1. GROUP 1: SYSTEMIC ACUTE RESPIRATORY SYNDROME

2.  On 12 March 2003, the World Health Organization (WHO) issued a global alert on the outbreak of a new form of pneumonia-like-disease.  The illness, officially known as severe acute respiratory syndrome (SARS), is potentially fatal and highly contagious, and has spread quickly to many parts of the world in a matter of a few weeks.  The disease has been reported in many countries such as China, Hong Kong, Vietnam, Singapore, Canada, US, with a large number of infections and a significant number of deaths.  Since SARS is transmitted person-to –person, extermination of the agents of transmission would not be a plausible solution.

3. i. victims who suffer from the illness display symptoms that are very much similar to those of the common flu ii. it spreads from person-to person with ease iii. with an incubation period of less than ten days, it acts fast-and in some cases, kills fast

4. Epidemiology of Severe Acute Respiratory Syndrome (SARS)

5. In Malaysia, the outbreak resulted is two deaths due to the probability of SARS in Jerantut, Pahang and Penang. The victim who involved with history has ever visited China or Singapore. Table below shows the total number of cases includes those who've recovered or died. This Table shows the incidence of SARS in Malaysia since WHO records began on April to May 2003.

6. SARS epidemic has believe start from Guangdong, China. Hong Kong, Vietnam, Singapore and Taiwan are the most Asian country have been effect by this syndrome. “Figure 1.Epidemic curve, Hong Kong.”

7. CountryCumulative number of case(s)Number of deaths Case fatality ratio (%) China 53273497 Hong Kong 175529917 India 300 Indonesia 200 Kuwait 100 Macao 100 MALAYSIA* 5240 Mongolia 900 Philippines 142 Republic of Korea 300 Singapore 2383314 Taiwan 3463711 Thailand 9222 Vietnam 6358 Table 2.The official number of SARS cases reported from Asian countries over the time period November 1, 2002 to July 31, 2003

8. WORLDWIDE. Table 3.The official number of SARS cases reported from countries over the time period November 1, 2002 to July 31, 2003 Country Cumulative number of case(s) Number of deaths Case fatality ratio (%) Australia 600 Canada 2514317 France 7114 Germany 900 Italy 400 New Zealand 100 Republic of Ireland 100 Romania 100

9. Russian Federation 100 South Africa 11100 Spain 100 Sweden 500 Switzerland 100 United Kingdom 400 United States 2909 Total 80987749.6

10. SIGN AND SYMPTOM  Signs and symptoms of SARS disease typically develop within two to 10 days after exposure to the virus.  SARS typically begins with flu-like signs and symptoms ; fever, chills, muscle aches and occasionally diarrhea. After about a week, signs and symptoms include: -Fever of 100.4 F (38 C) or higher -Dry cough -Shortness of breath

11.  Insufficient oxygen in blood  Abnormalities are noted on chest X-ray.  Loss of appetite  Rash  Acute respiratory distress syndrome  Other less common symptoms.

13.  For PCR testing, there are at least 2 different clinical specimens needed (eg:nasopharyngeal and stool.) Besides that, there can also be the same clinical specimen collected on 2 or more days during the course of the illness for example 2 or more nasopharyngeal aspirates are obtained for diagnosis  The peak detection rate for SARS-associated coronavirus depends on the type of the specimen obtained.  week 2after illness onset for respiratory specimens  weeks 2 to 3 for stool or rectal swab specimens  week 4 for urine specimens.  If a positive PCR result has been obtained, it should be confirmed by repeating the PCR using the original sample or having the same sample tested in a second laboratory. Amplifying a second genome region could further increase test specificity.

14.  ELISA or IFA is a negative antibody test on acute serum followed by positive antibody test on convalescent serum.  Antibodies against SARS-CoV become detectable with high sensitivity around 10 days after the onset of infection, but they can be undetectable prior to this by current testing methods.  Positive antibody test results indicate that there has been an infection with SARS-CoV.  Seroconversion from negative to positive, or a four-fold rise in antibody titre in the serum of a convalescent patient compared with that patient’s serum during acute illness, denotes a recent infection.  A negative serological result 21 days after onset of symptoms indicates absence of SARS-CoV infection. Cross-reactions with antibodies to other agents (including the human coronaviruses HCoV-229E and HCoV-OC43) are not known.  Antibody determination using IFA or ELISA was the most reliable method for identifying infections with SARS-CoV.

15.  Patient specimens such as respiratory secretions, blood, or stool can be inoculated in suitable cell lines for growth of the infectious agent.  Vero cells have been used for culture. After isolation, the virus has to be confirmed and this is usually done with nucleic acid based tests.  Positive results indicate presence of viable SARS-CoV, whilst negative cell culture results do not exclude SARS.  These viruses were originally isolated in organ cultures of human embryonic trachea and subsequently grown in tissue culture in fibroblasts.  Although most coronaviruses are highly species specific,able to employ a larger variety of receptors on the cell surface,show a marked degree of tissue tropism influenced by both host cell surface characteristics and by viral S-glycoprotein

16.  At the onset of fever, 70-80 % of the patients have abnormal chest radiographs  Chest X-ray findings typically begin with a small, unilateral, patchy shadowing, and progress over 1-2 days to become bilateral and generalized, with interstitial or confluent infiltrates. Air- space opacities eventually develop during the course of the disease. In patients who deteriorate clinically, the air-space opacities may increase in size, extent, and severity  The initial radiographic changes may be indistinguishable from those associated with other causes of bronchopneumonia.

18. Antibiotic therapy Routinely prescribed for SARS because it is non specific Some antibiotics are known to have immunomodulatory properties Eg:quinolones and macrolides

19. A nucleoside analogue High doses result in more adverse effects,especially in elderly Ribavirin Oseltamivir phosphate not a recommended treatment apart no evidence that this drug has any efficacy against SARS-CoV Neuraminidase inhibitor Lopinavir-ritonavir co-formulation used in combination with ribavirin inhibit the coronaviral proteases, thus blocking the processing of the viral replicase polyprotein and preventing the replication of viral RNA. Protease inhibitor ANTIVIRAL THERAPY

20. family of cytokines important in the cellular immune response type I (interferon α and β, sharing components of the same receptor) type II (interferon γ which binds to a separate receptor system) with different antiviral potentials and immunomodulatory activities. Human interferons used in some hospitals in China and Hong Kong Human immunoglobulin Traditional herbal medicine used in China glycyrrhizin, an active component derived from liquorice roots Alternative medicine

21. SARS outbreak put a large number of patients in hospital, resulted in the death of many patients, disrupted the lives of countless people and damaged the economy On the positive side, however it highlighted the importance of a cohesive professional and community response in resolving the crisis rapidly a much higher level of preparedness for infectious disease.It is much more from than just control of infectious diseases