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Update: Severe Acute Respiratory Syndrome --- United States, May 14, 2003

CDC continues to work with state and local health departments, the World Health Organization (WHO), and other partners to investigate cases of severe acute respiratory syndrome (SARS). This report provides an update on reported SARS cases worldwide and in the United States.

During November 1, 2002--May 14, 2003, a total of 7,628 SARS cases were reported to WHO from 29 countries, including the United States; 587 deaths (case-fatality proportion: 7.7%) have been reported (1). The 345 SARS cases identified in the United States have been reported from 38 states, with 281 (81%) cases classified as suspect SARS and 64 (19%) classified as probable SARS (more severe illnesses characterized by the presence of pneumonia or acute respiratory distress syndrome) (Figure,Table) (2).

Of the 64 probable SARS patients, 44 (69%) were hospitalized, and three (5%) required mechanical ventilation. No SARS-related deaths have been reported in the United States. Of the 64 cases, 62 (97%) were attributed to international travel to areas with documented or suspected community transmission of SARS during the 10 days before illness onset; the remaining two (3%) probable cases occurred in a health-care worker who provided care to a SARS patient and a household contact of a SARS patient. Among the 62 probable SARS cases attributed to travel, 35 (56%) patients reported travel to mainland China; 18 (29%) to Hong Kong Special Administrative Region, China; six (10%) to Singapore; three (5%) to Hanoi, Vietnam; and eight (13%) to Toronto, Canada. Seven (11%) of these 62 probable patients had visited more than one area with SARS during the 10 days before illness onset.

Laboratory testing to evaluate infection with the SARS-associated coronavirus (SARS-CoV) has been completed for 96 cases (23 probable and 73 suspect). Of 20 probable SARS patients with complete test results, six with laboratory-confirmed infection with SARS-CoV have been identified (3,4); this number remains unchanged since the last update (5). None of the 73 suspect SARS patients evaluated has had laboratory-confirmed infection with SARS-CoV. Negative findings (i.e., the absence of antibody to SARS-CoV in convalescent serum obtained >21 days after symptom onset) have been documented for 90 cases (73 suspect and 17 probable).

Since the previous update (5), the epidemiology of SARS in the United States has not changed markedly; secondary spread to contacts such as family members and health-care workers is limited, and most cases continue to be associated with international travel to areas where SARS is being transmitted in the community. CDC has developed interim recommendations for businesses and other organizations with employees returning from areas with community transmission of SARS and for other organizations and institutions (e.g., schools) hosting persons arriving in the United States from such areas (6,7). CDC does not recommend quarantine of persons traveling to the United States from areas with SARS nor the cancellation or postponement of classes, meetings, or other gatherings that would include travelers from areas with SARS. Activities to prevent importation and spread of SARS from inbound travelers (6) include 1) pre-embarkation screening of persons traveling from areas with SARS, 2) assessment by health authorities of ill persons aboard flights arriving from areas with SARS to ensure that ill passengers are isolated and evaluated promptly and that appropriate follow-up of other passengers occurs, 3) distribution of health alert notices to travelers arriving in the United States to notify them of the importance of monitoring their health for 10 days after departure and promptly seeking medical evaluation if they have fever or respiratory symptoms, and 4) the rapid detection and isolation of persons in the United States who have traveled from an area with SARS who have symptoms compatible with early suspect SARS within 10 days of arrival.

Reported by: State and local health departments. SARS Investigative Team, CDC.

References

  1. World Health Organization. Cumulative number of reported cases of severe acute respiratory syndrome (SARS). Available at http://www.who.int/csr/sarscountry/2003_05_14/en.
  2. CDC. Updated interim U.S. case definition of severe acute respiratory syndrome (SARS). Available at http://www.cdc.gov/ncidod/sars/casedefinition.htm.
  3. CDC. Severe acute respiratory syndrome (SARS) and coronavirus testing---United States, 2003. MMWR 2003;52:297--302.
  4. CDC. Update: Severe acute respiratory syndrome---United States, 2003. MMWR 2003;52:357--60.
  5. CDC. Update: Severe acute respiratory syndrome---United States, 2003. MMWR 2003;52:411--3.
  6. CDC. Interim guidance for institutions or organizations hosting persons arriving in the United States from areas with SARS. Available at http://www.cdc.gov/ncidod/sars/hostingarrivals.htm.
  7. CDC. Interim guidance for businesses and other organizations with employees returning from areas with SARS. Available at http://www.cdc.gov/ncidod/sars/business_guidelines.htm.



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