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mGuide SARS: Follow the course of the SARS outbreak

AP Photo | Ric Feld


7/18/03 MMWR Weekly | Update: SARS -- Worldwide and U.S., June 18, 2003

Updates reported SARS cases worldwide as of July 11, 2003, and in the U.S. as of July 15, 2003. Twenty-nine countries report a total of 8,427 probable SARS cases and 813 deaths (case fatality proportion: 9.6%) to the World Health Organization. United States reports 418 cases (344 suspect; 74 probable), no deaths. The case count reflects two revisions of the laboratory criteria in the SARS case definition: 1) convalescent serum should be collected >28 days after symptom onset, and 2) cases with negative convalescent serum specimens should be excluded. Also summarizes changes in CDC travel alerts for Beijing and mainland China, Hong Kong, Toronto, and Taiwan.

6/20/03 MMWR Weekly | Update: SARS --- U.S., June 18, 2003

Updates reported SARS cases in the U.S. and worldwide as of June 18, 2003, and summarizes changes in CDC travel recommendations for provinces of China. A total of 8465 probable SARS cases reported to the World Health Organization from 29 countries; 801 deaths (case fatality proportion: 9.5%). United States reports 409 cases (334 suspect; 75 probable) from 42 states and Puerto Rico, no deaths. Laboratory testing to evaluate infection completed for 136 suspect cases and 45 probable cases; eight cases confirmed. CDC downgrades its travel advisory for Mainland China to alert status for all provinces except Beijing, where the travel advisory remains in effect.

6/13/03 MMWR Weekly | Update: SARS --- Toronto, Canada, 2003

Describes a second wave of SARS cases among patients, visitors, and health-care workers (HCWs) in a Toronto hospital approximately 4 weeks after SARS transmission was thought to be interrupted. After relaxation of SARS control measures, five patients in a rehabilitation hospital were reported with febrile illness; investigation of pneumonia cases in that hospital identified eight cases of previously unrecognized SARS among patients. Investigation indicates that patients with unrecognized SARS probably contributed to transmission among HCWs. Indicates that continued transmission of SARS can occur when HCWs adhere to expanded infection-control precautions, Directs HCWs to maintain suspicion for SARS, even after a decline in cases.

6/13/03 MMWR Weekly | Update: SARS --- U.S., June 11, 2003

As of June 11, 2003, the World Health Organization (WHO) has received reports from 29 countries of 8,435 probable cases, including 70 from the United States; 789 deaths (case fatality proportion: 9.4%). In the United States, 42 states and Puerto Rico report a total of 393 cases, no deaths. Describes the eighth probable U. S. SARS case with laboratory evidence of SARS-associated coronavirus (SARS-CoV) infection. Serologic testing for antibody to SARS-CoV continues.

6/5/03 MMWR Weekly | Update: SARS --- U.S., June 4, 2003

Updates SARS cases reported worldwide and in the United States. As of June 4, 2003, the World Health Organization has received reports of 8,402 cases from 29 countries; 772 deaths (case fatality proportion: 9.2%) reported. In the United States, 41 states and Puerto Rico report 373 cases, no deaths. CDC's recommendations for travel to Hong Kong downgraded from travel advisory to travel alert; travel alert to Singapore removed on June 4. U. S. surveillance case definition revised to reflect epidemiologic criteria for travel exposure.

5/30/03 MMWR Weekly | Update: SARS --- U.S., May 28, 2003

Updates information on reported cases of SARS in the world and in the United States; reports seventh case of laboratory-confirmed illness. As of May 28, 2003, the World Health Organization (WHO) receives reports of 8,240 cases from 28 countries, including the United States; 745 deaths reported (case-fatality proportion: 9.0%). In the United States and Puerto Rico, 363 SARS cases from 41 states account for 297 suspect SARS and 66 probable SARS. New cases of SARS reported in Toronto, Canada; CDC reissues travel alert for Toronto. Surveillance case definition continues to recognize cases in persons whose illness meets clinical criteria and began within 10 days of travel to Toronto.

5/23/03 MMWR Weekly | SARS --- Taiwan, 2003

Describes accelerated SARS transmission in Taiwan due to exposure within health-care facilities. The outbreak began with an employee at a Taipai hospital. As of May 22, a total of 137 probable cases were associated with exposures at hospital A. Secondary clusters at eight additional hospitals are linked to hospital A. The number of SARS cases in Taiwan associated with health-care settings is likely to increase.  In response, health officials have reorganized outbreak response to limit nosocomial transmission and educate health-care workers to suspect SARS in time to implement infection-control procedures.

5/23/03 MMWR Weekly | Update: SARS --- United States, May 21, 2003

Updates numbers of reported cases in United States as of May 21, 2003. A total of 7,956 SARS cases reported to the World Health Organization from 28 countries ;666 deaths(case-fatality proportion: 8.4%). United States reports 355 cases from 40 states, no deaths. Laboratory testing to evaluate infection completed for 122 cases; six cases confirmed. Case reports for United States continue decrease; most cases associated with international travel. New interim surveillance case definition provides criteria to exclude reported cases subsequently found to have other causes of SARS-like symptoms. Clinical judgment should be used to guide management of patients.

5/16/03 MMWR Weekly |

Cluster of SARS Cases Among Protected Health-Care Workers-Toronto, Canada, April 2003

Reviews work exposures associated with a cluster of SARS cases among health-care workers (HCWs) in a hospital that occurred despite compliance with infection-control practices. Case history of index patient attended by affected HCWs described. Provides contact, droplet, and airborne precautions adopted to prevent and control transmission including updated infection-control precautions during aerosol-generating procedures for patients who have SARS.

5/14/03 MMWR Weekly | Update: SARS --- U.S., 2003

Provides update on reported SARS cases worldwide. As of May 14, 2003, a total of 7,628 cases reported to the World Health Organization from 28 countries; 587 deaths (case-fatality proportion 7.7%). Total cases account for 345 reported from 38 states in United States; 281 (81%)classified as suspect and 64 (19%) classified as probable. No deaths reported in United States. Most cases continue to be associated with international travel to areas affected by SARS. Provides CDC recommendations to prevent and control transmission for inbound travelers from areas with community transmission of SARS. CDC not recommending quarantine for persons traveling from such areas.

5/9/03 MMWR Weekly | Update: SARS --- Singapore, 2003

Summarizes epidemiologic features of SARS in Singapore; discusses super spreaders and national prevention and control programs. As of April 30, 201 probable cases and 722 suspect cases reported; 25 patients died (case-fatality proportion:12.5%). Surveillance indicates 76% of infections acquired in a health-care facility. Five patients categorized as super spreaders who were associated with transmissions to > 10 health-care workers, family and social contacts, or visitors to health care facilities. Infection-control measures include designating one hospital for SARS cases, expanding environmental practices to protect health-care workers, stopping general hospital visitation, and providing dedicated ambulance service. Infectious Disease Act amended, requiring more stringent quarantine measures and providing penalties for violations.

5/9/03 MMWR Weekly | Update: SARS --- U.S., 2003

As of May 7, United States identifies 328 SARS cases reported from 38 states; 265 classified as suspect SARS, 63 classified as probable. No SARS-related deaths reported in United States. Laboratory testing to evaluate infection completed for 69 cases. Six cases identified as laboratory-confirmed infection with SARS-CoV; all probable cases. Collection and testing of convalescent serum ongoing to characterize epidemiology of SARS. Majority of cases associated with travel and secondary spread to family members and health-care workers.

5/2/03 MMWR Weekly | Update: SARS --- U.S., 2003

Updates case reports of Severe Acute Respiratory Syndrome (SARS) to the World Health Organization as of April 30 2003. Twenty-six countries report 5,663 cases and 372 deaths (case fatality proportion: 6.6%). United States reports 289 cases from 38 states and no deaths. United States issues outbreak control plan to include travel alerts and advisories and distribution of health alert notices to travelers arriving from areas affected by SARS.

4/29/03 MMWR Dispatch | Interim Surveillance Case Definition---U.S., 2003

Updates CDCs interim surveillance case definition to include laboratory criteria for evidence of infection with SARS-associated coronavirus (SARS-CoV). Cases now classified as suspect or probable and include laboratory confirmation. Several lab tests (e.g., indirect fluorescent antibody or enzyme-linked immunosorbent assays, reverse transcriptase polymerase chain reaction specific for viral RNA) are specified in the new criteria. Definition should be used for reporting and classification purposes only.

4/25/03 MMWR Weekly | Update: SARS---U.S., 2003

Updates information on reported SARS cases worldwide and among U.S. residents, and summarizes information on a Pennsylvania resident with SARS linked to travel to Toronto. As of April 23, 3003, a total of 25 countries reported 4,288 SARS cases and 251 deaths (case-fatality proportion 5.8%). United States reports 245 SARS cases from 37 states, 39 of which are consistent with the interim U.S surveillance case definition for probable SARS. CDC issues interim travel guidance for Toronto, Ontario, Canada. CDC also announces plan to update its interim surveillance case definition to include laboratory criteria.

4/18/03 MMWR Weekly | Update: SARS---U.S., 2003

Updates information on reported SARS cases among U.S. residents as additional cases are reported to the World Health Organization (3,293 from 22 countries as of April 16, 2003). In the United States, local transmission limited to health-care workers (HCWs) and close contacts of suspected SARS patients who were travelers outside country. United States reports 208 suspected cases reported from 34 states. Provides guidance for conducting surveillance of HCWs following exposure to SARS patients and for preventing secondary transmission of SARS to close contacts. CDC continues to develop and refine laboratory testing.

4/11/03 MMWR Weekly | SARS and Coronavirus Testing --- U.S., 2003

Summarizes the clinical histories of five U. S. residents with both suspected SARS and laboratory evidence of infection with a novel coronavirus. As of April 9, 2003, a total of 16 countries reported 2,722 cases of SARS and 106 deaths to the World Health Organization; United States reports 166 cases from 30 states. CDC recommends persons postpone elective travel to mainland China, Hong Kong, Hanoi, and Singapore. Interim infection-control guidance is revised. Evidence accruing that a novel coronavirus is the causative agent of SARS. On April 4, 2003, SARS is added to the list of quarantinable diseases in the United States.

4/4/03 MMWR Weekly | Update: Outbreak of SARS --- Worldwide, 2003

As of April 2, 2003, the World Health Organization received reports of 2,223 suspected cases from 16 countries. CDC implements an interim suspected SARS case definition; 100 cases were reported from 28 states in the United States. The disease has been relatively less severe among patients in the United States. CDC advises persons to postpone elective travel to Hong Kong and Guangdong Province China; travel notices provided to passengers whose travel originated in affected areas. Laboratory investigations detect a new coronavirus in SARS patients, as well as human pneumovirus. Transmission in health-care settings reported and CDC develops interim infection-control guidelines.

3/28/03 MMWR Weekly | Update: Outbreak of SARS --- Worldwide, 2003

Epidemiologic investigations conducted by CDC in collaboration with other public health authorities (e.g., Hong Kong, Vietnam, Taiwan, Thailand, and United States) links apparent transmission from an ill resident to other residents of a Hong Kong hotel with subsequent transmission in other countries. The World Health Organization indicates 1323 cases and 49 deaths reported from 14 locations. A novel coronavirus and metapneumovirus are identified as possible agents of SARS.

3/21/03 MMWR Dispatch | Preliminary Clinical Description of SARS

By March 21, 2003, the World Health Organization had identified the majority of patients as adults aged 2570 years. SARS begins with mild respiratory illness, with incubation typically 27 days but as long as 10 days. Lower respiratory phase begins after days 37. Illness is variable, ranging from mild to death. Although efficacious treatment regimens are unknown, physicians have tried antibiotics, antiviral therapy, and steroids.

3/21/03 MMWR Weekly | Outbreak of SARS --- Worldwide 2003

CDCs initial report on the outbreak prompted by a Chinese report of 305 cases of SARS and five deaths had been reported during 11/16/02-- 2/9/03. Excluding China, a total of 11 countries had reported 264 cases. CDC publishes a preliminary case definition and infection-control guidelines for the United States.

AP Photo | Martin Meissner


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