Four more patients hospitalised in new SARS alert Exotic Market Yields a SARS Clue

HONG KONG (AFP) - Four more patients have been admitted to two Hong
Kong hospitals suffering fever and chest infections, key symptoms of
the deadly SARS virus, raising fears of a new outbreak of the disease.

A 79-year-old man from an old age home in Kowloon, was admitted to
Queen Elizabeth Hospital Friday suffering a chest infection.

Tests for influenza and the SARS-causing coronavirus were being
conducted on the man, who was in an isolation ward receiving
treatment, a hospital spokesman said on Saturday.

Five elderly patients admitted earlier from the same elderly home
remained in hospital. All six patients were in a stable condition
while four had already tested negative for the coronavirus, he said.

Meanwhile, tests were continuing on another three elderly female
patients, aged 81 to 86, from an old age home in Hung Hom had who were
recently admitted to the hospital with chest infections. One woman
also had a fever.

Tests were still being carried out on the three, he added.

The cases are the latest in a string of SARS alerts over the past two
weeks in which the first stage of a new three-tier warning system for
the disease has been raised amid heightened fears the deadly virus
could return as the weather turns cooler.

The World Health Organisation (WHO) has warned SARS could return with
the onset of the northern hemisphere winter. Many experts believe the
disease could be seasonal like other viruses, such as flu.

In the early part of the year SARS struck more than 8,000 people and
left more than 900 dead in 32 countries, with some 349 of the
fatalities and 5,327 of the infections recorded in China.

Hong Kong was the second worst-affected region with 297 SARS-related
deaths and nearly 1,800 infections.

By Ed Edelson
HealthDay Reporter

THURSDAY, Sept. 4 (HealthDayNews) -- It was just your typical
live-animal food market in Shenzhen, China, with a palm civet here, a
raccoon-dog there on display for the benefit of chefs, but it provided
an important hint about the way an innocuous virus that lives
peacefully in the human respiratory tract became the deadly virus
SARS, researchers say.

Swabs from two Himalayan palm civets, members of a cat-like family,
turned up a coronavirus resembling one that is carried by many humans
but does no harm, scientists at the University of Hong Kong report in
the Sept. 5 issue of Science. The virus was also found in a
raccoon-dog and a ferret badger from the same market, and in some
employees at the market.

Although the workers showed no signs of illness, the discovery
"indicates a route of interspecies transmission" that created the
severe acute respiratory syndrome virus, the report says.

"The concept here is that we know that coronaviruses are mutable,"
says Dr. Philip Tierno, director of clinical microbiology and
immunology at New York University Medical Center and author of The
Secret Life of Germs.. "But it was not known previously that animal
and human strains could recombine to become more profoundly infective
that the human strains we knew in the past."

The animal market was a logical place to look, the Hong Kong
researchers explain, because the first cases of SARS, reported last
November, occurred in restaurant workers from that region who handled
wild mammals regarded as exotic foods. The Shenzhen market had a
variety of species, held individually in small wire cages, that came
from different regions of China.

"The Chinese lay out animals in open markets and sell for food animals
we wouldn't eat, and that cohort together," Tierno says. "You have
humans working in close proximity with these animals. If an animal is
slaughtered, viruses can spread from animal to human."

Genetic analysis shows a family resemblance between the human and
animal coronaviruses, the report says, although the human SARS virus
is missing a large segment found in the animal virus.

The discovery indicates that the open-air markets are places where
SARS-like animal viruses can "amplify and transmit to new hosts,
including humans, and this is critically important from the public
health point of view," the researchers write.

But it isn't clear that any of the virus-carrying animals in that
market were the original source of the virus, they say. It is
conceivable that they were all infected "from another, as yet unknown
animal source, which is in fact the true reservoir in nature."

Much more work in markets, in the wild and in laboratories "will help
to better understand the animal reservoirs in nature and the
inter-species events that led to the origin of the SARS outbreak," the
researchers say.

Meanwhile, a report by a panel of Central Intelligence Agency experts
warns that while the SARS outbreak has been contained after infecting
more than 8,400 people worldwide and causing about 815 deaths, the
disease could re-emerge this winter, the time when respiratory
diseases are most likely to spread.

"SARS has not been eradicated," says a report prepared by the National
Intelligence Council to CIA Director George G. Tenet. "We remain
vulnerable."

If the disease takes hold in Asian or African countries with
inadequate health-care systems, it could cause more deaths than the
first outbreak, the experts warn.

A quick response to contain the disease is necessary because
"currently, SARS has no vaccine, no effective treatment and no
reliable point-of-care diagnostic test," they say.

The U.S. Centers for Disease Control and Prevention says it plans to
have a better SARS surveillance system in place this year.

More information

Everything you need to know about SARS is available from the U.S.
Centers for Disease Control(http://www.cdc.gov/ncidod/sars) and
Prevention or the World Health
Organization(http://www.who.int/csr/sars/en/index.html).

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