and highly activated macrophages in lung tissue specimens of from patients who have died of the disease without having received treatment with ribavirin and steroids. We know that, at the dosage given intravenously, ribavirin has a modest level of activity against the coronavirus that causes SARS. The final consensus is that, because of potential teratogenicity, we should avoid giving ribavirin to pregnant women at 1:10 against this novel coronavirus. Other treatments, such as plasmaphere-sis, intravenous immunoglobulin, and pen-ta-globulin, have been tried by clinicians at other hospitals, but no randomized, controlled studies have been possible. At the moment, we do not have a strong feeling that these modalities are working.—V. C. C. Cheng, M. Peiris, and K. Y. Yuen