By the way, the illness now has an official name "ARDS" - Acute Respiratory
Distress Syndrome.
--Yolandra Gomez
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UNEXPLAINED RESPIRATORY DISTRESS SYNDROME
Press Release June 4, 1993
The State of New Mexico Dept. of Health has been informed that preliminary
test results from the Centers for Disease Control indicate the possibility of
a viral agent as the cause for the present outbreak of unexplained respiratory
distress syndrome. It may be spread through aerosolized rodent excrement
(feces and urine). e.g. field mice, prairie dogs.
These results have been reported to be positive on three specimens from
patients who had met the case definition of the current syndrome under
investigation.
The Department of Health wishes to stress that these *findings are extremely
preliminary and we await further confirmation.*
While further tests are being performed, the attached recommendations for
prevention of illness have been suggested.
(I left these out, since they are rather lengthy--if anyone really wants
to see them let me know and I'll send them to you. Yolandra)
Further information will be forthcoming and released throughout the weekend.
The State of New Mexico Dept of Health and the Dept of Environment are
continuing to coordinate this investigation with the Centers for Disease
Control, the Navajo Nation, the Indian Health Service, the Scientific
Laboratory, and the University of New Mexico Hospital and Medical Center.
Public information numbers are 1-800-879-3421, (505) 827-2393 and
(505) 827-2619. Press information can be obtained on (505) 827-2616.
Newly reported cases in other states may be reported to the Centers for
Disease Control at 404-639-3159.
Inquiries regarding Arizona cases are asked to call (602) 230-5932.
PRESS RELEASE June 7, 1993
I. Cases - 13 cases in NM with onset of disease on or after Jan. 1, 1993.
Arizona has also reported cases. The number of deaths is now at 7. The
reason count has changed is due to more precise definition on 5/30/93.
Some cases have been determined to have other diseases, while several
cases have been added. No deaths have occurred since Saturday, May 29, 1993.
Of 13 cases, 8 are Native American, 5 are Anglo. 7 are female and 6 are
male. 4 cases have recovered and been discharged. In NM, 1 case is
currently hospitalized. Of deaths, 5 are NA, 3 are Anglo. 4 females and
3 males. The age range in cases is 13 years to 87 years.
II. Case Presentation - Typically, cases have had a non-specific prodrome
consisting of fever and muscle aches, and at least one of cough, headache
and/or conjunctivitis. Having these symptoms does not mean that a person
has the disease, since these symptoms also are part of many other, usually
mild, diseases. Those who have the disease develop an acute onset of
difficulty breathing (dyspnea) which progressively gets worse. The majority
of cases have needed mechanical ventilation. Some have recovered, while
others have died despite mechanical ventilation.
III. Cause - There is now preliminary evidence from several patients that
the disease is caused by an unusual virus called a hantavirus. Further
tests are underway on other patients and more specific confirmatory tests
are being done to confirm these preliminary results. Even if confirmed, these
results seem to indicate that this is probably a new virus or at least a
variant of a known virus.
This virus is a virus that is carried by mice or rats. Exactly which kind
of mouse or rat is not known at this time. Experts from the Centers for
Disease Control and Prevention are now in NM to trap rodents and send samples
to the CDC lab in Atlanta to determine which kind of rodents are
carriers of this virus.
It is probably that this is not a new disease. It is more likely that the
disease has been in the rodent populations for many years, but previously
caused so few deaths that the cause remained unknown.
IV. Transmission - The disease can be spread from rodents to people. The
virus is in the rodent's urine and possibly saliva and feces. The virus
becomes airborne through misting of the urine or dust from feces or nexts.
Other viruses of this type are not spread from one person to another. There
has been no spread to either family or health care worker contacts.
V. Prevention - The disease can be prevented by avoiding contact with mice,
field mice and packrats, and avoiding contact with their urine and droppings
unless special precautions are taken. These precautions are outlined on
the attached sheet, "Preliminary Recommendations for Rodent Control" dated
June 5, 1993. i
VI. Treatment - Recommendations have been developed by the work group and
have been faxed to health care facilities and physicians in the
northwestern quadrant of NM, and are being mailed to the rest of the state.
Physicians or faciliites may request this information by contacting the
Division of Epidemiology, Evaluation and Planning at 505-827-0006.
Persons who live or have spent extensive time in Northwestern NM or who
have had close contact with a case of acute respiratory distress, should see
a physician if they develop fever and muscle aches. Diagnostic and treatment
recommendations for both the prodrome and the full-blown disease have been
sent to physicians. Infectious Disease physicians are closely involved with
ongoing development and updating of diagnostic and treatment recommendations.
VII. Coordination of Effort - Close cooperation has developed and continues
between all agencies in the area.
1. Navajo Nation
2. New Mexico Department of Health
3. Indian Health Service
4. University of New Mexico School of Medicine
5. University Hospital
6. Office of the Medical Investigator
7. Centers for Disease Control and Prevention
8. Arizona Department of Health Services
VIII. Common Questions.
Q. Is it safe to travel to the area?
A. Yes. There are no travel restrictions. Persons are advised to avoid
contact with rodents as outlined above.
Q. What about health care workers?
A. No health care worker who has worked with the cases have become ill with
this disease or with other viruses of this family of viruses. However,
because of this possible risk, universal precautions, including good
handwashing and eye protection is advised. Specific recommendations and
guidelines are under development.
Q. What are common symptoms?
A. Typically, cases have had a non-specific prodrome consisting of one or
more of: fever, cough, muscle aches (myalgia) and/or conjunctivitis.
Having these symptoms does not mean that a person has this disease, since
these symptoms also are part of many other, usually mild, diseases.
Q. Are the cases confined to Navajos or to the Navajo Nation?
A. No. Two cases have been diagnosed elsewhere; one in Albuquerque and one
in northeastern NM.
IX. Press follow-up
Press communication will be coordinated by the Press secretary, Office of
the Governor, State of New Mexico at 505-827-3035. Fax number is
505-827-3047.
As this investigation could be hindered by persons being reluctant to
participate due to their names being publicized, the investigative team
requests the absolute cooperation and partnership of the press in respecting
the privacy of cases and their families. All press are urged not to use
identifying information in any public release.
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Yolandra Gomez | Business/Urgent: +1 505 277 4462
Dept. of Pediatrics UNM SOM | Fax: +1 505 277 8465
ycgomez@carina.unm.edu | Other: +1 505 256 3089