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Home arrow Home arrow WHO advised to update international health regulations and require reporting of both suspect and pro
WHO advised to update international health regulations and require reporting of both suspect and pro
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Sunday, 18 May 2003
Inaccurate reporting of SARS cases is complicating contingency planning for the international public health community.  According to Reuters (WRAPUP 2-WHO says China doctors still under-reporting SARS, 17 May 2003: http://www.alertnet.org/thenews/newsdesk/SP203643.htm):

"After visits by WHO officials to Beijing hospitals, the U.N. health agency said it was concerned that some cases were being excluded because patients had no known contact with a SARS victim or because they had mild symptoms that cleared up. "They fit the case definition but because they get better in a few days they are not seen as probable cases," Daniel Chin, the head of the WHOs Beijing team of SARS experts, said in a statement.

The patients were being sent home or moved out of isolation wards to general wards, where they could infect others, he said.

"Clinicians are making this decision because theres an assumption that SARS patients must be very sick. But theres a spectrum of severity for SARS," Chin said."

Analysis of the probable case in Finland (ProMEDmail: http://www.promedmail.org) with a history of travel to Toronto as the risk factor for exposure has been noted as interesting. As the date of onset of the last reported probable case of SARS in Toronto was 19 Apr 2003 [several days before his visit], the likelihood of exposure to SARS while in Toronto is markedly reduced (unless there was "silent" transmission through asymptomatically infected individuals). The dilemma is the ultimate classification of a case that may meet the clinical case definition but does not really meet the epidemiologic definition; yet one of the laboratory tests was positive for the SARS-associated coronavirus.

According to the paper "International Law, Communicable Diseases and the Geopolitical Objective of Minimal Interference with World Trade and Travel" (http://www.humanitarian.net/law/sars_travel.html):

The recent controversy surrounding early reporting of Severe Acute Respiratory Syndrome (SARS) by the Chinese government is confounded by international law as defined in the International Health Regulations (IHR),that constitutes the "only international health agreement on communicable diseases that is binding on [WHO] Member States." IHR presently applies to only three infectious diseases, cholera, plague and yellow fever. [1] WHO member states have no international legal obligation under the IHR to report SARS cases to WHO or to refrain from certain trade and travel restricting measures aimed at stopping the spread of SARS. Thus, the only international agreement on infectious diseases binding on WHO member states has been irrelevant to the SARS outbreak.

In the context of present international travel related risks, the US State Department: Severe Acute Respiratory Syndrome (SARS) Public Announcement includes the following warning:

The CDC and the World Health Organization (WHO) are tracking SARS’s origin and method of transmission as well as determining how its spread can be contained. SARS has severely taxed health care systems in affected countries; neighboring countries have curtailed flights in and out of affected locations and blocked transfer of SARS patients for medical care. In light of the continually evolving nature of the geographic spread of SARS, American citizens should regularly consult the CDC’s website (http://www.cdc.gov) and the WHO’s website (http://www.who.int) for updates.

Strong efforts are being made to contain SARS. Some countries have implemented measures such as mandatory screening of incoming passengers at airports, and persons with SARS-like symptoms may be quarantined and/or sent to designated hospitals until the authorities are satisfied they do not have SARS.

Medical evacuation of SARS patients remains problematic. Securing transport and locating a destination willing to accept such patients is difficult, if not impossible. Since medical evacuation possibilities may change, family members of SARS patients may wish to consult with the nearest U.S. Embassy/Consulate General for the latest information.
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