SARS

What is SARS?

• Severe Acute Respiratory Syndrome

• Respiratory illness

• Asia, North America, and Europe

• Previously unrecognized coronavirus

Symptoms

• Fever of greater than 100.4o F

• Cough or difficulty breathing

• Headache

• Body aches

Spread of SARS

• Primary method appears to be close person-to-person contact

• Potentially by fomites, or air-borne routes

Incubation period for SARS

• 2- 7 days

• May be as long as 10 days

Who is at risk?

• Most US cases occur in travelers with history to areas with ongoing transmission

• China, Hong Kong, Singapore, Hanoi • Household contacts of people with SARS• Healthcare workers exposed to SARS

patients

Case Definition

• Clinical Criteria

• Epidemiologic Criteria

• Laboratory Criteria

Clinical Criteria

• Asymptomatic or mild respiratory illness

• Moderate respiratory illness

• Severe respiratory illness• Radiographic evidence of pneumonia OR• Respiratory distress syndrome

Epidemiologic Criteria

• Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or recently documented or suspected community transmission of SARS

• Close contacts within 10 days of onset of symptoms with a person known or suspected to have SARS infection

Laboratory Criteria

• Confirmed– Detection of SARS- CoV antibody less than 21

days after the onset of illness or– Detection of SARS- CoV RNA using RT-PCR then

confirmed using a second PCR assay using separate specimens and primers

– Isolation of SARS-CoV

• Negative– Absence of antibody in convalescent sera obtained

more than 21 days after onset of symptoms.

• Undetermined– laboratory testing not preformed or incomplete

Case Classification

• Probable Case:– meets the clinical criteria for severe respiratory

illness of unknown etiology with onset since 2/13/03 and epidemiologic criteria and laboratory criteria confirmed, negative or undetermined.

• Suspect Case:– meets the clinical criteria for moderate

respiratory illness of unknown etiology with onset since 2/13/03 and epidemiologic criteria and laboratory criteria confirmed, negative, or undetermined.

Treatment of SARS

• Should be similar to that used for patients affected with serious community acquired atypical pneumonia

• Antivirals and steroids have not been tested in clinical trails and their effectiveness is unknown

Mortality of SARS

• As of 5/15/03 8% overall

0 to 50% depending on the age group – Overall 14-15%

Canada: 15-19%

China: 3- 13%

Hong Kong: 11-17%

Singapore: 13-15%

Vietnam: 8%

Travel

• Travel Alert- Informs travelers of a health concern in a particular area

No recommendation against nonessential travel to the area.

Singapore, Hanoi, Toronto (WHO removed Toronto as of 5/14, CDC still lists Toronto as area under Travel alert)

• Travel Advisory- Potentially more serious situation There is a recommendation against nonessential travel to the area

China, Hong Kong, and Taiwan

Quarantine

• CDC quarantine officers are distributing health alert cards to all passengers returning from areas on travel alerts or advisories

• Cards inform travelers about SARS, asked to monitor health for 10 days

• Procedures for airlines and ships

Cumulative # of Reported Probable Cases in Selected Countries

Country Total # of Cases

# of Deaths

Canada 143 23

China 5124 267

Hong Kong 1698 227

Singapore 205 28

Thailand 8 2

United States 65 0

Vietnam 63 5

Michigan cases

• 3 suspect cases as of 5/15/03

• All with travel history to Asia

• All have recovered

Misconceptions

• No reason to believe related to terrorist activities

• Does not appear to be caused by a paramyxovirus

• No travel restrictions, instead travel advisories and alerts

• No evidence of spreading disease within the USA

References

• www.cdc.gov

• www.cdc.gov/mmwr/

• www.who.int/en/