SARS

 

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by acorona virus, called SARS-associated corona virus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.

 

The SARS outbreak of 2003

According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had travelled to other parts of the world with SARS. SARS did not spread more widely in the community in the United States. For an update on SARS cases in the United States and worldwide as of December 2003, see Revised U.S. Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS) and Update on SARS Cases --- United States and Worldwide, December 2003.

 Symptoms of SARS

In general, SARS begins with a high fever (temperature greater than 100.4°F [>38.0°C]). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.

 How SARS spreads
 

The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.

 What does “close contact” mean?

In the context of SARS, close contact means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS. Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within 3 feet, and touching someone directly. Close contact does not include activities like walking by a person or briefly sitting across a waiting room or office.

CDC response to SARS during the 2003 outbreak

CDC worked closely with WHO and other partners in a global effort to address the SARS outbreak of 2003. For its part, CDC took the following actions:

 

- Activated its Emergency Operations Center to provide round-the-clock coordination and response.

- Committed more than 800 medical experts and support staff to work on the SARS response.

- Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.

- Provided assistance to state and local health departments in investigating possible cases of SARS in the United States.

- Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.

- Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.

 What CDC is doing now

CDC continues to work with other federal agencies, state and local health departments, and healthcare organizations to plan for rapid recognition and response if person-to-person transmission of SARS-CoV recurs. CDC has developed recommendations and guidelines to help public health and healthcare officials plan for and respond quickly to the reappearance of SARS in a healthcare facility or community. These are available in the document Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS). CDC provides the latest information on SARS on the SARS website.

New diagnostic test:

April 21, 2003 -- Microbiologists in Hong Kong have developed a simple and rapid non-invasive diagnostic test that can identify the newly discovered corona virus associated with Severe Acute Respiratory Syndrome (SARS).

The test, described in a technical brief online in the journal Clinical Chemistry, is a real-time quantitative assay that can produce results in as little as three to four hours. It can detect the presence of the corona virus in nasal swabs or throat cultures before an antibody response is detectable. Prior to the development of this new rapid test, diagnostic tests for SARS could detect the corona virus antibodies that are produced after infection, which in some cases is within 14 days of illness onset, or as long as 21 days after onset of fever. By contrast, the new test is often positive early in the disease, and the procedure can be completed within a few hours. 

A rapid method of prompt identification of SARS will help contain the spread of the disease and facilitate prompt treatment and improved outcomes.  The scientists in Hong Kong aim to adapt this new test to a high-throughput format as testing of suspected cases is expected to increase rather than decrease with the rapid global spread of this disease.

As of April 19, 2003, a total of 3547 SARS cases with 182 deaths have been reported from 25 countries, including 220 cases in the United States. Asia remains the worst affected area on the globe

Guidance for Persons Who May Have Been Exposed to Severe Acute Respiratory Syndrome (SARS)

The following guidance is intended to help clinicians manage persons (other than healthcare workers or household contacts) who may have been exposed to SARS through travel to an area where SARS cases have been reported or who were identified as a result of a public health investigation. These recommendations are based on the experiences in the United States to date and may be revised as more information becomes available.

 

Persons who may have been exposed to SARS should be vigilant for fever (i.e., measure temperature twice daily) or respiratory symptoms for 10 days following exposure. During this time, in the absence of both fever and respiratory symptoms, persons who may have been exposed to SARS need not limit their activities outside the home and should not be excluded from work, school, out-of-home child care, church, or activities in other public areas. Additional measures, such as active symptom monitoring or home quarantine, may be considered by public health authorities in some circumstances.

 

Clinicians should consult local health authorities for the most current local guidelines on management of contacts.

Exposed persons should notify their healthcare provider immediately if fever OR respiratory symptoms develop.

 

Before arriving at the healthcare setting, exposed persons should notify the healthcare provider of the possible exposure to SARS so that the necessary precautions can be taken to prevent transmission to others in the healthcare setting.

 

Symptomatic persons exposed to SARS should follow the infection control precautions provided in Supplement I, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome.

 

If a person exposed to SARS has symptoms while at work, school, out-of-home child care, church, or other public setting, local public health authorities should be consulted regarding the need for education and follow-up of persons in attendance.