Rick-
Don't mean to be an alarmist, but I just got the following at my "real job" here at a Hospital in the U.S.. With your note regarding the Far East andyour upcoming visit I thought this might be of some interest to you and any recent travelers there on this forum. Not trying to disparage that lovely part of the World, there are plenty of nasty diseases from elsewhere, just that this one is new and still relatively unknown-
Kirt Simmons
March 17, 2003
TO: All Hospital Administrators and Chiefs of Staff
PLEASE DISTRIBUTE TO ALL PHYSICIANS ON YOUR STAFF
CDC Issues Health Alert About Atypical Pneumonia
Atlanta: In response to reports of increasing numbers of cases of an
atypical pneumonia that the World Health Organization (WHO) has called
Severe Acute Respiratory Syndrome (SARS), the Centers for Disease Control
and Prevention (CDC) today announced several steps to alert US health
authorities at local and state levels.
CDC activated its emergency operations center on Friday, March 14, upon
learning of several cases reported in Canada among travelers recently
returned from Southeast Asia and their family members.
CDC has been working with the World Health Organization (WHO) since late
February to investigate and confirm outbreaks of this severe form of
pneumonia in Viet Nam, Hong Kong, and parts of China. No cases have been
identified to date in the United States.
"The emergence of two clusters of this illness on the North American
continent indicates the potential for travelers who have been in the
affected areas of Southeast Asia to have been exposed to this serious
syndrome," said Dr. Julie L. Gerberding, CDC Director. "The World Health
Organization has been leading a global effort, in which CDC is
participating, to understand the cause of this illness and how to prevent
its spread. We do know that it may progress rapidly and can be fatal.
Therefore, we are instituting measures aimed at identifying potential cases
among travelers returning to the United States and protecting the people
with whom they may come into contact."
The WHO issued a global alert about the outbreak on March 12, cautioning
that the severe respiratory illness may spread to hospital staff. No link
has been made between this illness and any known influenza, including the
"bird flu" (A[H5N1]) outbreak reported in Hong Kong on February 19.
Severe Acute Respiratory Syndrome (SARS)
Interim Information and Recommendations for Health Care Providers
The Centers for Disease Control and Prevention (CDC) and the World Health
Organization have received reports of patients with severe acute respiratory
syndrome (SARS) from Canada, China, Hong Kong Special Administrative Region
of China, Indonesia, Philippines, Singapore, Thailand, and Vietnam. The
cause of these illnesses is unknown and is being investigated. Early
manifestations in these patients have included influenza-like symptoms such
as fever, myalgias, headache, sore throat, dry cough , shortness of breath,
or difficulty breathing. In some cases these symptoms are followed by
hypoxia, pneumonia, and occasionally acute respiratory distress requiring
mechanical ventilation and death. Laboratory findings may include
thrombocytopenia and leukopenia. Some close contacts, including healthcare
workers, have developed similar illnesses. In response to these
developments, CDC is initiating surveillance for cases of SARS among recent
travelers or their close contacts.
Case Finding
Clinicians should be alert for persons with onset of illness after February
1, 2003 with:
* Fever (>38° C)
AND
* One or more signs or symptoms of respiratory
illness including cough, shortness of breath, difficulty breathing,
hypoxia, radiographic findings of pneumonia, or respiratory distress
AND
One or more of the following:
* History of travel to Hong Kong or Guangdong Province in
People's Republic of China, or Hanoi, Vietnam, within seven days of symptom
onset
* Close contact with persons with respiratory illness having
the above travel history. Close contact includes having cared for, having
lived with, or having had direct contact with respiratory secretions and
body fluids of a person with SARS.
Diagnostic Evaluation
Initial diagnostic testing should include chest radiograph, pulse oximetry,
blood cultures, sputum Gram's stain and culture, and testing for viral
respiratory pathogens, notably influenza A and B and respiratory syncytial
virus. Clinicians should save any available clinical specimens (respiratory,
blood, and serum) for additional testing until a specific diagnosis is made.
Clinicians should evaluate persons meeting the above description and, if
indicated, admit them to the hospital. Close contacts and healthcare workers
should seek medical care for symptoms of respiratory illness.
Infection Control
If the patient is admitted to the hospital, clinicians should notify
infection control personnel immediately. Until the etiology and route of
transmission are known, in addition to standard precautions(1), infection
control measures for inpatients should include:
* Airborne precautions (including an isolation room with
negative pressure relative to the surrounding area and use of an N-95
respirator for persons entering the room)
* Contact precautions (including use of gown and gloves for
contact with the patient or their environment)
Standard precautions routinely include careful attention to hand hygiene.
When caring for patients with SARS, clinicians should wear eye protection
for all patient contact.
To minimize the potential of transmission outside the hospital, case
patients as described above should limit interactions outside the home until
the epidemiology of illness transmission is better understood. Placing a
surgical mask on case patients in ambulatory healthcare settings, during
transport, and during contact with others at home is prudent.
Treatment
Because the etiology of these illnesses has not yet been determined, no
specific treatment recommendations can be made at this time. Empiric therapy
should include coverage for organisms associated with any community-acquired
pneumonia of unclear etiology, including agents with activity against both
typical and atypical respiratory pathogens (2). Treatment choices may be
influenced by severity of the illness. Infectious disease consultation is
recommended.
Reporting
Healthcare providers and public health personnel should report cases of SARS
as described above to their state or local health departments.
For more information contact your state or local health department or the
CDC Emergency Operations Center 770-488-7100(-this is 24/7). Updated
information will be available at
/ncidod/sars
References
1. Garner JS, Hospital Infection Control Practices Advisory Committee.
Guideline for isolation precautions in hospitals. Infect Control Hosp
Epidemiol 1996;17:53-80, and Am J Infect Control 1996;24:24-52.
2. Bartlett JG, Dowell SF, Mandell LA, File Jr, TM, Musher DM, and Fine MJ.
Practice Guidelines for the Management of Community-Acquired Pneumonia in
Adults. Clin Infect Dis 2000;31:347-82.
.pdf>
Text of a travelers' health alert card:
HEALTH ALERT NOTICE
FOR INTERNATIONAL TRAVELERS ARRIVING IN OR RETURNING TO THE USA FROM HONG
KONG AND GUANGDONG PROVINCE, PEOPLE'S REPUBLIC OF CHINA, AND HANOI, VIETNAM
TO THE TRAVELER: During your recent travel, you may have been exposed to
cases of severe acute respiratory disease syndrome. You should monitor your
health for at least 7 days. If you become ill with fever accompanied by
cough or difficulty in breathing, you should consult a physician. To help
your physician make a diagnosis, tell him or her about your recent travel to
these regions and whether you were in contact with someone who had these
symptoms. Please save this card and give it to your physician if you become
ill.
TO THE PHYSICIAN: The patient presenting this card may have recently
traveled to Hong Kong or Guangdong Province in the People's Republic of
China or Hanoi, Vietnam, where cases of atypical pneumonia have been
identified. If you suspect atypical pneumonia (also being called severe
acute respiratory disease syndrome [SARS]), please contact your city,
county, or state health officer (see or call
the CDC Emergency Operations Center 770-488-7100).
)
