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Description

Clinical criteria for severe acute respiratory syndrome (SARS) must be interpreted in the context of the prevailing epidemiologic laboratory criteria as published by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

• WHO clinical criteria (5/01/03):
  • Suspect SARS case:
    • A person presenting after November 1, 2002, with high fever (>38°C), and
    • Cough or difficulty breathing, and
    • Close contact with SARS patient or travel criteria to SARS area (see History)
  • Probable SARS case:
    • A suspect case with radiographic pneumonia or respiratory distress syndrome, or
    • A suspect case with confirmatory laboratory studies (see “Lab”), or
    • A suspect case with autopsy findings
• CDC clinical criteria (12/12/03):
  • Early illness:
    • 2 or more constitutional symptoms—fever, chills, rigors, myalgia, headache, diarrhea, sore throat, or rhinorrhea
  • Mild to moderate illness:
    • Temperature >100.4°F (>38°C)
    • 1 or more lower respiratory findings—cough, shortness of breath, or difficulty breathing
  • Severe illness:
    • Clinical criteria of mild to moderate illness, and
    • 1 or more of the following—radiographic evidence, acute respiratory distress syndrome, or autopsy findings
• SARS time line:
  • November 2002: A series of severe idiopathic respiratory illnesses begin occurring in Southeast Asian countries (China, Hong Kong, Vietnam, and Singapore).
  • February 11, 2003: The Chinese Ministry of Health notifies the WHO that 305 cases of acute respiratory syndrome of unknown etiology have occurred in Guangdong province in southern China from November 16, 2002 to February 9, 2003.
  • Late February: SARS outbreak in Toronto
  • March 12: WHO issues global SARS alert as number of reported cases steadily increases.
  • March 14: CDC activates emergency operations center with 1st confirmed death of SARS patient.
  • March 15: WHO issues travel advisories and warnings.
  • March 17: 167 cases and 4 deaths reported in 7 countries
  • March 24: CDC implicates a coronavirus as the causative SARS agent.
  • April 10: The New England Journal of Medicine e-publishes “A Novel Coronavirus Associated with SARS.”
  • April 13: Vancouver team sequences the coronavirus.
  • April 16: WHO confirms coronavirus as the cause of SARS as a Netherlands team infects monkeys with the virus. The monkeys go on to develop SARS, and then have the coronavirus recovered from them.
  • April 18: Worldwide cases rapidly multiplying—3,461 cases, 170 deaths, 27 countries
  • May 17: Deaths dramatically rise—7,761 cases, 623 deaths, 31 countries.
  • June 9: Reported cases slow—8,421 cases, 784 deaths, 32 countries.
  • July 5: WHO declares the SARS epidemic over.
  • Since July 2003: <12 confirmed new cases, including a “second SARS mini-outbreak” in March 2004, started by a young postgraduate student who was working at an institute of virology in Beijing.
• Overall statistics to date:
  • Worldwide: >9,000 cases, nearly 1,000 deaths, 29 countries affected
  • US: 134 suspected cases, 19 probable cases, eight confirmed cases, no deaths, 17 states involved
• Transmission:
  • Direct or indirect contact of mucous membranes with infectious respiratory droplets or fomites
  • Period of infectivity: Most likely during period with active symptoms (fever, cough)
  • Incubation period: 2–10 days; mean 6 days
  • All cases can be traced to contact with individuals from Asian countries or community spread from an individual whose illness could be traced to Asia.
  • There have been no suspected SARS cases among casual contacts of the US cases.
  • Many health care workers were infected after providing care to SARS patients.
  • No evidence that SARS is transmitted from asymptomatic individuals
  • However, health care workers who developed SARS may have been a source of transmission within health care facilities during the early phases of illness, when symptoms were mild and not recognized as SARS.
  • There is no evidence that SARS can be spread after recovery from the disease.
  • Pediatric population:
    • Children pose a lower risk of transmission than do adults.
    • Vertical transmission of SARS-CoV from infected mothers to their newborns has not been observed.
    • None of the newborns had clinical, laboratory, or radiological evidence suggestive of SARS-CoV infection.

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