SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

1. SEVERE ACUTE RESPIRATORY SYNDROME (SARS) Quek Boon Har UMMC

2. What are the signs and symptoms of SARS ? • begins generally with a prodrome of fever (> 38 oC), chills, headache, myalgia, and malaise • followed later by a respiratory phase characterised by a dry, unproductive cough and difficulty in breathing • may also complains of headache, sore throat, loss of appetite, confusion, rash, diarrhoea • lab abnormalities – lymphopenia, leukopenia, mild thrombocytopenia, and elevations in serum CK and/or transaminase • chest X-ray may be normal initially, but may show lobar consolidation or interstitial filtration later on

3. What is the cause of SARS ? • preliminary findings – coronavirus, a group of viruses which have a halo or crown like (corona) appearance when viewed under microscope • common cause of mild to moderate URTI in humans • associated with respiratory, gastrointestinal, liver and neurologic diseases in animals

4. How contagious is SARS ? • close contact with an infected person (e.g. health care workers and family members) • examples of close contact include having care for, lived with, or had direct contact with aerosolized (exhaled) droplets and bodily secretions from an infected person • may also spread by indirect contact such as touching the skin of other people or objects that are contaminated with infectious droplets and then touching one’s eye(s), nose, or mouth • coronavirus can survive on environmental surfaces for up to 3 hours

5. How fast does SARS spread ? • less infectious than influenza • short incubation period, usually 2 to 7 days (3-5 days being most common, in some cases up to 10 days) • rapid spread due to speed of international travel • risk of nosocomial transmission

6. Prevention of transmission of SARS For all contacts with suspects or probable SARS patients, careful hand hygiene is urged, including hand washing with soap and water. If hands are not visibly soiled, alcohol-based hand rubs may be used as an alternative to hand washing

7. Prevention of transmission of SARS If one has • traveled to a known SARS area in the last 10 days, or have had close contact with a co-worker or family member with suspected or probable SARS AND • developed fever (>38oC) or respiratory symptoms (e.g. cough or difficulty breathing) *** should not go to work, or other public area *** seek evaluation by a healthcare provider immediately

8. Prevention of transmission of SARS For suspect or probable SARS case: • wear a surgical mask in the presence of others • wash hands often and well, especially after blowing nose • if ongoing respiratory symptoms are present, should sleep in separate room, use own eating utensils and not share any linen or towels with others • should limit interactions outside home until 10 days after resolution of fever and respiratory symptoms

9. Prevention of transmission of SARS For household contact living with a case: • disposable gloves should be used for any direct contact with body fluids of a SARS patient; gloves should be immediately removed and discarded after the activity and hands should be cleaned • environmental surfaces soiled by body fluids should be cleaned with warm water and detergent, followed by wiping with a household disinfectant, e.g. dilute bleach; gloves should be worn during this activity • need to monitor health for 10 days – take temperature daily • pursue normal activities but should isolate oneself from others quickly if develop fever or unwell and seek medical attention

10. Prevention of transmission of SARS In an outpatient setting • separate assessment area • surgical mask should be placed on the suspect patient • health care personnel should wear N-95 respirators while evaluating, taking care of and transporting suspect patient • if N-95 respirators are not available, surgical masks should be worn

11. Air travel Those at risk of acquiring SARS from another passenger could be: • directly within inhalation distance of droplets released by coughing or sneezing (within approximately one metre) • in contact with surfaces that the passenger may have contaminated by coughing or sneezing and enabling self inoculation of the virus by transfer of the object via hands to mouth or eyes

12. Air travel If you must travel: • assemble a travel health kit containing basic first aid and medical supplies, including a thermometer, household disinfectant, surgical masks, disposable gloves and alcohol-based hand rubs • monitor own health for 10 days after returning from the affected area

13. References: • CDC website • WHO website • Interim Australian Infection Control Approach to SARS by the Department of Health and Ageing in conjunction with the Communicable Disease Network of Australia • Infection Watch by the Infectious Disease Control Team, UMMC

14. Check out the CDC and WHO SARS websites for more information ……..The end……..