Issue
Number 372
March 17, 2003
CONTENTS OF THIS ISSUE
- Severe Acute Respiratory Syndrome (SARS): Interim Information
and Recommendations for Health Care Providers
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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:
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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
- 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
- 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
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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, Español 888-246-2857,
TTY 866-874-2646.
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