1. SARS

2. What is SARS? Severe Acute Respiratory Syndrome Respiratory illness Asia, North America, and Europe Previously unrecognized coronavirus

3. Symptoms Fever of greater than 100.4 o F Cough or difficulty breathing Headache Body aches

4. Spread of SARS Primary method appears to be close person-to-person contact Potentially by fomites, or air-borne routes

5. Incubation period for SARS 2- 7 days May be as long as 10 days

6. Who is at risk? Most US cases occur in travelers with history to areas with ongoing transmission China, Hong Kong, Singapore, Hanoi Household contacts of people with SARS Healthcare workers exposed to SARS patients

7. Case Definition Clinical Criteria Epidemiologic Criteria Laboratory Criteria

8. Clinical Criteria Asymptomatic or mild respiratory illness Moderate respiratory illness Severe respiratory illness Radiographic evidence of pneumonia OR Respiratory distress syndrome

9. Epidemiologic Criteria Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or recently documented or suspected community transmission of SARS Close contacts within 10 days of onset of symptoms with a person known or suspected to have SARS infection

10. Laboratory Criteria Confirmed –Detection of SARS- CoV antibody less than 21 days after the onset of illness or –Detection of SARS- CoV RNA using RT-PCR then confirmed using a second PCR assay using separate specimens and primers –Isolation of SARS-CoV Negative –Absence of antibody in convalescent sera obtained more than 21 days after onset of symptoms. Undetermined –laboratory testing not preformed or incomplete

11. Case Classification Probable Case: –meets the clinical criteria for severe respiratory illness of unknown etiology with onset since 2/13/03 and epidemiologic criteria and laboratory criteria confirmed, negative or undetermined. Suspect Case: –meets the clinical criteria for moderate respiratory illness of unknown etiology with onset since 2/13/03 and epidemiologic criteria and laboratory criteria confirmed, negative, or undetermined.

12. Treatment of SARS Should be similar to that used for patients affected with serious community acquired atypical pneumonia Antivirals and steroids have not been tested in clinical trails and their effectiveness is unknown

13. Mortality of SARS As of 5/15/03 8% overall 0 to 50% depending on the age group –Overall 14-15% Canada: 15-19% China: 3- 13% Hong Kong: 11-17% Singapore: 13-15% Vietnam: 8%

15. Travel Travel Alert- Informs travelers of a health concern in a particular area No recommendation against nonessential travel to the area. Singapore, Hanoi, Toronto (WHO removed Toronto as of 5/14, CDC still lists Toronto as area under Travel alert) Travel Advisory- Potentially more serious situation There is a recommendation against nonessential travel to the area China, Hong Kong, and Taiwan

16. Quarantine CDC quarantine officers are distributing health alert cards to all passengers returning from areas on travel alerts or advisories Cards inform travelers about SARS, asked to monitor health for 10 days Procedures for airlines and ships

17. Cumulative # of Reported Probable Cases in Selected Countries CountryTotal # of Cases # of Deaths Canada14323 China5124267 Hong Kong1698227 Singapore20528 Thailand82 United States650 Vietnam635

18. Michigan cases 3 suspect cases as of 5/15/03 All with travel history to Asia All have recovered

19. Misconceptions No reason to believe related to terrorist activities Does not appear to be caused by a paramyxovirus No travel restrictions, instead travel advisories and alerts No evidence of spreading disease within the USA

20. References www.cdc.gov www.cdc.gov/mmwr/ www.who.int/en/