Report of an expert workshop on SARS
Mar 1, 2005 - 5:34:00 PM
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"An urgent need exists for antiviral drugs to prevent and treat SARS. During the first global outbreak, various interventions were used in management, including antivirals like ribavirin, interferon, and protease inhibitors, as well as host immunomodulary agents, particularly systemic corticosteroids. However, the uncontrolled nature of these observations and the uncertain natural history of untreated SARS mean that no drug interventions of proven therapeutic or prophylactic value have been established to date."
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By Pankaj, US Correspondent,
[RxPG] International experts in infectious disease and epidemiology consider it likely that there will be a recurrent outbreak of severe acute respiratory syndrome (SARS) or other newly emerging and serious transmissible respiratory pathogens, according to the published conclusions of a workshop on the highly infectious disease.
Writing in the first issue for March 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine, an expert panel developed recommendations concerning the care and treatment of patients with SARS based on prior clinical experience. According to the report, 8,098 persons in 29 countries developed probable SARS between November 1, 2002, and August 7, 2003. The heaviest burden of illness was felt in China, Hong Kong, Taiwan, Singapore, Viet Nam, and Canada. About 23 to 32 percent of SARS patients become critically ill, with acute lung injury affecting 16 percent of all patients with SARS and 80 percent of critically ill patients with the disease. The worldwide fatality rate among all SARS outbreaks was 9.6 percent, but those suffering from SARS-related critical illness died at a 50 percent rate. Worldwide, children were relatively protected from this severe illness. The report notes that the first symptom of SARS is often fever followed by diffuse muscle pain (myalgia), headache, nonproductive cough, and breathlessness (dyspnea). Rapid breathing (tachypnea) and rapid heart rate (tachycardia) are also common early symptoms. Lower respiratory problems, including cough and shortness of breath, typically begin 2 to 7 days after symptoms onset. The average time from exposure to symptom onset is approximately one week. Infection from patients to healthcare workers in the hospital has been a "prominent and worrisome feature of SARS outbreaks. In Singapore and Toronto, healthcare workers have accounted for half of all SARS cases and 20 percent of all critically ill SARS cases."
The Workshop report noted: "An urgent need exists for antiviral drugs to prevent and treat SARS. During the first global outbreak, various interventions were used in management, including antivirals like ribavirin, interferon, and protease inhibitors, as well as host immunomodulary agents, particularly systemic corticosteroids. However, the uncontrolled nature of these observations and the uncertain natural history of untreated SARS mean that no drug interventions of proven therapeutic or prophylactic value have been established to date." Because the clinical and pathologic mechanisms of SARS are indistinguishable from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), the clinical management of severe SARS should be similar to that for ALI and ARDS. In these illnesses, mechanical ventilation with a low tidal volume strategy here has been shown to improve survival in these patients.
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