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. REDUCING THE RISK OF IMPORTING SARS THROUGH INTERNATIONAL TRAVEL (Updated 09.04.03) Key points On 2 April 2003 WHO recommended that "persons travelling to Hong Kong and Guangdong Province of China consider postponing non-essential travel." An earlier WHO recommendation suggested that countries where there had been cases of SARS enhance screening at departure points to prevent suspect cases from travelling. Countries should develop national SARS-related travel policies. Countries should develop information sheets (such as a health alert card) for international travellers. This should detail the incubation period for SARS, and explain what they should do and who they should report to if they develop a fever. Airlines should develop polices to prepare for and manage a potential case of SARS detected in-flight, and how to manage other passengers on the same flight.
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WHO recommendations to limit the spread of SARS by international travel WHO released its first SARS-related travel advice on 15 March 2003 (http://www.who.int/csr/sarsarchive/2003_03_15/en/). It provided advice to travellers who developed SARS-like symptoms, and recommendations to airlines on what to do if a possible SARS case was identified in-flight. On 27 March 2003, WHO recommended new measures to prevent travel-related spread of SARS (http://www.who.int/csr/sarsarchive/2003_03_27/en/). These included a screening process to identify people with possible SARS symptoms leaving an affected area. Individual countries, as they make their own travel advice, may wish to take into account national considerations. Information updates on affected areas and the number of SARS cases, deaths and evidence of local transmission are issued daily by WHO (http://www.who.int/csr/sars). On 2 April, 2003, WHO recommended that "that persons travelling to Hong Kong and Guangdong Province of China consider postponing non-essential travel." (http://www.who.int/csr/sarsarchive/2003_04_02/en/). This recommendation is based on concerns about more general community transmission of SARS in these regions. This is a temporary recommendation and it will be reassessed in the light of the evolution of the SARS outbreak in currently affected areas. Other areas of the world could become subject to recommendations if the situation demands. This recommendation applies only to travellers entering Hong Kong SAR and Guangdong province and not to passengers directly transiting through international airports within those areas.
Travellers' Alert All travellers, including airline/ship crews, should be aware of the main symptoms and signs of SARS. They should seek immediate medical attention should fever occur, and ensure that information about their recent travel is passed on to health care staff. Travellers who develop these symptoms are advised not to undertake further travel until they have recovered. Many countries are now distributing SARS health alert cards (for an example see ANNEX 5). These cards briefly describe the symptoms of SARS, advise travellers to seek immediate medical care when showing these symptoms, specify the potential incubation period (14 days), and give a contact address and telephone number/hotline of a SARS referral centre. Cards may also contain advice for physicians. Some countries distribute SARS health alert cards to passengers arriving from SARS-affected areas which combine this health alert information with a short questionnaire on the traveller's health status (in this case the card has a perforation to allow the health questionnaire to be collected by quarantine staff, while the health alert information remains with the traveller) (for an example see ANNEX 5). This approach is designed to identify suspect SARS cases on arrival. These cases would be referred to airport/port health authorities for assessment and management (Figure 3). The PPHSN SARS Task force has also produced a travel advisory that goes further than WHO (see ANNEX 3). This careful attitude helps to avoid SARS long-distance spread through travel to and from infected zones and prevents the importation of SARS "home" (lots of close contacts...). This is particularly important in places where control measures may not be easy to implement (and SARS importation may have serious public health consequences).
Advice to airline staff and national airport health authorities See "In-flight care of suspected case of SARS". See "Contacts of suspected cases on aircraft ". In order to respond to these recommendations, airlines will have to ensure that flights with passengers from affected areas are provided with sufficient gloves, face masks and disinfectant, and they should ideally ensure that a seat in an isolated area can be made available when needed. Airlines must also make sure that flight attendants are properly trained.
Disinfection of aircraft See WHO Guide to Hygiene and Sanitation in Aviation (http://www.who.int/csr/ihr/guide.pdf). Although these recommendations are mainly directed to air travel, the same procedures are recommended for international travel from affected areas by sea, rail or road. |
