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|Basic Information| |General Information| |Information For Close Contacts of SARS Patients| |Diagnosis/Evaluation| |Treatment|
A New Disease
Called SARS
Severe acute respiratory syndrome (SARS) is a respiratory illness that has
recently been reported in Asia, North America, and Europe. As of April 20, about
198 suspect cases of SARS and 38 probable cases of SARS had been reported in the
United States. This fact sheet provides basic information about the disease and
what is being done to combat its spread.
Symptoms Of SARS
In general, SARS begins with a fever greater than 100.4°F [>38.0°C]. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms. After 2 to 7 days, SARS patients may develop a dry cough and have trouble breathing.
How SARS Spreads
The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or by other ways that are currently not known.
Who is At Risk For SARS
Cases of SARS continue to be reported mainly among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health-care workers who did not use infection control procedures while taking care of a SARS patient. In the United States, there is no indication of community spread at this time.
Possible cause of SARS
Scientists have detected a previously unrecognized coronavirus in patients with SARS. The new coronavirus is the leading hypothesis for the cause of SARS, however, other viruses are still under investigation as potential causes.
RECOMMENDATIONS
The recommendations and guidelines for people who may be affected by this outbreak.
For individuals considering travel to affected parts of Asia:
People planning elective or nonessential travel to mainland China and Hong Kong, Singapore, and Hanoi, Vietnam may wish to postpone their trips until further notice.
For individuals who think they might have SARS:
People with symptoms of SARS (fever greater than 100.4°F [>38.0°C] accompanied by a cough and/or difficulty breathing) should consult a health-care provider. To help the health-care provider make a diagnosis, tell them about any recent travel to places where SARS has been reported or whether there was contact with someone who had these symptoms
For family members caring for someone with SARS:
Interim infection control recommendations for patients with suspected SARS in the household. These basic precautions should be followed for 10 days after respiratory symptoms and fever are gone. During that time, SARS patients are asked to limit interactions outside the home (not go to work, school, or other public areas).
For health-care workers:
Transmission of SARS to health-care workers appears to have occurred after close contact with sick people before recommended infection control precautions were put into use
WHAT IS BEING DONE ABOUT SARS
In a global effort to address the SARS outbreak the following actions have been taken:
Activated its Emergency Operations Center to provide round-the-clock coordination and response.
Committed more than 300 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 ongoing 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.
GENERAL INFORMATION
The Illness
What is SARS?
Severe acute respiratory syndrome (SARS) is a respiratory illness that has
recently been reported in
Asia,
North America, and
Europe.
What are the symptoms and signs of SARS?
The illness usually begins with a fever (measured temperature greater than
100.4°F [>38.0°C]). The fever is sometimes associated with chills or other
symptoms, including headache, general feeling of discomfort and body aches. Some
people also experience mild respiratory symptoms at the outset.
After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that
might be accompanied by or progress to the point where insufficient oxygen is
getting to the blood. In 10 percent to 20 percent of cases, patients will
require mechanical ventilation.
If
I were exposed to SARS, how long would it take for me to become sick?
The incubation period for
SARS is typically 2 to 7 days; however, isolated reports have suggested an
incubation period as long as 10 days. The illness usually begins with a fever
(>100.4°F [>38.0°C]) (see signs and symptoms, above).
What medical treatment is recommended for patients with SARS?
It recommends that patients with SARS receive the same treatment that would be
used for any patient with serious community-acquired atypical pneumonia of
unknown cause.
Is the use of ribavirin (or other
antiviral drugs) effective in the treatment of patients with SARS?
At present, the most efficacious treatment regimen, if any, is unknown. In
several locations, therapy has included antivirals such as oseltamivir or
ribavirin. Steroids also have been given orally or intravenously to patients in
combination with ribavirin and other antimicrobials. In the absence of
controlled clinical trials, however, the efficacy of these regimens remains
unknown. Early information from laboratory experiments suggests that ribavirin
does not inhibit virus growth or cell-to-cell spread of one isolate of the new
coronavirus that was tested. Additional laboratory testing of ribavirin and
other antiviral drugs is being done to see if an effective treatment can be
found.
Spread of SARS
How is SARS spread?
The primary way that SARS appears to spread is by close person-to-person
contact. Most cases of SARS have involved people who cared for or lived with
someone with SARS, or had direct contact with infectious material (for example,
respiratory secretions) from a person who has SARS. Potential ways in which SARS
can be spread include touching the skin of other people or objects that are
contaminated with infectious droplets and then touching your eye(s), nose, or
mouth. This can happen when someone who is sick with SARS coughs or sneezes
droplets onto themselves, other people, or nearby surfaces. It also is possible
that SARS can be spread more broadly through the air or by other ways that are
currently not known.
How long is a person with SARS infectious to others?
Information to date suggests that people are most likely to be infectious when
they have symptoms, such as fever or cough. However, it is not known how long
before or after their symptoms begin that patients with SARS might be able to
transmit the disease to others.
Who is most at risk of contracting SARS?
In the United States,
cases of SARS continue to be reported primarily among people who have had direct
close contact with an infected person, such as those sharing a household with a
SARS patient and health-care workers who did not use infection control
procedures while caring for a SARS patient.
Cause of SARS
What is the cause of SARS?
Scientists at CDC and other
laboratories have detected a previously unrecognized coronavirus in patients
with SARS. This new coronavirus is the leading hypothesis for the cause of SARS,
however, other viruses are still under investigation as potential causes.
What are coronaviruses?
Coronaviruses are a group of
viruses that have a halo or crown-like (corona) appearance when viewed under a
microscope. These viruses are a common cause of mild to moderate
upper-respiratory illness in humans and are associated with respiratory,
gastrointestinal, liver and neurologic disease in animals.
What evidence is there to suggest that coronaviruses may be linked with SARS?
Scientists isolated a virus
from the tissues of two SARS patients and then used several laboratory methods
to characterize it. Examination by electron microscopy revealed that the virus
has the distinctive shape and appearance of coronaviruses, and genetic analysis
suggests that this new virus does belong to the family of coronaviruses but
differs from previously identified family members. Tests of serum specimens from
people with SARS showed that they appeared to have been recently infected with
this virus. Other tests demonstrated that this previously unrecognized
coronavirus was present in a variety of clinical specimens (including specimens
obtained by nose and throat swab) from other SARS patients with direct or
indirect links to the outbreak. These results and other findings reported from
laboratories participating in the World Health Organization (WHO) network
provide growing evidence in support of the hypothesis that this new coronavirus
is the cause of SARS. Additional studies of the link between this coronavirus
and SARS are under way.
If
coronaviruses usually cause mild illness in humans, how could this new
coronavirus be responsible for a potentially life-threatening disease such as
SARS?
There is not enough
information about the new virus to determine the full range of illness that it
might cause. Coronaviruses have occasionally been linked to pneumonia in humans,
especially people with weakened immune systems. The viruses also can cause
severe disease in animals, including cats, dogs, pigs, mice, and birds.
Has new information about coronavirus changed the recommendations for medical
treatment for patients with SARS?
The possibility that
coronavirus is the cause of SARS has not changed treatment recommendations. The
new coronavirus is being tested against various antiviral drugs to see if an
effective treatment can be found.
Is
there a test for SARS?
No "test" is available yet
for SARS. However, CDC, in collaboration with WHO and other laboratories, has
developed 2 research tests that appear to be very promising in detecting
antibodies to the new coronavirus. CDC is working to refine and share this
testing capability as soon as possible with laboratories across the United
States and internationally.
What about reports from other laboratories suggesting that the cause of SARS may
be a paramyxovirus?
Researchers from several
laboratories participating in the WHO network have reported the identification
of a paramyxovirus in clinical specimens from SARS patients. These laboratories
are still investigating the possibility that a paramyxovirus is a cause of SARS.
The Outbreak
What is being doing to combat this health threat?
CDC is working closely with
WHO and other partners as part of a global collaboration to address the SARS
outbreak. For its part in this international effort, CDC has taken the following
actions:
Activated its Emergency Operations Center to provide round-the-clock coordination and response.
Committed more than 300 infectious disease 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 ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.
Issued multiple notices providing guidance on ways to minimize the risk for SARS in health-care facilities, in the household, when traveling, and in other settings.
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.
Travel and Quarantine
What are quarantine officials doing to prevent and control the spread of SARS?
Quarantine inspectors or their designees are distributing health alert cards to
air passengers returning in airplanes either directly or indirectly to the
United States from China, Singapore, and Vietnam. The notices inform travelers
about SARS and its symptoms and asks them to monitor their health for 10 days
and to see a doctor if they get a fever with a cough or have difficulty
breathing. CDC distributes approximately 18,000 health alert notices each day to
air travelers returning from the affected regions at 23 ports of entry.
Inspectors also are boarding airplanes if a traveler has been reported with
symptoms matching the case definition of SARS.
What information about SARS is being
provided to people traveling on ships?
SARS information contained on health alert cards is being provided by the major
shipping associations and the International Council of Cruise Lines to people
traveling on cargo ships and cruise ships at U.S. ports. Inspectors also are
boarding ships if a passenger or crew member has been reported with symptoms
matching the case definition of SARS.
What does a quarantine inspector do?
Quarantine inspectors serve as important guardians of health at borders and
ports of entry into the
United States. They routinely
respond to illness in arriving passengers and ensure that the appropriate
medical action is taken.
What is considered routine health inspections of airplanes or ships versus what
is happening now?
Routine health inspections consist of working with airline, cargo ship, and
cruise ship companies to protect passengers and crew from certain infectious
diseases. Quarantine inspectors meet arriving aircraft and ships reporting ill
passengers and/or crew and assist them in getting appropriate medical treatment.
What is the risk to individuals who may have shared a plane or boat trip with a
suspected SARS patient?
Cases of SARS continue to be reported primarily among people who have had direct
close contact with an infected person, such as those sharing a household with a
SARS patient and health-care workers who did not use infection control
procedures while attending to a SARS patient. SARS also has occurred among air
travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and
mainland China.
Who actually notifies quarantine
officials of potential SARS cases? Is it the crew of the airplane or ship? The
passengers?
Under foreign quarantine regulations, the master of a ship or captain of an
airplane coming into the United States from a foreign port is required by law to
report certain illnesses among passengers. The illness must be reported to the
nearest quarantine official. If possible, the crew of the airplane or ship will
try to relocate the ill passenger or crew member away from others. If the
passenger is only passing through a port of entry on his/her way to another
destination, port health authorities may refer the passenger to a local health
authority for assessment and care.
What does a quarantine official do if a passenger is identified as meeting the
case definition for suspected SARS?
Quarantine officials arrange for appropriate medical assistance to be available
when the airplane lands or the ship docks, including medical isolation.
Isolation is important not only for the sick passenger's comfort and care but
also for the protection of members of the public. Isolation is recommended for
travelers with suspected cases of SARS until appropriate medical treatment can
be provided or until they are no longer infectious.
What does a quarantine official do if a passenger identified as meeting the case
definition for suspected SARS refuses to be isolated?
Many levels of government (Federal, State, and local) have basic authority to
compel isolation of sick persons to protect the public. In the event that it is
necessary to compel isolation of a sick passenger, State and local officials to
ensure that the passenger does not infect others.
Other
Is
there any reason to think SARS is or is not related to terrorism?
Information currently
available about SARS indicates that people who appear to be most at risk are
either health-care workers taking care of sick people or family members or
household contacts of those who are infected with SARS. That pattern of
transmission is what would typically be expected in a contagious respiratory or
flu-like illness.
RECOMMENDATIONS
Personal and Household
What should I do if I think I have SARS?
If you are ill with a fever greater than 100.4°F (>38.0°C) that is accompanied
by a cough or difficulty breathing or that progresses to a cough and/or
difficulty breathing, you should consult a health-care provider. To help your
health-care provider make a diagnosis, tell him or her about any recent travel
to regions where cases of SARS have been reported and whether you were in
contact with someone who had these symptoms.
What has been recommended to prevent transmission of SARS in households?
Interim infection control recommendations for patients with suspected SARS in
the household. The basic precautions outlined in this document include the
following:
Infection control precautions should be continued for SARS patients for 10 days after respiratory symptoms and fever are gone. SARS patients should limit interactions outside the home and should not go to work, school, out-of-home day care, or other public areas during the 10-day period.
During this 10-day period, all members of the household with a SARS patient should carefully follow recommendations for hand hygiene, such as frequent hand washing or the use of alcohol-based hand rubs.
Each patient with SARS should cover his or her mouth and nose with a tissue before sneezing or coughing. If possible, a person recovering from SARS should wear a surgical mask during close contact with uninfected persons. If the patient is unable to wear a surgical mask, other people in the home should wear one when in close contact with the patient.
Disposable gloves should be considered for any contact with body fluids from a SARS patient. However, immediately after activities involving contact with body fluids, gloves should be removed and discarded, and hands should be washed. Gloves should not be washed or reused, and are not intended to replace proper hand hygiene.
SARS patients should avoid sharing eating utensils, towels, and bedding with other members of the household, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
Common household cleaners are sufficient for disinfecting toilets, sinks, and other surfaces touched by patients with SARS, but the cleaners must be used frequently.
Other members of the household need not restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness
Travel and Quarantine
Are there any travel restrictions related to SARS?
At this time there are no travel restrictions in place that are directly related
to SARS. However, a travel advisory recommends that individuals who are planning
nonessential or elective travel to the People’s Republic of
China (i.e., mainland China
and Hong Kong); Hanoi, Vietnam; or Singapore may wish to postpone their trip
until further notice.
What should I do if I have recently traveled to a country where cases of SARS
have been reported?
You should monitor your own health for 10 days following your return. If you
become ill with a fever of more than 100.4°F [>38.0°C] that is accompanied by a
cough or difficulty breathing or that progresses to a cough and/or difficulty
breathing, you should consult a health-care provider. To help your health-care
provider make a diagnosis, tell him or her about any recent travel to regions
where cases of SARS have been reported and whether you were in contact with
someone who had these symptoms.
Information For Close Contacts Of SARS Patients
A
new disease called SARS
Severe acute respiratory syndrome (SARS) is a respiratory illness that has
recently been reported in
Asia,
North America, and
Europe. As of April 14, about 190 suspected cases of SARS
had been reported in the
United States. This fact
sheet describes the disease and important guidelines for preventing the spread
of SARS
Symptoms of SARS
In general, SARS begins with a fever greater than 100.4°F [>38.0°C]. Other
symptoms may include headache, an overall feeling of discomfort, and body aches.
Some people also experience mild respiratory symptoms. After 2 to 7 days, SARS
patients may develop a dry cough and have trouble breathing.
How SARS spreads
The primary way that SARS appears to spread is by close person-to-person
contact. Most cases of SARS have involved people who cared for or lived with
someone with SARS, or had direct contact with infectious material (for example,
respiratory secretions) from a person who has SARS. Potential ways in which SARS
can be spread include touching the skin of other people or objects that are
contaminated with infectious droplets and then touching your eye(s), nose, or
mouth. This can happen when someone who is sick with SARS coughs or sneezes
droplets onto themselves, other people, or nearby surfaces. It also is possible
that SARS can be spread more broadly through the air or by other ways that are
currently not known.
Who is at risk for SARS
Cases of SARS continue to be reported mainly among people who have had direct
close contact with an infected person, such as those sharing a household with a
SARS patient and health care workers who did not use infection control
procedures while taking care of a SARS patient. In the United States, there is
no indication of community spread at this time.
What you should do to protect yourself
Health Authority has issued interim guidelines for patients with suspected SARS
in the health-care setting and in households. These guidelines may change as we
learn more about SARS. If you get sick with the symptoms described above and
have been in close contact with someone who might have SARS, see your health
care provider and follow the guidelines below.
GUIDELINES
If you think you (or someone in your family) might have SARS, you should:
Consult a health care provider as soon as possible.
Cover your mouth and nose with tissue when coughing or sneezing. If you have a surgical mask, wear it during close contact with other people. A mask can reduce the number of droplets coughed into the air.
If you have SARS and are being cared for at home, you should:
Follow the instructions given by your health care provider.
Limit your activities outside the home during this 10-day period. For example, do not go to work, school, or public areas.
Wash your hands often and well, especially after you have blown your nose.
Cover your mouth and nose with tissue when you sneeze or cough.
If possible, wear a surgical mask when around other people in your home. If you can’t wear a mask, the members of your household should wear one when they are around you.
Don’t share silverware, towels, or bedding with anyone in your home until these items have been washed with soap and hot water.
Clean surfaces (counter or tabletops, door knobs, bathroom fixtures, etc.) that have been contaminated by body fluids (sweat, saliva, mucous, or even vomit or urine) from the SARS patient with a household disinfectant used according to the manufacturer’s instructions. Wear disposable gloves during all cleaning activities. Throw these out when you are done. Do not reuse them.
Follow these instructions for 10 days after your fever and respiratory symptoms have gone away.
If you are caring for someone at home who has SARS, you should:
Be sure that the person with SARS has seen a health care provider and is following instructions for medication and care.
Be sure that all members of your household are washing their hands frequently with soap and hot water or using alcohol-based hand wash.
Wear disposable gloves if you have direct contact with body fluids of a SARS patient. However, the wearing of gloves is not a substitute for good hand hygiene. After contact with body fluids of a SARS patient, remove the gloves, throw them out, and wash your hands. Do not wash or reuse the gloves.
Encourage the person with SARS to cover their mouth and nose with a tissue when coughing or sneezing. If possible, the person with SARS should wear a surgical mask during close contact with other people in the home. If the person with SARS cannot wear a surgical mask, other members of the household should wear one when in the room with that person.
Do not use silverware, towels, bedding, clothing, or other items that have been used by the person with SARS until these items have been washed with soap and hot water.
Clean surfaces (counter or tabletops, door knobs, bathroom fixtures, etc.) that have been contaminated by body fluids (sweat, saliva, mucous, or even vomit or urine) with a household disinfectant used according to the manufacturer’s instructions. Wear disposable gloves during all cleaning activities. Throw these out when done. Do not reuse them.
Follow these instructions for 10 days after the sick person’s fever and respiratory symptoms have gone away.
If you develop a fever or respiratory symptoms, contact your health care provider immediately and tell him or her that you have had close contact with a SARS patient.
Initial diagnostic testing for suspected SARS patients 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. A specimen for Legionella and pneumococcal urinary antigen testing should also be considered. Clinicians should save any available clinical specimens (respiratory, blood, and serum) for additional testing until a specific diagnosis is made. Acute and convalescent (greater than 21 days after onset of symptoms) serum samples should be collected from each patient who meets the SARS case definition. Paired sera and other clinical specimens can be forwarded through State and local health departments for testing.
Clinicians evaluating suspected cases should use standard precautions (e.g., hand hygiene) together with airborne (e.g., N-95 respirator) and contact (e.g., gowns and gloves) precautions. Until the mode of transmission has been defined more precisely, eye protection also should be worn for all patient contact. As more clinical and epidemiologic information becomes available, interim recommendations will be updated.
SARS is an infectious illness that appears to spread primarily by close person-to-person contact, such as in situations in which persons have cared for, lived with, or had direct contact with respiratory secretions and/or body fluids of a person known to be a suspect SARS case. Potential ways in which infections can be transmitted by close contact include touching the skin of other persons or objects that become contaminated with infectious droplets and then touching your eyes, nose or mouth.
Workers, who in the last 10 days have traveled to a known SARS area, or have had close contact with a co-worker or family member with suspected or probable SARS could be at increased risk of developing SARS and should be vigilant for the development of fever (greater than 100.4° F) or respiratory symptoms (e.g., cough or difficulty breathing). If these symptoms develop you should not go to work, school, or other public areas but should seek evaluation by a health-care provider and practice infection control precautions recommended for the home or residential setting; be sure to contact your health-care provider beforehand to let them know you may have been exposed to SARS.
As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission.
The routine use of personal protective equipment (PPE) such as respirators, gloves, or, using surgical masks for protection against SARS exposure is currently not recommended in the general workplace (outside the health-care setting).
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.
Clinicians evaluating suspected cases should use standard precautions (e.g., hand hygiene) together with airborne (e.g., N-95 respirator) and contact (e.g., gowns and gloves) precautions. Until the mode of transmission has been defined more precisely, eye protection also should be worn for all patient contact. As more clinical and epidemiologic information becomes available, interim recommendations will be updated.
Satyam Foundation
2275 Huntington Drive, #207
SAN MARINO, CA 91108
USA
Email:
info@satyamfoundation.org
We
acknowledge World Health Organization (WHO) & Centers for Disease Control and
Prevention (CDC) for the information
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