On March 12, 2003, the World Health Organization (WHO) issued a historic
global alert for severe acute respiratory syndrome (SARS), a deadly new
infectious disease with the potential for rapid spread from person to
person and via international air travel. WHO and its partners, including
the Centers for Disease Control and Prevention (CDC), promptly initiated
a rapid, intense, and coordinated investigative and control effort that
led within 2 weeks to the identification of the etiologic agent, SARS-associated
coronavirus (SARS-CoV), and to a series of decisive and effective containment
efforts. By the time SARS-CoV transmission was brought to an end in July
2003, more than 8,000 cases and 780 deaths had been reported to WHO.
The emergence
of SARS-CoV provided a dramatic illustration of the potential for a
new disease to suddenly appear and spread, leading to widespread health,
social, and economic consequences. Fortunately, the world also witnessed
the power of traditional public health measures-including surveillance,
infection control, isolation, and quarantine-to contain and control an
outbreak. Although the United States had a limited SARS outbreak, it
is clear that we are susceptible to the more widespread outbreaks experienced
in other countries. It is not possible to predict whether SARS-CoV will
reappear, but it could from its original animal reservoir, persistent
infection in humans, or the laboratory. To achieve the type of swift
and decisive response that is required to control a SARS outbreak, we
must be prepared.
Public Health Guidance for Community-Level Preparedness and Response
to Severe Acute Respiratory Syndrome (SARS) outlines a framework
and approach to assist public health and healthcare officials in preparing
for and responding rapidly and decisively to the appearance of SARS-CoV
in a healthcare facility or a community. The document has its basis
in the United
States Government Interagency SARS Concept of Operations Plan (CONPLAN), which outlines the Federal government's strategy
for a coordinated national response to an outbreak of SARS. The CONPLAN
provides planning guidance for a timely, coordinated response by federal
agencies to a SARS emergency and serves as a foundation for the development
of operational plans and procedures at the national, state, and local
levels.
Whereas
the focus of the CONPLAN is interagency and intergovernmental coordination,
CDC's Public Health Guidance for Community-Level Preparedness
and Response to Severe Acute Respiratory Syndrome (SARS) provides
planning guidance, strategies, and tools for the local public health
and healthcare officials who provide the first line of readiness and
action in detecting and containing a SARS outbreak. The guidance has
been prepared in close collaboration with domestic and international
partners and incorporates many of the concepts and approaches that were
successfully used to contain the spread of SARS-CoV in the United States
and in other counties with more widespread outbreaks. In addition, it
integrates and builds on preparedness and response plans for other public
health emergencies, such as pandemic influenza and bioterrorism.
The document
includes suggested activities to be conducted both in the absence of
SARS-CoV transmission in the world and in the context of a recurrence
of person-to-person transmission. A companion document, In
the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance,
Clinical and Laboratory Evaluation, and Reporting,
consolidates the recommended activities for the setting of no person-to-person
transmission. If SARS-CoV transmission is documented anywhere in
the world, CDC will promptly review all available information and provide
additional guidance as indicated via the Health Alert Network (HAN),
Epi-X, and partner organizations. Current information will also
be posted on CDC's SARS website.
The basic
strategy that controlled SARS outbreaks worldwide was rapid and decisive
surveillance and containment. The keys to successful implementation
of such a strategy are up-to-date information on local, national, and
global SARS activity; rapid and effective institution of control measures;
and the resources, organizational and decision-making structure, and
trained staff vital to swift and decisive implementation. This guidance
document accounts for two important features of SARS outbreaks: 1)
they are neither regional nor national but rather confined to limited
geographic - and
even institutional - settings, and 2) they are dynamic, meaning that
the characteristics of an outbreak can change quickly.
The document is divided into four levels of increasingly detailed information:
the executive summary, the core plan, stand-alone supplements that address
the key measures for SARS preparedness and response, and appendices to
each supplement that provide guidance and tools for local-level preparedness
and response activities. The document provides guidance on each of the
following key components of SARS preparedness and response:
- Command
and Control
- Surveillance
and Information Technology
- Preparedness
and Response in Healthcare Facilities
- Community
Containment Measures, Including Non-Hospital Isolation and Quarantine
- Management
of International Travel-Related Transmission Risk
- Laboratory
Diagnostics
- Communication
and Education
- SARS
Investigations and Epidemiologic Research
- Infection
Control
Using this guidance document, localities can develop operational SARS
preparedness and response plans that reflect consistent approaches among
and within jurisdictions to outbreaks of similar characteristics, while
taking into account available healthcare and public health resources
and other factors that are unique to each community. The document will
be updated as necessary to reflect increased understanding of SARS-CoV
transmission dynamics and availability of improved prevention tools.
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