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HHS Pandemic Influenza Response and Preparedness Plan [website]
This purpose of this Pandemic Influenza Preparedness and Response Plan developed by the Department of Health and Human Services (HHS) is to define and recommend preparedness activities that should be undertaken before a pandemic that will enhance the effectiveness of a pandemic response. It is also to describe federal coordination of a pandemic response and collaboration with state and local levels and to describe interventions that should be implemented. The plan includes a core section, which describes coordination and decision making at the national level; provides an overview of key issues for preparedness and response; and outlines action steps to be taken at the national, state, and local levels before and during a pandemic. Annexes 1 and 2 provide information to health departments and private sector organizations to assist them in developing state and local pandemic influenza preparedness and response plans. Annexes 3-13 contain technical information about specific preparedness and response components.
United States. Department of Health and Human Services
2004-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement E: Managing International Travel-Related Transmission Risk
"The rapid global spread of SARS-CoV in 2003 was facilitated by international travel, as illustrated by the initial dissemination of the SARS outbreak from Hong Kong. Although travelers visiting SARS-affected areas are potentially at risk of contracting SARS-CoV disease, SARS-CoV transmission is generally localized and often limited to specific settings (e.g., hospitals) or households of SARS patients, even in settings with large outbreaks. Consequently, the overall of risk of SARS-CoV disease for outbound travelers who are not exposed to these settings is low. Nevertheless, nearly all U.S. laboratory-confirmed SARS cases were in travelers to SARS-affected areas. Screening and evaluating travelers for SARS-like symptoms, educating them about SARS, and reporting illness should therefore decrease the risk of travel-associated SARS. Because SARS-CoV can sometimes be transmitted on conveyances (e.g., airplanes), it is also important to prevent spread from an ill passenger with a SARS-like illness and to identify and monitor contacts on the conveyance for SARS-like illness. Because of the significant impact of travel on the spread of communicable diseases such as SARS-CoV disease, legal authority exists at local, state, federal, and international levels to control the movement of persons with certain communicable diseases within and between jurisdictions. Measures that might be used to modify the risk of travel-related SARS-CoV disease range from distribution of health alert notices and arrival screening to quarantine of new arrivals and restrictions or prohibitions on nonessential travel. Although the states have authority for movement restrictions within states, federal laws govern movement between states and across international borders."
Centers for Disease Control and Prevention (U.S.)
2004-07-20
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SARS Control and Psychological Effects of Quarantine, Toronto, Canada
"Knowledge and understanding of the experiences of quarantined persons are critical to maximize infectious disease containment and minimize the negative effects on those quarantined, their families, and social networks. The objectives of our study were to assess the level of knowledge about quarantine and infection control measures of persons who were placed in quarantine, to explore ways by which these persons received information, to evaluate the level of adherence to public health recommendations, and to understand the psychological effect on quarantined persons during the recent SARS outbreaks in Toronto, Canada."
Centers for Disease Control and Prevention (U.S.)
Hawryluck, Laura; Gold, Wayne L.; Robinson, Susan
2004-07
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Environmental and Occupational Health Response to SARS, Taiwan, 2003
"Industrial hygiene specialists from the National Institute for Occupational Safety and Health (NIOSH) visited hospitals and medical centers throughout Taiwan. They assisted with designing and evaluating ventilation modifications for infection control, developed guidelines for converting hospital rooms into SARS patient isolation rooms, prepared designs for the rapid conversion of a vacated military facility into a SARS screening and observation facility, assessed environmental aspects of dedicated SARS hospitals, and worked in concert with the Taiwanese to develop hospital ventilation guidelines. We describe the environmental findings and observations from this response, including the rapid reconfiguration of medical facilities during a national health emergency, and discuss environmental challenges should SARS or a SARS-like virus emerge again."
Centers for Disease Control and Prevention (U.S.)
Esswein, Eric J. (Eric John); Kiefer, Max; Wallingford, Ken
2004-07
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Mice Susceptible to SARS Coronavirus
"The outbreak of severe acute respiratory syndrome (SARS) that emerged in China in November 2002 was caused by a novel coronavirus (SARS-CoV) that was detected in lungs, nasopharyngeal aspirates, and feces of infected patients. This outbreak in humans is striking because of the high rate of illness and death associated with it. The SARS-CoV outbreak likely resulted from zoonotic transmission, and natural animal reservoirs of viruses nearly identical to SARS-CoV increase the likelihood of its reemergence in humans." This article covers the technical aspects of experiments done related to the novel coronavirus.
Centers for Disease Control and Prevention (U.S.)
Wentworth, David E.; Gillim-Ross, Laura; Espina, Noel
2004-07
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Collecting Data To Assess SARS Interventions
"With cases of severe acute respiratory syndrome (SARS) occurring across geographic regions, data collection on the effectiveness of intervention strategies should be standardized to facilitate analysis. We propose a minimum dataset to capture data needed to examine the basic reproduction rate, case status and criteria, symptoms, and outcomes of SARS."
Centers for Disease Control and Prevention (U.S.)
Meltzer, Martin; Scott, II, R. Douglas; Gregg, Edward
2004-07
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Emerging Infections: What Have We Learned from SARS?
"Given the current size and mobility of the human population, emerging diseases pose a continuing threat to global health. This threat became reality with the outbreak of severe acute respiratory syndrome (SARS). The emergence of a disease requires two steps: introduction into the human population and perpetuated transmission. Although preventing the introduction of a new disease is ideal, containing a zoonosis is a necessity. The lessons that we have learned from SARS were the topic of a meeting of The Royal Society on January 13, 2004, in London, England." This Conference Summary details the conclusions of that meeting.
Centers for Disease Control and Prevention (U.S.)
Galvani, Alison P.
2004-07
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Psychosocial Impact of SARS
This editorial focuses on the need for research on how SARS affects patients' mental health so that the proper mental health care can be provided at various levels. "Since nearly all resources are devoted to biomedical research and medical treatment, psychosocial problems of SARS patients and their families are largely ignored. Our review of the literature using the ISI Web of Knowledge on January 17, 2004, substantiated this observation. To date, no systematic study examining psychosocial consequences of SARS has been published in scientific journals. A systematic exploration of how SARS negatively affects patients' mental health is needed so that appropriate interventions may be implemented at individual, family, and societal levels."
Centers for Disease Control and Prevention (U.S.)
Tsang, Hector W.H.; Scudds, Rhonda J.; Chan, Ellen Y.L.
2004-07
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Transporting Patient with Suspected SARS
This editorial focuses on the postive effects that the use of portable isolation units (PIU) had in Taiwan during the SARS crisis. Description of the crisis and how the PIUs were used are provided and conclusions of the editorial cite that PIUs "...enabled the safe transport of SARS patients between hospitals by air and road and decreased the risk of cross-infecting transport personnel. The anxiety of transport personnel was decreased, as was the fear felt by the population of the outer islands. In addition, the credibility of the local health authorities was improved among the general population in Taiwan."
Centers for Disease Control and Prevention (U.S.)
Tsai, Shin-Han; Tsang, Chiu-Man; Wu, Hsueh-Ru
2004-07
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Model Parameters and Outbreak Control for SARS
"Severe acute respiratory syndrome (SARS), a viral respiratory disease, has been reported in 32 countries as of July 11, 2003. SARS is believed to have originated in Guangdong Province, China, in November 2002. Researchers at the Erasmus Medical Center in Rotterdam, the Netherlands, identified a coronavirus as the agent responsible for infecting 8,437 persons worldwide, with 813 deaths as of July 11, 2003. According to recent epidemiologic data from Hong Kong, a person exposed to SARS enters an incubation period with a mean length of 6.4 days. Symptomatic persons in that study were hospitalized at a mean rate of 1/4.85 days-1. Those who recovered were discharged a mean of 23.5 days after diagnosis, while the mean period to death was 35.9 days after diagnosis. Because no specific treatment for SARS exists, control of the epidemic relied on rapid diagnosis and isolation of patients, an approach that is reported to be effective. However, most early SARS cases in Toronto occurred in hospitals, with movement of SARS patients between hospitals contributing to the disease?s initial spread. In Taiwan, 94% of SARS cases occurred through transmission in hospital wards, and similar effects occurred in Hong Kong and Singapore. Although the SARS epidemic was eventually controlled, the measures used to achieve that control varied greatly in scope from one place to another. Control of an outbreak relies partly on identifying what disease parameters are likely to lead to a reduction in the reproduction number R0. Here we calculate the dependence of R0 on model parameters."
Centers for Disease Control and Prevention (U.S.)
Chowell, Gerardo; Castillo-Chávez, Carlos; Fenimore, Paul W.
2004-07
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SARS Coronavirus Detection
"Recently, a new coronavirus was identified as the suspected causative agent of an increased number of atypical pneumonia cases reported from Hong Kong, Singapore, Vietnam, and Canada (1-4). Subsequent publications demonstrated that this new coronavirus was detectable in patients with severe acute respiratory syndrome (SARS) (5,6), classified according to the World Health Organization's case definition (7). During the first 6 months of 2003, a total of 8,422 patients were affected. This fact, together with the reappearance of the SARS associated coronavirus (SARS-CoV) in China in late 2003, makes it clear that rapid and reliable diagnostic tools are essential for accurate disease reporting and subsequent disease management."
Centers for Disease Control and Prevention (U.S.)
Nitsche, Andreas; Schweiger, Brunhilde; Ellerbrok, Heinz
2004-07
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Providing Logistical Support to Quarantined Citizens During a Public Health Emergency
"Government and local/regional public health departments should develop plans for providing logistical support to individuals quarantined as a result of a public health emergency. A clear, yet flexible, response plan for delivering food, medicine, and supplies to affected individuals should be developed and widely communicated once a quarantine is announced. Public health officials should coordinate with major volunteer and relief organizations to boost manpower and avoid duplication of effort, and should be receptive to smaller groups willing to offer assistance during a crisis."
Lessons Learned Information Sharing (LLIS)
2004-06-07?
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Epidemiologic Clues to SARS Origin in China
An epidemic of severe acute respiratory syndrome (SARS) began in Foshan municipality, Guangdong Province, China, in November 2002. This document outlines the results of a SARS study on case reports through April 30, 2003, including data from case investigations and a case series analysis of index cases. A total of 1,454 clinically confirmed cases (and 55 deaths) occurred; the epidemic peak was in the first week of February 2003. Healthcare workers accounted for 24% of cases. Clinical signs and symptoms differed between children (65 years). Several observations support the hypothesis of a wild animal origin for SARS. Cases apparently occurred independently in at least five different municipalities; early case-patients were more likely than later patients to report living near a produce market (odds ratio undefined; lower 95% confidence interval 2.39) but not near a farm; and 9 (39%) of 23 early patients, including 6 who lived or worked in Foshan, were food handlers with probable animal contact.
Centers for Disease Control and Prevention (U.S.)
Xu, Rui-Heng; He, Jian-Feng; Evans, Meirion R.
2004-06
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Diagnostic Criteria during SARS Outbreak in Hong Kong
This document details the diagnostic criteria during the SARS outbreak in Hong Kong. The accuracy of diagnostic criteria in the outbreak and the importance of epidemiologic criteria are discussed. The document concludes that further studies are needed to evaluate the diagnostic accuracy of these criteria in a nonoutbreak situation when the case prevalence is low. A novel coronavirus caused more than 8,000 probable cases of severe acute respiratory syndrome (SARS) worldwide during the 2003 outbreak. Before the etiologic agent was identified, the diagnosis of SARS was made according to a set of clinical-epidemiologic criteria as suggested by the Centers for Disease Control and Prevention (CDC).
Centers for Disease Control and Prevention (U.S.)
Chan, Louis Y.; Lee, Nelson; Chan, Paul K.S.
2004-06
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SARS and Common Viral Infections
In 2002, the California Unexplained Pneumonia (CUP) Project, a respiratory surveillance project that uses enhanced laboratory techniques to identify etiologic agents of severe pneumonia, was initiated at the California Department of Health Services (CDHS) in collaboration with the Centers for Disease Control and Prevention (CDC) Emerging Infections Program. The CUP project?s extensive diagnostic testing algorithm was applied to specimens submitted to CDHS for SARS testing. This document details how in California, molecular testing was useful in decreasing suspicion for severe acute respiratory syndrome (SARS), by detecting common respiratory pathogens (influenza A/B, human metapneumovirus, picornavirus, Mycoplasma pneumoniae, Chlamydia spp., parainfluenza virus, respiratory syncytial virus, and adenovirus) in 23 (45%) of 51 patients with suspected SARS and 9 (47%) of 19 patients with probable SARS.
Centers for Disease Control and Prevention (U.S.)
Louie, Janice K.; Hacker, Jill K.; Mark, Jennifer
2004-06
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement F: Laboratory Guidance
"Laboratory diagnostics are essential for detecting and documenting a reappearance of SARS-CoV, responding to and managing outbreaks, and managing concerns about SARS in patients with other respiratory illnesses. The identification of SARS-CoV led to the rapid development of enzyme immunoassays (EIA) and immunofluorescence assays (IFA) for serologic diagnosis and reverse-transcription PCR (RT-PCR) assays for detection of SARS-CoV RNA in clinical samples. These assays can be very sensitive and specific for detecting antibody and RNA, respectively, in the later stages of SARS-CoV infection. However, both are less sensitive for detecting infection early in illness. As part of SARS preparedness, CDC is working to improve diagnostics by developing new tools that should make definitive diagnosis early in illness possible. In the interim, CDC is applying new knowledge about the natural history of SARS-CoV disease to improving diagnostic yield by optimizing the type, timing, and quantity of specimens collected."
Centers for Disease Control and Prevention (U.S.)
2004-05-21
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SARS in Healthcare Facilities, Toronto and Taiwan
"The healthcare setting was important in the early spread of severe acute respiratory syndrome (SARS) in both Toronto and Taiwan. Healthcare workers, patients, and visitors were at increased risk for infection. Nonetheless, the ability of individual SARS patients to transmit disease was quite variable. Unrecognized SARS case-patients were a primary source of transmission, and early detection and intervention were important to limit spread. Strict adherence to infection control precautions was essential in containing outbreaks. In addition, grouping patients into cohorts and limiting access to SARS patients minimized exposure opportunities. Given the difficulty in implementing several of these measures, control measures were frequently adapted to the acuity of SARS care and level of transmission within facilities. Although these conclusions are based only on a retrospective analysis of events, applying the experiences of Toronto and Taiwan to SARS preparedness planning efforts will likely minimize future transmission within healthcare facilities."
Centers for Disease Control and Prevention (U.S.)
2004-05
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Frequently Asked Questions About SARS
This document produced by the CDC [Centers for Disease Control and Prevention] answers frequently asked questions about SARS [Severe Acute Respiratory Syndrome], including: what is it, what are its signs and symptoms, what is the cause of it, how does it spread, how contagious is it, what is the medical treatment for it, and what is the history of the disease, among others.
Centers for Disease Control and Prevention (U.S.)
2004-04-26
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Creating Makeshift Morgues in Hospitals During A Major Emergency
In the event of a major medical emergency, hospital administrators should consider using remote, isolated, or unused spaces in their facilities as makeshift morgues. Temperatures in these rooms can be set very low and air conditioning systems fully engaged to facilitate the proper handling of the deceased. In addition, transportation and traffic plans to and from these areas would need to be revisited and redesigned to allow for easy transfer of the deceased.
Lessons Learned Information Sharing (LLIS)
2004-04-19?
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SARS Commission First Interim Report: SARS and Public Health in Ontario (Volume 4)
"SARS [severe acute respiratory syndrome] showed that Ontario's public health system is broken and needs to be fixed. Despite the extraordinary efforts of many dedicated individuals and the strength of many local public health units, the overall system proved woefully inadequate. SARS showed Ontario's central public health system to be unprepared, fragmented, poorly led, uncoordinated, inadequately resourced, professionally impoverished, and generally incapable of discharging its mandate. The SARS crisis exposed deep fault lines in the structure and capacity of Ontario's public health system. Having regard to these problems, Ontario was fortunate that SARS was ultimately contained without widespread community transmission or further hospital spread, sickness and death. SARS was contained only by the heroic efforts of dedicated front line health care and public health workers and the assistance of extraordinary managers and medical advisors. They did so with little assistance from the central provincial public health system that should have been there to help them."
Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome (Campbell Commission
2004-04-15
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SARS Commission Interim Report: SARS and Public Health in Ontario
"SARS [severe acute respiratory syndrome] showed that Ontario's public health system is broken and needs to be fixed. Despite the extraordinary efforts of many dedicated individuals and the strength of many local public health units, the overall system proved woefully inadequate. SARS showed Ontario's central public health system to be unprepared, fragmented, poorly led, uncoordinated, inadequately resourced, professionally impoverished, and generally incapable of discharging its mandate. The SARS crisis exposed deep fault lines in the structure and capacity of Ontario's public health system. Having regard to these problems, Ontario was fortunate that SARS was ultimately contained without widespread community transmission or further hospital spread, sickness and death. SARS was contained only by the heroic efforts of dedicated front line health care and public health workers and the assistance of extraordinary managers and medical advisors. They did so with little assistance from the central provincial public health system that should have been there to help them. These problems need urgently to be fixed."
Ontario. Ministry of Health and Long-Term Care
Campbell, Archie
2004-04-15
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Infectious Disease Control Guide for School Staff
"This material is provided to schools in the state of Washington to assist district staff members in their efforts to preserve and protect the health of both students and employees. Infectious diseases are very common in the school-age child. Because several of the diseases addressed in this manual are vaccine-preventable, it is expected that their incidence in the state will be reduced with the continued implementation of the immunization law (RCW 28A.210.060-170, see Appendix I). School districts should always refer to the most updated version of the specific law or regulation."
Washington State Office of Superintendent of Public Instruction
2004-04
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Wisconsin Pandemic Influenza Preparedness
"To prepare for the next influenza pandemic, the Wisconsin Department of Health and Family Services (DHFS), Division of Public Health (DPH), in cooperation with many state and local organizations and partners have developed this Wisconsin Pandemic Influenza Preparedness Document which provides strategies to reduce pandemic influenza-related morbidity, mortality, and social disruption in the state."
Wisconsin. Department of Health and Family Services
2004-04
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Commission of the European Communities: On Community Influenza Pandemic Preparedness and Response Planning
This working paper addresses key issues of national and EU relevance of influenza pandemic, preparedness and response planning. It explains the stages of an influenza pandemic on the, basis of the definitions of the World Health Organisation (WHO) and sets out the main, objectives of action. Moreover, it outlines the role of the Commission and the Member States, in pandemic preparedness planning and defines key actions at pre-determined phases and, levels in the main areas of management and co-ordination, surveillance, prevention, mitigation and response, communication, civil protection and research. Particular reference is, made to animal health legislation and actions that aim to prevent and control influenza in, animals, in particular avian influenza, which can have a major role in the emergence and, impact potential of human influenza.
European Commission. Joint Research Centre
2004-03-26?
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Commission Working Paper on Community Influenza Pandemic Preparedness and Response Planning
"This working paper addresses key issues of national and EU relevance of influenza pandemic preparedness and response planning. It explains the stages of an influenza pandemic on the basis of the definitions of the World Health Organisation (WHO) and sets out the main objectives of action. Moreover, it outlines the role of the Commission and the Member States in pandemic preparedness planning and defines key actions at pre-determined phases and levels in the main areas of management and co-ordination, surveillance, prevention, mitigation and response, communication, civil protection and research. Particular reference is made to animal health legislation and actions that aim to prevent and control influenza in animals, in particular avian influenza, which can have a major role in the emergence and impact potential of human influenza. The paper has been prepared following extensive consultations on pandemic influenza with the members of the Communicable Disease Surveillance and Response Network Committee hereinafter referred to as 'Network Committee', established under Decision 2119/98/EC of the European Parliament and Council1 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community, and an ad hoc group on influenza set up to advise the Commission services. […] The paper should serve as a launchpad for a debate on co-ordinating preparedness against influenza and on recommendations that can be made in this respect. This will be done in parallel with the development of a general plan for public health emergencies that the Health Ministers requested following the SARS outbreak, and will provide the basis for a specific component of this general plan in order to fine-tune measures in respect of an influenza pandemic."
European Commission
2004-03-26
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Business Shelter-In-Place (SIP) Student Guide
This document is a student guide for a video. It is intended to describe the planning elements necessary to develop a plan for sheltering-in-place occupants in a place of business during a short-term chemical emergency.
United States. Department of Energy
2004-03
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Action Plan for Pandemic Influenza Florida Department of Health [Draft]
"This plan establishes the framework and guidelines for ensuring that an effective system of health and medically related emergency management is in place to contain adverse outcomes of an influenza pandemic."
Florida. Department of Health
2004-03
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Action Plan for Pandemic Influenza, Florida Department of Health
"Influenza A viruses periodically cause worldwide epidemics, or pandemics, with high rates of illness and death and considerable health care infrastructure disruption. Advanced planning for a large scale and widespread health emergency is required to optimize health care delivery through a pandemic. Unlike other public health emergencies, an influenza epidemic will impact on multiple communities across Florida simultaneously. Each local jurisdiction must be prepared to respond in the context of uncertain availability of external resources and support. Therefore, contingency planning is required to mitigate the impact of an influenza epidemic through planning and preparation by the coordinated efforts of all levels of government in collaboration with their stakeholders. The 'Florida Action Plan for Pandemic Influenza', intended to be dynamic and iterative, consists of preparedness and response components that are consistent with the general principals of emergency response. Each section aims to assist and facilitate appropriate planning at all levels of government for the next influenza pandemic. With direction from the Pandemic Influenza Coordinating Committee, the Florida Department of Health's Division of Disease Control coordinated the development of this plan in collaboration with numerous other public health agencies and interested individuals."
Florida. Department of Health and Rehabilitative Services
2004-03
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Fear and Stigma: The Epidemic within the SARS Outbreak
Because of their evolving nature and inherent scientific uncertainties, outbreaks of emerging infectious diseases can be associated with considerable fear in the general public or in specific communities, especially when illness and deaths are substantial. Mitigating fear and discrimination directed toward persons infected with, and affected by, infectious disease can be important in controlling transmission. Persons who are feared and stigmatized may delay seeking care and remain in the community undetected. This article outlines efforts to rapidly assess, monitor, and address fears associated with the 2003 severe acute respiratory syndrome (SARS) epidemic in the United States. Although fear, stigmatization, and discrimination were not widespread in the general public, Asian-American communities were particularly affected.
Centers for Disease Control and Prevention (U.S.)
Person, Bobbie; Sy, Francisco S.; Holton, Kelly
2004-02
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Global Surveillance, National Surveillance, and SARS
The international response to the severe acute respiratory syndrome (SARS) outbreak, from March to July 2003, tested the assumption that a new and emerging infection-one that had not yet demonstrated its full epidemiologic potential but was spreading from person to person and continent to continent -could be prevented from becoming endemic. Within 4 months after the first global alert about the new disease, all known chains of transmission had been interrupted in an outbreak that affected 27 countries on all continents. Most public health experts and scientists believe that the question of whether SARS has become endemic, or will re-emerge, can only be answered after at least 12 months of post-outbreak surveillance. This document discusses the lesson made clear by the SARS experience in its early course: inadequate surveillance and response capacity in a single country can endanger national populations and the public health security of the entire world. As long as national capacities are weak, international mechanisms for outbreak alert and response will be needed as a global safety net that protects other countries when one nation's surveillance and response systems fail. The document concludes that protection against the threat of emerging and epidemic-prone diseases requires strong defense systems at national as well as international levels.
Centers for Disease Control and Prevention (U.S.)
Heymann, David L.; Rodier, Guénaël
2004-02
