Introduction

Severe Acute Respiratory Syndrome (SARS) is ‘Flu-like illness’. An epidemic of SARS affected 26 countries and resulted in over 8000 cases in 2003. Since then, a small number of cases have occurred as a result of laboratory accidents or through animal-to-animal transmission (Guangdong, China).

Other countries/areas in which chains of human-to-human transmission occurred after early importation of cases were Hong Kong Special Administrative Region, Taiwan, Toronto, Singapore and Hanoi Vietnam.

Causative agent: SARS Coronavirus (SARS-CoV)

Transmission: Primarily from person-to-person through droplet. If a sick person coughs or sneezes, the virus can be carried in saliva droplets to people nearby or onto the mucus membranes (eyes, nose or mouth) or onto nearby surfaces on which the virus may persists for up to several days without cleaning, thus infecting them.

Transmission of SARS-CoV occurs mainly during the second week of illness which corresponds to the peak of virus excretion in respiratory secretions and stool and when cases with severe disease start to deteriorate clinically.

Incubation period (IP): 2 – 10days (Mean IP is 5 days)

Should SARS re-emerge in epidemic form, World Health Organisation (WHO) will provide guidance on the risk of travel to affected areas.

Sign & Symptoms

Initial symptoms are flu-like and include fever, malaise, muscle aches and pain (myalgia), headache, and shivering (rigors). No individual symptoms or cluster of symptoms has proven specific for a diagnosis of SARS. Although fever is the most frequently reported symptoms, it may be absent on initial measurement.

Cough (initially dry), shortness of breath and diarrhea may be present in the first week but more commonly reported in the second week of illness.

Clinical Definition of SARS

A person with:

A history of fever or a measured fever (? 38°C)

AND

One or more symptoms of lower respiratory tract illness (cough, difficulty breathing, shortness of breath)

AND

One or more of the following exposures during the 10 days prior to onset of symptoms:

Close contact with a person who is a suspect or probable case of SARS

History of travel, to an affected area

AND

Radiographic evidence of lung infiltrates consistent with pneumonia or Acute Respiratory Distress Syndrome (ARDS) OR autopsy findings consistent with the pathology of pneumonia or ARDS without an identifiable cause

AND

No alternative diagnosis can fully explain the illness

Laboratory definition of SARS

A person with symptoms and signs that are clinically suggestive of SARS AND

With positive laboratory findings for SARS-CoV following precise diagnostic criteria. Testing should only be undertaken in a national or regional reference laboratory as per WHO recommendations (www.who.int/csr/resources/en/SARSReferenceLab1.pdf)

Complication

Pneumonia or Acute Respiratory Distress Syndrome (ARDS) which lead to fatalities.

Treatment

Symptomatic treatment. Advise rest, drink plenty of fluids and take regular antipyretic (e.g. Paracetamol) to relieve symptom of fever.

No specific treatment for SARS.

Prevention & Precautions

Prophylaxis – None

Precautions

Follow travel recommendations if any are issued by World Health Organization (WHO).

Avoid traveling to affected area (where relevant).

Ensure frequent and proper hand washing and personal hygiene.

Avoid touching mucosal surfaces such as nose and eyes (it can be route of infection).

Use a face mask or handkerchief to cover your mouth and nose if you are forced to travel in close contact (within one meter) with a person with suspected symptoms.

Seek medical attention if at any time you feel ill. Alert medical staff if you have traveled to a SARS infected area within the last 10 days.

References organisation/ support

International Travel & Health, WHO 2006

Control of Communicable Diseases Manual, 18th Edition by David L. Heymann, MD, Editor, 2004

http://travelhealth.co.uk/