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Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies 27 April 2004

Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies 27 April 2004. Jeffrey S. Duchin, M.D . Chief, Communicable Disease Control, Epidemiology and Immunization Section, Public Health - Seattle & King County Division of Allergy and Infectious Diseases,

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Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies 27 April 2004

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  1. Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies27 April 2004 Jeffrey S. Duchin, M.D.Chief, Communicable Disease Control, Epidemiology and Immunization Section, Public Health - Seattle & King County Division of Allergy and Infectious Diseases, University of Washington

  2. SARS Presentation Overview The presentation has five sections: • Chronology and Clinical Features • Command and Control • Surveillance & Case and Contact Investigations • Infection Control & Roles of Healthcare System • Isolation and Quarantine

  3. SARS & Preparedness for Biological Emergencies Isolation & Quarantine

  4. SARS & Preparedness for Biological Emergencies Isolation & Quarantine • Usually voluntary, but can be mandatory. • Legal quarantine authority exists at federal, state and local levels and covers “isolation” and “quarantine”

  5. Isolation & Quarantine • Isolation: • Restriction of movement and/or separation of sick infected persons with contagious disease • Usually in a hospital setting, but can also be at home or in a dedicated isolation facility • Quarantine • Restriction of movement and/or separation of well persons presumed exposed to a contagious disease • Usually at home, but can be in a dedicated quarantine facility • Individual(s) or community/population level

  6. SARS & Preparedness for Biological EmergenciesSARS Isolation • Persons with suspect SARS are to remain in isolation and adhere to infection control recommendations until 10 days after resolution of fever AND cough improving • Persons with SARS exposure and fever or respiratory symptoms should remain in isolation and adhere to infection control recommendations for 72 hours • If progress to meet suspect SARS case definition, isolation as above • If symptoms resolve, no restrictions • If symptoms persist but still do not meet SARS case definition, additional 72-hour isolation followed by re-evaluation

  7. SARS & Preparedness for Biological EmergenciesIsolation and Quarantine • Rely on patients to comply with voluntary isolation request • Need official isolation requests/orders and accompanying instructions, guidelines, Q & A, etc., for patients, their families and other exposed persons • Critical importance of patient education by clinician regarding need for compliance with isolation and with infection control recommendations • Importance of public education regarding “modern quarantine” • Community-based quarantine measures • increase social distance • restrict movement of populations

  8. SARS & Preparedness for Biological EmergenciesIsolation & Quarantine: Considerations • Is quarantine likely to be effective in substantially decreasing disease transmission? • Can the exposed population be defined? • Are there other potentially effective disease control measures available (treatment, prophylaxis)? • Is quarantine logistically feasible (are resources available to implement quarantine)? • Is there a sound legal basis for isolation & quarantine authority? • Will quarantine authority be recognized and enforced? • What are the consequences for noncompliance? • Effect of public perception (fear) on compliance with public health recommendations

  9. SARS & Preparedness for Biological EmergenciesIsolation & Quarantine: Considerations • Risks to persons under quarantine • Can the needs of persons under quarantine (including those who become ill) be met? • Who makes the decision to implement isolation or quarantine? • Is there a process for delivering isolation and/or quarantine orders? • Procedures for due process and legal challenge? • Have the appropriate response partners been educated and prepared: judiciary, law enforcement, the public?

  10. Severe Acute Respiratory SyndromeSARS Resources • CDC web site: www.cdc.gov (see Preparedness Planning webpage) • WHO SARS website: http://www.who.int/csr/sars/en/ • Guidelines for Isolation Precautions in Hospitals • www.cdc.gov/ncidod/hip/ISOLAT/Isolat.htm • Guidelines for Infection Control in Health Care Personnel, 1998 • www.cdc.gov/ncidod/hip/GUIDE/infectcont98.htm • Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994 • www.cdc.gov/mmwr/preview/mmwrhtml/00035909.htm

  11. SARS &Other Public Health Emergencies Questions?

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