Health Advisory
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) IN TAIWAN

The Delaware Division of Public Health (DPH) is transmitting the following advisory from the Centers for Disease Control and Prevention.

DPH emphasizes the following:

• This is a laboratory acquired infection and has been contained via measures as noted in the CDC advisory below.
• While Taiwan's alert level is high, this event is not predicted to impact the general population in Taiwan or abroad. There is no evidence of circulation in the general population.
• Taiwan's alert level is expected to return to normal following the self-imposed isolation and evaluation period.

DPH advises the Delaware health care community to continue with current recommendations to monitor the occurrence of SARS-like symptoms and to prepare appropriate infection control procedures. However, there is no reason at this time to take additional measures. DPH is in communication with CDC on this issue and will distribute via the Delaware Health Alert Network further information as it becomes available.

Because influenza and SARS have common clinical features. Patients may be concerned that they have SARS, especially if they have recently traveled internationally. In general, SARS begins with a high fever (greater than 100.4°F. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia. In contrast, influenza produces fever of about 102°F that lasts for 3-4 days, and almost always includes a severe dry cough, and severe muscle aches and abrupt onset of extreme tiredness.

DPH has prepared guidelines to assist the health care community to prepare to monitor and plan for SARS. We encourage health care providers to use the information to review infection control and patient education procedures, and to acquire necessary personal protective equipment. This document on our website at www.state.de.us/dhss/main/hottopics/sars.html.

This is an official
CDC Health Advisory
Severe Acute Respiratory Syndrome (SARS) in Taiwan

Distributed via Health Alert Network
December 17, 2003, 14:10 EST (2:10 PM EST)
CDCHAN-00170-03-12-17-ADV-N

On December 17, 2003, the Taiwanese Department of Health reported a single case of infection with SARS-associated coronavirus (SARS-CoV) in a research scientist in Taiwan. The press release from the Taiwanese Department of Health is provided below and is also available on that agency's website at http://sars.doh.gov.tw/news/2003121701.html. Additional information about the report is available on the website of the World Health Organization (WHO) http://www.who.int/csr/don/2003_12_17/en/.

CDC is in close communication with the Department of Health in Taiwan and with WHO regarding this report. This is the second case of SARS-CoV infection that was likely acquired in a laboratory setting since the initial worldwide outbreak, and it reinforces the need for careful adherence to recommended laboratory safety practices for SARS-CoV. Recommendations for these laboratory protocols are available in Supplement F, Appendix F 4, "Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with SARS", in CDC's draft Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) http://www.cdc.gov/ncidod/sars/sarsprepplan.htm.

Since this appears to be a laboratory-acquired infection with no evidence of secondary transmission reported to date, the guidelines and recommendations for SARS surveillance, evaluation, and reporting in the absence of SARS-CoV transmission still apply. For more information, see the CDC document, "In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting" http://www.cdc.gov/ncidod/sars/absenceofsars.htm.

Additional information will be reported as more is learned about the situation.

Confirmed SARS Case in Research Laboratory in Taiwan - December 17, 2003

A 44 year-old male researcher was confirmed to have SARS on December 17, 2003 in Taiwan. A senior scientist in the Institute of Preventive Medicine, National Defense University in Taipei, sponsored by the National Science Council, has been working on a SARS study in Taiwan's only P4 laboratory since June. His work laboratory is suspected as the source of infection, which is undergoing further investigation.

After developing a fever on December 10, the researcher stayed home to rest and recuperate. The patient noted initial symptoms and signs were similar to the flu until he developed diarrhea. He then visited the Tri-Service General Hospital on the evening on December 16, at which time a chest X-ray revealed pneumonia in his right lung. SARS was immediately suspected, thus throat swab, gargling fluid, and blood samples were obtained to conduct a real-time PCR and RT-PCR tests for the SARS coronavirus. The tests in the Tri-Service General Hospital came back as SARS-positive. In the early morning of December 17, which was six hours later, the case was further confirmed by the virology laboratory of Taiwan's Center for Disease Control.

This SARS infection is the second SARS-CoV infection of a research person working on SARS research since the Singapore case this last September. Why infection in a P4 laboratory occurred is currently being investigated. Contact tracing was immediately performed, while environmental sampling from the P4 laboratory is now underway.

So far, no fever has been detected in the researcher's colleagues or family members, who are now undergoing a 14-day self-initiated health check program. Close contacts will be put under home quarantine if fever should develop in these persons.

The control level for SARS precaution has been raised from level zero to the more stringent level B by the special SARS committee as of 12:00 AM on December 18, 2003. Taiwan CDC had already initiated fever monitoring as scheduled in government institutions and schools in Taiwan as of December 15 as part of its efforts to prevent the reemergence of SARS and the flu. This measure will become mandatory after this laboratory infection episode. Travelers with fever will be restricted from leaving Taiwan and will be required to obtain a health certificate from a hospital. Taiwan CDC has ordered all the laboratories which work on SARS-CoV culture to undergo stringent disinfection procedures and all research on viral cultures will be suspended until biosafety has been guaranteed and approved by the government. The SARS control level will return to level zero if no new cases are detected in the following 21 days. No community or hospital SARS infections have been identified in Taiwan since July 5.

SOURCE: Department of Health, Taiwan: http://sars.doh.gov.tw/news/2003121701.html