Department of microbiology 12 January 2015

SEVERE ACUTE RESPIRATORY SYNDROME(SARS)

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SEVERE ACUTE RESPIRATORY SYNDROME

www.businesscontinuityinternational.com
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Epidemiological approaches
 CLINICAL MICROBIOLOGY
Identification and Analyzation:
• Study design
• Research domain
• Data collection
• Analytical techniques
STUDY DESIGN
• Results of epidemiological studies are available as Real time collection

• Upon detection of the outbreak, Studies are carried as:

 Identification of the causative agent
 Investigation of the possible routes and modes of its transmission
 define and validate diagnostic criteria
 Evaluation of candidate treatments
 Forecast the spread of the epidemic
 Devise and evaluate evidence-based prevention
 Monitor policies and strategies.

• The first case of SARS was identified in Asia in Feb. 2003 where 8,098 people became ill and 774
died.
RESEARCH DOMAIN
• The first challenge for epidemiologists is to develop new surveillance and alert tools to detect in
real time.

• Identified more than 300 journal articles covering epidemiological research into the SARS
outbreak

• The researchers, analysis the descriptive epidemiological studies and investigate the
distribution of SARS.

• Analytical epidemiological studies, tried to discover the cause of SARS.

• The median (average) submission-to-acceptance and acceptance-to-publication intervals for

SARS articles submitted during the epidemic were 55 and 77.5 days, respectively.
DATA COLLECTION
• Search bibliographic databases for all published articles on epidemiology.

• Presentation of the entire literature identification–selection process.

• To compare the publication timelines of academic research articles with that of public health
information, they access to,
 The MEDLINE database via PubMed
 The Science Citation Index Expanded and the Social Sciences Citation Index databases
 In case of SARS, Morbidity and Mortality Weekly Report for the Centers for Disease Control and
Prevention (CDC)
 The Weekly Epidemiological Record and Bulletin of the WHO, and Canada Communicable
Disease Report for the Public Health Agency of Canada.
ANALYTICAL TECHNIQUES

• Articles were classified into four large categories:

 Investigation and surveillance
 case management
 prevention and control
 Psychobehavior

• A detailed analysis includes the study designs, and the information given by the authors on the
statistical, informatics, and quality-control methods.
• A data-collection grid was devised:

 For each retained article,

 recording of the study type and design,
 the type and size of the sample population,
 the software used for data management and statistical analyses,
 the quality assurance and quality-control processes described in their Materials and Methods.
 The collected data were coded in a relational database.
Mathematical model for SARS transmission.
• Susceptible individuals are infected by infectious.

• After stage of latency, Infectious individuals lose

infectiousness by death, recovery, or isolation.

• When quarantine is implemented, a proportion, q, of new

infections are quarantined before they become infectious.

• The same proportion of susceptible individuals who were

contacts of infectious persons but were not infected are also
quarantined.

• Susceptible individuals are released from quarantine after

10 days; and that compliance with quarantine is complete.
Typology of Studies

The distributions of the 11 research

domains are as follows-

 52%- case-management
 16%- assessment of diagnostic tests
 23%- Investigation and surveillance
 19%- psychobehavioral studies.
 6%- prevention and control.
 AETIOLOGY OF SARS
• A novel coronavirus (SCoV ) is the aetiological agent of severe acute respiratory syndrome (SARS).
• Coronaviruses are characterized by their irregular shape and a crown-like appearance of their
outer envelope.
• An envelope shows the presence of glycoproteins in a lipid bilayer.
• Inside the envelope, there is a nucleocapsid, with the genetic material, positive strand single strand
RNA (+ssRNA), and a few enzymes.
• The detection of coronavirus viruses in small, live wild mammals in a retail market indicates a
route of interspecies transmission.
• Coronaviruses are classified as members of the order Nidovirales.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Investigational approaches
Symptoms-
Hallmark symptoms-
• Cough
• Difficulty in breathing
• Fever greater then 100.4 degrees F
• Other breathing symptoms

Common symptoms -
• Chills and shaking
• Cough starts usually 2-3 days after other symptoms
• Fever
• Muscle aches
• Head aches
Less common symptoms-

• Cough that produces phlegm (sputum)

• Diarrhoea
• Dizziness
• Nausea and vomiting
• Runny nose
• Sore throat
STAGE 2(LOWER REPIRETORY TRACT PHASE)
• Dry cough
• Dyspenea
• Progressive hypoxemia in many cases
• Respiratory failure that requires mechanical ventilation in some case
SIGNS AND TESTS-

Tests used for diagnosing SARS-

• Arterial blood tests

• Blood clotting tests
• Blood chemistry tests
• Chest x-ray or chest CT scan
• Complete blood count (CBC)
Tests used to quickly identify the virus that causes SARS include-

• Antibody tests for SARS

• Direct isolation of the SARS virus
• Rapid polymerase chain reaction (PCR) test for SARS virus
TREATMENT

• Antibiotics to treat bacteria that cause pneumonia.

• Antiviral medications(although how well they work for the SARS is unknown).

• High doses of steroids to reduce swellings in the lungs.

• Oxygen, breathing support(mechanical ventilation), or chest therapy.

PROGNOSIS

• The death rate from the SARS was 9 to 12 % of those that diagnosed. In people over
age 65, the death rate was higher than 50%. The illness was milder in younger
patients.

• Viruses in the coronavirus family are known for their ability to change (mutate) in
order to spread among humans.
SARS
 REFRENCES
Reports and Articles-
• Anatomy of the Epidemiological Literature on the 2003 SARS Outbreaks in Hong Kong and
Toronto: A Time-Stratified Review
• Isolation and Characterization of Viruses Related to the SARS Coronavirus from Animals
inSouthern China.

Web sites-
• www.who.int/csr/sars/diagnosticstests/en
• Pennstatehershey.adams.com
• www.ncbi.nlm.gov/pubmedhealth/
• www.businesscontinuityinternational.com
• www2.hendrix.edu
• www.devicemag.com
• www.cnn.com
THANK YOU