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Following is information regarding the current WHO investigation of atypical pneumonia. Included are: a news release from the CDC, interim information and recommendations for health care providers, and text of a travelers' health alert card which will be distributed to targeted international travelers returning to the U.S.
Atlanta: In response to reports of increasing numbers of cases of an atypical pneumonia that the World Health Organization (WHO) has called Severe Acute Respiratory Syndrome (SARS), the Centers for Disease Control and Prevention (CDC) today announced several steps to alert US health authorities at local and state levels.
CDC activated its emergency operations center on Friday, March 14, upon learning of several cases reported in Canada among travelers recently returned from Southeast Asia and their family members. The federal public health agency:
CDC has been working with the World Health Organization (WHO) since late February to investigate and confirm outbreaks of this severe form of pneumonia in Viet Nam, Hong Kong, and parts of China. No cases have been identified to date in the United States.
"The emergence of two clusters of this illness on the North American continent indicates the potential for travelers who have been in the affected areas of Southeast Asia to have been exposed to this serious syndrome," said Dr. Julie L. Gerberding, CDC Director. "The World Health Organization has been leading a global effort, in which CDC is participating, to understand the cause of this illness and how to prevent its spread. We do know that it may progress rapidly and can be fatal. Therefore, we are instituting measures aimed at identifying potential cases among travelers returning to the United States and protecting the people with whom they may come into contact."
The WHO issued a global alert about the outbreak on March 12, cautioning that the severe respiratory illness may spread to hospital staff. No link has been made between this illness and any known influenza, including the "bird flu" (A[H5N1]) outbreak reported in Hong Kong on February 19.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization have received reports of patients with severe acute respiratory syndrome (SARS) from Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand and Vietnam. The cause of these illnesses is unknown and is being investigated. Early manifestations in these patients have included influenza-like symptoms such as fever, myalgias, headache, sore throat, dry cough , shortness of breath or difficulty breathing. In some cases, these symptoms are followed by hypoxia, pneumonia and occasionally acute respiratory distress requiring mechanical ventilation and death. Laboratory findings may include thrombocytopenia and leukopenia. Some close contacts, including healthcare workers, have developed similar illnesses. In response to these developments, CDC is initiating surveillance for cases of SARS among recent travelers or their close contacts.
Clinicians should be alert for persons with onset of illness after February 1, 2003 with:
AND One or more of the following:
Initial diagnostic testing should include chest radiograph, pulse oximetry, blood cultures, sputum Gram's stain and culture, and testing for viral respiratory pathogens, notably influenza A and B and respiratory syncytial virus. Clinicians should save any available clinical specimens (respiratory, blood, and serum) for additional testing until a specific diagnosis is made. Clinicians should evaluate persons meeting the above description and, if indicated, admit them to the hospital. Close contacts and healthcare workers should seek medical care for symptoms of respiratory illness.
If the patient is admitted to the hospital, clinicians should notify infection control personnel immediately. Until the etiology and route of transmission are known, in addition to standard precautions(1), infection control measures for inpatients should include:
Standard precautions routinely include careful attention to hand hygiene. When caring for patients with SARS, clinicians 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 healthcare settings, during transport and during contact with others at home is prudent.
Because the etiology of these illnesses has not yet been determined, no specific treatment recommendations can be made at this time. Empiric therapy should include coverage for organisms associated with any community-acquired pneumonia of unclear etiology, including agents with activity against both typical and atypical respiratory pathogens (2). Treatment choices may be influenced by severity of the illness. Infectious disease consultation is recommended.
Healthcare providers and public health personnel should report cases of SARS as described above to their state or local health departments.
For more information contact your state or local health department or the CDC Emergency Operations Center (770) 488-7100. Updated information will be available at: http://www.cdc.gov/ncidod/sars/
FOR INTERNATIONAL TRAVELERS ARRIVING IN OR RETURNING TO THE USA FROM HONG KONG AND GUANGDONG PROVINCE, PEOPLE'S REPUBLIC OF CHINA, AND HANOI,VIETNAM
TO THE TRAVELER: During your recent travel, you may have been exposed to cases of severe acute respiratory disease syndrome. You should monitor your health for at least 7 days. If you become ill with fever accompanied by cough or difficulty in breathing, you should consult a physician. To help your physician make a diagnosis, tell him or her about your recent travel to these regions and whether you were in contact with someone who had these symptoms. Please save this card and give it to your physician if you become ill.
TO THE PHYSICIAN: The patient presenting this card may have recently traveled to Hong Kong or Guangdong Province in the People's Republic of China or Hanoi, Vietnam, where cases of atypical pneumonia have been identified. If you suspect atypical pneumonia (also being called severe acute respiratory disease syndrome [SARS]), please contact your city, county or state health officer (see: http://www.cdc.gov/other.htm or call the CDC Emergency Operations Center (770) 488-7100).
For public inquiries, call Centers for Disease Control and Prevention (CDC) hotline:
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