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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
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Healthcare Worker Seroconversion in SARS Outbreak
Serum samples were obtained from healthcare workers 5 weeks after exposure to an outbreak of severe acute respiratory syndrome (SARS). This document examines a sensitive dot blot enzyme-linked immunosorbent assay, complemented by a specific neutralization test, showing that only persons in whom probable SARS was diagnosed had specific antibodies. The document suggests that subclinical SARS is not an important feature of the disease.
Centers for Disease Control and Prevention (U.S.)
Chow, Pierce K. H.
2004-02
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine
"Community containment strategies, including isolation and quarantine, are fundamental public health measures used to control the spread of communicable diseases. All such strategies have in common the primary goal of preventing person-to-person spread of disease by separating those with disease or at increased risk for developing disease from those at lower risk. Although the terms 'isolation' and 'quarantine' have often been used interchangeably, they actually represent distinct concepts. Isolation is a commonly used practice in modern public health. Isolation refers to the separation of ill persons with a communicable disease (e.g., SARS patients) from those who are healthy. A prototypical example is the isolation of persons with potentially infectious tuberculosis. Isolation not only prevents transmission of infection to others but also allows for the focused delivery of specialized health care to ill persons. SARS patients can be isolated in a hospital, at home, or in a designated community-based facility. […] In this document, 'quarantine' refers to interventions-either voluntary or compulsory-in which active monitoring is accompanied by a restriction on the activities of persons exposed to SARS-CoV to prevent transmission if they develop SARS-CoV disease. Quarantine may also have a specific legal definition that may differ among jurisdictions based on applicable laws. Although quarantine, by definition, restricts some personal liberties, it is a collective action implemented for the common good. Modern quarantine is predicated on the need to aid persons who are infected with or exposed to infectious agents while protecting others from the dangers of inadvertent exposure. As such, it differs substantially from the quarantine of the past."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine: Appendix D1: Interventions for Community Containment
"Contacts of SARS patients can be managed by use of a range of interventions, all of which are designed to facilitate early recognition of illness in persons at greatest risk of becoming infected and thereby to prevent transmission to others. Whereas many of these interventions are applied individually to persons identified as contacts of a person with possible or known SARS-CoV disease, others are applied to larger groups of persons, or communities, who share a similar risk of exposure." This document provides a summary and overview of these interventions.
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine: Appendix D3: Guidelines for Evaluating Homes and Facilities for Isolation and Quarantine
"Ideally, persons who meet the criteria for a confirmed or probable case of SARS-CoV disease or a SARS RUI and who do not require hospitalization for medical reasons should be isolated in their homes. The home environment is less disruptive to the patient's routine than isolation in a hospital or other community setting. Any home being considered as an isolation setting should be evaluated by the patient's physician, health department official, or other appropriate person to verify its suitability. […] When persons requiring isolation cannot be accommodated either at home or in a healthcare facility, a community-based facility for isolation will be required. The availability of a community-based facility will be particularly important during a large outbreak. Much of the work in identifying and evaluating potential sites for isolation should be conducted in advance of an outbreak as part of preparedness planning. Each jurisdiction should assemble a team to identify appropriate locations and resources for community SARS isolation facilities, establish procedures for activating them, and coordinate activities related to patient management. The team should consider the use of both existing and temporary structures. Options for existing structures include community health centers, nursing homes, apartments, schools, dormitories, and hotels. Options for temporary structures include trailers, barracks, tents, and bubble systems."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine: Appendix D2: Frequently Asked Questions About Use of Community Containment Measures
This document provides a list of frequently asked questions regarding community containment measures. It is useful for practitioners and policy makers who may become involved in non-hospital isolation and quarantine following a disease outbreak or other public health emergency.
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement I: Infection Control in Healthcare, Home, and Community Settings
"This new Supplement outlines the infection control recommendations for prevention of SARS-CoV transmission in healthcare, household, and community settings. During the 2003 global epidemic, SARS-CoV caused unprecedented levels of morbidity and mortality among healthcare personnel and disrupted healthcare delivery systems, leading in some instances to closure of hospitals. Rapid implementation and adherence to infection control measures proved essential for controlling transmission in healthcare settings. To assist healthcare facilities in controlling SARS-CoV transmission, CDC issued several infection control guidance documents that evolved with improved understanding of the virus and its modes of transmission. This Supplement consolidates, updates, and replaces the previous guidelines and provides new information to guide infection control practices for prevention of SARS-CoV transmission."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement C: Preparedness and Response in Healthcare Facilities
"The current version of Supplement C emphasizes that SARS preparedness and response planning in healthcare facilities should not occur in a vacuum but rather should build on existing preparedness activities and relationships with the public health community. Although healthcare facilities will likely play a key role in the follow-up of exposed patients and healthcare workers, it will be important to coordinate these activities with the local health department, especially for patients being discharged and for healthcare workers who live in the community. Supplement C now recommends that healthcare facilities work with health departments to coordinate this follow-up. Because activity restrictions for healthcare workers who have been exposed to SARS-CoV might depend on the level of SARS-CoV transmission in the community, Supplement C now recommends coordinating decisions on these restrictions with the health department, in accordance with the guidance in Supplement D. The recommendations for surveillance in healthcare settings have been revised for consistency with the recommendations in Supplement B. The guidance clarifies that, in patients who have epidemiologic links to SARS-CoV, the presence of either fever or lower respiratory symptoms should prompt further evaluation. In addition, in accordance with the new SARS case definition, when persons have a high risk of exposure to SARS-CoV (e.g., persons previously identified through contact tracing or self-identified as close contacts of a laboratory-confirmed case of SARS-CoV disease; persons who are epidemiologically linked to a laboratory-confirmed case of SARS-CoV disease), the clinical criteria should be expanded to include, in addition to fever or lower respiratory symptoms, the presence of two or more other early symptoms of SARS-CoV disease."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement B: SARS Surveillance
"This version of Supplement B includes the revised U.S. SARS surveillance case definition and an updated domestic case reporting form. The revised surveillance case definition reflects changes in the interim position statement on SARS surveillance adopted by the Council of State and Territorial Epidemiologists (CSTE) in November 2003. The current version of Supplement B clarifies and revises questions to be used by healthcare providers to screen persons requiring hospitalization for radiographically confirmed pneumonia. The screening question related to travel now includes specific geographic locations that are likely sites for a reappearance of SARS-CoV. Employment in a laboratory that contains live SARS-CoV has been added as an epidemiologic risk factor for SARS-CoV exposure. The revised Supplement clarifies that, in the absence of SARS-CoV transmission in the world, children hospitalized for radiographically confirmed pneumonia need not be screened for potential SARS-CoV disease, unless circumstances suggest that a child might be at high risk for exposure to SARS-CoV. The recommendations for surveillance in healthcare settings have been revised for consistency with the recommendations in Supplement C. The guidance clarifies that, in a setting of ongoing SARS-CoV transmission in a facility or community, the presence of either fever or lower respiratory symptoms should prompt further evaluation. In addition, in accordance with the new SARS case definition, when persons have a high risk of exposure to SARS-CoV (e.g., persons previously identified through contact tracing or self-identified as close contacts of a laboratory-confirmed case of SARS-CoV disease; persons who are epidemiologically linked to a laboratory-confirmed case of SARS-CoV disease), the clinical screening criteria should be expanded to include, in addition to fever or lower respiratory symptoms, the presence of any early symptoms of SARS-CoV disease. The current version provides some guidance for prioritization of contacts for monitoring if health department resources become overburdened during an ongoing outbreak. General reporting requirements have also been clarified."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2: Supplement A: Command and Control
"Because of the multifaceted nature of a SARS response and the impact of a SARS outbreak on many sectors of society-political, economic, social, healthcare, and others-a well-defined command and control structure with strong leadership is required to coordinate the response, allocate resources appropriately, and ensure the dissemination of consistent information in a timely manner. Control of SARS requires policymakers, healthcare and public health professionals, community leaders, and the public to work in a coordinated manner within a well-defined collaborative framework. Emergency preparedness and response capacities at the national, state, and local levels must be harmonized to allow a seamless response. The sustained, coordinated efforts required to control SARS lend themselves to the principles and structure of incident command and management systems. These systems use a predetermined organizational structure for potential mass casualty events that addresses planning, operations, logistics, finance, and administration. They are useful in maximizing the use of limited resources, monitoring the status of an outbreak, and consolidating the control of a large number of individual resources. Legal preparedness is another key component of SARS preparedness and response. A response to an outbreak of SARS may require coordination of federal, state, and local legal authorities to impose a variety of emergency public health and containment measures, at both the individual and community levels. Experience from the 2003 SARS outbreak demonstrates how closely legal issues are intertwined with public health responses. Within days of the appearance of SARS, Canada, Hong Kong, and Singapore instituted health measures, including large-scale community-based restrictions, to prevent the further spread of SARS-CoV."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
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Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2
"This is an updated version of the draft guidance document issued by the Centers for Disease Control and Prevention (CDC) on November 3, 2003. CDC revised the draft based on comments received from public health partners, healthcare providers, professional organizations, and others. CDC will continue to update the document as necessary to incorporate additional comments and to reflect increased understanding of SARS-CoV transmission dynamics and the availability of improved prevention tools."
Centers for Disease Control and Prevention (U.S.)
2004-01-08
