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Thursday, March 20, 2003



Mystery illness tied
to local cases

But two Kauai cases are not likely
to be from the same virus


By Helen Altonn
haltonn@starbulletin.com

The state Department of Health is investigating two Kauai cases that meet the technical definition of the killer syndrome that began in southern China but probably are not the same virus, health officials say.

The patients -- both women -- had relatively mild illnesses and recovered completely with no transmission to family members, said state epidemiologist Paul Effler.

He and state Health Director Chiyome Fukino reported the suspect cases of the mysterious flulike illness known as severe acute respiratory syndrome yesterday.

"These are suspect cases only because the definition says they are," Effler said. "Are they likely cases? I don't think so, based on the fact that the clinical presentation is different."

Fukino said the department is monitoring the situation closely and working with the health-care community to investigate and isolate any potential Hawaii cases.

As of yesterday, 254 suspected cases were reported worldwide, with at least 10 deaths. They involve mostly health workers caring for patients with the syndrome and close family contacts.

Most cases are from Vietnam, Hong Kong, southern China and Singapore.

A Kauai resident who traveled to Hong Kong was admitted to Wilcox Memorial Hospital on Feb. 26 with fever and mild respiratory symptoms, and a health-care worker in contact with the patient was admitted March 8, Effler said.

He said the hospital isolated the traveling woman as a precaution because doctors were alerted in February to look for avian flu, a type of influenza detected in Hong Kong that is carried by birds.

"It's somewhat of a historical situation," Effler said, pointing out that the Kauai woman was hospitalized before the Centers for Disease Control issued a case definition for severe acute respiratory syndrome over the weekend.

The symptoms include a fever higher than 100.4 degrees, one or more respiratory symptoms (a cough, shortness of breath and difficulty breathing), recent travel to areas with the infection or close contact with a person diagnosed with the illness.

The Kauai patient was discharged in three days and recovered fine, Effler said. She did not develop pneumonia.

But after the syndrome case definition came out, health officials decided to take another look at the case to see if it met the criteria, he said.

"We decided she did because it's such a loose case definition," Effler said.

The health agency also began following up on patient contacts at the hospital and identified a staff member who was hospitalized March 8 with pneumonia, he said.

This was about eight days after the first patient, which is a rather long incubation period, he said. The syndrome appears to have an incubation of two to seven days, but the technical definition now goes to 10 days, which the department is using for surveillance purposes, he said.

The hospital worker was discharged after two days, Effler said, explaining neither patient was sick enough to require the kind of treatment needed for patients in other areas.

He said 60 staff members were identified at Wilcox who had contact with either of the two patients. More than 50 have been contacted, and none has had any serious respiratory illness.

The Health Department is calling all the hospitals every day to see how many respiratory admissions are occurring and if there are any suspect cases. They have looked at many cases, but they do not meet all the criteria.

Hong Kong health officials announced yesterday they had traced the infection's spread to people who stayed on the ninth floor of the Metropole Hotel in Kowloon from Feb. 21 to 22.

Laboratories in Germany and Hong Kong examining specimens from hospitalized cases identified particles of paramyxovirus, a family of viruses that cause measles, mumps and respiratory diseases.

The CDC's Division of Quarantine at Honolulu Airport is issuing a health alert to anyone coming into Hawaii from the Hong Kong area.


Hawaii Department of Health



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