Health Information
UPDATED SARS INFORMATION

The Delaware Division of Public Health (DPH) continues to investigate reports of SARS in Delaware, but none have met the clinical and epidemiologic case definition. This Advisory provides three updates from the Centers for Disease Prevention and Control (CDC).

Update Number 1
Interim Guidance for Institutions or Organizations Hosting Persons Arriving in the United States from Areas with Severe Acute Respiratory Syndrome (SARS)

Thousands of people arrive in the United States from areas where SARS outbreaks are occurring to participate in gatherings such as academic courses, business meetings, or sporting events. Guidance is needed to provide a consistent, rational approach to SARS prevention without unnecessarily stigmatizing these groups or interfering with collegial pursuits, commerce, and other important activities.

At this time, CDC does not recommend canceling or postponing classes, meetings or other gatherings that will include persons traveling to the United States from areas with SARS. CDC also does not recommend quarantine of persons arriving from areas with SARS. [Quarantine is the restriction of activities of well persons.]

If organization representatives become aware of a person from an area with SARS who develops fever or respiratory symptoms, the following steps should be taken:

• Exclude the ill person from activities (e.g., classes, meetings, and other public areas) and locate him/her in a separate area to minimize contact with other people while awaiting further medical evaluation.
• Alert appropriate health-care personnel that an individual from an area with SARS requires evaluation, so that advance preparations can be made to implement infection control procedures to prevent transmission to others during transport and in the health-care setting.
• Remind the treating health-care provider to notify the Delaware Division of Public Health (1-888-295-5156) if SARS is suspected. Further information for health-care providers about the management of persons with suspected SARS is available at http://www.cdc.gov/ncidod/sars/exposuremanagement.htm.

The full text of this advisory, including additional steps that organizations can take to address SARS concerns, can be found at http://www.cdc.gov/ncidod/sars/hostingarrivals.htm.

Update Number 2
Interim Guidelines for Businesses and Other Organizations with Employees Returning to the United States from Areas with SARS

In this country, only a small number of suspected or probable cases of SARS have been detected among exposed healthcare personnel and household contacts of SARS patients. Casual contact with SARS patients at schools, other institutions, or in non-healthcare work settings has not resulted in documented transmission in the United States. Persons returning from areas with SARS should be vigilant for fever (i.e., measure temperature twice a day) and respiratory symptoms (cough, shortness of breath, or difficulty in breathing) over the 10 days after departure. These persons need not limit their activities and should not be excluded from work, meetings, or other public areas, unless fever or respiratory symptoms develop. Persons returning from areas with SARS should notify their healthcare provider immediately if fever OR respiratory symptoms develop within 10 days after departure. The healthcare provider should be contacted in advance so arrangements can be made, if necessary, for infection control measures to prevent transmission to others in the healthcare setting.

The full text of this advisory can be found at http://www.cdc.gov/ncidod/sars/business_guidelines.htm.

Update Number 3
Updated Interim U.S. Case Definition for Severe Acute Respiratory Syndrome (SARS)

The previous CDC SARS case definition (published April 30, 2003) has been updated as follows:

• Epidemiologic criteria for travel exposure have been updated to specify dates of illness onset for each area:
  
  

  Travel criteria for suspect or probable U.S. cases of SARS

  Area	First date of illness onset for inclusion as reported case ‡	Last date of illness onset for inclusion as reported case †
  China (mainland)	November 1, 2002	Ongoing
  Hong Kong	February 1, 2003	Ongoing
  Hanoi, Vietnam	February 1, 2003	May 25, 2003
  Singapore	February 1, 2003	Ongoing
  Toronto, Canada	April 23, 2003	May 30, 2003
  Taiwan	May 1, 2003	Ongoing

  
  ‡ The WHO has specified that the surveillance period for China should begin on November 1; the first recognized cases in Hong Kong, Singapore and Hanoi (Vietnam) had onset in February 2003. The dates for Toronto and Taiwan are linked to CDC’s issuance of travel recommendations.

  † The last date for illness onset is 10 days (i.e., one incubation period) after removal of a CDC travel alert. The case patient’s travel should have occurred on or before the last date the travel alert was in place.

• Interim criteria for exclusion of previously reported cases have been added. (A case may be excluded as a suspect or probable SARS case if an alternative diagnosis can fully explain the illness or the case was reported on the basis of contact with an index case that was subsequently excluded as a case of SARS.)

The full text of the updated case definition can be found at http://www.cdc.gov/ncidod/sars/casedefinition.htm.