Term Paper: Acute Respiratory Syndrome SARS Epidemic

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[. . .] Facial masks were advised to prevent the transmission through respiratory secretions. The disease outbreak was more or less confined to people working in close proximity with the infected person. With improved infection control methods, reduced contacts and hospitalization of infected people and quarantining of exposed people the spread of the disease was controlled to a great extent.

China and Hong Kong

China was the most affected by the SARS outbreak. With only 37 SARS cases (as of April 19) in Beijing, the epidemic was believed to have been under control. However the Chinese health care officials were shocked when more than 400 SARS cases were reported between April 20th and 21st. The WHO cleared China from the list of regions "with recent local transmission' on June 24 but by this time SARS took a heavy toll with 5300 affected patients and 349 deaths. Infection in Hong Kong began in early march and towards the end of March peaked to a maximum rate of around hundred infections per day until it gradually subsided towards the end of April. By the middle of June there were 1755 people affected by SARS and 295 patients were dead. An important fact is that 30% of the infected people were healthcare workers. Taiwan was the third worst affected region after china and Hong Kong with a total of 671 infected cases (as of July 11th 2003) and 84 deaths. [Kamps]

Toronto, Vietnam and Singapore

As per data available on June 2nd 2003, when the world health organization removed Toronto from the list of places with "recent local transmission" of the disease there were a total of 251 cases with 43 casualties. In Vietnam, the Hanoi region was most affected with a total of around 70 cases but the epidemic was totally contained by the end of April. In Singapore the first instance of SARS infection occurred around the end of February and between 25th February and 30th April there were a total of 238 SARS cases of which 33 were fatal. 76% of the infections in Singapore occurred within the hospice environment. The WHO cleared Singapore from the list of "recent local transmission" on the 31st of May. [Kamps]

Treatment for SARS

The search for effective antiviral drugs is still underway and here we shall discuss the treatment methods that were used during the outbreak of the disease in 2003 and also touch upon the latest developments in the search for a potent drug for the virus. Treatment for the SARS CoV was based primarily on a theoretical approach and physicians had to modify their treatment depending on the response to the particular drugs that were administered. As a precautionary measure antibiotics were used to ward off any respiratory infections from common pathogens. Several types of antiviral drugs were administered though there were no clear-cut evidence as to their effectiveness against SARS CoV.


Ribavirin is a guanosine analogue and possesses immunosuppressive properties. It has been tested to be useful against a variety of DNA and RNA viruses. This drug was extensively used in conjunction with corticosteroids during the SARS epidemic. However ribavirin has not shown any positive in vitro activity against SARS virus and there is still no conclusive evidence as to its effect against SARS CoV in vivo. So ribavirin is primarily used as a preventive drug against other viral pathogens. It has been observed from clinical studies that SARS patients show acute symptoms during the 3rd and fourth week of the disease even though the viral load is found to be substantially reduced at this time. This is attributed to the severe reactions of the immune system. Ribavirin has been proved to be a powerful inhibitor of proinflammatory mediators that are triggered by the viral invasion. Hence the efficacy of the drug (if at all) has been ascribed to restricting the acute response from the immune system. There is a marked reduction in macrophage activation and increase in production of Th1 cytokine and simultaneous reduction in levels of Chapter 2 cytokines. High concentrations of this drug has been shown to have serious side effects like bradycardia (slowing down of heart rate) and anemia. [Kamps]


This drug is used in fight against AIDS as a potential Protease inhibitor and is useful in halting the virus replication process. It is believed that the use of Lopinavir-ritonavir combinational drug would inhibit SARS CoV protease formation, and consequently arrest the virus replication. So this drug is potentially more useful if it is administered at an early stage before the virus has replicated much.

Immunomodulatory Treatment

As discussed earlier, part of the problem with SARS infection is dealing with the acute reaction of the immune system. During the acute stages of the disease there is a high level of proinflammatory cytokines which results in alveolar macrophages. That is, even after the initial stage of viral replication is halted and the viral load has been substantially reduced from the system the immune system continues to be hyperactive and this results in lung damage. Immunomodulatory agents such as corticosteroids have the effect of suppressing this hyperactive reaction from the immune system and provide relief from symptoms that are bought about by the excessive release of proinflammatory cytokines. However there is a hidden danger in the use of corticosteroids as their efficacy in relieving symptoms is time Specific. If the corticosteroids are administered before the immune system begins to be over active there is a danger of allowing the viral replication unchecked. On the contrary too much delay would allow the cytokine overflow and consequent damage to the lungs and worsening of the symptoms. So in order for corticosteroids to be effective they must be administered in a timely manner and over a required period of time. The dosage also needs to be carefully planned in accordance with the physical characteristics of the each person. Inappropriate prescription of these drugs would result in immunosuppression and make the host susceptible for opportunistic infections. Other immunomodulatory agents that are also used for this purpose include Thymosin alpha 1, cyclophosphamide etc. [Kamps]


Interferons have shown their positive effect in arresting viral replication. In vitro experiments conducted in Germany have revealed that interferon ? is very effective in this regard. So, interferons maybe highly effective during the initial days of the attack as they can halt the replication of the virus. Since ribavirin had little effect on preventing the replication of the virus inside the host, in future medics may use interferons as an effective medicine to contain the viral load inside the host. Cinatl et.al 2003 proved the antiviral potency of interferons, Quoting from the study "We showed that interferons inhibit SARS-CoV replication in vitro. Interferon ss was most potent, showing prophylactic protection and antiviral potential after infection. Interferon ss could be the drug of choice, alone or in combination with other antiviral drugs," [J Cinatl]

Critical Care

In acute stages of the disease patients may experience severe breathing disorders necessitating both invasive and noninvasive forms of ventilation. It has been found now that the lung impairment which results in late stages of the disease is not due to the increase in viral load inside the host but more because of the hyperactive immune response to the virus resulting in immunopathological lung damage. Studies indicate that 20% of SARS patients manifested acute symptoms of dyspnea (breathing difficulty) and required intubation and mechanical ventilation. Noninvasive ventilation is preferred as a non-infecting and safer form of providing breathing support as invasive ventilation has been known to cause pneumoccocal infections, particularly in patients who are taking corticosteroids. However, for patients who do not improve with non-invasive ventilation it becomes necessary to use mechanical ventilation. Under these circumstances enough precautions must be taken to prevent the possibility of infection from endotracheal intubation. [Kamps]

SARS Vaccine [Latest Researches]

There are several ongoing researches for finding a good vaccine for SARS. China has already tested its SARS vaccine on humans and the results have proved to be encouraging. The U.S. has already developed 3 vaccines. Researchers working in the National Institute of allergy and infectious diseases (United States) have tested the latest SARS vaccine and experimented its efficacy by testing it on monkeys. The latest vaccine is directly delivered into the respiratory tract of the animal and it is effective in a single dose. Anthony S. Fauci, M.D., the director of NIAID says, "We now have three technologically unique approaches to restricting SARS replication in animals," These important studies of SARS vaccines demonstrate the outstanding progress we have made against this newly recognized and deadly disease.." [NIH]

The vaccine was formed by inserting the SARS S. genetic material into an impotent human parainfluenza virus. The vaccine is designed to target SARS-S protein which is present in the corona. For the test the researchers used two different types of the vaccine, one with SARS S. protein encoded in it and the other without the SARS spike… [END OF PREVIEW]

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