Recombinomics Commentary 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 .  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.