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Good Chance SARS Will Return in Fall

It is quite possible severe acute respiratory syndrome (SARS) will flare this fall, according to a consensus statement by a number of experts published by the Journal of Epidemiology and Community Health on its website in advance of the October print publication.

Season of the year affects viral respiratory infections, particularly the coronavirus family to which SARS belongs, and case numbers decline in warmer months, the experts note.

The authors of the consensus point out the importance of public health measures to respond quickly to infectious disease and contain its spread. It has not been proven whether preventive measures currently in use -- such as home quarantine, facemasks, and restricting public events -- are effective. What does count, they write, are effective isolation procedures and early detection of the disease.

Dr. Joseph J.Y. Sung, from Chinese University of Hong Kong, said even if the World Health Organisation thinks the initial crisis is over, "we should not be complacent. There is, in my personal view, a high possibility that the epidemic will come back during the winter."

Dr. Sung noted that the corona virus responsible for SARS is unlikely to mutate to a benign infection and attenuated symptoms. "Without herd immunity and attenuation of the virus, when the next epidemic comes, one would still expect to have large-scale outbreak with severe symptoms."

Dr. Abu S.M. Abdullah, from University of Hong Kong, said anecdotal reports suggest temperature changes may have limited the outbreak of SARS in Vietnam and Guangzhou province in China. "The wider use of heaters in Toronto and air conditioning in Hong Kong and Singapore, usually to keep the room temperature within 18-22 degree Celsius, might have contributed to the long lasting outbreak in these developed cities."

Dr. Martyn Regan, of the Health Protection Agency (North West), in Chester, England, postulates that at the moment "we could however be merely in the eye of the storm as part of a cyclical perhaps seasonal trend in the incidence of epidemic SARS." As coronavirus remain, the potential for the chain of events that lead to outbreaks of SARS in China and elsewhere "must be assumed to still exist."

It is possible, based on current evidence, that further cases of SARS "will reoccur later this year riding on the tide of other seasonal respiratory viruses," he adds.

Dr. Li-Yang Hsu and Dr. Nicholas Paton, from Singapore General Hospital, write that the current crackdown on unsanctioned capture and sale of wildlife in southern China, and the heightened awareness of the disease in that region, means "SARS is unlikely to recur this autumn. However, we also believe that subsequent outbreaks will occur, although these will be smaller and more easily contained if the lessons learnt from this epidemic are not forgotten."

Dr. Shiu-hung Lee, from The Chinese University of Hong Kong, declares that in light of current public health actions, "it is anticipated that Hong Kong is unlikely to face another SARS epidemic of such a magnitude as the last one." There might be sporadic cases of atypical pneumonia, he adds.
J Epidemiol Community Health 2003;54:1:Publication ahead of October print issue.

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