Missouri Department of Health & Senior Services
MARCH 21, 2003

FROM: RICHARD C. DUNN
DIRECTOR

Severe Acute Respiratory Syndrome (SARS) is a febrile respiratory illness of unknown etiology that has recently been reported in a number of countries, particularly in parts of Asia. A number of suspect cases are now under investigation in the United States. This illness is of concern for several reasons, including its ability to cause severe illness and death in some patients, its transmissibility from person to person (including transmission within medical care facilities), and the increasing numbers of cases that have been reported in recent days from Asia, North America, and Europe.

This Health Alert, which updates and expands the information contained in Health Alert 42 (released March 17, 2003), summarizes what is currently known about SARS, and provides current recommendations regarding diagnosis, treatment, and infection control. The following points should be emphasized:

• If a patient is suspected to have SARS, the Missouri Department of Health (DHSS) should be immediately notified at 1-800-392-0272 (24 hours a day/7 days a week).
  
  
• Because transmission of the etiologic agent of SARS has occurred in health care facilities, it is essential that immediate appropriate infection control measures be taken whenever a potential SARS case presents to an emergency room, physician's office, or other medical care setting. Consequently, any person who presents with a febrile respiratory illness should be promptly queried about recent travel history to SARS-epidemic countries (per current CDC guidance), and about any recent contact with a potential SARS case, in order to triage this patient according to risk of having SARS. "Recent travel" currently means travel within the preceding 10 days in the Hong Kong Special Administrative Region or Guangdong Province, Peoples' Republic of China; Hanoi, Vietnam; Singapore; or Toronto, Canada. The definition of high risk travel for SARS is subject to change; the most current information is found at http://www.cdc.gov/ncidod/sars. Patients triaged as being high risk or suspected to have SARS should have a surgical mask placed on them immediately, and they should be placed in airborne isolation as soon as practicable, with droplet precautions including use of face shields for health care workers, and contact precautions as outlined in the section below entitled "Infection Control Recommendations for Health Care and Community Settings." These recommendations are also found at http://www.cdc.gov/ncidod/sars/infectioncontrol.htm
  
  
• During the course of the investigation, CDC has received anecdotal reports that aerosol-generating procedures may have facilitated transmission of the etiologic agent of SARS in some cases. Procedures that induce coughing can increase the likelihood of droplet nuclei being expelled into the air. These potentially aerosol-generating procedures include aerosolized medication treatments (e.g., albuterol), diagnostic sputum induction, bronchoscopy, airway suctioning, and endotracheal intubation. For this reason, healthcare personnel should ensure that patients have been evaluated for SARS before initiation of aerosol-generating procedures. Aerosol-inducing procedures should be performed on patients who may have SARS only when such procedures are deemed medically necessary. These procedures should be performed using airborne precautions as previously described for other infectious agents, such as Mycobacterium tuberculosis; "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities" (http://www.cdc.gov/mmwr/preview/mmwrhtml/00035909.htm).

This health alert will be updated as additional information and new diagnostic, treatment, and infection control recommendations become available.

Summary Information on Severe Acute Respiratory Syndrome (SARS)

Please contact the Missouri Department of Health and Senior Services (DHSS) if you have any questions at 1-800-392-0272.

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