Immunization Action Coalition and the Hepatitis B Coalition

IAC EXPRESS

Previous issues index

Home page

Issue Number 372            March 17, 2003

CONTENTS OF THIS ISSUE

  1. Severe Acute Respiratory Syndrome (SARS): Interim Information and Recommendations for Health Care Providers

----------------------------------------------------------

Back to Top

(1 of 1)
March 17, 2003
SEVERE ACUTE RESPIRATORY SYNDROME (SARS): INTERIM INFORMATION AND RECOMMENDATIONS FOR HEALTH CARE PROVIDERS

CDC has asked its partners to distribute the following announcement:

***************************

Severe Acute Respiratory Syndrome (SARS): Interim Information and Recommendations for Health Care Providers

3/15/2003 6:00 pm Eastern Standard Time

The Centers for Disease Control and Prevention (CDC) and the World Health Organization have received reports of patients with severe acute respiratory syndrome (SARS) from Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand, and  Vietnam. The cause of these illnesses is unknown and is being investigated. Early manifestations in these patients have included influenza-like symptoms such as fever, myalgias, headache, sore throat,  dry cough, shortness of breath, or difficulty breathing. In some cases these symptoms are followed by hypoxia, pneumonia, and occasionally acute respiratory distress requiring mechanical ventilation and  death. Laboratory findings may include thrombocytopenia and leukopenia. Some close contacts, including healthcare workers, have developed similar illnesses. In response to these developments, CDC is initiating surveillance for cases of SARS among recent travelers or their close contacts.

CASE FINDING
Clinicians should be alert for persons with onset of illness after February 1, 2003 with:

  • Fever (>38° C)
     
    AND
     
  • One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty breathing, hypoxia, radiographic findings of pneumonia, or respiratory distress
     
    AND
     
    One or more of the following:
     
  • History of travel to Hong Kong or Guangdong Province in People's Republic of China, or Hanoi,  Vietnam, within seven days of symptom onset
     
  • Close contact with persons with respiratory illness having the above travel history. Close contact  includes having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS.

DIAGNOSTIC EVALUATION
Initial diagnostic testing should include chest radiograph, pulse oximetry, blood cultures, sputum Gram's stain and culture, and testing for viral respiratory pathogens, notably influenza A and B and  respiratory syncytial virus. Clinicians should save any available clinical specimens (respiratory, blood, and serum) for additional testing until a specific diagnosis is made. Clinicians should evaluate persons  meeting the above description and, if indicated, admit them to the hospital. Close contacts and healthcare workers should seek medical care for symptoms of respiratory illness.

INFECTION CONTROL
If the patient is admitted to the hospital, clinicians should notify infection control personnel immediately. Until the etiology and route of transmission are known, in addition to standard precautions(1), infection control measures for inpatients should include:

  • Airborne precautions (including an isolation room with negative pressure relative to the surrounding area and use of an N-95 respirator for persons entering the room)
     
  • Contact precautions (including use of gown and gloves for contact with the patient or their environment)

Standard precautions routinely include careful attention to hand hygiene. When caring for patients with SARS, clinicians should wear eye protection for all patient contact.

To minimize the potential of transmission outside the hospital, case patients as described above should limit interactions outside the home until the epidemiology of illness transmission is better understood.  Placing a surgical mask on case patients in ambulatory healthcare settings, during transport, and during contact with others at home is prudent.

TREATMENT
Because the etiology of these illnesses has not yet been determined, no specific treatment recommendations can be made at this time. Empiric therapy should include coverage for organisms associated with any community-acquired pneumonia of unclear etiology, including agents with activity  against both typical and atypical respiratory pathogens(2). Treatment choices may be influenced by severity of the illness. Infectious disease consultation is recommended.

REPORTING
Healthcare providers and public health personnel should report cases of SARS as described above to their state or local health departments.

For more information contact your state or local health department or the CDC Emergency Operations Center, 770-488-7100. Updated information will be available at http://www.cdc.gov

REFERENCES

  1. Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-80, and Am J Infect Control 1996;24:24-52. http://www.cdc.gov/ncidod/hip/ISOLAT/Isolat.htm
     
  2. Bartlett JG, Dowell SF, Mandell LA, File Jr, TM, Musher DM, and Fine MJ. Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2000;31:347-82. http://www.journals.uchicago.edu/CID/journal/issues/v31n2/000441/000441.web.pdf

***************************

Below is a traveler's health alert card that will be distributed to targeted international travelers returning to the U.S.

HEALTH ALERT NOTICE

FOR INTERNATIONAL TRAVELERS ARRIVING IN OR RETURNING TO THE USA FROM HONG KONG AND GUANGDONG PROVINCE, PEOPLE'S REPUBLIC OF CHINA, AND HANOI, VIETNAM

TO THE TRAVELER:
During your recent travel, you may have been exposed to cases of severe acute respiratory disease syndrome. You should monitor your health for at least 7 days. If you become ill with fever accompanied by cough or difficulty in breathing, you should consult a physician. To help your physician make a diagnosis, tell him or her about your recent travel to these regions and whether you were in contact with someone who had these symptoms. Please save this card and give it to your physician if you become ill.

TO THE PHYSICIAN:
The patient presenting this card may have recently traveled to Hong Kong or Guangdong Province in the People's Republic of China or Hanoi, Vietnam, where cases of atypical pneumonia have been identified. If you suspect atypical pneumonia (also being called severe acute respiratory disease syndrome [SARS]), please contact your city, county, or state health officer (see http://www.cdc.gov or call the CDC Emergency Operations Center 770-488-7100).

For public inquiries, call Centers for Disease Control and Prevention (CDC) hotline: English 888-246-2675, Espaņol 888-246-2857, TTY 866-874-2646.   

 

Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: admin@immunize.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131

This page was updated on March 17, 2003