The New Probable SARS Case - 9 September 2003

09 Sep 2003

A new probable SARS case

The Singapore General Hospital (SGH) has picked up a new probable SARS case. It appears to be a single, isolated case. The patient is currently isolated at the Communicable Disease Centre (CDC). Investigations are on-going to establish the source of infection. His contacts have largely been followed up and all of them are well. As a precautionary measure, MOH has served HQOs on his close contacts.

Chronology of events

The patient is a 27-year-old Chinese Singaporean post-doctoral student working on West Nile virus at a microbiology laboratory in the National University of Singapore (NUS). He also does some work at the Environment Health Institute (EHI) laboratory of the National Environment Agency. He last visited the EHI laboratory on 23 August 03. He has no history of travel to previously SARS-affected areas and no known contact with SARS patients.

On 26 Aug 03, he went to work at the NUS lab and was well but he developed fever around midnight. On 27 Aug 03, he consulted a general practitioner and was given a course of antibiotics. The fever persisted and he sought treatment at the SGH A&E on 29 Aug 03. His chest X-ray was normal. He was diagnosed to have a viral fever and discharged from the A&E. As he did not feel better, he consulted a Chinese physician on 1 Sep 03. Two days later, on 3 Sep 03, he sought treatment again at the SGH A&E and was admitted.

From the time he became unwell on midnight of 26 Aug 03 till his admission to SGH on 3 Sep 03, he remained at home apart from his two visits to SGH A&E, the GP and Chinese physician.

When he was admitted to the SGH, he complained of fever, muscle aches and joint pains, but did not have any significant respiratory symptoms. He developed a dry cough after admission. Three serial chest X-rays at SGH were all normal. However, on 8 Sep 03, when his PCR and serology test results were returned positive, the patient was transferred to the CDC for further management. He remains well.

Diagnosis

A repeat of his PCR tests was done in NUH lab today and was confirmed positive. In view of his positive PCR and serology results, MOH is treating him as a probable SARS case.

Source of infection

Investigations are underway to identify the patient's source of infection.

Precautionary measures at the laboratories

Pending investigation, the two laboratories have suspended all their research activities. Meanwhile, the staff members of the laboratories have also been asked to stay at home until the all-clear is given. No staff member has fever or feels unwell.

Precautionary measures at the SGH

Although the patient was isolated throughout his stay in the SGH and the staff who had contact with him were in protective gear, the SGH is not taking any chances and has ramped up its precautionary measures to Orange Alert Level. These include restrictions to visitation of the affected wards and more intensive temperature surveillance of staff.

Home Quarantine Orders

Family members of case: 8

TCM Sinseh: 2

SGH A&E outpatients: 8

Visitors: 3

Discharged patients: 4

Total: 25

Conclusion

MOH has notified the WHO of the incident and the details of the case. WHO has informed us that the case does not fulfil the case definition for SARS under the new WHO guidelines post-SARS.

MOH's assessment is that this case was a low public health risk as the patient was picked up and isolated early.