Learning from SARS Preparing for the Next Disease Outbreak: Workshop Summary (2004) / Chapter Skim
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Appendix B: Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease Among Persons Presenting with Community-Acquired Illness
Appendix B: Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease Among Persons Presenting with Community-Acquired Illness
Pages 281-291
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From page 281... ...
Many studies have been undertaken or are underway to evaluate whether there are specific laboratory and/or clinical parameters that can distinguish 1This document provides guidance on the clinical evaluation and management of patients who present from the community with fever and/or respiratory illnesses. The material in this document supplements the information provided in Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 282... ...
In the absence of any person-toperson transmission of SARS-CoV worldwide, the overall likelihood that a patient being evaluated for fever or respiratory illness has SARS-CoV disease will be exceedingly low unless there are both typical clinical findings and some accompanying epidemiologic evidence that raises the suspicion of exposure to SARS-CoV. Therefore, one approach in this setting would be to consider the diagnosis only for patients who require hospitalization for unexplained pneumonia and who have an epidemiologic history that raises the suspicion of exposure, such as recent travel to a previously SARS-affected area (or close contact with an ill person with such a travel history)
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From page 283... ...
As part of the evaluation, in addition to identification of suggestive clinical features, clinicians should routinely incorporate into the medical history questions that may provide epidemiologic clues to identify patients with SARS-CoV disease. ADDITIONAL CONSIDERATIONS In some settings, early recognition of SARS-CoV disease may require additional measures.
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From page 284... ...
or close contacta with ill persons with a history of recent travel to such areas, OR · Is employed in an occupation at particular risk for SARS-CoV ex posure, including a healthcare worker with direct patient contact or a worker in a laboratory that contains live SARS-CoV, OR · Is part of a cluster of cases of atypical pneumonia without an alter native diagnosis Persons with such a clinical and exposure history should be evalu ated according to the algorithm in Figure B-1. Once person-to-person transmission of SARS-CoV has been documented in the world, the diagnosis should still be considered in patients who require hospitalization for pneumonia and who have the epidemiologic history described above.
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From page 285... ...
The diagnosis of nosocomial SARS-CoV disease may be particularly challenging, however, since many inpatients may have other reasons for developing nosocomial fever, lower respiratory symptoms, and pneumonia. Therefore, in hospitals known to have or suspected of having patients with SARS-CoV disease, clinicians and public health officials must be particularly vigilant about evaluating fever and respiratory illnesses among inpatients.
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From page 286... ...
If clinicians have concerns about the possibility of SARS-CoV disease in a patient with a history of travel to other previously affected areas (e.g., while traveling abroad, had close contact with another person with pneumonia of unknown etiology or spent time in a hospital in which patients with acute respiratory disease were treated) , they should contact the health department.
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From page 288... ...
2Exposure history for SARS-CoV, once SARS-CoV transmission is documented in the world: In settings of no or limited local secondary transmission of SARS-CoV, patients are considered exposed to SARS-CoV if, within 10 days of symptom onset, the patient has: · Close contact with someone suspected of having SARS-CoV disease, OR · A history of foreign travel (or close contact with an ill person with a history of travel) to a location with documented or suspected SARS-CoV, OR · Exposure to a domestic location with documented or suspected SARS-CoV (including a laboratory that contains live SARS-CoV)
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From page 289... ...
Factors that might be considered include the strength of the epidemiologic exposure to SARS-CoV, nature of contact with others in the residential or work setting, strength of evidence for an alternative diagnosis, and evidence for clustering of pneumonia among close contacts. Isolation precautions should be discontinued on the basis of an alternative diagnosis only when the following criteria are met: · Absence of strong epidemiologic link to known cases of SARS-CoV disease · Alternative diagnosis confirmed using a test with a high positive-predictive value · Clinical manifestations entirely explained by the alternative diagnosis · No evidence of clustering of pneumonia cases among close contacts (unless >1 case in the cluster is confirmed to have the same alternative diagnosis)
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From page 290... ...
. Detailed information for persons who work in laboratories that contain live SARS-CoV is provided in Supplement F, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 291... ...
APPENDIX B 291 status, even in the absence of typical clinical features of SARS-CoV disease, when such patients have epidemiologic risk factors for SARS-CoV disease (e.g., close contact with someone suspected to have SARS-CoV disease or exposure to a location [domestic or international] with documented or suspected recent transmission of SARS-CoV)
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