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SARS Epidemic in the Press LETTERS SARS Epidemic in these peaks were identified by deter- on airport measures, increased quar- mining the most frequently covered antine measures in China, and the the Press topics, specifically: the death of Carlo identification of the civet cat as a To the Editor: On March 12 2003, Urbani, the Italian WHO officer who probable source of SARS-CoV. the World Health Organization identified the disease in Hanoi; the Coverage tended to be greater on (WHO) issued a global alert regarding first two probable cases in Italy; the weekends, probably because political severe acute respiratory syndrome death of a suspected case in Naples; stories constitute less competition for (SARS) in Vietnam, Hong Kong, and and the press conference announcing space on these days. China’s Guangdong Province. Three the first meeting of the Italian Evidently, the daily newspaper days later, for the first time in its his- National Task Force. The highest peak coverage of SARS has been quite tory, WHO recommended postponing occurred on April 23, after the extensive in Italy, especially in the nonessential travel to the affected announcement that the number of aftermath of WHO alerts and state- areas and screening airline passengers cases had reached 4,000 and that a ments by the Ministry of Health (1). These initiatives, together with vaccine would not be available any- regarding new cases and more strin- the awareness of the modes transmis- time soon. In the days after the peak, gent control measures. During out- sion of the coronavirus associated coverage remained quite high, in breaks of infections, both the media with SARS (SARS-CoV), led to association with the definition of and the public are often criticized for extensive press coverage. SARS as a “global threat” by WHO overreacting, yet public concern over To describe the extent of this cov- and the twofold increase in the num- serious health hazards is essential in erage in Italy and to identify the ber of probable cases in Italy. The guiding prevention activities (3–5) events that prompted peak coverage, high press coverage was followed by and in deciding whether to adopt we reviewed the five Italian daily an overall decrease, although small measures that could place restrictions newspapers with the highest circula- peaks occurred in association with the on civil rights, such as quarantine (6). tion (2) from March 12 to March 30. conflicts among European Ministries Although we did not evaluate the The articles were identified by hand search (reading headlines, subheads, and titles) and were classified accord- ing to the publication date and page number. We assigned one point to full articles and to front-page articles or headlines and half a point to short arti- cles. We also reviewed all national newspapers for articles published before the travel advisory (March 12–15)(Figure). Before the travel advisory, no arti- cles were published in the five news- papers, whereas on March 14, one article was published in a smaller newspaper (“Osservatore Romano,” the Vatican newspaper). On March 16 (the day after the advisory), six arti- cles appeared in the five newspapers; through May 31, a total of 750 articles were published. The proportion of Figure. Number of articles on SARS published in the five newspapers with the highest articles that appeared on the front- nationwide circulation in Italy, by date of publication; March 15 to May 31, 2003. The white page was 9.6%, although this percent- area of the bars represents the number of articles or headlines appearing on the front age was higher early in the study page. An asterisk indicates days on which newspapers were not published (Easter and (50%) than at the time of absolute May 1). The World Health Organization (WHO) global alert was March 12 and the WHO peak coverage (12%). travel advisory was March 15. a, death of Carlo Urbani; b, first 2 probable cases in Italy; c, task force press conference; d, death of suspected case in Naples; e, WHO warning of After the first wave of articles in “global threat”; f, two-fold increase of probable cases in Italy; g, European conflict on air- mid-March, several peaks occurred port measures; h, increased quarantine measures in China; i, Civet cat identified as prob- until mid-April. The events prompting able source. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 2, February 2004 381 EMERGENCE OF SARS quality of risk-communication of the SARS-associated region. Those teenagers with diarrhea journalists or of the experts quoted in were tested for Norovirus in their the articles, wide press coverage of Coronavirus stool by RT-PCR. For those teenagers the WHO global alert may have con- Infection in with cough, throat swabs were cul- tributed to public-health bodies’ tak- Teenagers tured for influenza and parainfluenza ing action towards containing the epi- virus. demic. To the Editor: A global outbreak To reduce the risk for false-posi- of severe acute respiratory syndrome tive PCR results, we followed meas- Acknowledgments (SARS) was reported in March 2003 ures to avoid contamination during The authors thank Nancy Binkin for (1). Most reported cases were in specimen handling and processing. her advice concerning related literature adults. Hong Kong, however, reported Two primer sets were used for RT- and Mark Kanieff for his editorial assis- 10 pediatric cases (2) with less PCR according to Ksiazek (4) and tance. aggressive clinical courses. Drosten (5). The targets are located in The disease became endemic in the RNA-dependent RNA polymerase Taiwan by the end of April 2003 (3). gene at different regions, which are Giovanni Rezza,* Raffaella Marino,* Hualien City, a geographically seclud- Francesca Farchi,* separated by approximately 3,000 bp. ed city in eastern Taiwan, had nine The laboratory used in RT-PCR analy- and Mirella Taranto* pediatric cases, all mild. The cases *Istituto Superiore di Sanità, Rome, Italy sis is not involved in viral culture or occurred in Tzu-Chi High School, a extraction preparation and is located private boarding school for 830 stu- far away from the laboratory for RNA dents 12 to 18 years of age, all of References extraction to avoid contamination. whom live in the same building and Negative-control cDNA was in- 1. World Health Organization. WHO recom- eat daily meals together in the school cluded in each analysis and confirmed mended measures for persons undertaking cafeteria. On April 28, when a student that no contamination had occurred. international travel from areas affected by (case-patient 1) visited the school severe acute respiratory syndrome (SARS) Two operators manipulated RT-PCR Wkly Epidemiol Rec 2003;78:97–9. nurse on the first day that he had a analysis for two specimens from the 2. Prima Communicazione; May 2003. n. 329. fever, an infection specialist from same sample. The specimens were p. 176. affiliated Tzu-Chi Medical Center analyzed in different rooms with inde- 3. Sandman PM, Lanard J. Fear is spreading immediately responded. The special- faster than SARS and so it should! [cited pendent reagents for assurance. Real- April 28, 2003]. Available from: URL: ist discovered that this student’s close time RT-PCR instead of nested RT- www.psandman.com/col/SARS-1/htm friend in the same class (case-patient PCR was used. 4. Covello V, Peters RG, Wojtecki JG, Hyde 2) was already febrile. Case-patient 2, Six schoolmates were positive for RC. Risk communication, the West Nile a Hong Kong resident who leaves virus epidemic, and bioterrorism: respond- SARS-CoV by RT-PCR, confirmed ing to the communication challenge posed Taiwan for Hong Kong every 3 later by DNA sequencing for repli- by the intentional or unintentional release months, had visited Hong Kong twice case. The tested DNA sequence was of a pathogen in an urban setting. J Urban in March and April 2003. Both stu- >99% identical with a published Health 2001:78:382–91. dents were isolated in the hospital on 5. CDCynergy emergency risk communica- SARS-CoV sequence. Norovirus was tion: your guide to effective emergency risk April 28. identified in one teenager’s stool by communication planning. Atlanta, GA: Tzu-Chi Medical Center began a RT-PCR; this virus belonged to U.S. Centers for Disease Control and search for other febrile students. On genogroup I by testing partial cDNA Prevention, 2003. [cited September 25, April 29, seven more schoolmates 2003]. Available from: URL: http: sequence for capsid protein. The test- //www.cdc.gov/communication/emer- were found to have fever >38°C. All ed length was 555 bp, and the virus gency/erc.htm were identified on their first day of was 96% identical to strain KU4aGI. 6. Rezza G. Severe acute respiratory syn- becoming febrile and were immedi- Culture of a throat swab for influenza drome. J Epidemiol Community Health ately isolated in the hospital. All nine 2003;57:643. and parainfluenza virus did not grow schoolmates underwent chest x-ray any virus. Address for correspondence: Giovanni Rezza, examinations and were tested for The initial signs and symptoms of Department of Infectious Diseases, Istituto SARS-associated coronavirus (SARS the nine teenagers were self-reported Superiore di Sanità, Viale Regina Elena 299, -CoV) by reverse transcription–poly- fever (9/9, range 37.8°C–39.4°C), 00161 Rome, Italy; fax (+39) 06 4938 7210; merase chain reaction (RT-PCR) (4) cough (4/9), general malaise (4/9), email: [email protected] and DNA sequencing. The tested diarrhea (4/9), rhinorrhea (3/9), length for SARS-CoV was 340 bp in headache (2/9), chills (2/9), sore the RNA-dependent polymerase throat (2/9), and myalgia (1/9). Cough 382 Emerging Infectious Diseases • www.cdc.gov/eid • Vol.
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