Severe Acute Respiratory Distress Syndrome

SARS is a newly recognized disease that emerged in February. The first cases of SARS are believed to have been in the Guangdong Province in southern Mainland China in late 2002. From there, the disease spread to Hong Kong and on to Hanoi, Vietnam in February. Infected travelers then carried it worldwide; by late March, more than 1,600 cases and 58 deaths in 13 countries were attributed to the disease.

The World Health Organization (WHO) has coordinated a worldwide investigation into the cause of SARS.

Laboratories are investigating two viruses in separate families, the paramyxovirus and corona virus families, as possible culprits. Identifying the cause will significantly aid in the development of technology for diagnosing and treating the disease.

The SARS outbreak has triggered these advisories:

* U.S. Centers for Disease Control (CDC) advises against nonessential travel to Hanoi, Hong Kong, Singapore and Mainland China.

* Health Canada advises against travel to Singapore, Taiwan, Hanoi, Mainland China and Hong Kong, and advises that alternate routing be considered if a traveler is transiting through any of these areas.

* The U.S. Department of State has suspended all official travel to Vietnam and recommends that all U.S. citizens in Vietnam depart.

* France advises deferring travel to Hong Kong and Mainland China, and recommends reconsidering trips to other affected areas.

* The WHO has not advised any itinerary changes, but is advising that all air passengers departing from a country affected by SARS be screened for symptoms of the disease. Affected areas according to the WHO include: Singapore; Toronto, Canada; Hong Kong; Taiwan; Beijing, Guangdong, and Shanxi provinces of China; and Hanoi.

Signs and Symptoms

Symptoms of SARS appear two to 10 days after exposure. According to the CDC, a person does NOT have SARS unless they have all of the following:

* Temperature greater than 38 C (100.4 F)

* One or more of the following: cough, shortness of breath, hypoxia, or X-ray findings of pneumonia

* Traveled within 10 days of the onset of symptoms to an area with documented community transmission of SARS (as of March 31, these areas include: Hong Kong, Mainland China, Singapore and Hanoi), OR had close contact within 10 days of onset of symptoms with a person infected with SARS.

Transmission

Of the many thousands of international travelers passing through the affected countries since Feb. 1, far less than 1 percent has contracted SARS.

However, the likelihood of infection is relatively high for travelers who come into close contact with a SARS-infected person. Before respiratory precautions and infection control procedures were instituted (including isolation of patients and the use of protective gear by healthcare workers), 56 percent of healthcare providers who cared for SARS patients became ill. Similarly, a high percentage of family members of SARS patients have contracted the disease.

The means of transmission of SARS has not been fully determined, but infection appears to require close contact with a SARS-infected person. Officials at the WHO have stated that close contact within an airplane could include sitting within two rows of a person who has symptoms of SARS. Flight attendants are also assumed to be at-risk. To date, there is no evidence that the ventilation system of the airline can spread the disease, although hundreds of passengers are now being monitored to determine whether this is true.