SARS

Sever Acute Respiratory Syndrome

 Introduction
• Severe acute respiratory syndrome (SARS) is a communicable viral respiratory
disease of zoonotic origin caused by the virus SARS CoV-1

• It is a contagious and potentially fatal respiratory illness.

• First appeared in China in November 2002, and the syndrome caused the 2002–2004
SARS outbreak.

• SARS spreads to over 24 countries.

• SARS was a relatively rare disease; at the end of the epidemic in June 2003, the
incidence was 8,422 cases with a case fatality rate (CFR) of 11%.

• No cases of SARS-CoV-1 have been reported worldwide since 2004.

• In December 2019, a second strain of SARS-CoV was identified: SARS-CoV-2.

• This strain causes coronavirus disease 2019 (COVID-19), the disease behind the COVID-19
pandemic.
Causative Agent

• SARS is Caused by the Coronavirus, called SARS associated coronavirus

(SARS-CoV).

• 2 main strains are SARS-CoV 1 and SARS-CoV 2

 Mode of Transmission
• The SARS virus is transmitted through droplets from coughing and sneezing and close human contact.

• The respiratory droplets are probably absorbed into body through the mucous membranes of mouth, nose
and eyes.

• It can also transmit through sharing utensils, speaking to someone too close(with in 3 feet distance), or
touching someone directly.

• Person with virus can spread the infection by leaving respiratory droplets on objects, such as door handles,
door bells, telephones.

• While diarrhea is common in people with SARS, the fecal–oral route is another mode of
transmission.

• And the virus is likely to remain active in the environment for several days.

• Incubation period is usually 2–7 days but may be as long as 10 days.

 Clinical features
• The disease is not contagious during the incubation period, before symptoms appear.

• Most cases of SARS begin with a high fever above 38°C.

• Other early symptoms include those common to flu, such as muscle pain, aches,
chills, headaches, diarrhoea, sore throat, cough, running nose, difficulty in breathing
and shortness in breath.

• SARS may eventually lead to pneumonia.

• Serious complications, such as respiratory failure, heart failure and liver failure may
occur in people aged over 60 years and those with pre-existing comorbidities.
 Diagnosis
• SARS is very rare, and the symptoms are common with those of flu and pneumonia.

• A person having all of the following symptoms must be diagnosed for SARS:

• Fever of at least 38°C

• Cough, difficulty in breathing, shortness of breathing

• Either history of

• Contact with someone with a diagnosis of SARS within the last 10 days

• Travel to any of the regions identified by the World Health Organization (WHO) as
areas with recent local transmission of SARS
• Following laboratory tests can help to confirm a diagnosis of SARS
• RT-PCR testing can detect the virus in blood, stool and nasal secretions.

• ELISA and Immunofluorescent assay can detect SARS-CoV antibodies in the serum
 Prevention and control
• There is a vaccine which can help the immune system to create enough
antibodies and decrease a risk of side effects like arm pain, fever, and headache.

• other preventive measures include:

• Hand-washing with soap and water, or use of alcohol-based hand sanitizer

• Disinfection of surfaces of fomites to remove viruses

• Avoiding contact with bodily fluids

• Put down toilet lid when flushing

• Using separate washrooms (if possible)

• Washing the personal items of someone with SARS in hot, soapy water
(eating utensils, dishes, bedding, etc.)
• Avoiding travel to affected areas

• Proper exit screening of travelers at airports, bus stands and stations.

• Wearing masks and gloves

• Keeping people with symptoms home from school

• Distancing oneself at least 6 feet, if possible, to minimize the chances of

transmission of the virus
 Treatments
• As SARS is a viral disease, antibiotics do not have direct effect but may be used against bacterial

secondary infection.

• Treatment of SARS is mainly supportive with antipyretics, supplemental oxygen and mechanical

ventilation as needed.

• While ribavirin is commonly used to treat SARS, there seems to have little to no effect on SARS-CoV, and

no impact on patient's outcomes.

• There is currently no proven antiviral therapy.

• Administration of corticosteroids, is recommended by the British Thoracic Society/British Infection

Society/Health Protection Agency in patients with severe disease and O2 saturation of <90%
Ebola Virus Disease
(EVD)
 Introduction
• Ebola, also known as Ebola virus disease (EVD) and Ebola haemorrhagic
fever (EHF), is a viral haemorrhagic fever in humans and other primates, caused
by ebolaviruses.

• It is a rare but serious disease with 50% average fatality rate

• Ebola was first identified in 1976, in two simultaneous outbreaks, one in Nzara (a
town in South Sudan) and the other in Yambuku (the Democratic Republic of the
Congo), a village near the Ebola River, for which the disease was named.

• Ebola outbreak in west Africa is a major one.

• EVD is most common in human beings and non-human primates (monkey,
chimpanzee, gorillas).

• It is believed that the virus is animal-borne, and bats of the pteropodidae

family are being considered as the natural Ebola virus host.

• The bats carrying the virus transmit it to other animals.

Causative agents

• EVD is caused by a group of viruses of the genus ebolavirus

• Species including are Zaire ebolavirus(EBOV), Sudan Virus(SUDV), Tai forest

virus(TAFV), Bundibugyo virus(BDBV), Reston virus Bombali virus(RESTV).

• EBOV species- Zaire ebolavirus, is the most dangerous of all EVD-causing

viruses.
 Mode of transmission
• Ebola virus is introduced into the human population through close contact with the blood or

other body fluids of the infected animals and of the who has developed symptoms of disease.

• When a person gets infected with Ebola, he/she will not show signs or symptoms of illness

immediately.

• After they develop symptoms of illness, they can spread Ebola virus to other via direct

contact( through broken skin or mucous membranes in the eyes, nose or mouth)with

• Blood or other body fluids(urine, saliva, sweat, faeces, vomits, breastmilk and semen) of an infected person.

• Objects (such as needle and syringes) that have been contaminated with body fluids.
 • Semen from a man who recovered from EVD, semen of a person may carry the
virus for several weeks to months after recovery.

• Ebola virus is not transmitted by food(though in certain part may spread

through consumption of bushmeat.

• There is also no evidence that mosquitoes or other insects can transmit.

• Burial ceremonies that involve direct contact with the body of the
deceased can also contribute in the transmission.
 Clinical features
• Symptoms may appear from 2-21 days after contact with the virus.
• Symptoms of EVD include:
• Fever
• Fatigue
• Muscle pain
• Sever headache
• Sore throat
• Weakness
This is followed by
• Vomiting
• Diarrhoea
• Rash
• Abdominal pain
• Impaired kidney and liver functions
• Unexplained haemorrhage(bleeding and bruising)
• Low WBC and platelet count.
Diagnosis

• It can be difficult to clinically distinguish EVD from other infectious

disease such as malaria, typhoid fever and meningitis.

• Confirmatory diagnostic methods for the detection include:

• ELISA

• Electron microscopy

• Serum neutralization test

• RT-PCR
 Prevention
• An Ebola vaccine, rVSV-ZEBOV, was approved in the United States in December
2019, It appears to be fully effective ten days after being given.

• Infection can also be prevented:

• Avoid close contact with an infected person's blood and body fluids

• Avoid direct or close contact with items that may have come in contact with an
infected person’s blood or body fluids
• Wear gloves and appropriate personal protective equipment while taking care of ill
patients.
• Wash your hand regularly after visiting patients in hospital as well as after taking care.
• Ensure safe and dignified burial of body of someone who died from EVD

• Avoid contacts with bats and non-human primates or blood fluids and raw meat
prepared from these animals or meat from an unknown source.
• Handle animals with gloves and other appropriate protective clothing.

• Consume thoroughly cooked animal products (blood and meat).

 Treatments
• Treatment of EVD is only symptomatic, there is no antiviral drug licensed by USFDA to treat EVD in people.

• Following basic interventions can significantly improve the chances of survival

1. Provide fluids and electrolytes intravenously or orally

2. Offer oxygen therapy to maintain oxygen status

3. Use medication to support blood pressure, reduce vomiting and diarrhoea and to manage fever and pain

4. Treat other infections, if they occur

• Recovery from EVD depends on good supportive care

• Those who recover develop antibodies that can last for 10 years or longer

• Blood transfusion from survivors, mechanical filtering of blood from patients, immune therapies are considered

as possible treatments for EVD.