Global update

As of April 1, 2003 the World Health Organization (WHO) has received reports of 1804 cases of SARS including 62 deaths from 15 countries.  Affected areas, i.e. those regions reporting local transmission of SARS are Toronto, Canada; Singapore; Guangdong, Hong Kong Special Administrative Region of China, Shanxi, Taiwan Province, China; and Hanoi, Vietnam.

WHO reported that in Vietnam and Singapore the SARS outbreak is controlled and stabilizing with reduced spread and few new cases detected.  The Guangdong outbreak is the largest reported and has also shown evidence of spread in the wider community.  In the Kong Special Administrative Region of China there continues to be a significant increase in SARS cases with spread beyond the initial focus in hospitals.  These developments suggest that in this region the virus may be transported from one person to another via an environmental means thought there is no satisfactory evidence in support of this possibility.

Transmission of SARS

The incubation period for SARS is currently believed to be 2-10 days, with persons only being contagious while ill.  It is believed to be spread by heavy droplets, NOT aerosolized droplets.  Close contact is also still believed to be an important factor for SARS transmission.  Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS.  Close contact in an aircraft would be sitting next to a case, in the same row, sitting two rows in front or two rows behind.

Prognosis

90% of SARS cases seem to recover in 6-7 days.  10% of cases progress to a more severe form of the syndrome.  The indicators for poor prognosis are being aged over 40 years and having a previous existing illness such as coronary heart disease, renal impairment or liver disease.  Mortality among the 10% of cases with poor prognoses is high, though the overall case fatality rate remains at 3%.

Diagnosis and causative agent

Data from the global WHO laboratory network indicate that a coronavirus is the primary cause of the disease, though the agent causing SARS is yet to be fully characterized.  Molecular based diagnostic tests based on polymerase chain reaction (PCR) and immunofluorescence assay (IFA) technologies are currently being developed to rapidly identify SARS cases.

Treatment

To date there is no vaccine or other prophylaxis available.  The global experience is that infection control methods work well in containing the spread of SARS in hospitals.  Ribavirin with or without steroids has been a successful treatment in many cases.  

WHO Travel advice

On March 27, 2003, WHO recommended screening of air passengers prior to travel from affected areas, which takes the form of answering two questions about possible symptoms that a person might have of SARS and about contacts with possible SARS cases.  No additional precautions for the screening of departing passengers at airports in any other country are recommended to date.

On April 2, 2003 WHO recommended that persons traveling to the Hong Kong Special Administrative Region of China and the Guangdong Province of China should consider postponing non-essential travel.  This recommendation applies only to travelers entering these areas, not to passengers directly transiting through international airports within those areas.  This is a temporary recommendation that will be reassessed as the situation evolves.

Additional travel advice from CAREC

While there have been no reported cases of SARS to date from any CAREC member countries, given the high level of international travel to and from the Caribbean, each country should be prepared for the possible importation of SARS cases.  Early detection, isolation and infection control are essential elements for containment of infection.

CAREC thus recommends that all member countries should:

•       Identify a contact for suspected SARS cases entering the country to report to that is accessible twenty-four hours, seven days per week.

•       Signs should be posted at airports alerting persons entering the country from affected areas of the contact number to call should they become ill within ten days of arrival with symptoms indicative of SARS.

•       If possible distribute a card or sheet of paper to persons entering the country from affected areas with the following information:

•       Establish a response plan in the event that a suspected or probable SARS case is imported into the country.  This plan should include:

-         Enhanced surveillance to ensure early case detection

-         Identification of a location for identified cases to be managed and treated with adequate isolation and infection control to minimize the possibility of transmission.

-         Identification of human resource for case management

-         Provision for adequate case and contact management

-         Appropriate laboratory preparedness