SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Public Health Link

To:	NHS Trusts - Medical Directors (England) Primary Care Trusts - Directors of Public Health Primary Care Trusts - Medical Directors Public Health Link
Cc (Groups):	Chairman - Professional Executive Committee of PCT Consultants in Communicable Disease DHSC - Directors of Public Health Strategic Health Authorities (England) - Directors of Public Health Territorial CMOs
Fax To:

From:	Sir Liam Donaldson - Chief Medical Officer - Department of Health
Date:	7 April 2003

Reference	CEM/CMO/2003/5
Category:	URGENT (cascade within 24 hours)

Title:	SEVERE ACUTE RESPIRATORY SYNDROME (SARS) - UPDATE

Broadcast Content:

PUBLIC HEALTH LINK

To: Directors of Public Health of PCTs to forward to:

- All GENERAL PRACTITIONERS - please ensure this message is seen by all practice nurses and non-principals working in your practice and retain a copy in your `locum information pack'.

- Deputising services

- Project manager/Nurse lead in Walk in Centres
- Lead nurses in PCTs
- Leads at nurse-led PMS Pilots

Medical Directors of NHS Trusts

to forward to:

- Accident and Emergency departments

Hospital Physicians, particularly those doing acute medical on call

- Paediatricians

- Nurse Executive Directors of NHS Trusts

Cc: - Regional Directors of Public Health

- Directors of Public Health of Strategic Health Authorities

- UK CMOs

- Chairmen of Professional Executive Committee

- Consultants in Communicable Disease Control

From: Sir Liam Donaldson, Chief Medical Officer, Department of Health

Date: 7th April 2003

Reference: CEM/CMO/2003/5

Category: **URGENT MESSAGE**

**PLEASE ACTIVATE THE CASCADE **

Dear Colleagues

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)- UPDATE

ACTION

Health professionals are asked to note the following updated information and advice further to the Public Health Link message of 14 March about Severe Acute Respiratory Syndrome (SARS) associated with East and SE Asia. Please note that this is an evolving situation and advice may change. The web-based information and guidance is regularly updated and should be consulted for full details.

The international situation
SARS is a severe respiratory infection which typically starts with fever and flu-like symptoms, progressing to an atypical pneumonia and sometimes adult respiratory distress syndrome. It appears to be an emerging infection, the aetiology of which is as yet unconfirmed. A viral infection, possibly a new coronavirus, has been implicated.
http://www.who.int/csr/sarscountry/2003_04_05/en/

As of 5 April 2,416 probable cases of SARS had been reported to the World Health Organization (WHO) from 20 countries
http://www.who.int/csr/sarscountry/2003_04_05/en/. Most have been as a result of direct transmission from a symptomatic case. Aerosol transmission if it occurs is rare. The possibility of transmission through other routes such as fomites (contaminated inanimate objects) is being considered in some settings.

In the Hong Kong Special Administrative Region of China and Guangdong Province in Southern China, ongoing transmission is known or suspected to be occurring. Preliminary data suggest that transmission has slowed or stopped in other affected areas (Hanoi in Vietnam, Singapore, Toronto in Canada, Beijing and Shanxi in China and Taiwan). A substantial outbreak has affected health care staff and patient family members in Toronto, Canada. http://www.phls.co.uk/publications/cdr/pages/news.html. This followed hospital admission of a person with SARS early in the epidemic and before the significance of the condition was appreciated. Infection control measures were not applied. Where conventional infection control measures are applied hospital outbreaks seem not to occur.

Travel advice
Since 2 April, the Department of Health has strongly advised against travel to Hong Kong and Guangdong. Travellers to other areas where SARS has been reported should be aware of the symptoms of the disease and seek medical advice should they develop them. The full travel advice is on the DH website at http://www.doh.gov.uk

Travellers should be advised to ensure they have adequate insurance to cover medical care and unplanned extensions to their stay.

Identification and early management of suspected cases
Cases in the UK are most likely to occur in people returning from an affected area, especially one where transmission is thought to be continuing. WHO has recommended that all people leaving affected areas are given information and screened before embarkation by being asked a series of questions. Those with symptoms will be asked to defer their travel. Any passengers who develop symptoms while in transit should be identified by the crew and WHO guidance followed.
http://www.who.int/wer/pdf/2003/wer7814.pdf

People who develop symptoms within 10 days of leaving an affected area are asked to contact their GP or NHS Direct by telephone in the first instance so that appropriate arrangements can be made for their further assessment either at home, in primary care or in an isolation area of an Accident and Emergency Department. Following assessment, cases should be admitted to hospital and nursed in a single room with full respiratory precautions if:

- their clinical condition indicates it, OR
- they have significant chest Xray changes.

Otherwise, they may be managed at home with advice about home hygiene. They should keep contact with others to a minimum.

Symptomatic suspected cases should wear a surgical mask during transit. Guidance on infection control should be followed when taking specimens for investigation.

Management of contacts
Close contacts of all probable cases and those suspected cases with known contact with a SARS case should be identified, given information and followed up until 10 days from the last contact. Close contacts of other suspected cases should be given information and told to seek advice immediately should they develop symptoms. Information leaflets are available to download.

Reporting of cases
Suspected cases should be notified to the local Consultant in Communicable Disease Control (CCDC), who will then inform the Communicable Disease Surveillance Centre (CDSC) duty doctor (0208-200-6868). If the need is urgent (for example if it is thought there has been local transmission or that hospital staff have been exposed to a probable SARS case), the CDSC duty doctor should be contacted directly.

Guidance and Information
Full up to date guidance for the public and professionals is maintained on the former Public Health Laboratory Service (PHLS) (now the Health Protection Agency) website at http://www.phls.co.uk/topics_az/SARS/menu.htm. The professional guidance available is listed in the Annex.

Locally, further advice may be obtained from the local Health Protection Unit of the Health Protection Agency, normally in the first instance the Consultant in Communicable Disease Control (CCDC).

ANNEX

SARS GUIDANCE FOR PROFESSIONALS

Guidance for public health professionals, including definitions, reporting, and management
http://www.phls.co.uk/topics_az/SARS/management_guidance.htm

Microbiological investigation
http://www.phls.co.uk/topic_az/SARS/clinical_guidance.htm

Guidance for General Practitioners
http://www.phls.co.uk/topic_az/SARS/GP_guidance.htm

Guidance for infection control in the community http://www.phls.co.uk/topics_az/SARS/community_guidance.htm

Infection control and management in hospital
http://www.phls.co.uk/topic_az/SARS/hospital_guidance.htm

Daily case count for the United Kingdom
http://www.phls.co.uk/topics_az/SARS/SARScasecount.htm

Health alert notice for travellers going to or returning from SARS affected countries
http://www.phls.co.uk/topics_az/SARS/traveller _health-alert.htm

Health alert notice for contacts of SARS cases
http://www.phls.co.uk/topics_az/SARS/case _contacts.htm

World Health Organization recommended measures for persons undertaking international travel from areas affected by Severe Acute Respiratory Syndrome (SARS) http://www.who.int/wer/pdf/2003/wer7814.pdf

Additional Information: