02 April 2003
Text: CDC Provides Answers on Newly Emerging Respiratory Illness
(Health agencies discourage nonessential travel to affected areas)
(3400)
The World Health Organization (WHO) April 2 recommended that persons
traveling to Hong Kong Special Administrative Region and Guangdong
Province, China consider postponing all but essential travel. A WHO
press release says the newly revised caution on travel is intended to
help in the prevention of further spread of severe acute respiratory
syndrome, SARS, beyond these two areas of China where it has proven
the most virulent.
The latest international information on this emerging disease is
available at http://www.who.int/csr/sars/en/
The U.S. Centers for Disease Control and Prevention is issuing
continually updated information on SARS. An international
collaboration of medical officials has made significant progress in
understanding the cause and nature of the illness since it prompted an
international health alert to be issued by the March 15.
Following is the text of the press release:
(begin text)
U.S. Centers for Disease Control and Prevention
Frequently Asked Questions
April 1, 2003
The Illness
What is SARS?
SARS is a respiratory illness that has recently been reported in Asia,
North America, and Europe. For additional information, check the World
Health Organization's (WHO) SARS Web site or visit other pages on
CDC's SARS Web site.
What are the symptoms and signs of Severe Acute Respiratory Syndrome
(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% to 20% of cases,
patients will require mechanical ventilation. For more information,
see the MMWR dispatch.
If I were exposed to SARS, how long would it take for me to become
sick?
The incubation period for SARS is typically 2-7 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?
CDC currently 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. Several
treatment regimens have been used for patients with SARS, but there is
insufficient information at this time to determine if they have had a
beneficial effect. Reported therapeutic regimens have included
antibiotics to presumptively treat known bacterial agents of atypical
pneumonia. Therapy also has included antiviral agents such as
oseltamivir or ribavirin. Steroids also have been administered orally
or intravenously to patients in combination with ribavirin and other
antimicrobials. For more information on SARS, see "Interim Information
and Recommendations for Health Care Providers" on CDC's SARS web site.
Spread of SARS
How is SARS spread?
The principal way SARS appears to be spread is through droplet
transmission; namely, when someone sick with SARS coughs or sneezes
droplets into the air and someone else breathes them in. It is
possible that SARS can be transmitted more broadly through the air or
from objects that have become contaminated.
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?
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. In the United States, there is no indication of community
transmission at this time. CDC continues to monitor this situation
very closely.
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. While the new
coronavirus is still the leading hypothesis for the cause of SARS,
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. Coronaviruses can survive in the
environment for as long as three hours.
What evidence is there to suggest that coronaviruses may be linked
with SARS?
CDC scientists were able to isolate a virus from the tissues of two
patients who had SARS and then used several laboratory methods to
characterize the agent. Examination by electron microscopy revealed
that the virus had the distinctive shape and appearance of
coronaviruses. Tests of serum specimens from patients with SARS showed
that the patients appeared to have recently been infected with this
coronavirus. Other tests demonstrated that coronavirus was present in
a variety of clinical specimens from patients, including nose and
throat swabs. In addition, genetic analysis suggests that this new
virus belongs to the family of coronaviruses but differs from
previously identified coronaviruses. These laboratory results do not
provide conclusive evidence that the new coronavirus is the cause of
SARS. Additional specimens are being tested to learn more about this
coronavirus and its link with SARS.
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 can also 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
How many cases of SARS have been reported so far?
Visit WHO's SARS page for daily updates on case reports in the United
States and other countries. (http://www.who.int/csr/sars/en/ ) To
date, most of the cases have been reported from China.
How many people have died from SARS?
Visit WHO's SARS page for a daily update of SARS cases and deaths.
What is CDC 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 160 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.
As always, CDC is committed to communicating regularly and effectively
with public health professionals, elected leaders, clinicians, and the
general public.
Travel and Quarantine
What are CDC's quarantine officials doing to prevent and control the
spread of SARS?
CDC's quarantine inspectors or their designees are distributing health
alert cards (http://www.cdc.gov/ncidod/sars/travel_alert.htm) to air
passengers returning in airplanes either directly or indirectly to the
United States from China, Singapore, and Vietnam. The notices ask
travelers 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 15,000 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.
The World Health Organization (WHO) has recommended procedures
(http://www.who.int/csr/sars/travel/en/) for pre-departure screening
of airline passengers from some countries for respiratory illnesses or
other symptoms of SARS.
What information about SARS is being provided to people traveling on
ships?
SARS information contained on CDC's 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 (as defined in
the foreign quarantine regulations [pdf]) 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 persons 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 has also occurred among air travelers, primarily
travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.
CDC is requesting locating information from travelers who are on
flights with people suspected of having SARS. CDC, with the help of
state and local health authorities, is attempting to follow-up with
these travelers for 14 days to make sure no one develops symptoms
consistent with SAR
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.
If I'm on board an airplane or ship with someone suspected of having
SARS, will I be allowed to continue to my destination?
CDC does not currently recommend that the onward travel of healthy
passengers be restricted in the event that a passenger or crew member
suspected of having SARS is removed from the ship or airplane by port
health authorities. All passengers and crew members may be advised by
port health authorities to seek medical attention if they develop SARS
symptoms.
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, CDC will work with appropriate 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.
CDC RECOMMENDATIONS
Personal and Household
What should I do if I think I have SARS?
If you are ill with a fever of over 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 CDC recommended to prevent transmission of SARS in
households?
CDC has developed interim infection control recommendations available
at http://www.cdc.gov/ncidod/sars/ic-closecontacts.htm 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.
CDC RECOMMENDATIONS
Healthcare Settings
What has CDC recommended to prevent transmission of SARS in the health
care setting?
Transmission of SARS to health care workers appears to have occurred
after close contact with symptomatic individuals before recommended
appropriate infection control precautions were implemented. CDC has
developed interim infection control recommendations for the management
of exposures to SARS in the health care and other institutional
settings. Visit http://www.cdc.gov/ncidod/sars/exposureguidance.htm to
read these recommendations.
Health care facilities should be vigilant in conducting active
surveillance for fever or respiratory symptoms among care givers with
unprotected exposure to SARS patients. Health care workers who develop
fever or respiratory symptoms during the 10 days following an
unprotected exposure to a SARS patient should not report for duty.
Such workers should stay home and report symptoms to the appropriate
facility point of contact (e.g., infection control or occupational
health) immediately. Exclusion from duty should be continued for 10
days after the resolution of fever and respiratory symptoms. During
this period, infected workers should avoid contact with people both in
the facility and in the community.
Exclusion from duty is not recommended for an exposed health care
worker if they do not have fever or respiratory symptoms; however, the
worker should report any unprotected exposure to SARS patients to the
appropriate facility point of contact immediately.
What precautions should health care facilities follow regarding visits
by close contacts of SARS patients?
Close contacts (e.g., family members or other members of the
household) of SARS patients are at risk for infection. Health care
facilities should implement a system to screen for fever or
respiratory symptoms among such contacts who visit the facility. Close
contacts with fever or respiratory symptoms should not be allowed to
enter the health care facility as visitors and should be educated
about this policy. Health care facilities should educate all visitors
about use of infection control precautions
(www.cdc.gov/ncidod/sars/infectioncontrol.htm) when visiting SARS
patients and should emphasize the importance of following these
precautions.
CDC RECOMMENDATIONS
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 CDC travel advisory recommends
that individuals who are planning nonessential or elective travel to
mainland China, Hong Kong, Hanoi, Vietnam, or Singapore may wish to
postpone their trip until further notice. For additional information
about travel advisories, check CDC's Travelers' Health site, which
will be updated as necessary.
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 over 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.
CDC has recommended guidelines for medical aircraft that transport
SARS patients. Should commercial airlines also follow these
guidelines?
No. This guidance (available at
http://www.cdc.gov/ncidod/sars/airtransport-sarspatients.htm) is
intended specifically for air medical transport (AMT) service
providers that use specialized aircraft to transport SARS patients. It
should not be generalized to commercial passenger aircraft. These
interim recommendations for AMT are based on standard infection
control practices, AMT standards, and epidemiologic information from
ongoing investigations of SARS, including experience from transport of
2 patients during this outbreak. Specific guidelines for airline crew
and flight personnel of commercial aircrafts are available at
http://wwwlink.cdc.gov/ncidod/sars/flight_crew_guidelines.htm
CDC also has developed interim guidance for cleaning of commercial
passenger aircraft after a flight with a suspected SARS passenger
http://www.cdc.gov/ncidod/sars/aircraftcleanup.htm
(end text)
(Distributed by the Office of International Information Programs, U.S.
Department of State. Web site: http://usinfo.state.gov)
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