Interim Guidance for State and Local Health Departments
March 18, 2003, 5:30 PM EST

The Centers for Disease Control and Prevention is assisting the World Health Organization (WHO) in investigating an outbreak of a severe acute respiratory syndrome of unknown etiology. Cases have been reported in China (Guangdong Province and the Hong Kong Special Administrative Region), Vietnam, Canada, Indonesia, Philippines, Singapore, and Thailand. This disease has been characterized by secondary transmission in the health care setting and within households. Most of the identified index cases have traveled to China and a few have had no reported contact with health care workers or sick patients while in China. The number of cases reported worldwide is available on the WHO website; the number of cases reported in the United States is available on the CDC Media Relations website. Cases have generally had a brief incubation period (3-5 days).

These cases are being reported in the media. Please expect an increase in public inquiries and volume of clinical visits. You should have already received several health alerts that include CDC press releases, an advisory card for travelers returning from affected areas, and interim guidance for healthcare workers. This information is available on this website and will be updated periodically.

We have asked clinicians to be alert for patients with onset of illness after February 1, 2003, with the signs and symptoms described in the Jika petugas kcase definition web page.

We are in the process of developing data collection instruments. Until other options are available, information on these patients should be called to the SARS Domestic Team at 770-488-7100. Questions about specimen collection, preparation, and transportation may also be addressed by this team. Clinical consultation is also available at this number from the Clinical Management Team. A more specific telephone number will be available shortly for the investigation teams.

Please include the following information for suspected cases when calling:

8-digit state-assigned unique identification number starting with the state FIPS code (e.g., for Georgia, the code is 13)
Month and year of birth
Sex
Onset date
Clinical status—alive or dead
If dead, date of death
If dead, whether an autopsy was performed—yes or no
Hospitalized—yes or no
If hospitalized, name of hospital
Whether on a mechanical ventilator—yes or no
Healthcare worker—yes or no
If healthcare worker, place(s) of employment
Possible epidemiologic ties to other cases: dates and places for recent travel, dates and type of exposure for those exposed to other ill persons, and if available, ID numbers for the presumed source of their infection
Type of specimens available
In addition to reporting suspected cases, the following clinical specimens should be collected in consultation with CDC:

Frozen and formalin fixed tissues from an autopsy
Transbronchial or pleural biopsy specimens fixed in formalin
Bronchioaveolar lavage (BAL) specimens spun with supernatant frozen and cell pellet fixed in formalin
Acute and convalescent serum samples, either at room temperature, iced, or frozen
Peripheral blood smear, dried, at room temperature
Nasopharyngeal wash or throat swab in viral transport medium, frozen
More specimen collection resources can be found on the SARS Specimen Collection page.

Related Links

Webcast: Preventing the Spread of SARS
Presentation: Epidemiologic & Clinical Aspects of Suspect SARS Cases - U.S., 2003 PowerPoint (176 KB/18 pages)
Also available in PDF format
Presentation: SARS: A Global Outbreak Due to Recognition of a New Clinical Entity 2003 PowerPoint (381 KB/17 pages)
Also available in PDF format