—from Epidemiological Bulletin, Vol. 24 No. 1, March 2003—

Severe Acute Respiratory Syndrome (SARS)

Management of SARS, Revised 11 April 2003 (WHO)

These guidelines are constantly reviewed and updated as new information becomes available. They are compiled to provide a generic basis on which national health authorities may wish to develop guidelines applicable to their own particular circumstance.

Please refer to Case Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS).

Management of Suspect and Probable SARS Cases
Hospitalize under isolation or cohort with other suspect or probable SARS cases (see Hospital Infection Control Guidance)

Take samples (sputum, blood, sera, urine,) to exclude standard causes of pneumonia (including atypical causes); consider possibility of coinfection with SARS and take appropriate chest radiographs.

- Take samples to aid clinical diagnosis of SARS including: White blood cell count, platelet count, creatine phosphokinase, liver function tests, urea and electrolytes, Creactive protein and paired sera. (Pair sera will be invaluable in the understanding of SARS even if the patient is later not considered a SARS case)

- At the time of admission the use of antibiotics for the treatment of community-acquired pneumonia with atypical cover is recommended

- Pay particular attention to therapies/interventions which may cause aerosolization such as the use of nebulisers with a bronchodilator, chest physiotherapy, bronchoscopy, gastroscopy, any procedure/intervention which may disrupt the respiratory tract. Take the appropriate precautions (isolation facility, gloves, goggles, mask, gown, etc.) if you feel that patients require the intervention/therapy.

- In SARS, numerous antibiotic therapies have been tried with no clear effect. Ribavirin with or without use of steroids has been used in an increasing number of patients. But, in the absence of clinical indicators, its effectiveness has not been proven. It has been proposed that a coordinated multicentred approach to establishing the effectiveness of ribavirin therapy and other proposed interventions be examined.

Definition of a SARS Contact
A contact is a person who may be at greater risk of developing SARS because of exposure to a suspect or probable case of SARS. Information to date suggests that risky exposures include having cared for, lived with, or having had direct contact with the respiratory secretions, body fluids and/or excretion (e.g. faeces) of a suspect or probable cases of SARS.

Management of Contacts of Probable SARS Cases
- Give information on clinical picture, transmission, etc. of SARS to the contact
- Place under active surveillance for 10 days and recommend voluntary home isolation
- Ensure contact is visited or telephoned daily by a member of the public health care team
- Record temperature daily
- If the contact develops disease symptoms, the contact should be investigated locally at an appropriate health care facility
- The most consistent first symptom that is likely to appear is fever

Management of Contacts of Suspect SARS Cases
As a minimum the following follow up is recommended:
- Give information on clinical picture, transmission etc. of SARS to the contact
- Place under passive surveillance for 10 days
- If the contact develops any symptoms, the contact should self report via the telephone to the public health authority
- Contact is free to continue with usual activities
- The most consistent first symptom which is likely to appear is fever

Most national health authorities may wish to consider risk assessment on an individual basis and supplement the guidelines for the management of contacts of suspected SARS cases accordingly.

Removal from Follow up
If as a result of investigations, suspected or probable cases of SARS are discarded (no longer meet suspect or probable case definitions) then contacts can be discharged from follow up.

Source: World Health Organization (WHO).

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Epidemiological Bulletin, Vol. 24 No. 1, March 2003