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The Honolulu Advertiser
Posted on: Monday, March 17, 2003

Outbreak possibly new flu strain, exotic virus

 •  State steps up vigilance on respiratory illness
 •  What you should know about the deadly illness

By Emma Ross
Associated Press

A respiratory illness spread largely among healthcare workers in Asia could be a new strain of flu or even an exotic virus passed from animals to people, a health official said yesterday.

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Probably the most feared by health experts, however, would be a new and deadly strain of flu.

The illness, which carries flu-like symptoms, has killed nine people — seven in Asia and two in North America. Its rapid spread in southeast Asia caused a rare worldwide health alert to be issued Saturday.

Health officials say it may be several more days before they are able to identify the disease. However, they said several of its features suggest it is caused by a virus, which can often be difficult to pinpoint quickly using standard lab tests.

"Certainly influenza is on the minds of many people," said Dr. David Heymann, communicable diseases chief for the World Health Organization.

Lab tests have ruled out some varieties of flu as well as some viruses that cause hemorrhagic fever. However, many other possibilities remain, Heymann said.

Those include "a new strain of influenza" or such exotic diseases as the closely related Hendra and Nipah viruses — both newly recognized, causing flu-like symptoms and capable of being spread from animals to people.

"If it really is the flu, it could be we have a new organism that could cause a pandemic," said Dr. R. Bradley Sack, director of Johns Hopkins' international travel clinic. "People immediately start thinking of 1917," when a flu epidemic killed at least 20 million people worldwide .

Experts discounted the possibility that terrorism is the source and believe it almost certainly is a contagious infection that spreads most easily from victims to their doctors, nurses and families through coughing, sneezing and other contact with nasal fluids.

"Nothing about that pattern suggests bioterrorism," said Dr. Julie Gerberding, head of the U.S. Centers for Disease Control and Prevention in Atlanta.

Officials said they are encouraged that some recent victims seem to be recovering, although they are unsure whether that is because of the many antibiotic and antiviral drugs they have been given or simply the natural course of the disease.

The illness is being called "severe acute respiratory syndrome," or SARS. The incubation period appears to be three to seven days. It often begins with a high fever and other flu-like symptoms, such as headache and sore throat. Victims typically develop coughs, pneumonia, shortness of breath and other breathing difficulties. Death results from respiratory failure.

WHO has been aware of the outbreak for about three weeks but issued its global alert last weekend because of concern that the illness would spread to North America and Europe.

WHO estimates that perhaps 500 people in all have been sickened if an earlier outbreak that peaked last month in Guangdong province in China turns out to be part of the same disease, as they suspect it is.

Ninety percent of the most recent cases have been healthcare workers.

The CDC prepared cards that were given to travelers arriving from Hanoi, Hong Kong or Guangdong province in China, warning they may have been exposed. It recommended they see a doctor if they get a fever accompanied by a cough or difficulty breathing during the next week.