SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

MEASURING HUMAN EXPOSURE TO SARS

Since SARS presents with vague constitutional symptoms, it may be hard to distinguish from the flu or other respiratory illnesses, especially during the winter months when these illnesses are endemic. A laboratory test for SARS does exist, but there is no gold standard as yet, and not all laboratories are equipped to run the confirmatory test. Furthermore, because the test lacks good sensitivity and specificity, it would be counter-productive to test every specimen without first ruling out other causes of respiratory illness. Because SARS is a newly emerging human infection, the case definition is still being clarified, but for the most up-to-date definition, healthcare workers should visit the CDC website at http://www.cdc.gov/ncidod/sars/casedefinition.htm. A very important part of the CDC case definition used to diagnose SARS is recent contact with someone who has had the disease or recent travel to a SARS outbreak area. In the absence of current SARS activity, however, the case definition may not be effective. Surveillance of certain sentinel groups has become important. These groups include healthcare workers in acute care hospitals; travelers returning from previously affected countries within 10 days prior to symptom onset and household contacts to healthcare workers or travelers. In fact, some health departments like California have set up transmission risk levels based on SARS activity:

• Level 0: No known SARS activity in the world. Monitor for pneumonia and pneumonia-related deaths among healthcare workers, travelers and their families.
• Level 1: SARS reported by at least one local hospital. Identify, monitor and evaluate patients and healthcare workers with fever and respiratory symptoms.
• Level 2: SARS reported by more than one hospital, but no nosocomial transmission. Active daily screening of healthcare workers, patients and visitors.
• Level 3: SARS reported by most hospitals and linkable transmission to healthcare workers. Evaluate all patients, healthcare workers, and visitors to new onset of fever or respiratory symptoms linked to possible or confirmed SARS cases.
• Level 4: SARS reported by all hospitals in the community and cases requiring isolation exceeds capacity. Continue level 1, 2, 3 activities.
  

All possible and probable cases of SARS should be reported to the local health department immediately.

1. State of California Health and Human Services agency. http://www.dhs.ca.gov/ps/dcdc/disb/sars.htm.
2. www.cdc.gov/niosh/topics/SARS
3. New York State Department of Health. www.health.state.ny.us/nysdoh/search/index.htm.
4. The Scientist. http://www.biomedcentral.com/news/20030912/04