Travel

As of March 15, 2003, the Centers for Disease Control and Prevention (CDC) has received reports of outbreaks of a severe form of pneumonia in Hong Kong SAR, Vietnam, and Guangdong, a province in southern China, Canada, Indonesia, Philippines, Singapore, and Thailand, which appears to have spread rapidly. For this reason, the Director General of the World Health Organization (WHO), Dr. Gro Harlem Brundtland, issued emergency guidance for travelers and airlines so that symptomatic persons receive immediate health care, are brought to the attention of public health authorities, and are advised against travel while ill. The CDC guidelines are as follows:

Case-Finding Definition

Clinicians should be alert for persons with onset of illness after February 1, 2003, with:

• Fever (>38? C [100.4? F]) AND
• One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty in 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 in the Peoples Republic of China or Hanoi, Vietnam, within 7 days of symptom onset
• Close contact with persons with respiratory illness having the above travel history. Close contact includes having cared for, lived with, or had direct contact with respiratory secretions and body fluids of a person with the severe acute respiratory syndrome (also being called SARS)

Additionally, airlines should

• Alert the destination airport of any passengers meeting the above criteria.
• Arriving passengers who are symptomatic should be referred to health authorities for assessment and care.
• Aircraft passengers and crew should be informed of the persons status as a suspect case of SARS.
• The passengers and crew should provide all contact details for the subsequent 14 days to the airport health authorities.

WHO has issued the following recommended case definition of SARS:

Suspect Case

A person presenting after 1 February 2003 with history of:

• high fever (>38?C) AND
• one or more respiratory symptoms including cough, shortness of breath, difficulty in breathing AND

One or more of the following:

• close contact with a person who has been diagnosed with SARS
• recent history of travel to areas reporting cases of SARS

Probable Case

A suspect case with chest x-ray findings of pneumonia or Respiratory Distress Syndrome

A person with an unexplained respiratory illness resulting in death, with an autopsy examination demonstrating the pathology of Respiratory Distress Syndrome without an identifiable cause.

Comments

In addition to fever and respiratory symptoms, SARS may be associated with other symptoms, including headache, muscular stiffness, loss of appetite, malaise, confusion, rash, and diarrhea.

CDC has been working with WHO to investigate and confirm the outbreaks of this severe form of pneumonia. The outbreaks appear to primarily involve health-care workers and close family contacts to suspect cases. WHO recommends the use of isolation and barrier nursing techniques for patients who have atypical pneumonia and any possible links to the outbreaks and that suspect cases be reported to national health authorities. As an added measure for hospitalized patients, CDC recommends standard and respiratory precautions with use of a personal respirator during any close contact with cases and suspect cases. Standard precautions routinely include careful attention to hand hygiene. When caring for patients with SARS, health-care workers should wear eye protection for all patient contact.

To minimize the potential of transmission outside the hospital, case patients as described above should limit interactions outside the home until the epidemiology of illness transmission is better understood. Placing a surgical mask on case patients in ambulatory health-care settings, during transport, and during contact with others at home is prudent.

CDC advises that persons planning elective or nonessential travel to areas affected by the outbreak may wish to postpone their trips until further notice.

Updates will be posted about the outbreaks as information becomes available.

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