Department of Health

SARS cases in Beijing and Anhui province

24 April 2004

Dear Doctor,

Subsequent to my letter sent to you on 23 April 2004 regarding two suspect SARS cases in Beijing (??) and Anhui (??) Province, there have been new developments. According to the Chinese Ministry of Health, upon expert panel review of the clinical, laboratory and epidemiological findings, the 26-year-old female patient in Anhui and the 20-year-old nurse in Beijing were classified as confirmed SARS cases. The Anhui patient was a laboratory researcher; she had worked at the Chinese National Institute of Virology in Beijing, developed symptoms on 25 March and was attended by the 20-year-old nurse while in a Beijing hospital. The nurse had onset of illness on 5 April. The mother of the Anhui patient became ill in Anhui on 8 April and died on 19 April; she was classified as a suspect SARS case. A 31-year-old male laboratory researcher who worked in the same virology institute developed symptoms on 17 April; he was classified as a suspect SARS case. The Mainland authorities have identified and quarantined 188 and 117 close contacts in association with the Beijing and Anhui patients respectively. Preliminary epidemiological investigations revealed that the source of infection could be related to the virology institute.

In Hong Kong, the Government has activated Alert Level of the three-level emergency response system relating to SARS. We continue our vigilant measures at the Airport and land and sea borders and have alerted the laboratories with research work on SARS specimens to maintain proper laboratory safety measures.

Please take special notice of febrile patients with respiratory symptoms, who reported history of visiting Beijing or Anhui Province during 10 days before symptom onset. Please ensure that masks are worn on these patients. Furthermore, if the patient has radiological evidence of pneumonia, you may wish to refer the patient to the Accident and Emergency Department (AED) of public hospitals for assessment.

To strengthen disease surveillance, we wish to solicit your assistance in notifying us of patients with pneumonia AND history of visiting Beijing or Anhui Province during 10 days before symptom onset. If you come across such cases, please fill in Appendix (Clinical Record Form for Community Acquired Pneumonia Cases with Travel History to Beijing/Anhui Province within 10 days of onset) and fax to appropriate addresses on that form. Please obtain patient consent for data transfer, and explain to the patient that Department of Health (DH) staff will approach him/her to collect more information about contact history. For your easy reference, the telephone and fax numbers of the Regional Offices are:

Regional Office	Fax No.	Tel. No.
Hong Kong	2572 7582	2961 8729
Kowloon	2375 8451	2199 9149
New Territories East	2699 7691	2158 5107
New Territories West	2439 9622	2615 8571

Please note that the above new system is not a substitute for notifying SARS cases. To notify a patient with high degree of suspicion of SARS, please call the respective Regional Offices during office hours, or call the DH Medical Control Officer (MCO) on pager 71163300 call 9179 after office hours.

Please maintain due vigilance in infection control measures in your health care facility and maintain good staff sickness records. Important things to observe include the followings:

Environment control

to avoid overcrowding in the patient waiting areas by scheduling patient appointment and reminding patients to adhere to it;
to provide adequate ventilation to the clinic;
to clean and disinfect the environment using 1:99 household bleach at least once daily or more frequently as indicated (for places such as patient lavatories). When there is a suspect SARS case, after transferal of suspect SARS patient, immediate disinfection of affected areas using 1:49 household bleach is recommended. It is preferably to evacuate the clinic before disinfection and leave the disinfected area vacant for 30 minutes.
to clean and disinfect equipment used in patient care; and
to maintain proper disposal of clinical wastes.

Precaution for health care workers

to exclude sick staff from duties and to remind them to obtain medical advice as necessary;
to wash hands after each patient contact, change of gloves/masks, gown/white coat/uniform; and
to wear personal protective equipment as appropriate for the setting, e.g., surgical/N95 masks, goggles, face shields, gowns, caps, gloves for high-risk procedures such as suctioning.

Precaution for patients

to request patients and accompanying persons to inform staff when they have fever and arrange medical assessment accordingly; and
to request patients and accompanying persons to wear surgical masks if they have symptoms of respiratory tract infection.

Advice and information for health care professionals can be found in the DH website: http://www.info.gov.hk/info/sars/e_profession.htm.

   Yours faithfully,

  (Dr Marina SUM)

   for Director of Health



	Last revision date: 22 March 2007