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| عنوان: Basic Information About SARS |
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| كد: | FACT SHEET
Basic Information About SARS
April 30, 2003, 5:00 PM ET
A new disease called SARS
Severe acute respiratory syndrome (SARS) is a respiratory illness that has recently been reported in Asia, North America, and Europe. This fact sheet provides basic information about the disease and what is being done to combat its spread. To find out more about SARS, go to www.cdc.gov/ncidod/sars/ and www.who.int/csr/sars/en/ . The Web sites are updated daily.
Symptoms of SARS
In general, SARS begins with a fever greater than 100.4°F [>38.0°C]. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms. After 2 to 7 days, SARS patients may develop a dry cough and have trouble breathing.
How SARS spreads
The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or by other ways that are currently not known.
Who is at risk for SARS
Most of the U.S. cases of SARS have occurred among travelers returning to the United States from other parts of the world affected by SARS. There have been very few cases as a result of spread to close contacts such as family members and health care workers. Currently, there is no evidence that SARS is spreading more widely in the community in the United States.
Possible cause of SARS
Scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. The new coronavirus is the leading hypothesis for the cause of SARS.
What CDC is doing about SARS
CDC is working closely with the World Health Organization (WHO) and other partners in a global effort to address the SARS outbreak. For its part, CDC has taken the following actions:
• Activated its Emergency Operations Center to provide round-the-clock coordination and response.
• Committed more than 300 medical experts and support staff to work on the SARS response.
• Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.
• Provided ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.
• Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.
• Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.
CDC RECOMMENDATIONS
CDC has issued recommendations and guidelines for people who may be affected by this outbreak.
For individuals considering travel to SARS-affected areas:
CDC advises that people planning elective or nonessential travel to mainland China, Hong Kong, Taiwan or Singapore may wish to postpone their trips until further notice. CDC also has issued travel alerts for Hanoi, Vietnam; and Toronto, Canada, to recommend that U.S. travelers to any of these places observe precautions to safeguard their health. Visit this page for more information about CDC’s advice to travelers.
For individuals who must travel to a SARS-affected area:
CDC advises that travelers in a SARS-affected area should wash their hands frequently to protect against SARS infection. In addition, CDC advises that travelers may wish to avoid close contact with large numbers of people as much as possible to minimize the possibility of infection. CDC does not recommend the routine use of masks or other personal protective equipment while in public areas. For more information, read the Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) for Persons Traveling to SARS-Affected Areas.
For individuals who think they might have SARS:
People with symptoms of SARS (fever greater than 100.4°F [>38.0°C] accompanied by a cough and/or difficulty breathing) should consult a health-care provider. To help the health-care provider make a diagnosis, tell them about any recent travel to places where SARS has been reported or whether there was contact with someone who had these symptoms.
For family members caring for someone with SARS:
CDC has developed interim infection control recommendations for patients with suspected SARS in the household. These basic precautions should be followed for 10 days after respiratory symptoms and fever are gone. During that time, SARS patients are asked to limit interactions outside the home (not go to work, school, or other public areas).
For health-care workers:
Transmission of SARS to health-care workers appears to have occurred after close contact with sick people before recommended infection control precautions were put into use. CDC has issued interim infection control recommendations for health-care settings as well as for the management of exposures to SARS in health-care and other institutional settings.
For more information, visit CDC's SARS Web site, or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY)
Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) for International Adoptees and Their Families
April 4, 2003, 3:00 PM EST
The Centers for Disease Control and Prevention (CDC) has been working closely with the World Health Organization (WHO) to investigate cases of Severe Acute Respiratory Syndrome (SARS). SARS is a respiratory illness that has recently been reported in Asia, North America, and Europe. The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms at the outset.
CDC has issued a travel advisory suggesting that people planning elective or nonessential travel to mainland China; Hong Kong; Singapore; and Hanoi, Vietnam, may wish to postpone their trips until further notice.
If, however you are so close to completing the adoption process that delay is not feasible or desirable and you decide to go ahead with your travel to an area with SARS, please keep the following guidelines in mind.
Before you leave:
• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer, household disinfectant, a supply of surgical masks, disposable gloves and alcohol-based hand rubs for hand hygiene.
• Inform yourself and others who may be traveling with you about SARS. For information about this illness, see CDC's SARS Web site.
• Be sure you are up to date with all your shots, and see your healthcare provider at least 4 to 6 weeks before travel to get any additional shots or information you may need. For information on CDC health recommendations for international travel, see CDC's Travelers' Health site.
• You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services can be found at this U.S. Department of State page.
• Identify in-country healthcare resources in advance of your trip.
While you are in an area with SARS:
• To protect against SARS infection, wash your hands frequently. As much as possible, avoid crowds. If wearing a surgical mask adds to your comfort level, you may wish to do so while in close contact with people who may be ill with respiratory symptoms.
• People with SARS pose a risk of transmission to close personal contacts and healthcare personnel in close contact. The duration of time after onset of symptoms during which a person with SARS can transmit the disease to others is unknown.
If you think you or a family member has SARS or symptoms compatible with SARS:
• If you or a family member becomes ill with fever and respiratory symptoms (for example, cough or shortness of breath), a visit to a healthcare provider is strongly recommended. The nearest U.S. Embassy or Consular Office can help you find a provider in the area. Again, you are encouraged to identify these resources in advance. Do not travel while sick and limit your contact with others as much as possible to help prevent the spread of any infectious illness you may have.
• The person who is ill should cover their mouth and nose with a facial tissue when coughing or sneezing. If possible, they should wear a surgical mask during close contact with healthy people to prevent spread of infectious droplets. If the sick person is unable to wear a surgical mask, family members should wear surgical masks when in close contact with the person who is ill.
• Use of disposable gloves should be considered for any direct contact with body fluids of a person with SARS. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.
• All family members staying with a person with SARS should carefully follow recommendations for hand hygiene (e.g., frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
• People with SARS should avoid sharing eating utensils, towels, and bedding with others, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
• Environmental surfaces (e.g., toilets, sinks) soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity. Wash hands afterwards and throw the gloves away.
• Other family members staying with a person with SARS do not need to restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness.
After your return:
• Families returning from one of the affected areas should monitor their health for 10 days. Any family member who becomes ill with fever or respiratory symptoms during this period should consult a healthcare provider and tell him or her about their recent travel.
Family members or other close contacts of person with SARS who develop fever or respiratory symptoms should be evaluated by a healthcare provider. When possible, in advance of the evaluation, healthcare providers should be informed that the individual is a close contact of a person with SARS. Family members or other close contacts with symptoms of SARS should follow the same precautions recommended for people with SARS.
The previous CDC SARS case definition (published April 16, 2003) has been updated as follows:
• Reported U.S. cases of SARS will be classified as suspect or probable based on the criteria outlined below.
• Toronto, Canada has been added to the areas with documented or suspected community transmission of SARS.
Suspect Case
Respiratory illness of unknown etiology with onset since February 1, 2003, and the following criteria:
• Measured temperature greater than 100.4°F (greater than 38°C) AND
• One or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia) AND
• Travel† within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS (see list below; excludes areas with secondary cases limited to healthcare workers or direct household contacts) OR
Close contact* within 10 days of onset of symptoms with a person known to be a suspect SARS case.
Probable Case
A suspect case with one of the following:
• Radiographic evidence of pneumonia or respiratory distress syndrome
• Autopsy findings consistent with respiratory distress syndrome without an identifiable cause
†Travel includes transit in an airport in an area with documented or suspected community transmission of SARS.
Areas with documented or suspected community transmission of SARS: People's Republic of China (i.e., mainland China and Hong Kong Special Administrative Region); Hanoi, Vietnam; Singapore; and Toronto, Canada.
*Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient known to be suspect SARS case.
GUIDELINES AND RECOMMENDATION
Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) for Persons Traveling to SARS-Affected Areas
April 22, 2003, 3:30 PM ET
The Centers for Disease Control and Prevention (CDC) is tracking reports of outbreaks of a respiratory illness called severe acute respiratory syndrome (SARS). The symptoms of SARS can be found at basic information about SARS. The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other persons or objects that are contaminated with infectious droplets and then touching the eye, nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other persons, or nearby surfaces. It is also possible that SARS can be spread more broadly through the air or by other ways that are currently not known.
You can learn more about SARS at the websites of both CDC and the World Health Organization (WHO). These websites are updated continually as new information about SARS and the areas affected is learned.
CDC has issued a travel advisory suggesting that people planning elective or nonessential travel to mainland China and Hong Kong, Singapore, and Hanoi, Vietnam, may wish to postpone their trips until further notice. CDC has also issued a travel alert for Toronto, Canada, to recommend that U.S. travelers to Toronto observe precautions to safeguard their health.
If you decide to go ahead with your travel to an area with SARS, please keep the following guidelines in mind.
Before you leave:
• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer, household disinfectant, a supply of surgical masks and disposable gloves (for use if you or someone you are traveling with becomes ill with SARS), and alcohol-based hand rubs for hand hygiene.
• Inform yourself and others who may be traveling with you about SARS. For information about this illness, see CDC's SARS Web site.
• Be sure you are up to date with all your shots, and see your health-care provider at least 4 to 6 weeks before travel to get any additional shots or information you may need. For information on CDC health recommendations for international travel, see CDC's Travelers' Health site.
• You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services can be found at this U.S. Department of State page.
• Identify in-country health-care resources in advance of your trip.
While you are in an area with SARS:
• To protect against SARS infection, wash your hands frequently.
• To minimize the possibility of infection, you may wish to avoid close contact with large numbers of people as much as possible. CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.
If you think you have SARS or symptoms compatible with SARS:
• If you become ill with fever and respiratory symptoms (for example, cough or shortness of breath), a visit to a health-care provider is strongly recommended. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting. The nearest U.S. Embassy or Consular Office can help you find a provider in the area. Again, you are encouraged to identify these resources in advance. Do not travel while sick and limit your contact with others as much as possible to help prevent the spread of any infectious illness you may have.
• The person who is ill should cover their mouth and nose with a facial tissue when coughing or sneezing. If possible, they should wear a surgical mask during close contact with healthy people to prevent spread of infectious droplets. If the sick person is unable to wear a surgical mask, other persons should wear surgical masks when in close contact with the person who is ill.
• Use of disposable gloves should be considered for any direct contact with body fluids of a person with SARS. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.
• All close contacts staying with a person with SARS should carefully follow recommendations for hand hygiene (e.g., frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
• People with SARS should avoid sharing eating utensils, towels, and bedding with others, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
• Environmental surfaces (e.g., toilets, sinks) soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity. Wash hands afterwards and throw the gloves away.
• Other close contacts staying with a person with SARS do not need to restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness.
After your return:
• Persons returning from one of the affected areas should monitor their health for 10 days. Any family member who becomes ill with fever or respiratory symptoms during this period should consult a healthcare provider and tell him or her about their recent travel. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.
Close contacts of person with SARS who develop fever or respiratory symptoms should be evaluated by a health-care provider. Before the evaluation, health-care providers should be informed that the individual is a close contact of a person with SARS. These persons with symptoms of SARS should follow the same precautions recommended for people with SARS.
Information for Clinicians
April 25, 2003
The Centers for Disease Control and Prevention (CDC) and the World Health Organization have received reports of patients with severe acute respiratory syndrome (SARS). A novel coronavirus, for which CDC recently completed genome sequencing is believed to be responsible for the global epidemic of SARS. Some close contacts of infected patients, including health-care workers, have developed similar illnesses. In response to these developments, CDC is issuing revised interim guidance concerning infection control precautions in the health-care and community setting. To minimize the potential for transmission, these precautions are recommended, as feasible given available resources, until the epidemiology of disease transmission is better understood.
Preliminary Clinical Description of Severe Acute Respiratory Syndrome
On March 21, 2003, this report was posted on the MMWR website (http://www.cdc.gov/mmwr).
Severe acute respiratory syndrome (SARS) is a condition of unknown etiology that has been described in patients in Asia, North America, and Europe. This report summarizes the clinical description of patients with SARS based on information collected since mid-February 2003 by the World Health Organization (WHO), Health Canada, and CDC in collaboration with health authorities and clinicians in Hong Kong, Taiwan, Bangkok, Singapore, the United Kingdom, Slovenia, Canada, and the United States. This information is preliminary and limited by the broad and necessarily nonspecific case definition.
As of March 21, 2003, the majority of patients identified as having SARS have been adults aged 25--70 years who were previously healthy. Few suspected cases of SARS have been reported among children aged <15 years.
The incubation period for SARS is typically 2--7 days; however, isolated reports have suggested an incubation period as long as 10 days. The illness begins generally with a prodrome of fever (>100.4°F [>38.0°C]). Fever often is high, sometimes is associated with chills and rigors, and might be accompanied by other symptoms, including headache, malaise, and myalgia. At the onset of illness, some persons have mild respiratory symptoms. Typically, rash and neurologic or gastrointestinal findings are absent; however, some patients have reported diarrhea during the febrile prodrome.
After 3--7 days, a lower respiratory phase begins with the onset of a dry, nonproductive cough or dyspnea, which might be accompanied by or progress to hypoxemia. In 10%--20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. The case-fatality rate among persons with illness meeting the current WHO case definition of SARS is approximately 3%.
Chest radiographs might be normal during the febrile prodrome and throughout the course of illness. However, in a substantial proportion of patients, the respiratory phase is characterized by early focal interstitial infiltrates progressing to more generalized, patchy, interstitial infiltrates. Some chest radiographs from patients in the late stages of SARS also have shown areas of consolidation.
Early in the course of disease, the absolute lymphocyte count is often decreased. Overall white blood cell counts have generally been normal or decreased. At the peak of the respiratory illness, approximately 50% of patients have leukopenia and thrombocytopenia or low-normal platelet counts (50,000--150,000/µL). Early in the respiratory phase, elevated creatine phosphokinase levels (as high as 3,000 IU/L) and hepatic transaminases (two to six times the upper limits of normal) have been noted. In the majority of patients, renal function has remained normal.
The severity of illness might be highly variable, ranging from mild illness to death. Although a few close contacts of patients with SARS have developed a similar illness, the majority have remained well. Some close contacts have reported a mild, febrile illness without respiratory signs or symptoms, suggesting the illness might not always progress to the respiratory phase.
Treatment regimens have included several antibiotics to presumptively treat known bacterial agents of atypical pneumonia. In several locations, therapy also has included antiviral agents such as oseltamivir or ribavirin. Steroids have also been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials. At present, the most efficacious treatment regimen, if any, is unknown.
In the United States, clinicians who suspect cases of SARS are requested to report such cases to their state health departments. CDC requests that reports of suspected cases from state health departments, international airlines, cruise ships, or cargo carriers be directed to the SARS Investigative Team at the CDC Emergency Operations Center, telephone 770-488-7100. Outside the United States, clinicians who suspect cases of SARS are requested to report such cases to their local public health authorities. Additional information about SARS (e.g., infection control guidance and procedures for reporting suspected cases) is available at http://www.cdc.gov/ncidod/sars. Global case counts are available at http://www.who.int/.
Reported by: World Health Organization, Geneva, Switzerland. Immunization and Respiratory Infections Div, Centre for Infectious Disease Prevention and Control, Health Canada, Ottawa, Canada. CDC SARS Investigation Team; TA Clark, MD, and B Park, MD, EIS officers, CDC.
With lots of thanks:
Mohsen salehi – student of veterinary medicine-(D.V.M)
I.A.U- shahrekord
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