Severe acute respiratory syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a respiratory illness.

During the global outbreak of SARS in 2003, more than 8,000 cases were reported worldwide, with nearly 800 fatalities. Most of these cases occurred in adults who live in or traveled to mainland China, Hong Kong and Taiwan; Hanoi, Vietnam; Singapore; or Toronto, Canada. SARS was also reported in people who had close contact with an infected person or someone who developed a respiratory illness after traveling to one of these areas (as long as the contact was within 10 days of the development of symptoms).

Only eight cases of SARS were reported in the United States. In July 2003, the World Health Organization declared the end of the global outbreak. In April 2004, several new cases were reported in east central China. Some of these cases have been linked to students who worked in a lab that contained the live SARS virus.


Causes/associated factors
SARS is caused by a coronavirus, a type of virus that commonly causes upper respiratory illnesses in humans. Coronaviruses generally survive in the environment for about three hours, but one study of the coronavirus associated with SARS found that the virus may be able to survive for up to 24 hours or longer. Coronaviruses, which can cause a variety of illnesses in animals as well, are known to mutate, or change, frequently.

Transmission
SARS is thought to spread by breathing infected respiratory droplets coughed or sneezed into the air or touching contaminated objects and then touching your eyes, nose or mouth. The virus may spread in other ways that are currently unknown.
The incubation period (time from exposure until symptoms appear) is typically two to seven days, but may be as long as 10 days. Research suggests that an infected person is most likely to spread the disease when he or she has symptoms, such as a fever or cough. It's not known how long a person remains infectious, however, either before or after symptoms appear.

The risk of developing SARS increases with direct close contact with an infected person, such as living with or caring for an infected person, or having direct contact with the respiratory secretions or bodily fluids of an infected person.


Signs/symptoms
SARS generally begins with a fever higher than 100.4°F. Additional symptoms may include:
shaking chills
headache
body aches
a general feeling of discomfort
Sometimes, mild respiratory symptoms or diarrhea may appear as well. Within two to seven days, you may develop a dry, nonproductive cough, shortness of breath and pneumonia. Severe symptoms may require hospitalization, including the help of a ventilator to breathe.


Diagnosis
To be diagnosed with probable SARS, you must have the symp- toms described above and chest X-rays showing pneumonia or acute respiratory distress syndrome without an identifiable source. Also, at least one of the following must have occurred in the 10 days before symptoms appeared:
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
potential workplace exposure to SARS, such as medical work with close patient contact or work in a lab that contains the live SARS virus
a cluster of cases of atypical pneumonia without an alternative diagnosis
If you suspect that you may have SARS, seek medical attention immediately. Let emergency staff know ahead of time that you're coming so they have an opportunity to isolate you from others. The doctor will ask questions about your medical history and symptoms and do a physical exam. He or she may order various tests, including a chest X-ray, pulse oximetry (a test to determine the amount of oxygen in your blood), antibody blood tests, blood count, and blood and sputum cultures.

Forced quarantine may be needed for anyone who displays the symptoms of SARS. It's important for local public health officials to be notified as well -- by either the doctor or patient -- so they can investigate to help prevent further illness.


Treatment
Since much is unknown about the specific coronavirus that causes SARS, the Centers for Disease Control and Prevention (CDC) recommends that doctors treat SARS as they would either typical or atypical pneumonia. Generally, a course of antibiotics and the antiviral medications oseltamivir or ribavirin are prescribed. Steroids may be also be given.
If you're treated in the hospital, you'll be placed in isolation. If you're recovering at home, stay home while you're sick and for 10 days after the fever and respiratory symptoms are gone. Don't go to work, school or other public areas. It's important to cover your mouth and nose with a tissue when you cough or sneeze and, if possible, wear a surgical mask when in close contact with anyone who's not infected.


Complications
Severe cases of SARS may be fatal. No one in the United States has died from SARS, however.

Pregnancy-specific information
Currently, information about the effect of SARS on pregnancy is unavailable.

Senior-specific information
Currently, information about the effect of SARS on older adults is unavailable.

Prevention
If you live with a person who's infected with SARS, wash your hands often with soap and water or use alcohol-based hand rubs. Wear a surgical mask when in close contact with the person, and wear disposable gloves when contacting his or her respiratory secretions or bodily fluids. After contact, throw away the gloves, and wash your hands thoroughly with soap and water. Don't share eating utensils, towels or bedding with the infected person. Use common household cleaners often to disinfect surfaces touched by the infected person. Wash utensils and launder clothes, towels and bedding with soap and hot water.
There are currently no travel advisories related to SARS. For the most up-to-date information, go to the CDC's Web site.

If you choose to travel to an area affected by SARS, consider these recommendations:

Bring a basic first aid kit, including a thermometer, household disinfectant and alcohol-based hand rub. Also include a supply of surgical masks and disposable gloves, to be used if you or a traveling companion develop SARS.

Make sure all your immunizations are up-to-date, including additional shots that may be required for your particular destination.

Check with your health insurance provider to understand your coverage benefits while traveling.

Research the availability of medical services and medical evacuation for your particular destination. This information is provided on consular information sheets listed by country available on the U.S. Department of State's Web site.
After returning from an area affected by SARS or after possible expo- sure to SARS, monitor your health for at least 10 days -- including taking your temperature twice a day. Notify your doctor if you develop a fever, cough or shortness of breath.

Again, before going to a medical facility, let medical personnel know ahead of time that you're coming so they have an opportunity to isolate you from others. If you develop a fever or respiratory symptoms, limit all interactions outside your home and follow the precautions listed above. If symptoms improve or go away within 72 hours, contact local public health authorities to approve a return to your normal routine.

If fever or respiratory symptoms continue but don't meet the criteria for SARS, follow the precautions listed above for another 72 hours and consult your doctor for an evaluation. Your doctor, along with public health authorities, will determine the next steps.