SARS

Severe Acute Respiratory Syndrome associated Coronavirus (SARS Co-V)

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2008)

I. IDENTIFICATION

CLINICAL DESCRIPTION, EPIDEMIOLOGIC and EXCLUSION CRITERIA:

Clinical Description
Early illness
• Presence of two or more of the following features: fever (might be subjective), chills, rigors, myalgia, headache, diarrhea, sore throat, or rhinorrhea

Mild-to-moderate respiratory illness
• Temperature of >100.4° F (>38° C)* and
• One or more clinical findings of lower respiratory illness (e.g., cough, shortness of breath, or difficulty breathing)

Severe respiratory illness
• Meets clinical criteria of mild-to-moderate respiratory illness and
• One or more of the following findings:
— Radiographic evidence of pneumonia, or
— Acute respiratory distress syndrome, or

Autopsy findings consistent with pneumonia or acute respiratory distress syndrome without an identifiable cause

Epidemiologic Criteria
Possible exposure to SARS-associated coronavirus (SARS-CoV)
One or more of the following exposures in the 10 days before onset of symptoms:
• Travel to a foreign or domestic location with documented or suspected recent transmission of SARS-CoV or
• Close contact with a person with mild-to-moderate or severe respiratory illness and history of travel in the 10 days before onset of symptoms to a foreign or domestic location with documented or suspected recent transmission of SARS-CoV

Likely exposure to SARS-CoV
One or more of the following exposures in the 10 days before onset of symptoms:
• Close contact§ with a person with confirmed SARS-CoV disease or
• Close contact§ with a person with mild-to-moderate or severe respiratory illness for whom a chain of transmission can be linked to a confirmed case of SARS-CoV disease in the 10 days before onset of symptoms

Exclusion Criteria
A case may be excluded as a SARS report under investigation (SARS RUI), including as a CDC-defined probable SARS Co-V case, if any of the following apply:
• An alternative diagnosis can explain the illness fully, or
• Antibody to SARS-CoV is undetectable in a serum specimen obtained >28 days after onset of illness, or
• The case was reported on the basis of contact with a person who was excluded subsequently as a case of SARS-CoV disease; then the reported case also is excluded, provided other epidemiologic or laboratory criteria are not present.

B.    REPORTING CRITERIA: Laboratory confirmation or epidemiologic link to confirmed case.

C.    LABORATORY CRITERIA FOR CONFIRMATION:
Tests to detect SARS-CoV are being refined and their performance characteristics assessed; therefore, criteria for laboratory diagnosis of SARS-CoV are changing. The following are general criteria for laboratory confirmation of SARS-CoV:

• Detection of serum antibody to SARS-CoV by a test validated by CDC (e.g., enzyme immunoassay), or
• Isolation in cell culture of SARS-CoV from a clinical specimen, or
• Detection of SARS-CoV RNA by a reverse transcription polymerase chain reaction test validated by CDC and with subsequent confirmation in a reference laboratory (e.g., CDC).

Information about the current criteria for laboratory diagnosis of SARS-CoV is available at http://www.cdc.gov/ncidod/sars/labdiagnosis.htm.

D.   CASE CLASSIFICATION:

SARS Report Under Investigation (RUI)

Reports in persons from areas where SARS is not known to be active
• SARS RUI-1: Cases compatible with SARS in groups likely to be first affected by SARS-CoV§§ if SARS-CoV is introduced from a person without clear epidemiologic links to known cases of SARS-CoV disease or places with known ongoing transmission of SARS-CoV

Reports in persons from areas where SARS activity is occurring
• SARS RUI-2: Cases meeting the clinical criteria for mild-to-moderate illness and the epidemiologic criteria for possible exposure
• SARS RUI-3: Cases meeting the clinical criteria for severe illness and the epidemiologic criteria for possible exposure

• SARS RUI-4: Cases meeting the clinical criteria for early or mild-to-moderate illness and the epidemiologic criteria for likely exposure to SARS-CoV

SARS-CoV disease
• Probable case of SARS-CoV disease: meets the clinical criteria for severe respiratory illness and the epidemiologic criteria for likely exposure to SARS-CoV
• Confirmed case of SARS-CoV disease: clinically compatible illness (i.e., early, mild-to-moderate, or severe) that is laboratory confirmed

II.    ACTIONS REQUIRED / PREVENTION MEASURES

A.   WISCONSIN DISEASE SURVEILLANCE CATEGORY I: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 24 hours of the identification of a case or suspected case.

B.    EPIDEMIOLOGY REPORTS REQUESTED:

Acute and Communicable Diseases Case Report (DPH 4151).

SARS Domestic Case Reporting Form

C.    PUBLIC HEALTH INTERVENTIONS:

Case investigation by LHD to include history of travel, dates, mode of transportation, contact identification and follow-up

Determine if case is outbreak-related and notify DPH Regional Office or CDES.

III.    CONTACTS FOR CONSULTATION

A.    DPH REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

B.    BCD / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 266-5326 or (608) 267-7321.

C.    WSLH / VIRUS ISOLATION: (608) 262-3185.

IV.    RELATED REFERENCES

1.   “SARS” CDC Disease Fact Sheet Series, http://www.cdc.gov/ncidod/sars/factsheet.htm

2.    Heymann DL, ed. SEVERE ACUTE RESPIRATORY SYNDROME. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004:480-487

3.    Pickering LK, ed. Coronaviruses. In: Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006:267-268.