SARS

[dothedd]

Abstract

Grant Number: 1U01AI061988-01
PI Name: SMITH, GALE
PI Email:
PI Title: VICE PRESIDENT, NOVAVAX
Project Title: Development of Recombinant SARS VLP Vaccines

Abstract: DESCRIPTION (provided by applicant): The objective of this grant proposal is to develop and manufacture preclinical and clinical lots of novel recombinant SARS subunit protein vaccines formulated with Novasome adjuvants for evaluation in small animal and primate challenge models to prevent SARS coronavirus infection and disease. This plan will develop three types of SARS vaccine candidates comprised of recombinant SARS coronavirus S, M, and E proteins, which have been codon-optimized, cloned, and expressed in baculovirus-infected insect cells at Novavax, Inc. Vaccine candidates include the following: (1) recombinant multiprotein immunogens displayed on Novasomes, (2) VLPs self-assembled in vivo, and (3) chimeric VLPs comprised of SARS viral proteins and human influenza virus hemagglutinin proteins. Vaccine immunogens, expressed in baculovirus-infected insect cells and/or CHO cells, will be purified by ultracentrifugation and chromatographic methods. Vaccine immunogens will be formulated with adjuvants and will be evaluated initially for mucosal and systemic immunogenicity in mice. Vaccine candidates that elicit SARS neutralizing antibodies in the murine immunogenicity model, as determined by microneutralization assays, will be evaluated further in a novel SARS mouse challenge model in collaboration with Dr. Kanta Subbarao (NIH), who recently developed the model. Preclinical lots of vaccine candidates that elicit neutralizing antibodies and reduce virus titers in the murine challenge model will be tested further in a SARS primate challenge model using cynomolgus monkeys in collaboration with Dr. James Estep (Battelle Institute) in their BSL3 primate facility. Finally, clinical lots of a SARS vaccine candidate that demonstrates the highest SARS neutralizing antibody titer and the greatest virus reduction in the primate challenge model will be manufactured and lot release tested. Toxicology studies of the SARS vaccine candidate will be conducted in rabbits. A clinical protocol for a Phase I clinical study will be prepared, and an IND application will be submitted to CBER/FDA.

Thesaurus Terms:
SARS virus, drug design /synthesis /production, recombinant virus, severe acute respiratory syndrome, vaccine development, vaccine evaluation, viruslike particle
cooperative study, glycoprotein, neutralizing antibody, toxicology, virus protein
Baculoviridae, chromatography, enzyme linked immunosorbent assay, laboratory mouse, tissue /cell culture, ultracentrifugation, western blotting

Institution: NOVAVAX, INC.
8320 GULIFORD RD, STE C
COLUMBIA, MD 20145
Fiscal Year: 2005
Department:
Project Start: 15-FEB-2005
Project End: 31-JAN-2008
ICD: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
IRG: ZAI1

[dothedd]

Novavax, Inc.
240-268-2031
NOVAVAX ANNOUNCES PROPRIETARY METHOD TO CREATE SARS VACCINE
AND RENEWAL OF NIH FUNDING FOR SARS VACCINE DEVELOPMENT
ROCKVILLE, MD (May 22, 2008) - /PRNewswire-FirstCall/ - Novavax, Inc. (NASDAQ: NVAX) today
announced that it has created a new proprietary process to develop a vaccine candidate against Severe Acute
Respiratory Syndrome (SARS). The company also received renewed research funding from the National Institutes
of Health (NIH) to continue preclinical development of SARS vaccine candidates using Novavax’s virus-like
particle (VLP) technology.
"Until now, it has been difficult to produce VLP vaccine candidates against SARS and other complex infectious
disease targets because many of these biological structures do not assemble efficiently," said Dr. Gale Smith, Vice
President, Vaccine Development. "Our new proprietary process uses select components of SARS and other
structural proteins that combine with cell membranes to form distinctive SARS coronavirus nanoparticles, which are
nearly identical to the human SARS virus but lack the genetic material needed to replicate and cause disease.”
"This new approach to create VLPs will allow us to continue our work to develop a SARS vaccine candidate and
expand the potential applications of our vaccine technology to a broad range of infectious diseases around the
world," said Rahul Singhvi, President and Chief Executive Officer of Novavax, Inc.
Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus and was first
reported in Asia in February 2003. According to the World Health Organization (WHO), subsequent to the 2003
breakout, over 8,000 people were infected, with 774 reported deaths. While there is currently no known reported
SARS transmission globally, WHO and other such agencies continue to monitor the SARS situation on a global
basis as health officials remain concerned that SARS or similar disease could reemerge.
The SARS VLP program is conducted under an NIH grant. Novavax does not have the commercial rights to this
product candidate.www.novavax.com/download/releases/SARs%20PR%20FO1.pdf



Release and Stability Testing Programs for a Novel Virus-Like Particle Vaccine
Release testing involves both standard potency assays and unique assays (particle size, NA activity) developed to ensure the physical, chemical, and biological stability of this type of vaccine.

Oct 2, 2010
By: Steven Pincus, Sarathi Boddapati, Jingning Li, Travis Sadowski
BioPharm International Supplements

Novavax Recombinant VLP Vaccines

Through the use of a recombinant baculovirus–insect host cell system, Novavax has developed a platform technology to produce VLP vaccines to multiple targets including influenza, SARS, and HIV. Influenza VLPs have been biochemically characterized and GMP-produced materials have been tested in five clinical trials, with a total of more than 5,000 subjects.1
www.biopharminternational.com/biopharm/article/articleDetail.jsp?id=690799&sk=&date=&pageID=2



Vaccine. 2011 Jul 14. [Epub ahead of print] Chimeric severe acute respiratory syndrome coronavirus (SARS-CoV) S glycoprotein and influenza matrix 1 efficiently form virus-like particles (VLPs) that protect mice against challenge with SARS-CoV. Liu YV, Massare MJ, Barnard DL, Kort T, Nathan M, Wang L, Smith G. Source Novavax Inc., 9920 Belward Campus Drive, Rockville, MD 20850, United States.

Abstract SARS-CoV was the cause of the global pandemic in 2003 that infected over 8000 people in 8 months. Vaccines against SARS are still not available. We developed a novel method to produce high levels of a recombinant SARS virus-like particles (VLPs) vaccine containing the SARS spike (S) protein and the influenza M1 protein using the baculovirus insect cell expression system. These chimeric SARS VLPs have a similar size and morphology to the wild type SARS-CoV. We tested the immunogenicity and protective efficacy of purified chimeric SARS VLPs and full length SARS S protein vaccines in a mouse lethal challenge model. The SARS VLP vaccine, containing 0.8ìg of SARS S protein, completely protected mice from death when administered intramuscular (IM) or intranasal (IN) routes in the absence of an adjuvant. Likewise, the SARS VLP vaccine, containing 4ìg of S protein without adjuvant, reduced lung virus titer to below detectable level, protected mice from weight loss, and elicited a high level of neutralizing antibodies against SARS-CoV. Sf9 cell-produced full length purified SARS S protein was also an effective vaccine against SARS-CoV but only when co-administered IM with aluminum hydroxide. SARS-CoV VLPs are highly immunogenic and induce neutralizing antibodies and provide protection against lethal challenge. Sf9 cell-based VLP vaccines are a potential tool to provide protection against novel pandemic agents.

[dothedd]

Suspect Fatal SARS in Russia ex-China Recombinomics Commentary 19:17 April 15, 2009 A Chinese woman has died from what may be Severe Acute Respiratory Syndrome (SARS) while traveling on a train from the Far East Russian city of Blagoveshchensk to Moscow, a medical source said on Wednesday. The train was stopped in the central Russian city of Kirov and around 60 train passengers were sent to a local hospital. Six of them are reported as running fevers, the source said, although Kirov Region officials have said that none of them were suffering from SARS. The above comments describe a suspect fatal SARS infection of a passenger traveling from northeast China to Moscow (see map). Although atypical pneumonia was the initial diagnosis, the etiological agent has not been identified. SARS presents as atypical pneumonia and is caused by a novel coronavirus (SARS-CoV). Other strains cause the common cold, as well as other respiratory disease. SARS spread internationally in early 2002 when a physician, who had been treating SARS patients in Guandong Province, traveled to Hong Kong to attend a wedding. He stayed in room 911 at the Metropole Hotel and vomited outside the elevator on the 9th floor. Other guests with rooms on the ninth floor became infected and spread the disease to Toronto, Hanoi, Singapore, and Hong Kong. Additional travelers spread the infection to Taiwan. There were approximately 900 confirmed fatalities and the spread of the disease cause significant political and travel impact. The virus had links to civet cats in Guangdong Province, as well as other exotic animals, but its natural reservoir was also identified in bats. A recurrence of SARS is likely, but the above fatality has not been confirmed. Symptoms can be confused with avian influenza. The first confirmed H5N1 case in mainland China was infected in Beijing during a SARS outbreak, and was initially diagnosed as SARS. The H5N1 (A/Beijing/1/2003) was clade 7 and a clade 7 outbreak was reported in Jiangsu at the end of 2008. That outbreak was followed by a spate of H5N1 in China, including Beijing. The cases suddenly stopped in January. The proximity of the originating train station to northeastern China raises additional concerns. Media Links Recombinomics Presentations Recombinomics Publications Recombinomics Paper at Nature Precedings Home | Founder | What's New | In The News | Contact Us Webmaster: [e-mail] © 2009 Recombinomics. All rights reserved.

[dothedd]

Saudi Arabia SARS-CoV Cases Raise Concerns
Recombinomics Commentary 20:45
September 24, 2012

The HPA has compared the sequencing of the virus isolate from the 49 year old Qatari national with that of a virus sequenced previously by the Erasmus University Medical Centre, Netherlands. This latter isolate was obtained from lung tissue of a fatal case earlier this year in a 60 year-old Saudi national. This comparison indicated 99.5% identity, with one nucleotide mismatch over the regions compared.

The above comments from the Health Protection Agency in the UK describe the re-emergence of SARS (Sudden Acute Respiratory Syndrome)-CoV (coronavirus). The HPA has only sequenced 200 BP, which is virtually identical to the same region for the earlier case from Saudi Arabia. The larger sequence from the Netherlands indicates the current virus is related to bat cornonaviruses, which are the same group as the SARS-CoV which emerged in 2002.

In 2002 sequences from SARS-CoV were released almost in real time and were quickly designated as novel. Release of sequences from these two recent (July and September) isolates would be useful.

Media reports have already claimed that these isolates are distinct from the SARS-CoV from 2002/2003, but that distinction is far from clear because of similarities with bat CoV, which has been cited as the natural reservoir for the 2002/2003 outbreaks.

[dothedd]

Saudi Arabia SARS-CoV Closely Related To Bat Coronaviruses
Recombinomics Commentary 23:15
September 24, 2012

The virus RNA was tested also in Dr. Ron Fouchier's laboratory in the Netherlands and was confirmed to be a new member of the beta group of corononaviruses, closely related to bat coronaviruses.

The above comments from Ali Mohamed Zaki of Dr Fakeeh hospital in Jeddah, Saudi Arabia (as posted at ProMED) indicate the SARS CoV from the fatal case in Saudi Arabia is closely related to the SARS CoV that caused the SARS outbreaks in 2002 and 2003. The more recent case (Qatar via Saudi Arabia was 99.5% identical based on a short sequence of about 200 BP, as noted by the HPA in the UK. This second cases is in critical condition with renal failure, which was also confirmed in the index case. Additional severe cases from the Middle East are under investigation.

The similarities with the 2003 outbreak raise concerns. The international spread in February, 2003 was largely linked to a physician who had been infected after treating cases in Guangdong Province. He came to Hong Kong for a wedding and stayed in room 911 at the Metropole Hotel where he infected multiple visitors / tourists on the 9th floor, who spread the virus to Hong Kong, Singapore, Vietnam (Hanoi), and Canada (Toronto).

The link of the rapid spread outside of mainland China to a single case raises concerns that the two confirmed and multiple suspect cases linked to Saudi Arabia may represent a similar situation. The SARS-CoV from the 2003 outbreak had been infecting patients in Guangdong Province in late 2002, but the Hong Kong physician precipitated the global expansion, raising concerns that the upcoming Hajj in Saudi Arabia may pose a significant world health risk.

Release of the sequences from the labs in the Netherlands and UK would be useful.

[dothedd]

Saudi Arabia SARS-CoV Cluster Raises Concerns
Recombinomics Commentary 11:45
September 25, 2012

The first case was confirmed in a patient in Saudi Arabia who has since died in Saudi Arabia.

The second case was confirmed in a patient from Qatar who had recently travelled to Saudi Arabia. This patient acquired their infection in the Middle East and had the infection diagnosed after travelling to London.

A further small number of possible cases are also being investigated.

The above comments from the UK Health Protection Agency press reelase raise concerns that the number of SARS-CoV cases is significantly higher than the two confirmed cases (60M and 49M), which were infected by a novel SARS-CoV “closely related to bat cornonavires” which are the natural reservoir for the 2002/2003 SARS-CoV identified in mainland China, which then spread to Hong Kong, Singapore, Vietnam, and Canada from a physician who treated patients in Guangdong Province ands then traveled to Hong Kong for a wedding.

The differences between the latest SARS-CoV and the earlier SARS-CoV remain unclear. The recent cases had renal failure, which was not seen in the 2002/2003 cases, but severe/fatal disease in older patients has been seen in both groups of cases.

Currently, there are only two confirmed cases, and it remains unclear if the additional fatal case represents a third case or is the first case counted twice (when the case was first noted in Saudi Arabia and then confirmed in the Netherlands), or represents a second fatal case. Similarly, detail on the above “small number of possible cases” has not been released.

The two confirmed cases have raise awareness and more confirmed cases are expected. Detail on the cases under investigation, as well as release of the sequences (full or partial) from the two confirmed cases, would be useful.

[dothedd]

Saudi Arabia SARS-CoV Case Fatality Rate Raises Concerns
Recombinomics Commentary 13:00
September 25, 2012

We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past three months, one of whom was treated in the UK but has since died.

The above comments from the UK Health Protection Agency increases concerns based on a high case fatality rate (CFR) for the novel SARS-CoV confirmed in two cases (60M and 49M). Although the above fatal case has not been SARS-CoV confirmed, the similarity with the current case (infected in the Middle East and flown to the UK for treatment) raises concerns that the above fatal case and the current critical case may be related.

The index case (60M) showed symptoms three months ago and died in Saudi Arabia, but the critical case is much more current (developed symptoms in Qatar on September 3 after travel to Saudi Arabia) and the disease onset dates for the “other cases of serious respiratory illness in the Middle East” has not been released. However, confirmation of SARS-CoV in the above fatal case would produce a CFR of 67%, which would be a significant concern.

More detail on the above fatal case, as well as the additional cases under investigation, (including, symptoms, disease onset dates, and locations) would be useful.

[dothedd]

Acute Renal Impairment In 2003 SARS-CoV Cases
Recombinomics Commentary 20:30
September 25, 2012

Haertl stressed that the coronavirus family also includes other viruses, including the common cold, and insisted the new virus was not SARS.
“This is not SARS, it will not become SARS, and it is not SARS-like,'' he said, pointing out that what sets the new virus apart was that it caused rapid kidney failure.

RESULTS: Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days)

The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001).

CONCLUSION: Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.

The above WHO comments (in red) comparing the clinical presentation of the SARS-CoV-like cases in Saudi Arabia / Qatar with SARS-CoV cases in 2003 are directly contradicted by actual data from cases infected with SARS-CoV in 2003 (in blue). The blue quotes are from an abstract of a paper entitled “Acute renal impairment in coronavirus-associated severe acute respiratory syndrome” which notes that about 6% of SARS cases developed acute renal impairment, and had a mortality rate above 90%.

Thus far in 2012 there have only been two confirmed SARS-CoV-like cases. One (60M) was fatal, while the other (47M) is in critical condition and on an ECMO machine. Since these two cases were identified about 3 months apart, and the associated CoV is virtually identical, it is likely that there are a large number of undetected cases, and the two confirmed cases may be among the severe cases which constitute a minority of SARS-CoV-like cases, as was seen in 2003.

Thus, the WHO claim that rapid kidney failure distinguishes the 2012 cases from the 2003 SARS-CoV cases is without scientific basis and is directly contradicted by published data.

Similarly, WHO has noted that the current CoV is not SARS-CoV, while the physician who identified the index case has indicated the sequence from the index case is closely related to bat CoVs, which is also true for the SARS-CoV from 2003.

Therefore, release of sequences from the 2012 cases is critical for independent confirmation of WHO statements on this SARS-CoV-like outbreak, which have a significant credibility problem.

[dothedd]

Acute Renal Failure In 2003 Probable SARS-CoV Cases
Recombinomics Commentary 22:15
September 25, 2012

He is now in a critical condition at Guy's and St Thomas' hospital in London.

"The patient, who has been isolated, is receiving extracorporeal membrane oxygenation (Ecmo) treatment, which delivers oxygen to the blood outside the body when the lungs are not able to," the hospital said in a statement.

Britain's Health Protection Agency also said the virus was from the same family as SARS but said it was different to any previously identified in humans, adding that it caused "acute respiratory illness".

WHO spokesman Gregory Haertl stressed that the new virus was not SARS itself, pointing out that what sets the new virus apart was that it caused rapid kidney failure.

Severe acute respiratory syndrome (SARS) is caused by a new coronavirus, and results in respiratory failure. Acute renal failure (ARF) may also occur and/or complicate the disease course

RESULTS: Patients were assigned to ARF (n = 13; 17%) and non-ARF groups (n = 65).

CONCLUSIONS: Development of ARF during the disease course in SARS patients is associated with catastrophic outcome.

The above comments (in red) describe the current Qatar case which is in critical condition in London and on an ECMO machine. The UK HPA has acknowledged that the coronavirus (CoV) belonged to the same family as the novel SARS CoV which caused the SARS cases reported in 2003. However, WHO has noted that the 2012 cases had rapid kidney (renal) failure.

In Taiwan, a sub-set of the confirmed or probable (those who died with SARS symptoms but were cremeated prior to sample collection) SARS cases developed acute renal failure, which were described in the above paper entitled “Acute renal failure in patients with severe acute respiratory syndrome”, which agreed (see above comments in blue) with a similar paper on 2003 SARS cases in Hong Kong. Both studies noted that a subset of SARS cases developed rapid kidney failure which was linked to a fatal outcome.

It is likely that the two confirmed 2012 SARS CoV-like cases represent a small subset of cases which are fatal or severe and are linked to rapid kidney failure, which was observed in 2003 SARS cases, such as the reported examples in Taiwan or Hong Kong.

Qatari with SARS-like virus on artificial lung: UK hospital September 25, 2012 in Diseases, Conditions, Syndromes


Qatari with SARS-like virus on artificial lung: UK hospital September 25, 2012 in Diseases, Conditions, Syndromes A Qatari man suffering from a mystery respiratory virus from the same family as the deadly disease SARS is on an artificial lung to keep him alive, a British hospital said Tuesday. Read more at: medicalxpress.com/news/2012-09-qatari-sars-like-virus-artificial-lung.html#jCp
Read more at: medicalxpress.com/news/2012-09-qatari-sars-like-virus-artificial-lung.html#jCp

[dothedd]

Saudi Arabia SARS-CoV Case Fatality Rate Raises Concerns
Recombinomics Commentary 13:00
September 25, 2012

We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past three months, one of whom was treated in the UK but has since died.

The above comments from the UK Health Protection Agency increases concerns based on a high case fatality rate (CFR) for the novel SARS-CoV confirmed in two cases (60M and 49M). Although the above fatal case has not been SARS-CoV confirmed, the similarity with the current case (infected in the Middle East and flown to the UK for treatment) raises concerns that the above fatal case and the current critical case may be related.

The index case (60M) showed symptoms three months ago and died in Saudi Arabia, but the critical case is much more current (developed symptoms in Qatar on September 3 after travel to Saudi Arabia) and the disease onset dates for the “other cases of serious respiratory illness in the Middle East” has not been released. However, confirmation of SARS-CoV in the above fatal case would produce a CFR of 67%, which would be a significant concern.

More detail on the above fatal case, as well as the additional cases under investigation, (including, symptoms, disease onset dates, and locations) would be useful.

[dothedd]

London1 Novel CoV 2012 nsp12 Coronavirus Sequence
Recombinomics Commentary 01:00
September 26, 2012

NOTE: Graph
www.recombinomics.com/News/09261201/London1_CoV_Novel.html


The above phylogenetic tree (generated by the UK Health Protection Agency - HPA) is of the partial sequence from the coronavirus polymerase gene (nsp12) from the Qatar case (49M) demonstrates the novel aspect of this cornonavirus (CoV). The HPA used a 208 base pair fragment representing positions 15303-15510 of the closet match, Bat coronovirus HKU5-5, sequenced by researchers at The University of Hong Kong from an isolate from Guangdong Province. The fragment had 35 differences (83% identity), in contrast to the Netherlands sequence from the index case (60M who died in Saudi Arabia), which had 1 difference (99.5% identity).

Thus, the coronavirus is clearly novel and does not match any public coronavirus sequence.

The HPA is to be commended for the rapid release of this important sequence.

[dothedd]

Five Suspect London1 Coronavirus Cases In Denmark
Recombinomics Commentary 13:00
September 26, 2012

Jens Peter Shen says that the two people independently had been visiting the Middle Eastern countries.

One of the hospitalized are in their late 20s and the other in the late 30s.

The hospitalized man's family has also been hospitalized. It is about a woman and two children. A total of five people that is in the hospital.

The above translation describes 5 patients in Denmark who have influenza-like symptoms linked to visits to Qatar and Saudi Arabia (three of the five are family members of one of the two travelers). These are milder cases, which were expected.

The two confirmed patients had renal failure, which was also seen in a small portion (about 6%) of SARS-CoV cases in 2003. Renal failure correlated with a poor prognosis, which is the case for the two confirmed cases in 2012 (one, 60M, died in Saudi Arabia, while the other, 49M, is in critical condition and on an ECMO machine).

The sequence from the Qatar case (London1) is novel and in group 2c (SARS-CoV is in group 2b) and is most closely related to a series of Bat coronavirus HKU-5 and HKU-4 isolates from Guangdong Province in China, which are rapidly evolving via natural homologous recombination.

The 208 BP fragment of the nsp12 polymerase gene is 99.5% identical to the corresponding region in the sequence from the index case (60M), signaling the emergence of a novel cornovirus in humans.

Results on the testing of the five suspect cases are expected later today.

[dothedd]

Human Betacoronavirus 2c EMC/12 - Human SARS CoV Match
Recombinomics Commentary 20:30
September 28, 2012

The Ron Fouchier Viroscience lab at the Erasmus Medical Centef has released the complete sequence (30118 BP) of an isolate, Human betacoronavirus 2c EMC/2012, from the recent fatal case (60M) from Saudi Arabia (at Genbank). The lab is to be congratulated for its rapid release of this important sequence.

Earlier the Health Protection agency had released a 208 BP fragment from a case from Qatar (47M requiring an ECO machine for breathing), which was 99.5% identical to the above sequence, confirming the emergence of a novel human cornavirus from group 2c, which was most closely related to bat coronavirus sequences from isolates from Guangdong Province. The full sequence was also most closely related to these group 2c bat isolates, which is incorporated in the name assigned to the isolate by the Fouchier lab.

The group 2c coronaviruses are distinct for the human SARS CoV, which maps to group 2b. However, coronavirus rapidly evolve via homologous recombination and portions of genes show regions of identity of high homology with coronavirus segments from other species or phylogenetic groups.

An example of this type of homology is seen for positions 14628-14656 which match to the polymerase gene in pp1a, where 28 of the 29 positions match human SARS CoV (see list here).

Correction: The above match is with human HKU-1, which is from group 2a. Example with human SARS Cov (group 2b) here (24/25 matches at positions 15475-15499).

The rapid evolution via recombination with sequence present in human SARS CoV raise concerns of human adaptation and species jumping of a novel coronavirus which produces severe and fatal disease in humans.

[dothedd]

Hong Kong (CNN) -- In the 2011 suspense movie "Contagion," Gwyneth Paltrow's globe-trotting character dies from a virus that stirred up our memories -- and fears -- of SARS, the respiratory epidemic from China that killed several hundred people around the world in 2003.

Paltrow played Patient Zero, a woman who travels through Hong Kong -- where we were treated to scenes of Kowloon, by some accounts the densest concentration of human life on the planet -- from where she boards a plane and subsequently spreads the deadly virus around the world.

While the movie was fiction, SARS was very real. It made us feel nervous, vulnerable and afraid.

But it also made us learn.

Exactly one decade after SARS hit, is the travel world ready if a similar epidemic -- a SARS 2.0 -- were to break out?
New SARS-like virus a medical mystery
The spread of coronavirus in UK
Hong Kong's 2003 SARS crisis Hong Kong's 2003 SARS crisis

Experts in the aviation, hotel and health industries agree we're now much better prepared than before to deal with such a potential calamity.
SARS -- what have we learned? SARS -- what have we learned?

But some still prefer to avoid publicly addressing the issue.

Here are five of the most important lessons we've learned about handling global epidemics, ten years on.

1. SARS helped the world realize we needed a global plan

"The most important change has been the adoption of the International Health Regulations in 2005," says Dr. Isabelle Nuttall, World Health Organization Director for the Global Capacities Alert and Response Department in Geneva, Switzerland.

The IHR, as Nuttall describes, is basically one massive global plan that maps an emergency response effort if a health emergency -- such as SARS -- strikes. At present, 194 states and territories have signed the legally binding agreement.

Ten years ago, a plan like this simply didn't exist.

"During SARS everything had to be invented," says Nuttall. "It was the first time we were dealing with such a disease, such an international threat. We had to mount new networks of clinicians and laboratories."

And there was no obligation to report anything quickly -- as the world learned from a secretive China in April 2003.

On one Saturday that month, health authorities in Beijing claimed just 37 confirmed SARS cases existed in the capital. One day later, Beijing revealed 346 confirmed cases with another 402 suspected.

The international community condemned China for withholding vital information.

Ten years later, the IHR now gives the World Health Organization "probing powers" into any signatory country to check in and make sure everything is okay. Countries are legally bound to report all they know.

READ: How SARS brought Hong Kong to its knees

2. SARS helped us be more alert with technology and training

While NORAD, North American Aerospace Defense Command, tracks airspace over the United States and Canada for potential threats, the World Health Organization boasts its own global watch system for brewing health crises.

Like a global plan, the capability for high-tech tracking also didn't exist ten years ago.

"We now have a system that is constantly screening the web 24/7 for information and rumors," says the WHO's Nuttal. "We analyze them -- and some turn out to be false. However, every single piece of information is touching our attention and bringing the information to a team of people."

While the World Health Organization has an army of 8,000 health and safety officials, the Kowloon Shangri-La in Hong Kong has an 800-person trained team of employees that both welcome and watch hotel guests.

"We always want to be alert, but we certainly don't want to be alarming," says Linda Wan, resident manager at the Kowloon Shangri-La.

The 20-year industry veteran, who moved from the United States to Hong Kong last year, has an old 2003 emergency SARS manual sitting on her desk. That has evolved into a general emergency response manual that the Shangri-La uses to train staff.

Employees are taught to sanitize public areas -- elevator buttons, escalator rails, door knobs and restroom doors -- every hour or based on foot traffic frequency.

In guest rooms, housekeeping disinfects frequently touched items with special focus on remote controls, light switches and bathrooms.

"If a guest is ill we may refer them to a nearby clinic and notify proper authorities of any heightened concern," says Wan.

Even before hotel guests check in, thermal imaging technology at major airports serves as an earlier field of defense against visitors arriving with a fever.

The closer your image is to the red side of the visible light spectrum, the warmer you are. Too warm and you get a visit to the quarantine room for questioning and a potential sick bed.

3. SARS taught us to appreciate breathing in deeply

You board your plane, amble down the aisle, spot your seat and then ... mentally cringe: your red-nosed neighbor for the next several hours is coughing and sneezing into already-moist tissues.

If air purity is a factor in which airplane you fly, the Boeing Dreamliner (battery problems notwithstanding) is best, according to Tom Ballantyne, the Sydney-based chief correspondent for Orient Aviation.

The two-decade aviation expert says the Dreamliner's technologically advanced systems mean its air is the best-filtered in the skies.

Another benefit of the state of the art system is a difference in cabin pressure. While other airplanes are pressurized at about 8,000 feet in altitude, the new Dreamliners are pressurized at 5,000 feet, "so it's a much more pleasant atmosphere."

Higher humidity levels also keep that dry cottonmouth feeling at bay.

The newer Boeing 777's and the latest versions of the Airbus A350 and A320 Neo also have well filtered air, adds Ballantyne.

"As newer models come out, their internal air purification systems are more advanced."

But the 747-400 sits on the opposite end of the clean air spectrum because it's "a relatively elderly aircraft" that's been in operation for nearly three decades, says Ballantyne.

While Singapore Airlines retired its last 747 passenger jet in April 2012, Hong Kong-based Cathay Pacific still has 18 in its fleet, United Continental operates 23 and British Airways boasts to be "the world's largest operator of the Boeing 747-400" -- with 57 aircraft.

READ: Hong Kong housing estate became 'ground zero'

4. SARS taught airlines to be financially more resilient

Between 2001 and 2005, an average of more than one major U.S. airline filed for Chapter 11 bankruptcy protection each year: TWA (2001), US Airways (2002) , United Airlines (2002) , US Airways again (2004) and both Northwest Airlines (2005) and Delta (2005) on the same day in a coincidence in timing.

But from 2006 onward, just one major U.S. airline filed for bankruptcy protection -- American Airlines in 2011.

The reason is that catastrophic events, such as 9/11 and SARS, taught airlines an important lesson.

When people stopped flying, "airlines recognized the thing that gets them into real trouble is running out of cash," says Paul Sheridan, head of consultancy Asia at Hong Kong-based Ascend. Airlines learned to "make sure they have enough cash flow" to weather turbulent times.

"Over the last five years, we've seen oil prices hit 150 bucks a barrel, swine flu and a volcanic ash cloud" that all impacted air passenger numbers, says Sheridan.

"The industry has had plenty of practice and (now keeps) more cash on hand. It's a pretty wide range for liquidity, but perhaps it's 10 percent of revenue, maybe a bit higher."

If it hadn't been for 9/11 and SARS, "a lot of airlines would have been bankrupt now if you threw the same issues over the last five years at them."

5. SARS -- and other big, bad diseases -- still scare us

Sometimes what we learn isn't through what is said, but through what is not.

Although SARS occurred a decade ago, an inordinate number of people and businesses declined comment for this article -- including all four international airports in the SARS hub cities of Hong Kong, Beijing, Singapore and Toronto.

"The responsible person has a very full schedule recently -- sorry," texted Hong Kong Airport Authority spokeswoman Chris Lam.

"This is something that we'd rather not revisit at this point in time," e-mailed Robin Goh, assistant vice president of corporate communications at Singapore's Changi Airport Group.

Beijing Capital Airport authorities told CNN it would take "several days to look at an application" for an interview after having been closed the entire week prior for Chinese New Year.

Toronto Pearson never replied to e-mailed interview requests.

"I don't know why (they would not talk) to tell you the truth," said Ballantyne of Orient Aviation. "I could understand the trouble with Beijing and bureaucracy, but I would have expected Singapore and Hong Kong to be willing to talk about it. You fly to Singapore and you can still see the signs and huge thermal imaging cameras. I'd be happy to say 'We've got these things.'"

In the hotel industry, similar caution appeared to exist.

Hong Kong's Kowloon Metropark (formerly the Metropole), the Hong Kong hotel that had the first reported SARS case in the city, declined an interview request.

"I'm sorry we do not want to put out any comments on the SARS issue because we want to look forward," said Anita Kwan, public relations manager at the Metropark Hotel in Kowloon. "I have spoken to the boss."

The Hong Kong Four Seasons, arguably the city's top hotel, also declined to discuss any precautions and response procedures it had in place.

"Feburary is our peak season and we are too busy to arrange any interview at this moment," said Angela Wong, the Four Seasons public relations manager.

And international airlines including Singapore Airlines, Cathay Pacific and Emirates Airlines all either stopped communicating, only released statements or declined interview requests through their public relations agency.

The lessons learned 10 years later? We have a global response plan and advanced technology for disease tracking. And we have better training for hygiene and healthier airline financial strategies.

Yet while we're much better prepared, SARS still scares us ... sometimes into silence.

[dothedd]

Novel coronavirus infection - from SARS to SARI

19.02.2013 19:41

Twelve cases, six deaths, no cure, a new deadly viral infection, fifty per cent mortality rate. It is lethal, it is unknown in humans, it can be transmitted from human to human, the mechanism is a mystery and it is spreading. On Sunday a patient admitted to hospital in the United Kingdom died of NCoV - Novel Coronavirus.

The scientific community is facing its worst nightmare: a pathogenic virus with the capacity to make a species jump and then become transmissible from human to human. It is called NCoV, or Novel coronavirus.

First appearing in 2012, Novel Coronavirus is a new strain of the Coronavirus which causes a number of infections to humans and animals, the most common of which is the common cold. It also causes more pathogenic diseases such as SARS (Severe Acute Respiratory Syndrome).

The World Health Organization states that there have been twelve reported cases of Novel Coronavirus infection, occasioning SARI (Severe Acute Respiratory Infection), kidney failure, pericarditis and disseminated intravascular coagulation, depending on the case. These cases were distributed as follows: 2 cases in Qatar, 5 in Saudi Arabia, 2 in Jordan, 3 in the UK. Six of these twelve patients have died.

Are there more cases?

How are these things documented? The WHO has claimed that there were two initial cases in Saudi Arabia, one of whom died, and they were unrelated since the victims came from different parts of the country. Then there was a cluster of three cases in the same family (2 died) but another family member living in the same house who developed similar symptoms does not count because he tested negative by Polymerase Chain reaction tests.

Both cases in Jordan died, the two from Qatar survived, one of the three in the UK has died (this was a cluster from the same family).

But what about, in the WHO's own report, "the number of health care workers with pneumonia associated with the cases...now considered probable case(s)"?

They don't count either. And those in Norway? Why have they "disappeared" from the media?

The WHO admits that the appearance of pneumonia among healthcare workers and family members "increases the suspicion that person-to-person transmission may have occurred". In the WHO's own reaction to the recent cases in the UK, this is more than confirmed: "The United Kingdom (UK) has informed WHO of another confirmed case of infection with the novel coronavirus (NCoV). This is the third case confirmed in the country this month and is in the same family cluster as the two recently confirmed cases. The latest confirmed case does not have recent travel history outside the UK".

The Novel Coronavirus is sufficiently serious to have the WHO instructing the affected countries to test for new cases and have enhanced surveillance measures and communication with neighbouring countries. With significant numbers of people travelling to the area for different reasons, watch out for the next pandemic.

Sources: WHO

Department of Communicable Disease Surveillance and Response, Global Influenza Programme

[dothedd]

WHO confirms 15th case of deadly new virusin Saudi Arabia

By Kate Kelland | Reuters – Tue, Mar 12,2013

news.yahoo.com/confirms-15th-case-deadly-virus-saudi-arabia-005137922.html

Emirati man dies of SARS-linked virus in Gemany

18 hrs ago (3/26/13)
news.yahoo.com/emirati-man-dies-sars-linked-virus-germany-193351228.html

[dothedd]

Panic grips Saudis amid fears of SARS-like virus May 13, 2013

Panic gripped Saudis in the country's east on Monday, where most cases of the deadly Coronavirus have been detected, witnesses said, as the death toll from the SARS-like virus in the kingdom hit 15.

Scores of people have reported to the emergency services at hospitals in the city of Al-Ahsa in Eastern Province, after showing even the slightest signs of a fever. "I felt the symptoms of a cold, accompanied by a fever," a young man told AFP by telephone from one hospital where he was admitted and placed in quarantine. "I came to hospital. The symptoms disappeared by the end of the day, but I am still kept in a quarantine with other patients, which scares me," he said, asking to remain anonymous. All cases admitted to hospitals in Al-Ahsa region have been placed in isolation, Saudi authorities said. Fifteen of the 24 people who have contracted the Coronavirus in Saudi Arabia Since August have died, the kingdom's health minister Abdullah al-Rabia said on Sunday. A total of 13 cases have been detected in the King Fahd hospital, in Al-Ahsa. The minister said on Sunday that three new suspected cases had been identified. In all, 34 cases have been reported worldwide since the virus was first detected in September 2012, with 18 of the victims dying, according to the World Heath Organisation. While the virus has been deadliest in Saudi Arabia, cases have also been reported in Jordan, Germany, Britain and France where two patients are now in hospital in the northern city of Lille. The virus is a cousin of Severe Acute Respiratory Syndrome (SARS), which triggered a scare 10 years ago when it erupted in east Asia, leaping to humans from animal hosts and eventually killing some 800 people. "I did not send my son to school because of the fear of the spread of the virus," said a mother, while authorities ordered schools to isolate suspected cases of infection immediately. Keiji Fakuda, WHO's assistant director general for health security and environment, told a Riyadh news conference on Sunday the new virus posed an "important and major challenge" for countries affected and for the world generally.