Severe Acute Respiratory Syndrome (SARS)

What is SARS?

Severe acute respiratory syndrome (SARS) is a respiratory illness that has recently been reported from Asia, North America and Europe. It is an atypical pneumonia of which the cause has not yet been determined. Due to the spread of SARS to several countries in a short period of time, emergency guidance has been issued for travellers and airlines.

What is the cause of SARS?

The cause of SARS has not been definitively identified. Recently, scientists had detected a previously unrecognised coronavirus in 2 patients with SARS. These findings are preliminary and do not provide conclusive evidence that coronavirus is the cause of SARS.

What are the symptoms?

The illness begins generally with a fever greater than 100.4°F (>38.0°C). The fever is sometimes associated with chills or other symptoms, including headache, malaise, and body aches. Some people also experience mild respiratory symptoms at the outset. After 3 to 7 days, one may develop a dry cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10%-20% of cases, patients will require mechanical ventilation or breathing support using a machine.

The incubation period for SARS is typically 2-7 days; however, isolated reports have suggested an incubation period as long as 10 days.

• high fever (>38 degree C)
  
• one or more respiratory symptoms including cough, shortness of breath, difficulty in breathing
  
• close contact with a person who has been diagnosed with SARS
  
• recent history of travel to areas reporting cases of SARS

How does the disease spread?

It is difficult to say exactly how SARS spreads. It may spread by air-borne droplets and close contacts with cases, including health care workers and family members, who have developed the illness. Examples of close contact include having cared for, lived with, or had direct contact with respiratory secretions and body fluids of people with SARS.

How is it diagnosed?

Although coronavirus has not been proven to be the cause of SARS, the Centre for Disease Control (CDC) and its partners are working to develop a new test to look for evidence of coronavirus infection in patients with SARS.

What is the treatment?

Patients with SARS receive the same treatment that would be used for any patient with serious community acquired atypical pneumonia of unknown cause. Reported treatment regimens have included antibiotics to presumptively treat known bacterial agents of atypical pneumonia. Therapy also includes antiviral agents such as oseltamivir or ribavirin. Steroids have also been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials.

How to prevent transmission of SARS?

It is recommended that patients with SARS be isolated with barrier nursing techniques and treated clinically. Any suspect cases should be reported to national health authorities.

Are there any travel restrictions related to SARS?

At this time there are no travel restrictions that are directly related to SARS. However, in response to enquiries from various agencies and travellers, World Health Organisation is now offering guidance for travellers, airline crew and airlines. Any traveller who develops symptoms is advised not to undertake further travel until they have recovered. Should a passenger or crewmember who meets the criteria above travel on a flight, the aircraft should alert the destination airport. On arrival, the sick passenger should be referred to airport health authorities for assessment and management. All passengers and crew should be advised to seek medical attention if they develop the symptoms. As a general precaution the aircraft may be disinfected.

However, it is recommended that individuals who are planning nonessential or elective travel to parts of China (Hong Kong and Guangdong Province) and Hanoi, Vietnam should postpone their trip until further notice.

What should one do if recently travelled to a country where cases of SARS have been reported?

One should monitor one’s health for 7 to 10 days following one’s return. If one becomes 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, one should consult a doctor for a diagnosis.