Epidemiological and investigational approaches for emerging infectious disease:Viral disease: SARS (severe acute respiratory syndrome)

1. SEVERE ACUTE RESPIRATORY SYNDROME(SARS)
www.lukejerram.com
Department of microbiology 12 January 2015

2. SEVERE ACUTE RESPIRATORY SYNDROME
www.businesscontinuityinternational.com

3. Epidemiological approaches
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

4. Identification and Analyzation:
• Study design
• Research domain
• Data collection
• Analytical techniques
CLINICAL MICROBIOLOGY

5. STUDY DESIGN
• Results of epidemiological studies are available as Real time collection
• Upon detection of the outbreak, Studies are carried as:
 Identification of the causative agent
 Investigation of the possible routes and modes of its transmission
 define and validate diagnostic criteria
 Evaluation of candidate treatments
 Forecast the spread of the epidemic
 Devise and evaluate evidence-based prevention
 Monitor policies and strategies.
• The first case of SARS was identified in Asia in Feb. 2003 where 8,098 people became ill and 774
died.

6. RESEARCH DOMAIN
• The first challenge for epidemiologists is to develop new surveillance and alert tools to detect in
real time.
• Identified more than 300 journal articles covering epidemiological research into the SARS
outbreak
• The researchers, analysis the descriptive epidemiological studies and investigate the
distribution of SARS.
• Analytical epidemiological studies, tried to discover the cause of SARS.
• The median (average) submission-to-acceptance and acceptance-to-publication intervals for
SARS articles submitted during the epidemic were 55 and 77.5 days, respectively.

7. DATA COLLECTION
• Search bibliographic databases for all published articles on epidemiology.
• Presentation of the entire literature identification–selection process.
• To compare the publication timelines of academic research articles with that of public health
information, they access to,
 The MEDLINE database via PubMed
 The Science Citation Index Expanded and the Social Sciences Citation Index databases
 In case of SARS, Morbidity and Mortality Weekly Report for the Centers for Disease Control and
Prevention (CDC)
 The Weekly Epidemiological Record and Bulletin of the WHO, and Canada Communicable
Disease Report for the Public Health Agency of Canada.

8. ANALYTICAL TECHNIQUES
• Articles were classified into four large categories:
 Investigation and surveillance
 case management
 prevention and control
 Psychobehavior
• A detailed analysis includes the study designs, and the information given by the authors on the
statistical, informatics, and quality-control methods.

9. • A data-collection grid was devised:
 For each retained article,
 recording of the study type and design,
 the type and size of the sample population,
 the software used for data management and statistical analyses,
 the quality assurance and quality-control processes described in their Materials and Methods.
 The collected data were coded in a relational database.

10. • Susceptible individuals are infected by infectious.
• After stage of latency, Infectious individuals lose
infectiousness by death, recovery, or isolation.
• When quarantine is implemented, a proportion, q, of new
infections are quarantined before they become infectious.
• The same proportion of susceptible individuals who were
contacts of infectious persons but were not infected are also
quarantined.
• Susceptible individuals are released from quarantine after
10 days; and that compliance with quarantine is complete.
Mathematical model for SARS transmission.

11. Typology of Studies
The distributions of the 11 research
domains are as follows-
 52%- case-management
 16%- assessment of diagnostic tests
 23%- Investigation and surveillance
 19%- psychobehavioral studies.
 6%- prevention and control.

12. AETIOLOGY OF SARS
• A novel coronavirus (SCoV ) is the aetiological agent of severe acute respiratory syndrome (SARS).
• Coronaviruses are characterized by their irregular shape and a crown-like appearance of their
outer envelope.
• An envelope shows the presence of glycoproteins in a lipid bilayer.
• Inside the envelope, there is a nucleocapsid, with the genetic material, positive strand single strand
RNA (+ssRNA), and a few enzymes.
• The detection of coronavirus viruses in small, live wild mammals in a retail market indicates a
route of interspecies transmission.
• Coronaviruses are classified as members of the order Nidovirales.

13. Investigational approaches
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

14. Symptoms-
Hallmark symptoms-
• Cough
• Difficulty in breathing
• Fever greater then 100.4 degrees F
• Other breathing symptoms
Common symptoms -
• Chills and shaking
• Cough starts usually 2-3 days after other symptoms
• Fever
• Muscle aches
• Head aches

15. Less common symptoms-
• Cough that produces phlegm (sputum)
• Diarrhoea
• Dizziness
• Nausea and vomiting
• Runny nose
• Sore throat

17. STAGE 2(LOWER REPIRETORY TRACT PHASE)
• Dry cough
• Dyspenea
• Progressive hypoxemia in many cases
• Respiratory failure that requires mechanical ventilation in some case

18. SIGNS AND TESTS-
Tests used for diagnosing SARS-
• Arterial blood tests
• Blood clotting tests
• Blood chemistry tests
• Chest x-ray or chest CT scan
• Complete blood count (CBC)

19. Tests used to quickly identify the virus that causes SARS include-
• Antibody tests for SARS
• Direct isolation of the SARS virus
• Rapid polymerase chain reaction (PCR) test for SARS virus

20. TREATMENT
• Antibiotics to treat bacteria that cause pneumonia.
• Antiviral medications(although how well they work for the SARS is unknown).
• High doses of steroids to reduce swellings in the lungs.
• Oxygen, breathing support(mechanical ventilation), or chest therapy.

21. PROGNOSIS
• The death rate from the SARS was 9 to 12 % of those that diagnosed. In people over
age 65, the death rate was higher than 50%. The illness was milder in younger
patients.
• Viruses in the coronavirus family are known for their ability to change (mutate) in
order to spread among humans.

22. SARS

23. REFRENCES
Reports and Articles-
• Anatomy of the Epidemiological Literature on the 2003 SARS Outbreaks in Hong Kong and
Toronto: A Time-Stratified Review
• Isolation and Characterization of Viruses Related to the SARS Coronavirus from Animals
inSouthern China.
Web sites-
• www.who.int/csr/sars/diagnosticstests/en
• Pennstatehershey.adams.com
• www.ncbi.nlm.gov/pubmedhealth/
• www.businesscontinuityinternational.com
• www2.hendrix.edu
• www.devicemag.com
• www.cnn.com

24. THANK YOU