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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 Vie tnam. 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 dur ing contact with others at home is prudent.
Treatment
Because the etiolo gy 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