Severe Acute Respiratory Syndrome (SARS)

1. Severe Acute Respiratory Syndrome (SARS) Epidemiology & Clinical Management WHO Western Pacific Regional Office April 18, 2003

2. Epidemiology & Clinical Management • Background • Chronology • Epidemiology • Case Definitions • Clinical Picture • Clinical Management • Summary - SARS

3. Background • Approximately 3293 cases in 22 countries as at 16 April 2003 • At least 159 deaths • A significant number of cases have been in health care workers

4. Chronology • SARS, an atypical pneumonia of unknown aetiology, was recognized at the end of February 2003 • The World Health Organization (WHO) is coordinating the international responses to provide epidemiological, clinical and logistical support as required

5. Chronology • 11 February :Chinese health officials reported “atypical pneumonia” in Guangdong Province, China; 305 cases/5 deaths (Nov02–Feb03) • 19 February :Hong Kong confirms human infection ofInfluenza H5N1 • 5 March : Outbreak in Hanoi recognized • 12 March :Hong Kongreports SARS outbreak • 14 March :Singapore reports 3 SARS cases • 15 March : The disease spread to outside Asia (Canada, Germany)

6. Chronology WHO initiates : • Global Alert (12 March) • Travel Advisory (15 March, 2 April) • Enhanced global surveillance • Global Outbreak Alert and Response Network • Specific Global Networks (Lab, Case Management, Epidemiology)

7. Chronology Activities since then : • travel advisories have been issued indicating non-essential travel to affected areas should not occur. • The global laboratory network has diagnosed the probable cause.

8. Epidemiology • Cause : New Corona Virus • Recent evidence of new corona virus identified with aetiological co-factors ? involved • Highly infectious

9. Epidemiology • Means of transmission • Evidence of person to person transmission • Close contact with body fluids (especially respiratory droplets ) • Contaminated hands, clothes, equipment; environment may also be important

10. Epidemiology • Incubation period • 2 –10 days and up to 13 days in exceptional cases • Onset and duration of infectivity unknown • Organism survival in environment • Duration unknown • Other corona virus are known to survive for up to 4 hours

11. Case Definitions A person presenting after 1 February 2003 with a history of: Suspect SARS Case • High fever >38 0C • AND • One or more respiratory symptoms including cough, shortness of breath or breathing difficulty • AND one or more of the following: • Close contact, within 10 days prior to onset of symptoms with a person diagnosed with SARS; • History of travel, within 10 days prior to onset of symptoms to an affected area (see archive of Affected Areas at http//www.who.int./csr/sars/en/).

12. Case Definitions Explanations: Close contact : having cared for, lived with, or had direct contact with the respiratory secretions or body fluids of a suspect or probable case of SARS. Affected area : an area in which local chain(s) of transmission of SARS is/are occurring as reported by the national public health authorities.

13. Case Definitions Probable Case A suspect case with chest X-Ray findings consistent with pneumonia or respiratory distress syndrome (RDS) OR A suspect case with an unexplained illness resulting in death, with autopsy examination demonstrating the pathology of RDS without an identifiable cause.

15. Clinical Picture – Onset / Presentation • Sudden onset of high fever with myalgia, chills, rigors and a non-productive cough • Most cases have bilateral pneumonia • ~ 90% begin to recover from day 6 or 7

16. Clinical Picture – Onset / Presentation • Rapid deterioration in 10% (+/-) of cases • Acute RDS • Require ICU admission & mechanical ventilation • Case fatality rate: ~ 4% • No specific treatment available

17. Clinical Picture – Management • SUPPORTIVE TREATMENT • Antibiotic Therapy : to cover causative organisms • Prophylactic Antibiotic Therapy : to prevent secondary bacterial infection • Maintain oxygenation : • intubate and ventilate as necessary

18. Clinical Picture – Management • SUPPORTIVE TREATMENT • Avoid interventions which may cause aerosolisation of • respiratory secretions: • Bronchoscopy • Nebulised bronchodilators • Chest physiotherapy • Gastroscopy • Any procedure / intervention that may release respiratory secretions

19. Clinical Picture – Management SUPPORTIVE TREATMENT In severe cases corticosteriods and ribavirin have been used, however there is no evidence to support their general or routine use at this stage.

20. Summary – SARS • Multi - Country Outbreak • New Pathogen: • Corona Virus family • Clinical Picture: • Fever and respiratory symptoms • ~ case fatality rate currently 4% • Transmission: • Close contact with symptomatic case(s) • Contaminated hands and objects

21. Summary – SARS • Prevention & Control: • Identification • Isolation of suspect and probable cases • Tracing & Monitoring of close contacts • Barrier nursing techniques for all suspect and probable cases • Public Education • Health care workers are currently at greatest risk therefore : • barrier nursing techniques are essential.

24. Barrier Nursing Techniques Barrier nursing techniques are designed to prevent either : • The patient infecting other people (routine B/N) or • The patient beinginfectedby others (reverse B/N) Strict routine barrier nursing must be used for all SARS patients.

26. Can You Now Answer These Questions? • What is SARS? • What causes SARS? • When and where was SARS first reported? • How many cases have been reported to date? • What is the main transmission route for SARS? • How infectious is SARS? • Who is at risk from SARS?

27. Can You Now Answer These Questions? • What are the clinical symptoms? • How should SARS patients be managed? • What should you do if some-one is exposed to the SARS virus? • How should you manage the close contacts of a person with SARS? • What steps should you take to minimise the risk of spreading SARS?

28. Take Home Messages • New member of the Corona Virus family • Evolving disease : • Incubation period, Prodrome, Lower respiratory phase • Patient management, including isolation • Prevention & control

29. Epidemiology & Clinical Management We hope YOU have learnt something about SARS : • Its Epidemiology • The Clinical Picture • Clinical Management – so far • Preventing & Controlling Transmission Thank you for listening.