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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

6.3a) SARS

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SARS was first reported in Asia in February 2003. The disease is a viral respiratory infection caused by SARS-associated coronavirus. It can cause fatal pneumonia associated with acute respiratory distress syndrome. Over a period of months, the illness spread to more than two dozen countries across the globe. According to the WHO, a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the U.S., only eight people had laboratory evidence of SARS (A6-73).172  Health workers contracted SARS from occupational exposure.

Although there have been very few cases of occupationally acquired SARS in the U.S., there is potential for spread of the disease within the workplace, especially for workers who experience daily contact with the general public. These include healthcare, medical transport, and airline personnel, as well as those who deal directly with potentially SARS infected material, such as laboratory technicians


RDRP scientists have worked within the context of a broader CDC response to identify the scope of potential risk and to provide guidelines and assistance to both the healthcare sector personnel and the general public. Within CDC, RDRP has unique expertise in issues related to industrial hygiene, such as environmental controls and personal protective equipment. Thus, RDRP’s role has been focused especially in these areas.  Together with other elements of CDC, infection control guidelines for SARS were developed. Recommendations and guidelines were posted on Web sites for instant dissemination. RDRP scientists also assisted CDC with the screening of international airline travelers for SARS and with disseminating SARS information to such travelers.

Outputs and Transfer

NIOSH dispatched industrial hygienists from its staff as part of CDC’s teams that responded to requests for assistance from Canada and Taiwan. RDRP helped staff the CDC’s Emergency Operations Center. RDRP assisted CDC in disseminating information on SARS to travelers at selected international airports such as Honolulu and Los Angeles, assisting two investigations in Toronto and one in Taiwan, and staffing the CDC command center to respond to requests for help and information. RDRP personnel as part of the CDC teams at the international airports greeted arriving international flights from Asia, screened the passengers for symptoms of SARS by asking questions about possible symptoms and if required taking temperatures. RDRP was represented on various CDC teams and committees and assisted in the development of numerous documents.

 A key CDC document to which RDRP contributed provided comprehensive guidance on preventing transmission, including occupational transmission, of SARS: CDC Public Health Guidance for Community-Level Preparedness and Response SARS Version 2, Supplement I: Infection Control in Healthcare, Home, and Community Settings (A6-74, A6-75).

RDRP-developed content was quickly posted to the NIOSH Web site to provide employers, employees, occupational health professionals, and others with timely information on SARS:

  • Understanding Respiratory Protection Against SARS (A6-76).

RDRP contributed a number of pages posted on the CDC Web site:

SARS in the workplace (A6-80, A6-81, A6-82, A6-83)

RDRP scientists co-authored a peer-reviewed paper titled Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation” (A6-84) and an MMWR article providing an update on the SARS epidemic (A6-85).

Responding to concerns about potential risk to airline crews, maintenance personnel, and other transportation employees, RDRP also contributed to the development of the CDC document “Guidance about SARS for Airline Flight Crews, Cargo and Cleaning Personnel, and Personnel Interacting with Arriving Passengers” (A6-86). RDRP scientists, together with CDC colleagues, provided this same information on a conference call with of the airline industry and air crew unions to discuss these guidelines.

Intermediate Outcomes

CDCs guidance documents, to which RDRP contributed, were very influential. Several OSHA guidance documents relating to avian flu and SARS refer to CDC guidelines, to which RDRP scientists have contributed.  An example is the 2004 “Guidance for Protecting Workers Against Avian Flu” ( [External link]). Google searches for several SARS-related documents show them to be cited by other organizations (A6-72).

End Outcomes

To what degree RDRP’s activities helped minimize spread of SARS to the U.S. cannot be determined. Fortunately, the impact of SARS on the U.S. was minimal. Neither the human suffering nor the economic impact that were felt in Canada and especially Toronto, ON were manifest in the U.S.

What’s Ahead

Discussed together with influenza in 6.3b.