Race against SARS: Can pandemic be prevented?
Gerberding J. Faster . . . but fast enough? Responding to the epidemic of severe acute respiratory syndrome. Editorial. N Engl J Med published on-line April 2, 2003, at www.nejm.org.
The public health response to severe acute respiratory syndrome (SARS) has been strikingly rapid on many fronts, but a global pandemic of a new infectious disease still is a real possibility, the author warned. "Concern is mounting about the potential for spread in schools, the workplace, airplanes, and other crowded areas," wrote Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention. "New cases among travelers from affected areas continue to emerge and have led to infections in household contacts and health care personnel in many countries, including the United States and Canada. The epidemic of SARS is apparently only months old, and it is entirely to soon to predict its ultimate scope or magnitude."
Epidemiologic evidence indicates that the transmission of SARS is facilitated by face-to-face contact, and this still appears to be the most common mode of spread. However, airborne transmission may have a role in some settings and could account for the extensive spread within buildings and other confined areas that has been observed in some places in Asia, she wrote. "Certainly, airborne transmission will make containment of the epidemic much more challenging," Gerberding noted. If the new coronavirus proves to be the cause of SARS, fomite or other modes of transmission could also be relevant, since coronaviruses can survive on contaminated objects in the environment for at least a few hours and have been isolated from the stool of some animals.
"Despite our long experience with other viral respiratory infections, we have no proven, successful population-based strategy for their prevention," she conceded. "Even when we have an effective vaccine, as in the case of influenza, annual infection rates and attributable mortality remain very high. If SARS transmission evolves to mimic that of influenza, containment may well be impossible without vaccination, prophylaxis, or treatment." There are reasons to be optimistic about future control measures, Gerberding added.
Vaccines are successful in preventing coronavirus infection in animals, and the development of an effective vaccine against this new coronavirus is a realistic possibility. Likewise, novel antiviral agents, antiviral drugs in development, or existing licensed drugs could be found to provide effective prophylaxis or treatment. "The emergence of SARS presents formidable global challenges," she concluded. "If we are extremely lucky, the epidemic will be curtailed, develop a seasonal pattern that will improve prospects for regional containment, or evolve more slowly than it has in this early stage. If the virus moves faster than our scientific, communications, and control capacities, we could be in for a long, difficult race. In either case, the race is on. The stakes are high. And the outcome cannot be predicted."
The public health response to severe acute respiratory syndrome (SARS) has been strikingly rapid on many fronts, but a global pandemic of a new infectious disease still is a real possibility, the author warned.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content