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Severe Acute
Respiratory Syndrome (SARS) |
This is an official CDC HEALTH UPDATE
Distributed via Health Alert Network
Friday, April 23, 2004
On April 23, 2004, the Chinese Ministry of Health (MOH) reported four
patients with possible severe acute respiratory syndrome (SARS) to the
World Health Organization (WHO). Two of the cases are from Beijing and
two are from Anhui Province, located in east-central China . One of
the patients in Anhui Province died. Below is a brief description of
the four cases.
The first patient is a 26-year-old female graduate student
from Anhui Province who worked at the National Institute of Virology
Laboratory of China 's Center for Disease Control in Beijing during March
7-22. The laboratory is known to conduct research on SARS coronavirus
(SARS-CoV). She developed fever and other SARS-like symptoms on March
25 while in Anhui Province ; she traveled by train to Beijing and was
admitted to a local hospital on March 29 with pneumonia. She returned
to Anhui Province on April 2 and is currently under medical observation.
Laboratory test results reported on April 23 showed evidence of antibodies
to SARS coronavirus (SARS-CoV).
The second patient is the mother of the 26-year-old graduate
student who had provided bedside care for her daughter during her recent
illness. The mother became ill on April 8 and was admitted to a hospital
in Anhui Province with pneumonia. She died on April 19; Chinese health
authorities have identified her illness as a possible SARS case.
The third patient is a 20-year-old female nurse (described
in CDC Health Advisory on April 22) who provided care to the 26-year-old
graduate student in a Beijing hospital from March 29 to April 2. The
nurse became ill on April 5, was admitted to a hospital in Beijing on
April 7, and was transferred to another Beijing hospital on April 14,
where she remains in intensive care. On April 22, her illness was identified
as possible SARS on the basis of positive test results for antibodies
to SARS-CoV in serum.
The fourth patient is a 31-year-old male graduate student
who worked at the same research laboratory in Beijing as the 26-year-old
graduate student. He reported fever on April 17 and was admitted to a
hospital in Beijing on April 22. Chinese health authorities have identified
the illness as possible SARS.
An epidemiologic investigation of these cases by Chinese public health
authorities is under way. The Chinese MOH has requested local health
authorities in China to enhance surveillance for SARS, influenza-like
illness, and pneumonia of unknown etiology, and has initiated measures
to prevent the spread of SARS among travelers, including screening of
travelers at ports of entry. Chinese health authorities are also actively
identifying contacts of these four patients and have identified 188 close
contacts of the third patient (the nurse). Five of these 188 contacts
have developed fever, and all the febrile contacts have been hospitalized
and isolated. The National Institute of Virology Laboratory in Beijing
has been closed, potentially exposed personnel are being screened, and
possible sources of infection for the two laboratory workers are being
investigated.
The U.S. Centers for Disease Control and Prevention (CDC) remains in
close communication with WHO about the reported cases of SARS in China
and will provide additional information as it becomes available. At this
time, CDC is not advising changes in the current U.S. SARS control measures
other than the recommendations stated in the HAN Advisory for April 22
(provided below).
CDC is recommending that U.S. physicians maintain a greater index of
suspicion for SARS in patients who 1) require hospitalization
for radiographically confirmed pneumonia or acute respiratory distress
syndrome (ARDS) AND 2) who have a history of
travel to mainland China (or close contact with an ill person with a
history of recent travel to mainland China) in the 10 days before onset
of symptoms . When such patients are identified,
they should be considered at high risk for SARS-CoV infection and the
following actions should be taken:
- Patients should immediately be placed in appropriate
isolation precautions for SARS (i.e., contact and airborne precautions
along with eye protection).
- Patients should promptly be reported to the state or
local health department. Health departments should immediately report
any SARS-CoV positive test result to CDC. Health departments should
also inform CDC of other cases or clusters of pneumonia that are of
particular concern by calling 770-488-7100.
- Patients should promptly be tested for evidence of SARS-CoV
infection as part of the diagnostic evaluation (see Appendix 2, "Guidelines
for Collecting Specimens from Potential SARS Patients," in the CDC document, "In
the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance,
Clinical and Laboratory Evaluation, and Reporting" at www.cdc.gov/ncidod/sars/absenceofsars.htm)
- The health department should identify, evaluate, and monitor
relevant contacts of the patient, as indicated. In particular, the
health status of household contacts or persons who provided care to symptomatic
patients should be assessed.
Health care providers are reminded to obtain a travel history for patients
presenting with acute respiratory illness. In addition, this new case
of possible SARS provides a reminder to all healthcare settings, especially
physician offices, outpatient clinics, and emergency departments, of
the importance of implementing infection control precautions at the point
of first contact with patients who have symptoms of a respiratory infection.
These include respiratory hygiene/cough etiquette, hand hygiene, and
droplet precautions (i.e., masks for close patient contact). For additional
information, see " Respiratory
Hygiene/Cough Etiquette in Healthcare Settings."
The reported possible cases of SARS in China represent an evolving situation,
and CDC will distribute updates as additional information is learned.
For more about SARS and the current U.S. SARS control guidelines, please
visit the CDC SARS website.
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