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Mystery pneumonia - the facts about the "killer bug"

Bupa investigative news - 20 March 2003
written by Rachel Newcombe, reporter for Bupa's Health Information Team

KEY POINTS

SARS stands for Severe Acute Respiratory Syndrome. It's has similar symptoms to pneumonia.

The World Health Organisation (WHO) issued a worldwide warning about SARS, amid concerns that it is a health threat.

The cause has now been identified as probably being a virus from the Paramyxoviridae family, responsible for diseases like mumps and measles. Scientists are now focusing on identifying the exact strain of the probable virus so that the most appropriate treatment can be used.

According to the WHO, the disease is spread from person to person, but only when in close contact. For example, living with or being in direct contact with an infected person.

Several international air passengers travelling back from the Far East have been affected, including a businessman returning to Manchester. Various regions in China and South East Asia appear to be bearing the brunt of the outbreak.

Experts aren't currently advising people to restrict international travel from the UK, but they do advise being on the lookout for signs and symptoms of the illness - see below

If you've travelled to the affected areas of the Far East recently and experience the main symptoms of SARS (listed below), consult a doctor. The main symptoms of SARS:

  • A high fever (over 38°C)

Along with:

  • One or more respiratory symptoms, including cough, shortness of breath and difficulty breathing

Click here for the latest SARS information

A pneumonia-like illness called Severe Acute Respiratory Syndrome (SARS) has recently affected a number of people worldwide. It has been spread, in part, by international air travel. The illness, which can be fatal, had initially baffled medical experts and triggered a global health warning from the World Health Organisation (WHO). This prompted a barrage of news reports. But what is the real picture? Is the disease as infectious as had first been feared? What are the symptoms? Should international travel be avoided?

What were the headlines?

Details of the disease have been widely covered by papers throughout the UK, as well as worldwide. Reports were featured when the warning was first released, as well as on subsequent days, when it became apparent that a Manchester businessman flew back to the UK and quickly became ill with the suspected virus.

Examples of UK headlines include, "Killer bug flies in on jet passengers", "Alert released over killer pneumonia", "Alert as 9 die of jet virus", "World on alert over killer bug" and "Worldwide alert as air travellers spread killer bug".

What is the bigger picture?

The World Health Organisation (WHO) took the step of issuing an emergency global warning on the weekend of 15-16th March after the condition was reported on three continents. They were said to be concerned that the condition could become a worldwide health threat, due to the speed of international travel.

Dr Gro Harlem Brundtland, director general of the World Health Organisation, said: "This syndrome, SARS, is now a worldwide health threat. The world needs to work together to find its cause, cure the sick, and stop its spread."

Initially, it wasn't known exactly what the disease was, other than the fact that it appeared to be a form of pneumonia. However, more is now known. Scientists from the Chinese Hospital of Hong Kong and the Prince of Wales Hospital since believe they've identified the mystery virus as belonging to the Paramyxoviridae family, responsible for diseases like mumps and measles. The outbreak has also been traced to the Metropole hotel in the Kowloon district of Hong Kong. The next key step is to establish if the virus is a new strain or whether it has been seen and treated before.

According to WHO, the disease is spread from person to person, but only when in close contact. They define "close contact" as being instances where people are caring for, living with or in direct contact with respiratory secretions and body fluids of a person with SARS. Almost all reported cases so far have occurred in health workers involved in caring for people with the disease or in several members of a family. The good news is that, WHO say there's "no evidence to date that the disease spreads through casual contact".

The main symptoms and signs of SARS include:

  • A high fever (over 38°C)

And

  • One or more respiratory symptoms, including cough, shortness of breath and difficulty breathing

And has been in one or more of the following situations:

  • Close contact with a person who has been diagnosed with SARS
  • Recent history of travel to areas reporting cases of SARS. The three areas are: Hanoi in Vietnam, Guandong province in southern China and Hong Kong.

Cases are so far known, or suspected, in Canada, China, Taiwan, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Slovenia, Thailand, Frankfurt and the UK. The first known outbreak began in the Guangdong province of southern China in November 2002, but no cause was identified.

“The current evidence seems to suggest that the illness isn't actually terribly infectious and you need to have been in very close contact with someone to be at risk. The current advice is that people don't need to limit their travel from the UK, but instead be on the lookout for the symptoms of the disease. In general most people who've travelled to the affected areas aren't at risk. If people have recently travelled to the Far East and develop symptoms such as a high fever and shortness of breath, they should seek advice from a healthcare professional and mention their travel.”

Dr Annabel Bentley,
assistant medical director
Bupa Group

What does this mean?

Although the threat of a potentially global infection can seem alarming, Bupa Group's assistant medical director, Dr Annabel Bentley, stressed that the disease is unlikely to pose a problem for most people.

"The WHO global outbreak alert was issued partly because the infectious organism wasn't known, and also as they were concerned because the virus appeared to spread rapidly to three continents, due to the speed of international travel," Dr Bentley explained.

However, she added, "The currently available information suggests that you have to be in very close contact with someone to be at risk. There's no evidence so far to suggest this disease spreads through casual contact, such as being in the same airport as someone or going to the same country."

The Department of Health (DoH) and Public Health Laboratory Service (PHLS) added the following advice: "Although the evidence from cases so far suggests that the infection is mainly passed to close contacts such as close family members and health care workers caring for a case, passengers on flights [that people known to have SARS have travelled on] who develop high fever and chest symptoms such as cough, shortness of breath and difficulties in breathing should make contact with a doctor and tell them their travel history."

ACTION POINTS

If you, or someone you know, develops respiratory problems similar to the symptoms listed below, and recent travel to South East Asia has been involved, seek medical advice.

Flights on which people suspected to have the virus travelled on include: flight KL0888 from Hong Kong to Amsterdam, KL2037 from Amsterdam to Manchester, SQ25 from New York to Singapore, via Frankfurt and CX251 from Taiwan to Heathrow, via Hong Kong. People who travelled on these flights should seek medical advice from a healthcare professional.

The main symptoms and signs of SARS include:

  • A high fever (over 38°C)

And

  • One or more respiratory symptoms, including cough, shortness of breath and difficulty breathing

And has been in one or more of the following situations:

  • Close contact with a person who has been diagnosed with SARS
  • Recent history of travel to areas reporting cases of SARS

What does this mean to me?

"What people need to do is stay well informed with the latest information," said Dr Bentley. "The current advice is that people don't need to limit their travel." If you've got a holiday or business trip departing from the UK, she suggests, "The best thing to do is keep an eye on the WHO and Foreign and Commonwealth Office (FCO) websites to see if there's any change in the situation."

Similarly, the DoH and PHLS said, "As the WHO advised at the weekend, other travellers from China, Hong Kong and South East Asia who develop symptoms of this kind should also contact local health services. Travellers to South East Asia need to be aware of these outbreaks and take them into account in their travel plans. The Department of Health and the Public Health Laboratory Service is monitoring the situation closely in liaison with the WHO and other authorities in the UK and will issue further advice as necessary."

If you have recently travelled to the Far East and develop symptoms such as a high fever and shortness of breath, seek advice from a healthcare professional and mention your travel, stressed Dr Bentley.

"Travellers returning to the UK from any of the affected countries who, within seven days of returning, develop sudden onset of high fever and one other symptom of pneumonia including cough, sore throat or shortness of breath, should seek medical advice," added a DoH spokesperson.

Summary

Although the virus has spread quickly, experts say that people do not need to cancel their travel plans, based on the information currently available. Being aware of the symptoms is sensible and, should you fall ill, consult a healthcare professional and mention recent overseas travel.

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