Outbreak preparedness & control

PPHSN Guidelines

For the Preparedness, Surveillance And 

Response To Severe Acute Respiratory Syndrome (SARS) 

in Pacific Island Countries And Territories

  Last update 

SURVEILLANCE (Updated 30 April 2003)

Please note that a SINGLE case of suspected/probable SARS is an outbreak.

PPHSN Case Definitions for hospital based surveillance

Suspected case 

Clinicians should be alert for persons with onset of illness after November 1, 2002 with: 

Fever (>38° C / 100.4 F) 

      AND 

One or more signs or symptoms of respiratory illness, including: 

• cough, 

• shortness of breath, 

• difficulty breathing, 

     AND 

A history of either of the following: 

• close contact*, within 14 days of onset of symptoms, with a person who has been diagnosed with SARS. 

• history of travel, within 14 days of onset of symptoms, to an area** (see table below) in which there are reported foci of transmission of SARS.

* close contact means having cared for, having lived with, or having had direct contact with respiratory secretions, body fluids and/or excretion (e.g. faeces) of a suspect or probable case of SARS.

Note 

In addition to fever and respiratory symptoms, SARS may be associated with other symptoms including: headache, muscular stiffness, loss of appetite, malaise, confusion, rash, and diarrhea.

Probable case 

• A suspected case with chest X-ray findings of pneumonia or adult respiratory distress syndrome. 

             OR 

• A person with an unexplained respiratory illness resulting in death, with an autopsy examination demonstrating the pathology of Respiratory Distress Syndrome without an identifiable cause.

Surveillance at points of entry

Possibilities for case surveillance among incoming passengers (mostly by air, but also by sea):

1. Health alert notice (see Advice to Arriving Travelers, Annex 5)

• A card or paper given to each passenger, preferably before arrival, informing about SARS and advising self-identification to appropriate authorities or health workers should fever or respiratory symptoms occur within 14 days of travel in a SARS-affected area or close contact with a person suspected of SARS. 

• Health alert notices are recommended for all incoming flights,

2. Health questionnaire

• A brief questionnaire given to each passenger, preferably before arrival, to include personal particulars (name, age, sex, passport information, permanent address and contact information), recent illness (e.g. fever or respiratory symptoms in the last 3 days), recent travel history, and contact information for at least the next 2 weeks. 

• If used for identifying suspect cases, these questionnaires should be quickly reviewed, and any person with illness and a travel or contact exposure should be immediately given a mask, and isolated for further evaluation. Such evaluation should occur in the case of fever or respiratory symptoms (and travel or contact exposure), even if the full SARS case definition is not met. 

• Such questionnaires may also be collected for the purpose of retaining information in the event that a case is later identified, and contact tracing is necessary. 

• Questionnaires, in addition to health alert notices, are also recommended for use on all incoming flights to identify sick passengers who have had SARS travel or contact exposure, and also saved for contact tracing should a case be later identified. If flights are many or resources are limited, the questionnaires may be used on priority incoming flights; that is, those which are most likely to have passengers from SARS-affected areas.

Surveillance within a country 

• Physicians and clinical staff should be briefed and updated on SARS; be aware of the case definition; and be kept informed of current SARS-affected areas. They must understand the importance of avoiding exposure within clinics, hospitals and other settings to suspect SARS patients, and of immediately isolating and providing barrier protection when a case is suspected. 

• They must understand the importance of immediate reporting of patients meeting SARS case definitions. 

• It is also important for health workers to assist the community in appropriate reactions to SARS or the threat of SARS, avoiding over-reaction.

Reporting

• Report all suspected/probable cases immediately to National Public Health Authorities, using the PPHSN reporting form (see ANNEX 2) or an equivalent form. 

• Report all suspected/probable cases immediately to PPHSN Coordinating Body (CB) Focal point or WHO Suva (through local WHO Office if present) using the PPHSN reporting form (a copy of the completed form used to report to the National Public Health Authorities) (see contacts list in ANNEX 1) 

• Report to PacNet or PacNet-restricted.

Minimum dataset

• Upon arrival:

o   affected area visited in the last 14 days and presence of symptoms.

o   identify of individuals and residence/contact in the next 14 days 

    (purpose: active surveillance/retrieving contacts of suspected or 

     probable case on board a plane or boat).

o   national health or port authorities may consider routinely collecting a 

    copy of the passenger seating list of every flight arriving from SARS 

    affected areas.

• Please see PPHSN reporting form for data items. 

• For PacNet or PacNet-restricted, same as on reporting form, EXCEPT reporter and patient details (you can send the form on PacNet or PacNet-restricted, but delete the 2^nd page).

PPHSN SARS Guidelines - 30/04/2003

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