Learning from SARS Preparing for the Next Disease Outbreak: Workshop Summary (2004) / Chapter Skim
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Appendix C: In the Absence of SARS-CoV Transmission Worldwide:
Appendix C: In the Absence of SARS-CoV Transmission Worldwide:
Pages 292-302
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From page 292... ...
The document provides guidance for surveillance, clinical and laboratory evaluation, and reporting in the setting of no known person-to-person transmission of SARS-CoV worldwide. Recommendations are derived from Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 293... ...
During this period of no known person-to-person transmission of SARS-CoV in the world, healthcare and public health officials must therefore do what they can to prepare for the possibility that SARS-CoV transmission may recur. This document provides guidance for surveillance, clinical and laboratory evaluation, and reporting in the setting of no known person-to-person transmission of SARS-CoV worldwide.
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From page 294... ...
In the absence of person-to-person transmission of SARS-CoV worldwide, the goal of domestic surveillance is to maximize early detection of cases of SARS-CoV disease while minimizing unnecessary laboratory testing, concerns about SARS-CoV, implementation of control measures, and social dis 3Persons who work in laboratories that contain live SARS-CoV should report any febrile and/or respiratory illnesses to the supervisor. They should be evaluated for possible exposures, and their clinical features and course of illness should be closely monitored, as described in Appendix F6, Supplement F, in Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 295... ...
Given these features, the potential sources of recurrence of SARS-CoV, and the predilection for SARS-CoV transmission to occur in healthcare settings or to be associated with geographically focused pneumonia clusters, surveillance efforts in the absence of person-to-person SARS-CoV transmission should aim to identify patients who require hospitalization for radiographically confirmed pneumonia or acute respiratory distress syndrome without identifiable etiology AND who have one of the following risk factors in the 10 days before the onset of illness: · Travel to mainland China, Hong Kong, or Taiwan, or close contact4 with an ill person with a history of recent travel to one of these areas, OR · Employment in an occupation associated with a risk for SARS-CoV exposure (e.g., healthcare worker5 with direct patient contact; worker in a laboratory that contains live SARS-CoV) , OR · Part of a cluster of cases of atypical pneumonia without an alternative diagnosis Infection control practitioners and other healthcare personnel should also be alert for clusters of pneumonia among two or more healthcare workers who work in the same facility.
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From page 296... ...
BOX C-2 Case Detection Severe respiratory illness in the context of a documented exposure risk is the key to diagnosing SARS-CoV disease. Providers should there fore consider SARS-CoV disease in patients requiring hospitalization for: · Radiographically confirmed pneumonia or acute respiratory dis tress syndrome of unknown etiology, AND · One of the following risk factors in the 10 days before illness onset: · Travel to mainland China, Hong Kong, or Taiwan, or close con tact with an ill person with a history of recent travel to one of these areas; OR · Employment in an occupation associated with a risk for SARS CoV exposure (e.g., healthcare worker with direct patient contact; worker in a laboratory that contains live SARS-CoV)
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From page 297... ...
During periods of increased respiratory infection in the community, healthcare facilities should offer procedure or surgical masks to persons who are coughing and encourage coughing persons to sit at least 3 feet away from others in waiting areas. Healthcare workers should practice Droplet Precautions, in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection.
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From page 298... ...
False-positive test results may generate tremendous anxiety and concern and expend valuable public health resources. Therefore, SARS-CoV testing should be performed judiciously, and preferably only in consultation with the local or state health department.
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From page 299... ...
· Arrange for confirmatory testing at an appropriate test site through the local or state health department. propriate confirmatory test site should be arranged through the local or state health department as outlined in Supplement F, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 300... ...
Persons working in laboratories that contain live SARS-CoV should report any fever and/or lower respiratory illness to the supervisor. They should be evaluated for possible exposures, and their clinical features and course of illness should be closely monitored as described in Appendix F6 in Supplement F, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)
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From page 301... ...
Therefore, in the setting of no person-to-person SARS-CoV transmission in the world, the evaluation and management algorithm applies only to adults, unless there are special circumstances that make the clinical and health department consider a child to be of potentially high risk for having SARS-CoV disease.
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From page 302... ...
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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