The World Health Organization is strongly recommending further investigation into the sources of infection of recent SARS cases in Guangdong, after the Ministry of Health of China today announced a fourth case of SARS in the province.
WHO was informed late yesterday afternoon about the most recent case - a 40-year-old male medical doctor who is the director of a hospital in Guangzhou.
Based on the clinical and laboratory findings supplied to WHO by the Ministry of Health of China, WHO has declared that the case should be considered to be a laboratory confirmed case of SARS. Laboratory findings from laboratories in Beijing and Guangdong have been confirmed in a WHO International Reference Laboratory in Hong Kong, SAR, after the laboratory was contacted directly by the Ministry of Health of China.
The case raises a number of concerns about the manner in which the man's infection was detected, treated and reported.
The patient was reported to have become unwell with fever and myalgia on January 7, 2004, and to have had a confirmed diagnosis of pneumonia made on January 14. Despite these facts, he was not properly isolated in hospital until January 16, he was not declared as a suspect case to the Ministry of Health of China until January 26, and WHO was not informed about this case until January 30.
Early detection, swift isolation and prompt reporting of cases are vital in the control of any infectious disease.
The Ministry of Health of China reports that only 9 close contacts and 39 casual contacts of this case have, to date, been identified by the Guangdong health authorities. All 48 contacts are reported to be well and under quarantine.
However, the thoroughness of the contact tracing must be urgently reviewed to ensure that all those who could have been exposed by this case have been identified, and that a rigorous review of all contacts of this case in the 14 days prior to the onset of his symptoms are assessed to ensure that none of them could have been the source of this man's illness.
The Ministry of Health of China reports that the source of infection of this case is unknown despite an investigation by local officials in Guangdong. This is the second confirmed case of SARS in Guangdong for whom a definitive source of infection cannot be identified. Human, animal and laboratory sources of infection should be investigated urgently, and a review of the findings from the investigations into all four reported SARS cases is required.
The Ministry of Health has dispatched an expert team from the national Chinese Centre for Disease Control and Prevention (CCDC) to Guangdong Province. The CCDC team will review the investigations undertaken to date and support the Guangdong provincial authorities in carrying out more extensive investigations and contact tracing.
WHO has offered its assistance to the Ministry of Health of China in addressing the above issues, and is discussing with the Ministry of Health how best to support the CCDC team currently in Guangdong province.
However, whilst this case raises a number of concerns, WHO would like to stress that the 40-year-old doctor is only one of four cases reported this year, and that recent months have provided examples of a strengthened system for SARS in Guangdong province. The threat to public health from SARS therefore appears to be small at this point in time, but the importance of discovering the source or sources of infection of SARS in Guangdong is more urgent than ever.