SEVERE ACUTE RESPIRATORY SYNDROME (SARS) INFORMATION SHEET 1 FOR HEALTH CARE PRACTITIONERS

Issued by the Department of Health, 2 April 2003

Introduction

Severe Acute Respiratory Syndrome (SARS) is a respiratory illness caused by a virus recently described in patients from Asia, North America and Europe. The World Health Organisation (WHO) is currently coordinating a global response to reported outbreaks of SARS. Cases have been reported from thirteen countries since February 2003. As of 31 March 2003, 1622 suspect and probable cases of SARS (incl 58 deaths) have been reported to WHO. Local transmission has been confined to Canada, Hong Kong Special Administrative Region of China (Hong Kong SAR), Singapore, Taiwan (China) and Vietnam. As of 31 March 2003, no cases were reported in South Africa.

The National Institute of Communicable Diseases (NICD) compiled the recommendations outlined below. Please note that this information sheet is subject to change as more is learnt about this condition.

Cases suspected to be SARS¹

Clinical cases suspected to be SARS need to meet the following criteria
(Adapted from CDC interim case definition for SARS - MMWR, March 28, 2003)

Respiratory illness of unknown etiology with onset since February 2003 and the following criteria:

• Pyrexia - measured temperature over 38°C
• Clinical presentation - one or more findings of respiratory illness (eg cough, shortness of breath, difficulty breathing, hypoxia or radiographic findings of either pneumonia or acute respiratory distress syndrome)
• Contact history - travel within 10 days of onset of symptoms to an area with suspected or documented community transmission of SARS² (excluding areas with secondary cases limited to health care workers or direct household contacts).

OR

Close contact within³ 10 days of onset of symptoms with either a person with respiratory illness and travel to a SARS area or a person under investigation or suspected of having SARS

2. Medical personnel must contact NICD (Contact numbers Dr L Blumberg 082 807 6770, Prof BD Schoub 082 908 8049 and Dr A Puren 082 908 8048) BEFORE sending specimens.

3. Specimens required

• Nasopharyngeal swab - sent in viral transport medium
• 5-10ml clotted blood (plain tube)

NB: SPECIMENS CANNOT BE PROCESSED UNLESS THERE IS PRIOR CONSULTATION WITH THE NICD.

4. Patients need to be isolated and barrier nursed with mask (ideally, HEPA mask - 8835 IF3, TB mask ) gown and glove precautions.

LABORATORY PROCEDURES OR SUSPECTED SARS

1. Receiving office

• Check with Dr Blumberg or Prof Schoub or Dr Puren if the case meets clinical criteria for SARS
• Specimens - Nasopharyngeal swab - viral transport media
  Clotted blood
• Despatch specimens to BSL - 4 laboratory

2. BSL - 4 Laboratory

Serum to be stored at 4°C

If coronovirus investigations are negative and referring doctor needs further investigations a convalescent-phase serum (10-14 days later) should be requested and the paired sera sent to Dr Marshall at Johannesburg Hospital for respiratory serology, after activation. Investigation should then be processed as for a routine diagnostic specimen.

Footnotes:

1. Suspected cases with either radiographic evidence of pneumonia or respiratory distress syndrome, or evidence of unexplained respiratory distress syndrome by autopsy, or designated “probable” cases by the World Health Organisation case definition.
2. Hong Kong Special Administrative Region and Guangdong province, China, Hanoi, Vietnam and Singapore
3. Close contact is defined as having cared for or having lived with or having had direct contact with respiratory secretions and/or body fluids of a patient