SARS What is SARS Severe Acute

SARS

What is SARS? • Severe Acute Respiratory Syndrome • Respiratory illness • Asia, North America, and Europe • Previously unrecognized coronavirus

Symptoms • Fever of greater than 100. 4 o 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- Co. V antibody less than 21 days after the onset of illness or – Detection of SARS- Co. V RNA using RT-PCR then confirmed using a second PCR assay using separate specimens and primers – Isolation of SARS-Co. V • 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 China 143 5124 23 267 Hong Kong Singapore Thailand 1698 205 8 227 28 2 United States 65 0 Vietnam 5 63

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/