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| 2003/04/12 22:04 |
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SARS: a particularly serious threat to international health
Although the last decades of the previous century witnessed the emergence of several new diseases, SARS needs to be regarded as a particularly serious threat for several reasons. If the SARS virus maintains its present pathogenicity and transmissibility, SARS could become the first severe new disease of the 21st century with global epidemic potential. As such, its clinical and epidemiological features, though poorly understood, give cause for particular alarm. With the notable exception of AIDS, most new diseases that emerged during the last two decades of the previous century or established endemicity in new geographical areas have features that limit their capacity to pose a major threat to international public health. Many (avian influenza, Nipah virus, Hendra virus, Haanta virus) failed to establish efficient human-to-human transmission. Others (Escherichia coli O157:H7, variant Creutzfeldt-Jakob disease) depend on food as a vehicle of transmission. Diseases such as West Nile Fever and Rift Valley Fever that have spread to new geographical areas require a vector as part of the transmission cycle and are associated with low mortality, often in high-risk groups, such as the elderly, the immunocompromised, or persons with co-morbidity. Still others (Neisseria meningitidis W135, and the Ebola, Marburg, and Crimean-Congo haemorrhagic fevers) have strong geographical foci. Although outbreaks of Ebola haemorrhagic fever have been associated with case-fatality rates in the range of 53% (Uganda) to 88% (Democratic Republic of the Congo), person-to-person transmission requires close physical exposure to infected blood and other bodily fluids. Moreover, patients suffering from this disease during the period of high infectivity are visibly very ill and too unwell to travel.
In contrast, SARS is emerging in ways that suggest great potential for rapid international spread under the favourable conditions created by a highly mobile, closely interconnected world. Anecdotal data indicate an incubation period of 2 to 10 days (average 2 to 7 days), allowing the infectious agent to be transported, unsuspected and undetected, in a symptomless air traveller from one city in the world to any other city having an international airport. Person-to-person transmission through close contact with respiratory secretions has been demonstrated. The initial symptoms are non-specific and common. The concentration of cases in previously healthy hospital staff and the proportion of patients requiring intensive care are particularly alarming. This "21st century" disease could have other consequences as well. Should SARS continue to spread, the global economic consequences - alreadyestimated at around US$ 30 billion - could be great in a closely interconnected and interdependent world.
Это из отчета WHO