Health Advisory
INTERIM GUIDANCE FOR STATE AND LOCAL HEALTH DEPARTMENTS: SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

The Centers for Disease Control and Prevention is assisting the World Health Organization (WHO) in investigating an outbreak of a severe acute respiratory syndrome of unknown etiology. Cases have been reported in China (Guangdong Province and the Hong Kong Special Administrative Region), Vietnam, Canada, Indonesia, Philippines, Singapore and Thailand. This disease has been characterized by secondary transmission in the health care setting and within households. Most of the identified index cases have traveled to China and a few have had no reported contact with health care workers or sick patients while in China. Approximately 150 cases have been reported. Cases have generally had a brief incubation period (3-5 days). At least two suspect cases have traveled in New York City and Atlanta while symptomatic.

These cases are being reported in the media. Please expect an increase in public inquiries and volume of clinical visits. You should have already received a health alert that includes a CDC press release, an advisory card for travelers returning from affected areas, and an interim advisory for health care workers. This information is available at: http://www.cdc.gov and will be updated periodically.

We have asked clinicians to be alert for patients with onset of illness after February 1, 2003 with:

• Fever (>38E° C)

AND

• One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty breathing, hypoxia, radiographic findings of pneumonia or respiratory distress

AND One or more of the following:

• History of travel to Hong Kong or Guangdong Province inPeople's Republic of China, or Hanoi, Vietnam, within seven days of symptom onset
• Close contact with persons with respiratory illness having the above travel history. Close contact includes having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS.

We are in the process of developing data collection instruments. Until other options are available, information on these patients should be called to the SARS Domestic Team at 770-488-7100. Questions about specimen collection, preparation and transportation may also be addressed by this team. Clinical consultation is also available at this number from the Clinical Management Team. A more specific telephone number will be available shortly for the investigation teams.

Please include the following information for suspected cases when calling:

• 8-digit state-assigned unique identification number starting with the state FIPS code (i.e., for Georgia, the code is 13)
• Month and year of birth
• Sex
• Onset date
• Clinical status B alive or dead
• If dead, date of death
• If dead, whether an autopsy was performed B yes or no
• Hospitalized B yes or no
• If hospitalized, name of hospital
• Whether on a mechanical ventilator -- yes or no
• Healthcare worker B yes or no
• If healthcare worker, place(s) of employment
• Possible epidemiologic ties to other cases: dates and places for recent travel, dates and type of exposure for those exposed to other ill persons, and if available, ID numbers for the presumed source of their infection
• Type of specimens available

In addition to reporting suspected cases, the following clinical specimens should be collected in consultation with CDC:

• Frozen and formalin fixed tissues from an autopsy
• Transbronchial or pleural biopsy specimens fixed in formalin
• Bronchioaveolar lavage (BAL) specimens, spun with supernatant frozen and cell pellet fixed in formalin
• Acute and convalescent serum samples, either at room temperature, iced or frozen
• Peripheral blood smear, dried, at room temperature
• Nasopharyngeal wash or throat swab in viral transport medium, frozen