April 11, 2003

Vanderbilt prepares for SARS

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Dr. Mark Denison

Vanderbilt prepares for SARS

Vanderbilt University Medical Center is screening patients for severe acute respiratory syndrome (SARS), the deadly virus that is spreading across much of Asia and parts of Canada.

In response to this possible pandemic, guidelines for treating patients with, or suspected of having SARS have been released at VUMC.

If a patient with suspected or diagnosed SARS is seen at Vanderbilt in either the ED, clinics or is admitted as an in-patient, use the following guidelines:

1. Place a surgical mask on the patient (unless they are having respiratory difficulty)

2. Place the patient in a single room with airborne and contact precautions (N95 respirators, gowns, gloves, and goggles)

3. Resources to aid in more definitive diagnosis of these patients are available through Vanderbilt Infection Control (dial 0, the operator can page Infection Control) as well as the Tennessee State Health Department (615-741-7247).

As of this week, 2,416 people in 20 countries were reported to have the disease, and more than 100 had died. China has seen the most number of incidents with 1,200 confirmed cases.

Researchers suspect the culprit to be a new coronavirus, from a family of highly changeable viruses that until now have been known to cause only minor illnesses in people, like colds and diarrhea.

Dr. Mark Denison, associate professor of Pediatrics, assistant professor of Microbiology and Immunology, is collaborating with the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRID) to understand the replication process of the coronavirus.

Denison’s two NIH grants deal with understanding the details of how the coronavirus makes and produces protein for replication and the functions of the host cell, and how the virus makes its replication factories and what that process does to the host cell.

Denison is working with the national health agencies to determine if interference with viral protein expression will be useful to halt the growth of this particular virus. Denison and three of his students are attending a global SARS conference in May in Amsterdam to present their research findings.

He is optimistic that this particular virus will be understood quickly. “I don’t think it will take years,” he said. “The technological tools are so much more advanced today.”

Denison, however, noted the seriousness of the virus and potential for widespread illness. “There are definitely concerning issues about this virus.”

Early manifestations in SARS patients have included influenza-like symptoms such as fever, myalgias, headache, sore throat, dry cough, shortness of breath, or difficulty breathing. In some cases these symptoms are followed by hypoxia, pneumonia, and occasionally acute respiratory distress requiring mechanical ventilation and death.

Laboratory findings may include thrombocytopenia and leukopenia. Some close contacts, including health care workers, have developed similar illnesses.

In response to these developments, the CDC is initiating surveillance for cases of SARS among recent travelers or their close contacts.

No cases have been confirmed in the United States, but experts are still cautious. The CDC is currently investigating 149 suspected SARS cases in the United States.

“Although travel between the United States and Southeast Asia is markedly diminished, I would not be surprised if a suspected SARS patient presented at Vanderbilt,” said Dr. William Schaffner, professor and chair of Preventive Medicine. “We clearly have to be prepared. Reassuringly, experience in the United States indicates good infection control practices have prevented transmission of SARS in hospitals and among health care workers.”

A suspect case of SARS is a person presenting with one or more signs or symptoms of respiratory illness, including cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of pneumonia or acute respiratory distress syndrome; fever above 101.4 degrees Fahrenheit; travel within 10 days of onset of symptoms to an area with documented transmission of SARS (Canada (Toronto), China, Hong Kong, Indonesia, Philippines, Vietnam, Singapore); or close contact within 10 days of onset of symptoms with a person with possible SARS.