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30 April 2003

CDC Director Says Global Collaboration Needed to Deal with SARS

(CDC scientists share findings with labs in Asia, Europe and
elsewhere) (2740)


A U.S. health official says severe acute respiratory syndrome (SARS)
provides striking evidence that a disease that emerges or reemerges
anywhere in the world can spread far and wide. Protecting the health
of the U.S. population requires global awareness and collaboration,
says Dr. Julie Gerberding, director of the Centers for Disease Control
and Prevention (CDC).

Gerberding told the Senate Health Committee April 29 that SARS
underscores the need for strong global public health systems, robust
health service infrastructures and expertise that can be mobilized
quickly across national boundaries to trace disease movements.

Gerberding said CDC experts are participating on teams assisting in
the SARS investigation in Canada, China, Hong Kong, Singapore, Taiwan,
Thailand and Vietnam -- the places most affected by the disease. The
World Health Organization (WHO) reports that the total number of SARS
cases around the world has climbed to almost 5,700 in 27 countries.
The syndrome is characterized by fever and respiratory symptoms which
advance to a life-threatening pneumonia in some cases.

As part of the global response to SARS, CDC has deployed over 40
scientists and other public health professionals internationally and
has assigned more than 400 staff members around the United States to
work on the disease.

Gerberding said WHO is coordinating frequent, regular communication
between CDC laboratory scientists and scientists from laboratories in
Asia, Europe and elsewhere to share findings, which are being posted
on a secure Internet site so that they can all learn from each other's
work.

She said WHO has also sponsored, with CDC support, a clinical video
conference broadcast globally to discuss the latest findings of the
outbreak and prevention of transmission in healthcare settings. The
video is now available online for download
(http://www.cdc.gov/ncidod/sars/webcast/broadcast040403.htm ). CDC
senior scientists and leading experts have also held numerous media
briefings to provide updated information of SARS cases, laboratory and
surveillance findings and prevention measures.

Further CDC information about SARS is available at
http://www.cdc.gov/ncidod/sars/

Following is the text of Gerberding's testimony as prepared for
delivery:

(begin text)

The Severe Acute Respiratory Syndrome Threat (SARS)
April 29, 2003
Witness: Julie L. Gerberding, MD, MPH
Director, Centers for Disease Control and Prevention

Testimony:

Good afternoon, Mr. Chairman and Members of the Committee. I am Dr.
Julie L. Gerberding, Director, Centers for Disease Control and
Prevention (CDC). Thank you for the invitation to participate today in
this timely hearing on a critical public health issue: severe acute
respiratory syndrome (SARS). I will update you on the status of the
spread of this emerging global microbial threat and on CDC's response
with the World Health Organization (WHO) and other domestic and
international partners.

As we have seen recently, infectious diseases are a continuing threat
to our nation's health. Although some diseases have been conquered by
modern advances, such as antibiotics and vaccines, new ones are
constantly emerging, such as Nipah virus, West Nile Virus,
vancomycin-resistant Staphylococcus aureus (VRSA), and hantavirus
pulmonary syndrome. SARS is the most recent reminder that we must
always be prepared for the unexpected. SARS also highlights that U.S.
health and global health are inextricably linked and that fulfilling
CDC's domestic mission--to protect the health of the U.S.
population--requires global awareness and collaboration with domestic
and international partners to prevent the emergence and spread of
infectious diseases.

Emergence of SARS

In February, the Chinese Ministry of Health notified WHO that 305
cases of acute respiratory syndrome of unknown etiology had occurred
in Guangdong province in southern China since November 2002. In
February 2003, a man who had traveled in mainland China and Hong Kong
became ill with a respiratory illness and was hospitalized shortly
after arriving in Hanoi, Vietnam. Health-care providers at the
hospital in Hanoi subsequently developed a similar illness. During
late February, an outbreak of a similar respiratory illness was
reported in Hong Kong among workers at a hospital; this cluster of
illnesses was linked to a patient who had traveled previously to
southern China. On March 12, WHO issued a global alert about the
outbreak and instituted worldwide surveillance for this syndrome,
characterized by fever and respiratory symptoms.

Since late February, CDC has been supporting WHO in the investigation
of a multi-country outbreak of unexplained atypical pneumonia now
referred to as severe acute respiratory syndrome (SARS). On Friday,
March 14, CDC activated its Emergency Operations Center (EOC) in
response to reports of increasing numbers of cases of SARS in several
countries. On Saturday, March 15, CDC issued an interim guidance for
state and local health departments to initiate enhanced domestic
surveillance for SARS; a health alert to hospitals and clinicians
about SARS; and a travel advisory suggesting that persons considering
nonessential travel to Hong Kong, Guangdong, or Hanoi consider
postponing their travel. HHS Secretary Tommy Thompson and I conducted
a telebriefing to inform the media about SARS developments.

As of April 23, 2003, a total of 4,288 probable cases of SARS have
been reported to WHO from 25 countries including the United States,
and 251 of these persons have died. In the United States, there have
been 39 probable SARS cases reported from 18 states. Of U.S. probable
cases, 27 have been hospitalized, and none have died. In addition, 206
suspect cases of SARS have been reported and are being followed by
state and local health departments.

CDC Response to SARS

CDC continues to work with WHO and other national and international
partners to investigate this ongoing emerging global microbial threat.
We appreciate the continued support of Congress, and of this Committee
in particular, in our efforts to enhance our nation's capacity to
detect and respond to emerging disease threats. The recent
supplemental appropriation of $16 million to address the SARS outbreak
will aid our identification and response efforts. SARS presents a
major challenge, but it also serves as an excellent illustration of
the intense spirit of collaboration among the global scientific
community to combat a global epidemic.

CDC is participating on teams assisting in the investigation in
Canada, mainland China, Hong Kong, Singapore, Taiwan, Thailand, and
Vietnam. In the United States, we are conducting active surveillance
and implementing preventive measures, working with numerous clinical
and public health partners at state and local levels. As part of the
WHO-led international response thus far, CDC has deployed over 40
scientists and other public health professionals internationally and
has assigned over 400 staff in Atlanta and around the United States to
work on the SARS investigation.

CDC has organized SARS work teams to manage various aspects of the
investigation, including providing domestic and international
assistance and developing evolving guidance documents. These work
teams have issued interim guidance regarding surveillance and
reporting; diagnosis; infection control; exposure management in
health-care settings, the workplace, and schools; biosafety and clean
up; specimen handling, collection, and shipment; travel advisories and
health alerts; and information for U.S. citizens living abroad and for
international adoptions. We have updated our travel advisories and
alerts for persons considering travel to affected areas of the world.
We have distributed more than 600,000 health alert notice cards to
airline passengers entering the United States from China, Hong Kong,
Singapore, and Vietnam, alerting them that they may have been exposed
to SARS, should monitor their health for 10 days, and if they develop
fever or respiratory symptoms, they should contact a physician. We
have begun distributing health alert notices to airline passengers
entering the United States from Toronto and at selected sites along
the U.S.-Canada border.

WHO is coordinating frequent, regular communication between CDC
laboratory scientists and scientists from laboratories in Asia,
Europe, and elsewhere to share findings, which they are posting on a
secure Internet site so that they can all learn from each other's
work. They are exchanging reagents and sharing specimens and tissues
to conduct additional testing.

On April 14, 2003, CDC announced that our laboratorians have sequenced
the genome for the coronavirus believed to be the cause of SARS.
Sequence information provided by collaborators at National
Microbiology Laboratory, Canada, University of California at San
Francisco, Erasmus University, Rotterdam and Bernhard-Nocht Institute,
Hamburg facilitated this sequencing effort. The sequence data confirm
that the SARS coronavirus is a previously unrecognized coronavirus.
The availability of the sequence data will have an immediate impact on
efforts to develop new and rapid diagnostic tests, antiviral agents
and vaccines. This sequence information will also facilitate studies
to explore the pathogenesis of this new coronavirus. We are also
developing and refining laboratory testing methods for this novel
coronavirus, which will allow us to more precisely characterize the
epidemiology and clinical spectrum of the epidemic. These discoveries
reflect significant and unprecedented achievements in science,
technology, and international collaboration.

In order to better understand the natural history of SARS, CDC is
investigating aspects of the epidemiologic and clinical manifestations
of the disease. In collaboration with our partners, we have
implemented or planned investigations to describe the spectrum of the
illness, to assess the natural history of the disease, to estimate the
risks of infection, and to identify risk factors for transmission.
These investigations are being conducted in concert with ongoing
surveillance and epidemiologic efforts.

Rapid and accurate communications are crucial to ensure a prompt and
coordinated response to any infectious disease outbreak. Thus,
strengthening communication among clinicians, emergency rooms,
infection control practitioners, hospitals, pharmaceutical companies,
and public health personnel has been of paramount importance to CDC
for some time. CDC has had multiple teleconferences with state health
and laboratory officials to provide them the latest information on
SARS spread, implementation of enhanced surveillance, and infection
control guidelines and to solicit their input in the development of
these measures and processes. WHO has sponsored, with CDC support, a
clinical video conference broadcast globally to discuss the latest
findings of the outbreak and prevention of transmission in healthcare
settings. The faculty was comprised of representatives from WHO, CDC,
and several affected countries who reported their experiences with
SARS. The video cast is now available on-line for download. Secretary
Thompson and I, as well as other senior scientists and leading experts
at CDC, have held numerous media telebriefings to provide updated
information on SARS cases, laboratory and surveillance findings, and
prevention measures. CDC is keeping its website current, with multiple
postings daily providing clinical guidelines, prevention
recommendations, and information for the public.

Prevention Measures

Currently, CDC is recommending that persons postpone non-essential
travel to mainland China, Hong Kong, Singapore, and Hanoi, Vietnam. We
are recommending that U.S. travelers to Toronto observe precautions to
safeguard their health, including avoiding settings where SARS is most
likely to be transmitted, such as Toronto health care facilities
caring for SARS patients. Persons planning travel to Toronto should be
aware of the current SARS outbreak, stay informed daily about SARS,
and follow recommended travel advisories and infection control
guidance, which are available on CDC's website at
www.cdc.gov/ncid/sars.

Persons who have traveled to affected areas and experience fever or
respiratory symptoms suggestive of SARS should use recommended
infection control precautions and contact a physician. They should
inform their healthcare provider about their symptoms in advance so
any necessary arrangements can be made to prevent potential
transmission to others. Health care facilities and other institutional
settings should implement infection control guidelines that are
available on CDC's website.

We know that individuals with SARS can be very infectious during the
symptomatic phase of the illness. However, we do not know how long the
period of contagion lasts once they recover from the illness, and we
do not know whether or not they can spread the virus before they
experience symptoms. The information to date suggests that the period
of contagion may begin with the onset of the very earliest symptoms of
a viral infection, so our guidance is based on this assumption. SARS
patients who are either being cared for in the home or who have been
released from the hospital or other health care settings and are
residing at home should limit their activities to the home. They
should not go to work, school, or other public places until ten days
after their fever has resolved and respiratory symptoms are absent or
improving.

If a SARS patient is coughing or sneezing, he should use common-sense
precautions such as covering his mouth with a tissue, and, if possible
and medically appropriate, wearing a surgical mask to reduce the
possibility of droplet transmission to others in the household. It is
very important for SARS patients and those who come in contact with
them to use good hand hygiene: washing hands with soap and water or
using an alcohol-based hand rub frequently and after any contact with
body fluids.

For people who are living in a home with SARS patients, and who are
otherwise well, there is no reason to limit activities currently. The
experience in the United States has not demonstrated spread of SARS
from household contacts into the community. Contacts with SARS
patients must be alert to the earliest symptom of a respiratory
illness, including fatigue, headache or fever, and the beginnings of
an upper respiratory tract infection, and they should contact a
medical provider if they experience any symptoms.

Emerging Global Microbial Threats

Since 1994, CDC has been engaged in a nationwide effort to revitalize
national capacity to protect the public from infectious diseases.
Progress continues to be made in the areas of disease surveillance and
outbreak response; applied research; prevention and control; and
infrastructure-building and training. However, SARS provides striking
evidence that a disease that emerges or reemerges anywhere in the
world can spread far and wide. It is not possible to adequately
protect the health of our nation without addressing infectious disease
problems that are occurring elsewhere in the world.

Last month, the Institute of Medicine (IOM) published a report
describing the spectrum of microbial threats to national and global
health, factors affecting their emergence or resurgence, and measures
needed to address them effectively. The report, Microbial Threats to
Health: Emergence, Detection, and Response, serves as a successor to
the 1992 landmark IOM report Emerging Infections: Microbial Threats to
Health in the United States, which provided a wake-up call on the risk
of infectious diseases to national security and the need to rebuild
the nation's public health infrastructure. The recommendations in the
1992 report have served as a framework for CDC's infectious disease
programs for the last decade, both with respect to its goals and
targeted issues and populations. Although much progress has been made,
especially in the areas of strengthened surveillance and laboratory
capacity, much remains to be done. The new report clearly indicates
the need for increased capacity of the United States to detect and
respond to national and global microbial threats, both naturally
occurring and intentionally inflicted, and provides recommendations
for specific public health actions to meet these needs. The emergence
of SARS, a previously unrecognized microbial threat, has provided a
strong reminder of the threat posed by emerging infectious diseases.

Conclusion

The SARS experience reinforces the need to strengthen global
surveillance, to have prompt reporting, and to have this reporting
linked to adequate and sophisticated diagnostic laboratory capacity.
It underscores the need for strong global public health systems,
robust health service infrastructures, and expertise that can be
mobilized quickly across national boundaries to mirror disease
movements. As CDC carries out its plans to strengthen the nation's
public health infrastructure, we will collaborate with state and local
health departments, academic centers and other federal agencies,
health care providers and health care networks, international
organizations, and other partners. We have made substantial progress
to date in enhancing the nation's capability to detect and respond to
an infectious disease outbreak; however, the emergence of SARS has
reminded us yet again that we must not become complacent. We must
continue to strengthen the public health systems and improve linkages
with domestic and global colleagues. Priorities include strengthened
public health laboratory capacity; increased surveillance and outbreak
investigation capacity; education and training for clinical and public
health professionals at the federal, state, and local levels; and
communication of health information and prevention strategies to the
public. A strong and flexible public health infrastructure is the best
defense against any disease outbreak.

Thank you very much for your attention. I will be happy to answer any
questions you may have.

(end text)

(Distributed by the Office of International Information Programs, U.S.
Department of State. Web site: http://usinfo.state.gov)