Summary of Severe Acute Respiratory Syndrome (SARS) Cases: Canada and International

March 29, 2003

Canada

No additional probable cases of SARS in Canada have been reported since yesterday. A total of 37 probable cases with SARS have been reported in Ontario, British Columbia and Manitoba, including 3 deaths (refer to Table 1). Cases were initially reported in travelers and their close contacts. Following this cases were reported in individuals in a hospital setting where some of the first cases were treated. Most recently, SARS has been reported in a few of the household contacts of these hospital-associated cases. There has been no evidence of transmission in the general community. Figure 1 shows the number of probable cases by symptom onset date.

The Ontario Ministry of Health and Long-Term Care has reported a total of 35 probable cases of SARS. Five of these cases occurred in a single extended family. The index case in this family had recently returned from Hong Kong. A physician who had close contact with members of this family was also diagnosed with SARS. An emergency room contact of one of the cases in the family cluster and one of his family members have since been identified as cases.

Most recent cases have been reported in persons associated with one Ontario hospital where a number of the initial cases were treated. The majority of these persons are thought to have contracted the illness as a result of unprotected contact with the initial cases prior to the recognition of SARS. Health care staff across the province are now alerted to SARS and have implemented infection control practices to protect themselves and their patients in an effort to prevent any further infection.

In addition to the cases linked to the family cluster and the subsequent hospital outbreak, three isolated cases have been reported in individuals who had travelled to Asia, including one in Ontario, one in British Columbia and one in Manitoba.

As of March 27, 75% of probable cases reported in Ontario were hospitalised. The clinical status of the majority of cases is either stable or improving. Persons with the most severe illness are elderly or have an underlying illness.

Both the index case in the Ontario family cluster and the BC resident with SARS stayed at the Metropole hotel in Hong Kong where a cluster of SARS cases has been reported. A Canadian with SARS [not counted in the official Canadian case count], who is currently hospitalised in Hong Kong, also stayed at the hotel. The other isolated cases reported in Ontario and Manitoba were linked with travel to Asia but neither stayed at the Metropole hotel.

Ontario has declared a provincial emergency and SARS is now a reportable diseases under Ontario's Health Protection and Promotion Act. The province has introduced a number of public measures in an effort to contain the spread of SARS. Key public health measures include extensive contact tracing of persons who may have come in contact with SARS cases, temporary suspension of elective procedures and restrictions of visits to hospitals and long-term care facilities. Isolation wards have been established at hospitals and health care staff are required to wear protective clothing to protect affected patients and prevent further spread of SARS.

Health Canada is supporting Ontario in its SARS response efforts by providing epidemiologic and infection control expertise, as well as emergency supplies as needed. Health Canada in collaboration with the Provinces and Territories has implemented enhanced surveillance for the detection of SARS cases, alerted laboratories and initiated special laboratory investigations in an effort to identify the cause of SARS. In addition, Health Canada is working quickly to implement a screening protocol for international travellers in response to the WHO recommendations to prevent travel-related spread of SARS. For regular updates on public health actions taken by Health Canada, please see the most recent update.

Table 1
Cumulative Number of SARS Cases Reported in Canada, March 29, 2003

Province/Territory	Number of Cases
British Columbia	1
Alberta	0
Saskatchewan	0
Manitoba	1
Ontario	35
Quebec	0
Nova Scotia	0
Newfoundland	0
New Brunswick	0
Prince Edward Island	0
Nunavut	0
North West Territories	0
Yukon	0
TOTAL	37

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International

Since November 1, 2002, 1550 cases of SARS (1513 outside of Canada) have been reported to the World Health Organization (refer to Table 2). The majority of cases are reported from Guangdong Province and Hong Kong Special Administrative Region of China, Singapore and Hanoi, Vietnam with Hong Kong presently showing the greatest increase in cases. Cases of SARS in other parts of the world have occurred in persons or close contacts of persons who have travelled to these destinations.

The Hong Kong Department of Health has determined that 7 individuals who contracted SARS had recently stayed in or visited the Metropole hotel in Kowloon last month. The 7 persons investigated include 3 visitors from Singapore, 2 from Canada, 1 from mainland China and a local Hong Kong resident. All 7 stayed in or visited the same floor of the hotel between 12 February and 2 March. The local Hong Kong resident is believed to be the index case for an outbreak in the Prince of Wales Hospital. He had visited an acquaintance staying at the hotel from 15 to 23 February. The visitor from mainland China, a medical doctor from Guangdong Province who became ill a week before staying at the hotel, is considered to be the original source of the infection. No further cases have been linked to the hotel.

The majority of cases have occurred in people who have had very close contact with other cases including household contacts and health care workers.

The main signs and symptoms seen in cases of SARS include fever (>38.0 degrees Celsius), cough and shortness of breath. Some cases develop increasing respiratory distress and require mechanical ventilation. As of 29 March 2003, 51 deaths have been reported outside of Canada, the majority (34) of which were reported in Guangdong Province of China. The total number of cases and deaths in Guangdong was only recently reported in the WHO cumulative international total. The WHO is coordinating global efforts to better characterize the clinical manifestations of SARS. Because awareness and surveillance of the disease have increased worldwide, an increase in the number of suspected cases is to be expected.

Table 2
Table 2 - Cumulative Number of SARS Cases* and Deaths Reported to WHO
November 1, 2002 to March 29, 2003

Country	Number of Cases	Number of Deaths
Canada	37	3
China, Guangdong Province	806**	34
China, Hong Kong SAR	470	10***
China, Taiwan	10	0
France	1	0
Germany	4	0
Italy	2	0
Republic of Ireland	2	0
Romania	3	0
Singapore	89	2
Switzerland	3	0
Thailand	3	1
United Kingdom	3	0
United States	59	0
Vietnam	58	4
TOTAL	1550	54
*Cumulative number of cases includes deaths. Case definitions vary from one country to another. Only probable cases are being reported by all countries except the US which is reporting suspect cases under investigation. **This is an updated report of cases from 16 November 2002 to 28 February 2003 in Guangdong Province. The number of cases was compiled from investigations as well as hospital reports and may include suspect as well as probable cases of SARS. ***One death attributed to Hong Kong SAR occurred in a case medically transferred from Vietnam. Source: http://www.who.int/csr/sarscountry/2003_03_29/en/