Severe acute respiratory syndrome ( SARS )

• sudden acute respiratory syndrome (SARS) is a severe respiratory infection which typically starts with fever and flu-like symptoms, progressing to an atypical pneumonia and sometimes adult respiratory distress syndrome. It appears to be an emerging infection, the aetiology of which is as yet unconfirmed. A viral infection, possibly a new coronavirus, has been implicated.
• As of 5 April 2003 2,416 probable cases of SARS had been reported to the World Health Organization (WHO) from 20 countries Most have been as a result of direct transmission from a symptomatic case. Aerosol transmission if it occurs is rare. The possibility of transmission through other routes such as fomites (contaminated inanimate objects) is being considered in some settings. In the Hong Kong Special Administrative Region of China and Guangdong Province in Southern China, ongoing transmission is known or suspected to be occurring. Preliminary data suggest that transmission has slowed or stopped in other affected areas (Hanoi in Vietnam, Singapore, Toronto in Canada, Beijing and Shanxi in China and Taiwan). A substantial outbreak has affected health care staff and patient family members in Toronto, Canada but now is under control.

Travel advice:

• WHO no longer recommends the restriction of travel to any areas (July 5th 2003)

Identification and early management of suspected cases:

• cases in the UK are most likely to occur in people returning from an affected area, especially one where transmission is thought to be continuing. WHO has recommended that all people leaving affected areas are given information and screened before embarkation by being asked a series of questions. Those with symptoms will be asked to defer their travel. Any passengers who develop symptoms while in transit should be identified by the crew and WHO guidance followed. http://www.who.int/wer/pdf/2003/wer7814.pdf
• people who develop symptoms within 10 days of leaving an affected area are asked to contact their GP or NHS Direct by telephone in the first instance so that appropriate arrangements can be made for their further assessment either at home, in primary care or in an isolation area of an Accident and Emergency Department. Following assessment, cases should be admitted to hospital and nursed in a single room with full respiratory precautions if: otherwise, they may be managed at home with advice about home hygiene. They should keep contact with others to a minimum.
  • their clinical condition indicates it, OR they have significant chest Xray changes
• symptomatic suspected cases should wear a surgical mask during transit. Guidance on infection control should be followed when taking specimens for investigation.

Management of contacts:

• close contacts of all probable cases and those suspected cases with known contact with a SARS case should be identified, given information and followed up until 10 days from the last contact.
• close contacts of other suspected cases should be given information and told to seek advice immediately should they develop symptoms. Information leaflets are available to download

Reporting of cases:

• suspected cases should be notified to the local Consultant in Communicable Disease Control (CCDC), who will then inform the Communicable Disease Surveillance Centre (CDSC) duty doctor (0208-200-6868). If the need is urgent (for example if it is thought there has been local transmission or that hospital staff have been exposed to a probable SARS case), the CDSC duty doctor should be contacted directly.

Guidance and Information:

• full up to date guidance for the public and professionals is maintained on the former Public Health Laboratory Service (PHLS) (now the Health Protection Agency) website at http://www.phls.co.uk/topics_az/SARS/menu.htm.
• locally, further advice may be obtained from the local Health Protection Unit of the Health Protection Agency, normally in the first instance the Consultant in Communicable Disease Control (CCDC)

Notes:

• impact of SARS on pulmonary function in survivors (2):
  • exercise capacity and health status of SARS survivors was considerably lower than that of a normal population at 6 months
    • significant impairment in surface area for gas exchange was noted in 15.5% of survivors in this particular study
    • the study authors suggested that functional disability appeared out of proportion to the degree of lung function impairment and may have been related to additional factors such as muscle deconditioning and steroid myopathy

Reference:

1. Severe acute respiratory syndrome (SARS) -Update. CEM/CMO/2003/5.
2. Hui DS et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax 2005;60:401-9.