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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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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
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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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Health Communication during SARS
Experience with the outbreak of severe acute respiratory syndrome (SARS) has reinforced the importance of a multipronged approach to preventing disease transmission. Timely health communication, along with surveillance, quarantine, isolation, and travel restrictions, figured prominently among the tools the Centers for Disease Control and Prevention (CDC) used to help contain the outbreak. During the SARS response, health communication was shown to be an integral element by ensuring that knowledge about prevention measures reached the public, healthcare providers, the media, and other stakeholders. Disseminating information and educational materials is a key element of CDC's response to disease outbreaks that affect international travelers. Electronic media greatly expedite the process of dissemination and enable prevention messages to reach an expanded audience. The SARS response may be compared with a situation approximately 10 years before, when an outbreak of plague occurred in India. This document examines the challenge in today's situation; controlling a disease outbreak that has potential for rapid international spread; and provides guidance tailored for specific audiences.
Centers for Disease Control and Prevention (U.S.)
Arguin, Paul M.; Navin, Ava W.; Steele, Stefanie F.
2004-02
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Making State Public Health Laws Work for SARS Outbreaks
This document, by the HHS/CDC Legal Response to Outbreak of Severe Acute Respiratory Syndrome (SARS), describes the updated federal laws and response plans for handling SARS and related communicable diseases. Federal authority is important to control the interstate and international movement of persons who are potentially infectious, but most isolation and quarantine orders will be performed by state and local officials, using state and local law. The document also discusses how existing laws might be modified to facilitate effective SARS control while providing legal protections to restricted persons.
Centers for Disease Control and Prevention (U.S.)
Richards, Edward P.; Rathbun, Katharine C.
2004-02
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Canada Pandemic Influenza Plan
"The Canadian Pandemic Influenza Plan maps out how Canada will prepare for and respond to a pandemic influenza outbreak. It does so by clarifying the roles and responsibilities of those who would be involved in such a public health emergency " governments at all levels, public health officials and front-line health care workers. As a practical working tool, it also provides guidelines and checklists to assist various jurisdictions with their emergency planning. The ultimate goal of the Plan is to minimize serious illness and death, in the event of an influenza pandemic, and also to ease any social or economic disruption that might be caused by a massive outbreak of the disease. Canada has had a pandemic influenza plan since 1988, and it continues to evolve based on research, evidence and lessons learned. The Canadian Pandemic Influenza Plan is the product of extensive dialogue and collaboration within the Pandemic Influenza Committee (PIC). Created in 2001, PIC consists of 17 voting members, including representatives from all provinces and territories. Expertise within PIC includes Chief Medical Officers of Health, epidemiologists, virologists, communicable disease specialists, clinical, public health and laboratory specialists. Committee members, in turn, have been greatly assisted through a process of consultation with a wider group of stakeholders, including the health non-government organization community, local governments, emergency planners, and bioethicists."
Canada
2004-02
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SARS Surveillance during Emergency Public Health Response, United States, March-July 2003
The emergence of severe acute respiratory syndrome (SARS) presented a challenge to public health and healthcare delivery systems worldwide. The previously unknown respiratory syndrome, characterized by nonspecific clinical symptoms, was highly transmissible in some circumstances, did not respond to antimicrobial therapy, and could rapidly progress to severe respiratory distress and death. When the World Health Organization (WHO) issued a historic global alert about cases of severe atypical pneumonia on March 12, 2003, there was an urgent global need for diagnosis of the etiologic agent, detection and containment of probable cases, guidance on the healthcare management of patients and potentially exposed persons, identification of measures to prevent and control infections, and timely public health communications to a wide range of audiences. On March 14, 2003, the U.S. Centers for Disease Control and Prevention (CDC) launched an emergency public health response and established national surveillance for SARS to identify case-patients in the United States and determine if domestic transmission was occurring. This document describe the surveillance system established to detect SARS in the United States, focusing on its design, challenges, and modifications that occurred as the outbreak evolved, and characteristics of the case-patients identified. Such information is critical for preparing for possible future outbreaks of SARS or other emerging microbial threats with nonspecific respiratory symptoms.
Centers for Disease Control and Prevention (U.S.)
Schrag, Stephanie J.; Brooks, John T.; Van Beneden, Chris
2004-02
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Introduction of SARS in France, March-April, 2003
Severe acute respiratory syndrome (SARS) was recently identified as a new clinical entity. SARS likely originated in the Guangdong Province of People's Republic of China and subsequently spread worldwide as infected persons traveled. During the 2003 outbreak, SARS was primarily transmitted by person-to-person contact between healthcare workers or household members and ill patients. Community transmission also occurred in several of the most affected areas, and an explosive outbreak from a common source occurred in Amoy Garden in Hong-Kong. As of June 2003, a total of 8,477 probable cases and 811 deaths had been reported from 32 countries. A novel coronavirus has been identified as the cause of SARS. Based on current knowledge, SARS is transmitted from symptomatic patients by close direct or indirect contacts through respiratory droplet secretions. In specific situations, other modes of transmission, such as airborne spread, may be possible. The incubation period ranges from 2 to 10 days, allowing SARS to spread over long distances by infected persons who travel. This document describes how SARS was introduced in France through a single patient who returned from Vietnam on March 23 and presents data that suggest transmission from this patient to other passengers may have occurred during his flight back from Hanoi to Paris.
Centers for Disease Control and Prevention (U.S.)
2004-02
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SARS Outbreak, Taiwan, 2003
This document examines the severe acute respiratory syndrome (SARS) outbreak in Taiwan, using the daily case-reporting data from May 5 to June 4, to learn how it spread so rapidly. The results indicate that most SARS-infected persons had symptoms and were admitted before their infections were reclassified as probable cases. This finding could indicate efficient admission, slow reclassification process, or both. The high percentage of nosocomial infections in Taiwan suggests that infection from hospitalized patients with suspected, but not yet classified, cases is a major factor in the spread of disease. Delays in reclassification also contributed to the problem. Because accurate diagnostic testing for SARS is currently lacking, the document concludes that intervention measures aimed at more efficient diagnosis, isolation of suspected SARS patients, and reclassification procedures could greatly reduce the number of infections in future outbreaks.
Centers for Disease Control and Prevention (U.S.)
Hsieh, Ying-Hen
2004-02
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Susceptibility of Pigs and Chickens to SARS Coronavirus
An outbreak of severe acute respiratory syndrome (SARS) in humans, associated with a new coronavirus (SARS-CoV), has been reported in Southeast Asia, Europe, and North America (1-3). According to the World Health Organization, SARS affected more than 8,200 people worldwide and killed more than 700. The sequence analysis of SARS-CoV suggests that it is substantially distinct from all other known coronaviruses (1,2). Based on the nucleotide sequence, the virus is speculated to have evolved and been maintained in an animal host. However, no conclusive data have been presented to date on a possible reservoir for this virus. This document includes the results of a study aimed to address the role of domestic animals in the outbreak (pigs & chickens), both from the public health perspective (as a potential source of virus for human infections) and the animal health perspective. A potential susceptibility of domestic species to SARS-CoV would have major implications on the management of livestock operations worldwide. The results of the survey indicate that these animals do not play a role as amplifying hosts for SARS-CoV.
Centers for Disease Control and Prevention (U.S.)
Weingartl, Hana M.; Copps, John; Drebot, Michael A.
2004-02
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Wresting SARS from Uncertainty
On March 15, 2003, with clusters of SARS cases being reported from China, Hong Kong, Vietnam, Singapore, and Canada, WHO issued a global travel alert. At that point, the international health community faced a potential pandemic for which there was no identified causal agent, no diagnostic laboratory assays, no defined properties or risk factors for transmission, no infection-control practices of proven efficacy, and no known treatment or prevention measures. Given that setting, the declaration on July 5 that SARS had been contained (in less than 4 months after its initial recognition), represented a remarkable achievement for a truly extraordinary international public health effort. Now, nearly 1 year after the world first faced this infectious disease challenge, the public health community is equipped with a broader understanding of the agent, its pathophysiology, clinical signs and symptoms, risk factors for transmission, and public health measures that can successfully contain the disease. The breadth of this understanding and international scope of the outbreak response are reflected in the range of manuscript topics in this issue of Emerging Infectious Diseases. This document reviews some of the salient features of the biology and epidemiology of SARS while underscoring some of the remaining unanswered questions.
Centers for Disease Control and Prevention (U.S.)
Lingappa, Jairam R.; McDonald, L. Clifford; Simone, Patricia
2004-02
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SARS-related Virus Predating SARS Outbreak, Hong Kong
A novel coronavirus has been identified as the cause of the 2003 global outbreak of severe acute respiratory syndrome (SARS) (1-5). Genetic analysis and epidemiologic studies suggest that SARS coronavirus (CoV) was introduced into humans not long ago. Recently, SARSCoV -like viruses were isolated in Himalayan palm civets and raccoon dogs in a retail live animal market in Guangdong Province, southern China (6), and some of the animals tested had antibodies to SARS-CoV-like virus. Phylogenetic analysis showed that the SARS-CoV-like animal viruses were closely related to the viruses found in humans. Serologic surveillance demonstrated that, in the same market, approximately 40% of wild animal traders and 20% of animal slaughterers had antibodies to SARSCoV or SARS-CoV-like animal virus, but none of them had had SARS-like symptoms in the past 6 months. These investigations raised questions about whether the presence of the animal SARS-CoV-like virus in the market was an isolated event or if this virus had been prevalent in the human population in southern China before the SARS outbreak. This document includes the results of a retrospective serologic study that was conducted to address these questions. The findings suggest that a small portion of healthy persons in Hong Kong had been exposed to SARS-related viruses at least 2 years before the recent SARS outbreak.
Centers for Disease Control and Prevention (U.S.)
Zheng, Jian; Guan, Yi, 1945-; Wong, Ka Hing
2004-02
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Multiple Contact Dates and SARS Incubation Periods
To make quarantine and isolation as effective as possible, knowing the range of the possible incubation period of SARS is essential. Mathematical modelers also need to know the characteristics of the incubation period to provide estimates of possible spread and model the potential impact of interventions. Many SARS patients often report more than one possible date of contact with another known SARS patient, however, which results in multiple dates of possible transmission and infection. These multiple dates prevent early detection of a discrete period of incubation for each patient, and thus the data from such patients cannot be used in standard statistical analytic techniques, such as regression analysis (unless the analyst chooses a single incubation period from the possible choices). This document presents a simple method that allows a simulation of the frequency distribution, including confidence intervals, of the possible incubation periods (in days) for SARS. The method allows use of data from patients with multiple potential incubation periods. One goal of the method was to keep it simple by using common computer spreadsheet software, allowing for easy replication, extension of the database and results, and rapid dissemination of the method. The method can also be used to calculate when infectious persons are most likely to have transmitted SARS to susceptible persons, even when multiple days of possible transmission exist.
Centers for Disease Control and Prevention (U.S.)
Meltzer, Martin
2004-02
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Combining Clinical and Epidemiologic Features for Early Recognition of SARS
Early recognition and rapid initiation of infection control precautions are currently the most important strategies for controlling severe acute respiratory syndrome (SARS). No rapid diagnostic tests currently exist that can rule out SARS among patients with febrile respiratory illnesses. Clinical features alone cannot with certainty distinguish SARS from other respiratory illnesses rapidly enough to inform early management decisions. A balanced approach to screening that allows early recognition of SARS without unnecessary isolation of patients with other respiratory illnesses will require clinicians not only to look for suggestive clinical features but also to routinely seek epidemiologic clues suggestive of SARS coronavirus exposure. This document discusses the key epidemiologic risk factors: 1) exposure to settings where SARS activity is suspected or documented, or 2) in the absence of such exposure, epidemiologic linkage to other persons with pneumonia (i.e., pneumonia clusters), or 3) exposure to healthcare settings. When combined with clinical findings, these epidemiologic features provide a possible strategic framework for early recognition of SARS.
Centers for Disease Control and Prevention (U.S.)
Jernigan, John A.; Low, Donald E.; Helfand, Rita F.
2004-02
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Detection of SARS Coronavirus in Patients with Suspected SARS
In early 2003, severe acute respiratory syndrome (SARS) was recognized as a newly emerging pneumonic disease. A proportion of patients have watery diarrhea, usually at a later stage of the illness, suggesting that the infection may not be confined to the respiratory tract. A novel coronavirus, designated as SARS coronavirus (SARS-CoV), was implicated as the causative agent, and the respiratory disease has been reproduced in a nonprimate animal model. Hong Kong was one of the regions most affected, with 1,700 patients. Specific laboratory tests to detect viral RNA and antibody responses were used to establish a cause in patients suspected to have SARS. Although virologic results for small cohorts of patients have been reported, analysis of results of these first-generation tests in routine clinical practice has not been published previously. This document reports the correlation of results of reverse transcriptase polymerase chain reaction (RT-PCR) and immunofluorescent serologic testing for SARS-CoV in 1,048 cases investigated for SARS in the first 5 weeks after the first-generation diagnostic tests became available in Hong Kong.
Centers for Disease Control and Prevention (U.S.)
Chan, Kwok H.
2004-02
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Ultrastructural Characterization of SARS Coronavirus
Severe acute respiratory syndrome (SARS) was first described during a 2002-2003 global outbreak of severe pneumonia associated with human deaths and person-to-person disease transmission. The etiologic agent was initially identified as a coronavirus by thin-section electron microscopic examination of a virus isolate. Virions were spherical, 78 nm in mean diameter, and composed of a helical nucleocapsid within an envelope with surface projections. We show that infection with the SARS-associated coronavirus resulted in distinct ultrastructural features: double-membrane vesicles, nucleocapsid inclusions, and large granular areas of cytoplasm. These three structures and the coronavirus particles were shown to be positive for viral proteins and RNA by using ultrastructural immunogold and in situ hybridization assays. In addition, ultrastructural examination of a bronchiolar lavage specimen from a SARS patient showed numerous coronavirus-infected cells with features similar to those in infected culture cells. Electron microscopic studies were critical in identifying the etiologic agent of the SARS outbreak and in guiding subsequent laboratory and epidemiologic investigations.
Centers for Disease Control and Prevention (U.S.)
Goldsmith, Cynthia S.; Tatti, Kathleen M.; Ksiazek, Thomas G.
2004-02
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Atypical SARS and Escherichia coli Bacteremia
This document describes a patient with severe acute respiratory syndrome (SARS) whose clinical symptoms were masked by Escherichia coli bacteremia. SARS developed in a cluster of healthcare workers who had contact with this patient. SARS was diagnosed when a chest infiltrate developed and when the patient's brother was hospitalized with acute respiratory failure. The document also highlights problems in atypical cases and offers infection control suggestions.
Centers for Disease Control and Prevention (U.S.)
Tan, Thuan Tong; Tan, Ban Hock; Kurup, Asok
2004-02
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HHS/CDC Legal Response to SARS Outbreak
Before the severe acute respiratory syndrome (SARS) outbreak, the Centers for Disease Control and Prevention's (CDC) legal authority to apprehend, detain, or conditionally release persons was limited to seven listed diseases, not including SARS, and could only be changed using a two step process: 1) executive order of the President of the United States on recommendation by the Secretary, U.S. Department of Health and Human Services (HHS), and 2) amendment to CDC quarantine regulations (42 CFR Parts 70 and 71). In April 2003, in response to the SARS outbreak, the federal executive branch acted rapidly to add SARS to the list of quarantinable communicable diseases. At the same time, HHS amended the regulations to streamline the process of adding future emerging infectious diseases. This document examines how the CDC's increased legal preparedness benefits future public health emergencies by establishing a multi-state teleconference program for public health lawyers and a Web-based clearinghouse of legal documents.
Centers for Disease Control and Prevention (U.S.)
Misrahi, James J.; Foster, Joseph A.; Shaw, Frederic E.
2004-02
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Interferon-B 1a and SARS Coronavirus Replication
A global outbreak of severe acute respiratory syndrome (SARS) caused by a novel coronavirus began in March 2003. The rapid emergence of SARS and the substantial illness and death it caused have made it a critical public health issue. Because no effective treatments are available, an intensive effort is under way to identify and test promising antiviral drugs. This document reports that recombinant human Interferon-B 1a potently inhibits SARS coronavirus replication in vitro.
Centers for Disease Control and Prevention (U.S.)
Jahrling, Peter B.; Hensley, Lisa E.; Fritz, Elizabeth A.
2004-02
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Crisis Prevention and Management during SARS Outbreak, Singapore
This document discusses crisis prevention and management during the first 3 months of the severe acute respiratory syndrome (SARS) outbreak in Singapore. Four public health issues are considered: prevention measures, self-health evaluation, SARS knowledge, and appraisal of crisis management. Telephone interviews with a representative sample of 1,201 adults, >21 years of age, were conducted. The research found that sex, age, and attitude (anxiety and perception of open communication with authorities) were associated with practicing preventive measures. The document concludes that analysis of Singapore?s outbreak improves understanding of the social dimensions of infectious disease outbreaks.
Centers for Disease Control and Prevention (U.S.)
Quah, Stella R.; Hin-Peng, Lee
2004-02
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SARS Preparedness Checklist for State and Local Health Officials
A planning checklist for widespread severe acute respiratory syndrome, modeled on an Association of State and Territorial Health Officials (ASTHO) pandemic influenza planning checklist, was developed jointly by ASTHO, the National Association of County and City Health Officials, and the Centers for Disease Control and Prevention. This checklist, distributed May 2003, has been widely used. The quick development and widespread acceptance of this checklist suggest that with periodic updating and modification such a planning document can be a useful tool for managing serious infectious disease threats. The value of plans developed using this checklist should be assessed in each community by carrying out realistic table-top and field exercises that involve all partners identified in the plan.
Centers for Disease Control and Prevention (U.S.)
Hopkins, Richard S.; Misegades, Lara; Ransom, James
2004-02
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Impressive and Rapidly Expanding Knowledge Base on SARS
In this document, the author discusses and praises the rapid collaboration of researchers gathering information on SARS under the leadership of the WHO. Events unfolded rapidly, requiring implementation of traditional control measures while generating in a matter of weeks an impressive body of knowledge about an unknown member of the coronavirus family. Scientific journals also played a major role in this endeavor, expediting online publication of peer-reviewed data and other evolving information.
Centers for Disease Control and Prevention (U.S.)
Hughes, James M.
2004-02
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Lack of SARS Transmission and U.S. SARS Case-Patient
In early April 2003, severe acute respiratory syndrome (SARS) was diagnosed in a Pennsylvania resident after his exposure to persons with SARS in Toronto, Canada. To identify contacts of the case-patient and evaluate the risk for SARS transmission, a detailed epidemiologic investigation was performed. On the basis of this investigation, 26 persons (17 healthcare workers, 4 household contacts, and 5 others) were identified as having had close contact with this case-patient before infection-control practices were implemented. Laboratory evaluation of clinical specimens showed no evidence of transmission of SARS-associated coronavirus (SARS-CoV) infection to any close contact of this patient. This document concludes that, under certain circumstances, SARS-CoV is not readily transmitted to close contacts, despite ample unprotected exposures. Improving the understanding of risk factors for transmission will help focus public health control measures.
Centers for Disease Control and Prevention (U.S.)
Peck, Angela J.; Newbern, E. Claire; Feikin, Daniel R.
2004-02
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Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong
This document examines a study on the transmission patterns of severe acute respiratory syndrome (SARS) among medical students exposed exclusively to the first SARS patient in the Prince of Wales Hospital in Hong Kong, before his illness was recognized. The outbreak study group conducted a retrospective cohort study of 66 medical students who visited the index patient's ward, including 16 students with SARS and 50 healthy students. The risk of contracting SARS was sevenfold greater among students who definitely visited the index case's cubicle than in those who did not (10/27 [41%] versus 1/20 [5%], relative risk 7.4; 95% confidence interval 1.0 to 53.3). Illness rates increased directly with proximity of exposure to the index case. However, four of eight students who were in the same cubicle, but were not within 1 m of the index case patient, contracted SARS. Proximity to the index case patient was associated with transmission, which is consistent with droplet spread. Transmission through fomites or small aerosols cannot be ruled out.
Centers for Disease Control and Prevention (U.S.)
Wong, Tze-wai
2004-02
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SARS-associated Coronavirus Transmission, United States
To better assess the risk for transmission of the severe acute respiratory syndrome-associated coronavirus (SARS-CoV), a SARS investigation group obtained serial specimens and clinical and exposure data from seven confirmed U.S. SARS patients and their 10 household contacts. SARS-CoV was detected in a day-14 sputum specimen from one case-patient and in five stool specimens from two case-patients. In one case-patient, SARS-CoV persisted in stool for at least 26 days after symptom onset. The highest amounts of virus were in the day-14 sputum sample and a day-14 stool sample. Residual respiratory symptoms were still present in recovered SARS case-patients 2 months after illness onset. Possible transmission of SARS-CoV occurred in one household contact, but this person had also traveled to a SARS-affected area. This document examines the results of that data. The data suggest that SARS-CoV is not always transmitted efficiently. Routine collection and testing of stool and sputum specimens of probable SARS case-patients may help the early detection of SARS-CoV infection.
Centers for Disease Control and Prevention (U.S.)
Peck, Angela J.; Isakbaeva, Elmira T.; Khetsuriani, Nino
2004-02
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Superspreading SARS Events, Beijing, 2003
One of the most intriguing aspects of coronavirus associated severe acute respiratory syndrome (SARS) has been the circumstances under which virus is transmitted to large numbers of persons. One so-called superspreading event occurred in a Hong Kong hotel, when transmission from an ill traveler from Guangdong led to export of the virus to several other countries. Another highly effective episode of viral transmission occurred onboard China Air's flight 112 from Hong Kong to Beijing on March 15, 2003. Superspreading also played major roles in transmission of SARS within Singapore and Toronto. The potential to transmit SARS-associated coronavirus (SARS-CoV) to large numbers of contacts is likely influenced by factors associated with the host, agent, and environment. To develop hypotheses for future international evaluation of this issue, this document reviews the circumstances of transmission associated with individual superspreading events.
Centers for Disease Control and Prevention (U.S.)
Shen, Zhuang
2004-02
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Lack of SARS Transmission among Healthcare Workers, United States
Healthcare workers accounted for a large proportion of persons with severe acute respiratory syndrome (SARS) during the worldwide epidemic of early 2003. This document examines an investigation conducted on healthcare workers exposed to laboratory- confirmed SARS patients in the United States to evaluate infection-control practices and possible SARS associated coronavirus (SARS-CoV) transmission. The investigation identified 110 healthcare workers with exposure within droplet range (i.e., 3 feet) to six SARS-CoV-positive patients. Forty-five healthcare workers had exposure without any mask use, 72 had exposure without eye protection, and 40 reported direct skin-to-skin contact. Potential droplet- and aerosol-generating procedures were infrequent: 5% of healthcare workers manipulated a patient's airway, and 4% administered aerosolized medication. Despite numerous unprotected exposures, there was no serologic evidence of healthcare-related SARS-CoV transmission. This document concludes that lack of transmission in the United States may be related to the relative absence of high-risk procedures or patients, factors that may place healthcare workers at higher risk for infection.
Centers for Disease Control and Prevention (U.S.)
Peck, Angela J.; Park, Benjamin J.; Kuehnert, Matthew J.
2004-02
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SARS among Critical Care Nurses, Toronto
To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), this document examines a study conducted among 43 nurses who worked in two Toronto critical care units with SARS patients. Eight of 32 nurses who entered a SARS patient's room were infected. The probability of SARS infection was 6% per shift worked. Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently wearing a mask (either surgical or particulate respirator type N95) while caring for a SARS patient was protective for the nurses, and consistent use of the N95 mask was more protective than not wearing a mask. Risk was reduced by consistent use of a surgical mask, but not significantly. Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. The document concludes that activities related to intubation increase SARS risk and use of a mask (particularly a N95 mask) is protective.
Centers for Disease Control and Prevention (U.S.)
Loeb, Mark; McGeer, Allison; Henry, Bonnie
2004-02
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Lack of SARS Transmission among Public Hospital Workers, Vietnam
Vietnam was one of the first countries affected by the global severe acute respiratory syndrome (SARS) outbreak and on April 28, 2003, was the first country to be removed from the World Health Organization (WHO) list of SARS-affected countries. Sixty-one patients with laboratory- confirmed SARS were hospitalized in two hospitals, six of whom died; including the index case-patient. All case-patients were epidemiologically-linked to the index case-patient, and most outbreak amplification occurred within one hospital. This document examines an investigation into whether nosocomial transmission occurred among healthcare workers in the second hospital.
Centers for Disease Control and Prevention (U.S.)
Ha, Le Dang; Bloom, Sharon A.; Maloney, Susan A.
2004-02
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Atypical SARS in Geriatric Patient
This document describes an atypical presentation of severe acute respiratory syndrome (SARS) in a geriatric patient with multiple coexisting conditions. Interpretation of radiographic changes was confounded by cardiac failure, with resolution of fever causing delayed diagnosis and a cluster of cases. SARS should be considered even if a contact history is unavailable, during an ongoing outbreak.
Centers for Disease Control and Prevention (U.S.)
Tee, Augustine K.H.
2004-02
