Semi-Daily Journal

CDC Atypical Pneumonia Briefing

Excerpts from the Center for Disease Control's briefing on "Atypical" pneumonia.

CDC Media Relations - Telebriefing Transcript - March 15, 2003: MR. SKINNER: Now I'd like to turn it over to Dr. Julie Gerberding, Director of CDC.

DR. GERBERDING: Thank you. I wanted to start by explaining why we are doing this on a Saturday. I'm fully aware this is not the optimal time to do a media briefing, but as the Secretary said, the situation is evolving very quickly, and we really do need to get the information out. And, hopefully, you will appreciate that getting information out any time is better than no information.

So we're going to tell you what we know today and recognize that this is ongoing, and we'll be updating you as regularly as we have new information. You will also be able to find information on the WHO website, which is their main mechanism for providing international summaries of these health data. And we will have links and so forth on our website as we go forward.

The situation today is that WHO has received reports of more than 150 new or suspected cases of a syndrome called Severe Acute Respiratory Syndrome, which is basically a very severe pneumonia-like illness that is being reported from a growing list of countries, including China, Hong Kong, Indonesia, Philippines, Singapore, Thailand and Vietnam. In addition, the case reports from Canada. No cases have been identified in the United States, but travelers through the United States who have been in contact or have traveled to the affected areas are under investigation to be sure that their time here did not result in exposure and an opportunity for persons to acquire the illness in this country.

Obviously, this is a very early stage of the investigation, and given the high prevalence of travel through Southeast Asia, we are alerting our public health communities and our clinicians to be on the lookout for cases, and I'll say in a couple of minutes what some of the other steps that we are taking are at this point in time.

We have activated CDC's Emergency Operation Center to manage this complex international multijurisdictional outbreak. Our role is to assist WHO and health officials in the affected countries, in particular in the area of epidemiologic investigation, laboratory diagnosis, and assessment of prevention intervention. We have as our current priority the detection of new cases using WHO case definition which I'll just briefly review for you.

WHO is defining a case as someone with a fever greater than 38 degrees Celsius (Editor's Note: 100.4 degrees Fahrenheit), respiratory symptoms which could be cough, shortness of breath or difficulty breathing, and either close contact with someone who's already been diagnosed with this syndrome or recent travel to areas reporting cases of the syndrome.

We recognize, because we do not have an etiologic diagnosis or a laboratory test for this illness right now, that this is a nonspecific case definition and may include people who really don't have the syndrome at all, may have some other more common respiratory illnesses, but it is a starting point for investigation. And as we either rule in or rule out cases as we go forward, the number of cases meeting the syndrome is expected to change.

Our priority also is on communication. And you can expect us to be providing you with regular updates as we go forward. As I mentioned, the Web sites will be good resources, but we are also taking a number of steps to put information out to a variety of collaborating partners. These steps include sending health alerts to the public health and the medical community. Later today we will be issuing guidance to clinicians about the case definition, the isolation recommendation, and what we can say about treatment and prophylaxis at this point in time.

We assume that this is spread person to person because we're seeing a large proportion of the cases in Asia among health care workers who were caring for the ill patients or household contacts of ill patients. We are recommending precautions to prevent airborne spreads, droplet spread and direct contact spread until we have further information. And so that means we're erring on the side of caution until we can be more specific.

We are also not recommending prophylaxis at this point in time since we don't have an etiologic agent, and our treatment recommendations are nonspecific, basically, utilizing the kinds of empiric treatment that would be appropriate for any patient with an unexplained pneumonia, including anti-microbials or anti-virals depending on the clinical judgment of the treating physician and the isolation and supportive care that I've already mentioned.

We're also preparing a health alert for passengers returning from areas where SARS has been diagnosed. The health alert basically advises travelers that if they become ill with fever within seven days following their return from the affected area, they should consult their physician. And, likewise, we're advising physicians where to get information either through our health alerting mechanism, our hotlines, or our Web sites where we are supporting the clinical community.

There is no WHO recommendation for travel restriction at this point in time, but we are advising persons planning nonessential or elective travel to affected areas that they may wish to postpone their trip until further notice. So we will provide additional information about travel advisories at www.cdc.gov/travel, and that will be updated periodically as we go forward.

So I think again this is an ongoing problem. We're at the very early stages of the investigation. We have received only a few laboratory samples at CDC, so we're only in the preliminary stages of looking for common and atypical organisms that could be contributing. And we're working with laboratories around the world to give the most expeditious diagnostic opportunities here a chance to solve this problem.

QUESTION: What about the time difference between infection and severe illness and in the couple of cases that we know about? Do you have any indication--I mean how quickly are people getting very, very sick?

DR. GERBERDING: Again, this is very preliminary, but the investigation in Hong Kong and Hanoi suggests that the incubation period is somewhere between two and seven days on average. You know, we're right now probably identifying the most severely ill patients, and so we want to be open to modifying that if we have better data in the future.

QUESTION: And just to get this right, you do not know yet if it's bacterial or viral infection, correct?

DR. GERBERDING: Correct. We do not have information about the etiology right now.

QUESTION: And also, do we know how contagious? I mean if I was on a subway car with someone who was ill, could I get it from them, or do you need to have that close like I'm-taking-care-of-me kind of contact.

DR. GERBERDING: What we know so far from the investigations in progress are that it's very close personal contact of the type defined by WHO as having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with the diagnosis. So there is no evidence to suggest that this can be spread through breath contact or through assemblages of large people; it really seems to require a fairly direct and sustained contact with a symptomatic individual.