Outbreak preparedness & control PPHSN Guidelines For the Preparedness, Surveillance And Response To Severe Acute Respiratory Syndrome (SARS) in Pacific Island Countries And Territories April 9th 2003 SARS is a new disease syndrome. Our knowledge about the best way to prevent and treat it is constantly evolving. These guidelines will be continuously updated. Please regularly check PPHSN website for the most up to date guidance. These guidelines have also been ‘harmonised’ with the WHO WPRO guidelines published on 4th April. MANAGEMENT OF CONTACTS OF SUSPECTED AND PROBABLE CASES (Updated 09.04.03) Key points Close contacts of a probable or suspect case of SARS are at high risk of becoming a case, and should be isolated in the community during their potential incubation period. Attack rates in health care workers caring for the initial cases of SARS is >50%. Travellers from affected areas should be given advice about whom to contact, and what to do if they develop a fever within their potential incubation period. Health departments should assign staff to undertake contact tracing and daily review of contacts in the community. Ideally, this should be in conjunction with a 24-hour SARS hotline.
|
General Most cases of SARS have been attributable to transmission through close contact with other cases. These include people living with or caring for cases at home or in hospital, who have prolonged exposure to droplet spread and/or body fluids including respiratory secretions. The incubation period is short, typically 2 to 7 days, but exceptionally up to 13 days (see figure 5). Close contacts should be informed that they may be at risk of contracting the infection. They should be advised to seek medical care urgently if they develop fever and respiratory symptoms within ten days of their contact with a case. Provide reassurance. Record name and contact details.
Contact tracing The aim of contact tracing is to identify individuals who had close contact with a SARS case, to advise them of that contact, and to give them advice about personal isolation and observation for symptoms of SARS, particularly fever. When a case of suspect or probable SARS is identified, the Department of Health should undertake contact tracing, in a similar manner to that undertaken for other infectious diseases. In the majority of cases, transmission of SARS appears to occur through either droplet spread or direct contact. The level of exposure that needs to be identified when contact tracing is close contact2 .
>> Figure 5: Risk assessment algorithm for contacts / travellers doing potential incubation period Contacts of probable cases Give information on SARS to the contact Place under active surveillance for 14 days and ideally insist on "home isolation". Give the contact a mask to wear if they develop respiratory symptoms, while waiting for clinical assessment. Ensure contact is visited or contacted daily by a member of the public health care team Record temperature twice daily (the earliest symptom of SARS is fever):
o If contact develops any symptoms, contact to be assessed at health care facility o The most consistent first symptom that is likely to appear is fever. (NB in Hong Kong and Singapore the authorities are recommending that the children of probable cases be kept away from school for 10 days from the date the parent was hospitalised as a precaution.) Contacts of suspected cases Give information on SARS to the contact Place under passive surveillance for 14 days Give the contact a mask to wear if they develop respiratory symptoms, while waiting for clinical assessment. Contact is free to continue with usual activities; however:
o Contact to self-report to public health authority if contact develop any symptoms o The most consistent first symptom which is likely to appear is fever o immediately report to doctor/physician/health authority o not report to work until advised by health authority o avoid public places until advised by health authority o minimize contact with family members and friends Contacts of suspected cases on aircraft If a passenger or member of aircrew has suspected/probable SARS on arrival and the immediate medical assessment of the ill passenger excludes SARS as a possible cause of his/her illness, the passenger should be referred to local health care facilities for any necessary follow up. If however, the initial medical assessment conducted in the airport concludes that the passenger is a suspect or probable case of SARS the following action should be taken: All close contacts3 of the ill passenger should be identified during the flight. All passengers should provide, to the health authorities, identification and details of their place(s) of residence for the next 14 days. National health or port authorities may consider routinely collecting a copy of the passenger seating list of every flight arriving from SARS affected areas. All passengers should be given information about SARS and advised to seek immediate medical attention if they develop any symptoms of SARS within 14 days of the flight. When seeking medical attention they should ensure that all those treating them are aware that they have been in contact with a suspect case of SARS. All passengers should be allowed to continue to travel so long as they are well. They must be informed that they may be refused permission to continue their journey if they develop fever and/or other symptoms. If over time it becomes apparent that the suspect case is a probable case of SARS, the health authority where the case is being cared for should inform other health authorities in those areas in which the close contacts reside so that active surveillance of each close contact is undertaken until 14 days after the flight. Health authorities may consider extending active surveillance to other passengers as well.
___________________________________________________ 2 close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS. [back to the text] 3 For the purposes of air travel, a close contact is defined as: passengers sitting in the same seat row or 4 rows in front or behind the sick passenger all flight attendants on board anyone having intimate contact, providing care or otherwise having contact with respiratory secretions of the ill passenger anyone on the flight living in the same household as the ill passenger If it is a flight attendant who is considered to be a SARS case, all passengers are considered to be contacts. [back to the text]
| 
