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The classic public health measures of surveillance and quarantine were key components in combating severe acute respiratory syndrome (SARS), a highly infectious new disease that first broke out in southern China in November 2002. Because China did not at first report the disease, it was not recognized as a major threat until March 2003, when the World Health Organization (WHO) issued a global alert and a travel advisory. WHO had been alerted by Dr. Carlo Urbani. Dr. Urbani himself soon contracted the disease and died. Epidemiologic detective work found that patients had all stayed in the same hotel in Hong Kong where a traveler from southern China had spent 1 night before falling ill with the syndrome. More than a dozen guests at the hotel had been infected by that one traveler, and they carried the disease to several other countries. By July 5, 2003, when WHO declared that SARS had been contained, the disease had infected people in 30 countries and had killed 812 people. Although a virus was identified, lab tests could not diagnose the disease until weeks after a patient had developed symptoms. No drug has been found effective against the virus, and treatment requires intensive respiratory therapy. SARS was contained by old-fashioned measures. The epidemic had severe economic impact wherever it broke out. There was concern that the disease would be seasonal and would break out again in 2004, but this did not occur. Since 2004 there have not been any known cases of SARS anywhere in the world.
Rabies, a fatal disease of the nervous system caused by a virus, kills an estimated 55000 people around the world each year, usually contracted through a dog bite. Although there is an effective vaccine against rabies, routine immunization of everyone is not recommended. Human exposure to the rabies virus in this country is relatively rare, and the vaccine is expensive and inconvenient to deliver. The rabies virus infects only mammals, and it is almost always transmitted when a rabid animal bites another animal or a human. Since the animal most likely to bite a human is the dog, mandatory immunizations of dogs against rabies is the first line of defense in the protection of people. The public health system has defined clear guidelines for responding to a report of a person's being bitten by a domestic or wild animal, depending on the likelihood that the animal is rabid. If the biting animal is wild, or if there is other reason to suspect that it is rabid, it must be killed and its brain tested for signs of rabies virus infection. Rabies virus affects the brain and from there travels to the salivary glands and is secreted in saliva. An animal capable of transmitting the virus in its saliva will already have brain involvement, exhibit symptoms, and be dead within a few days.To control rabies, public health practitioners conduct surveillance for rabies in wildlife. Bats are the most dangerous rabies threats to humans. Even in parts of the country where the disease is not endemic among most wildlife, rabid bats are likely to be found. Because the animals are nocturnal and elusive, contact with bats may go unnoticed. The rabies surveillance system has been remarkably successful. The cost of rabies control is significant, however.