SARS returns: Look for pneumonia, travel history

Will China cases spread beyond borders?

On Jan. 13, 2004, the World Health Organization (WHO) reported a new suspect case of severe acute respiratory syndrome (SARS) in a 35-year-old man living in Guangdong province, China. The case is the third recent report of suspected or confirmed SARS in patients in southern China. No link has been established at present between the confirmed case and the two recent suspect SARS cases, and the source of exposure for all three cases is unclear.

In light of these reports, the CDC is recommending that clinicians in the United States maintain a greater index of suspicion of SARS in patients who require hospitalization for radiographically confirmed pneumonia or acute respiratory distress syndrome (ARDS) AND who have a history of travel to Guangdong province (or close contact with an ill person with a history of recent travel to Guangdong province) in the 10 days before onset of symptoms. When such patients are identified, the following actions should be taken:

• Patients should be placed immediately in appropriate isolation precautions for SARS (i.e., contact and airborne precautions).
• Patients should be reported promptly to the state or local health department.
• Patients should be tested promptly for evidence of SARS-CoV infection as part of the diagnostic evaluation. (See Appendix 2, "Updated Guidelines for Collecting Specimens from Potential SARS Patients," in the CDC document In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting at www.cdc.gov/ncidod/sars/absenceofsars.htm.)
• The health department should identify, evaluate, and monitor relevant contacts of the patient, as indicated. In particular, the health status of household contacts or people who provided care to symptomatic patients should be assessed.

In addition, the CDC continues to recommend that health care providers and public health officials identify and report patients who require hospitalization for radiographically confirmed pneumonia or ARDS without identifiable etiology AND who have one of the following risk factors in the 10 days before the onset of illness:

• Travel to mainland China, Hong Kong, or Taiwan, or close contact with an ill person with a history of recent travel to one of these areas.

OR

• Employment in an occupation associated with a risk for SARS-CoV exposure (e.g., health care worker with direct patient contact; worker in a laboratory that contains live SARS-CoV).

OR

• Part of a cluster of cases of atypical pneumonia without an alternative diagnosis.

Diagnostic testing for SARS should be considered in such patients, as described in the guidelines at www.cdc.gov/ncidod/sars/absenceofsars.htm. "Infection control practitioners and other health care personnel should also be alert for clusters of pneumonia among two or more health care workers who work in the same facility," the CDC warned.