Severe Acute Respiratory Syndrome (SARS)

Posted: 09 Nov 2008 08:00 PM PST

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated
coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more
than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was
contained.

Background:

This atypical pneumonia has been named Severe Acute Respiratory Syndrome (SARS) by World Health Organization (WHO).
SARS is an infectious disease of the respiratory system characterized by atypical inflammation of the lungs (pneumonia). Scientists
at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. This new coronavirus is
the leading hypothesis for the cause of SARS.

SARS appears to be primarily spread from person-to-person through droplet transmission when in direct close contact with a person
with SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated
with infectious droplets and then touching your eye(s), nose, or mouth. SARS is an emerging disease. Knowledge about its clinical
behavior, response to treatment, and modes and risks of transmission are continually evolving.

Early symptoms in patients with SARS have included fever (>100°F), muscle aches, dry cough, shortness of breath, or difficulty
breathing. The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]) which is sometimes
associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also
experience mild respiratory symptoms at the outset.

After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point
where insufficient oxygen is getting to the blood. Ten percent of 20 percent of SARS cases may progress to requiring the use of a
respirator. No specific treatment recommendations can be made at this time, however, medical personnel is instructed to treat
general clinical signs. CDC currently recommends that patients with SARS receive the same treatment that would be used for any
patient with serious community-acquired atypical pneumonia. The virus suspected to be the cause of SARS (coronavirus) is being
tested against various antiviral drugs to see if an effective treatment can be found.

Epidemiologic Criteria:

1. Travel (including transit in an airport) within ten days of onset of symptoms to an area with current or previously documented or
suspected community transmission of SARS.

2. Close contact within ten days of onset of symptoms with a person known or suspected to have SARS.

Mode of Transmission:

1. The primary mode of transmission appears to be direct mucous membrane (eye, nose, and mouth)

2. Contact with infectious respiratory droplets and/or through exposure to fomites.

3. Transmission through casual and social contacts has occasionally occurred as a result of intense exposure to a case of SARS (in
work place, in vehicles) or in high risk transmission settings, such as health care settings, and in household settings.

4. Contamination of inanimate materials or objects by infectious respiratory secretions or body fluids (saliva, tears, urine, and stool)
which have been found to contain the virus.

For how long will the SARS virus exist on surfaces?

1. The virus is stable in urine and feces at room temperature for at least one to two days, in stool from patients with diarrhea for up
to four days.

2. It survives on paper, on a plastered wall after 36 hours, on plastic surface and stainless steel after 72 hours, on a glass slide after
96 hours.

3. Hospital environmental samples from a number of sites, including walls and the ventilation system, tested positive for SARS virus.

4. Virus loses infectivity after exposure to different commonly used disinfectants and fixatives. Heat at 56ºC rapidly kills the virus.

5. Other risk factors:

a. Household contact with a probable case of SARS

c. Male sex

d. Presence of co-morbidities

What are the signs and symptoms of SARS?

1. Sudden onset of high grade fever, usually greater than 38ºC

2. Headache and overall feeling of discomfort and body aches

3. Mild respiratory symptoms at the start and after two days, the patient develops dry cough and have respiratory difficulty.

Treatment:

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. Treatment choices may be influenced by severity of the illness. Consultation is recommended.

Clinical Course and Management of SARS:

1. It is difficult to decide on the appropriate time to discharge a SARS patient.

2. SARS appears to have lingering after effects once the acute phase of the disease ends.

3. Psychosocial aspects of this illness “should not be underestimated.”

Preventive Measures:

1. Consult a doctor promptly if there are respiratory symptoms such as fever, malaise, chills, headache, joint pain, dizziness, rigors,
cough, sore throat and runny nose. Early treatment is the KEY.

2. Build up good body immunity. This means taking proper diet, having regular exercise and adequate rest, reducing stress, and
avoiding smoking.

3. Maintain good personal hygiene. Cover nose and mouth when sneezing or coughing.

4. Wear mask if you develop runny nose, sore throat and cough.

5. Wear protective mask in public areas, classrooms, computer rooms, public transports, and communal areas in hostels.

6. Wash hands properly and keep them clean. Use liquid soap for hand washing and disposable towels for drying hands.

Resources:

Handbook of Common Communicable and Infectious Diseases 2006 Ed

Centers for Disease Control and Prevention (CDC)