Previous Health Alerts - Severe Acute Respiratory Syndrome (SARS)

Issued: 3 April 2003

Page content: Frequently asked questions | Further information | Information for medical practitioners

The World Health Organization (WHO) has issued a global health alert for authorities to be aware of a new atypical pneumonia called Severe Acute Respiratory Syndrome (SARS) which has been found in several countries in South East Asia and other countries where people have travelled after visiting infected areas. Reports to date have been received from many countries including Canada, China, Hong Kong Special Administrative Region of China, Taiwan, Singapore and Viet Nam. The exact nature of the infection is still under investigation.

Since the WHO health alert, Australia has intensified its disease surveillance capacity with information to hospitals, health workers and General Practitioners about symptoms to look for and infection control procedures to undertake if presented with a potential suspect case of SARS. While a number of patients in Australia have been placed under investigation after presenting with symptoms of the disease following recent travel from Asia, only one probable case of SARS has been found in Australia and this person is now well.

The Commonwealth Department of Health and Ageing, through the Office of the Chief Medical Officer, is in daily contact with the World Health Organization (WHO), which is coordinating the global response to this disease. The Chief Medical Officer has been convening a meeting every day with State and Territory health officials and infectious diseases specialists via the Communicable Diseases Network of Australia (CDNA), to ensure that Australia is aware of the very latest developments world-wide, including suspected cases and deaths from SARS and any breaking news on research into the causes of and possible treatments for this new disease.

The Department of Human Services, in collaboration with the Commonwealth Department of Health and Ageing, and health departments in other states and territories has compiled information on identification of SARS and Frequently asked questions. For further information we have provided links to the Department of Health and Ageing, the World Health Organization and other sites.

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Frequently asked questions

These FAQs have been copied from the Australian Department of Health and Ageing website and are current as of 2 April 2003.

What is SARS?
SARS is a serious illness, probably caused by an unknown type of virus. It spreads from person to person, but only to people who are in close contact with an infected person who is unwell. We anticipate that diagnostic tests will be developed for the virus soon.

Is SARS common?
No. Other causes of infection in the respiratory tract are far more common than SARS. Most people who have a cough and fever will not have SARS but will have another common viral illness.

What are the symptoms of SARS?
People with SARS have a high fever (over 38 degrees celsius), feel short of breath and have a dry cough. With the fever people may have a bad headache, are confused, feel generally sick and have body aches and pains. Sneezing does not appear to be a common symptom of SARS.

What should I do if I have any of these symptoms?
First don't be overly concerned, many people get respiratory infections every day and the probability that your symptoms are SARS is very low. However, you should identify where the closest medical facility is to you. If you have a fever, or feel alternately hot and cold you should seek advice from your local doctor. Remember that it is probably not SARS.

If I am exposed to SARS, how long would it take for me to become sick?
Most cases have become unwell between 2 and 7 days after exposure to a person ill with SARS, in some cases this has been up to 10 days.

Can SARS be treated with antibiotics or other drugs?
People with suspected SARS will be treated with antibiotics that are affective against the diseases that cause similar symptoms. At this stage there is no specific treatment for SARS itself, other than good health care in hospital for severe cases.

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What is my risk of getting SARS?
The risk of getting SARS while travelling overseas is very low. SARS has almost exclusively been transmitted from cases to close contacts such as family, close friends or someone who has cared for them during their illness.

Are children at a greater risk of getting SARS?
There is no evidence to suggest that children are at a greater risk of getting SARS but good personal hygiene practices should be ensured, especially during travel.

How is SARS spread?
Droplets from infected cases as a result of coughing carry the virus to close contacts. They can also contaminate objects for a short period of time. However, contact with the eyes or mouth as a mode of spread can be avoided by good personal hygiene, such as using liquid soap for handwashing and disposable towels for drying hands.

Can I get SARS through airconditioning in hotels or other places?
There is no evidence that SARS spreads through airconditioning systems.

Is it safe to use public swimming pools?
There is no evidence that SARS can be transmitted through swimming. The same precautions for close contact with a person who is coughing should be taken in pool areas.

Can SARS kill?
The mortality rate of SARS is believed to be less than 5% of people known to be infected. Quickly identifying symptoms and using general medical management and hospitalisation has kept the death rate low.

Is SARS influenza?
No. SARS is caused by a different virus. Influenza is much more contagious than SARS. Influenza vaccines do not protect against SARS. However, people who are recommended to have annual flu vaccinations should do so. Those travelling overseas may also consider being vaccinated as it will be important to prevent as much influenza as possible and to reduce the number of people who, on developing flu, might be initially considered to have SARS. This would also reduce the pressure on hospitals to manage patients with influenza at a time when SARS cases may occur and hospital beds are needed.

Could this be the next flu pandemic?
No. SARS is different from flu.

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Is SARS everywhere in the world?
No. SARS is known to have spread in Hong Kong SAR, Taiwan (China), Guangdong Province in China, Ontario Province in Canada, Singapore and Viet Nam. Single cases of SARS have been reported in some other countries but there has not been additional spread to other people.

How many cases of SARS have been reported so far?
Detailed information is available every day on the website for the World Health Organization. Up until the 2nd of April 2003 there have been around 1800 cases throughout the world.

Have terrorists released SARS as an attack?
Very unlikely. There is no evidence that SARS has been linked to terrorism.

How can I best protect myself from SARS?
In most situations you will not be at any risk of SARS. If you see someone who is obviously unwell and is coughing, step away and avoid physical contact. Cover your nose and mouth with a mask, tissues or a cloth.

Can I buy masks in Australia to take on international travel?
Surgical masks are available in Australia. When it becomes damp, you should dispose of the mask, wash your hands and put on a new mask. Masks may be unnecessary when there is no close person to person contact.

What if I can't move away from someone who is sick?
If you are in a position where you cannot move away you can protect yourself by wearing a surgical mask, avoid letting your own fingers come into contact with your eyes or mouth and washing your hands very well and frequently. Use a disposable towel for drying hands. If you do not have access to a tap, use an alcohol wipe to clean your hands.

Are health workers provided with information on how to manage SARS?
Guidelines are in place for health care workers to assess a person with symptoms common to SARS.

Should I avoid the places where SARS is spreading?
Commonwealth health authorities have issued a caution to Australians planning to travel overseas, particularly East Asia, that they may not be able to return immediately if they show any symptoms consistent with Severe Acute Respiratory Syndrome (SARS).
The Commonwealth Department of Health and Ageing strongly recommends that Australians consider deferring, until further notice, non-essential travel to China, particularly Guangdon Province, Hong Kong SAR, Singapore, Vietnam and Toronto in Canada.

Australian resident in countries where local transmission of SARS has been reported, and who have chronic illnesses, should seek medical advice about any need for extra precautions.

Chief Medical Officer, Professor Richard Smallwood, said the World Health Organisation (WHO) has now recommended new measures related to international travel including screening of air passengers departing from Canada, Singapore, mainland China, Hong Kong and Viet Nam. This includes screening measures that could see people with fever or other flu-like symptoms being excluded from further travel, until they have recovered.

What is Australia's travel advice?
While the risk of contracting SARS is very low and, to date, almost all known cases have been contracted through close personal contact with a seriously ill person, it is recommended that Australians consider deferring, until further notice, non-essential travel to China, Hong Kong SAR, Singapore, Vietnam and Toronto in Canada. However, if people decide to visit these regions, precautions should be taken. Some simple preventative measures include carrying alcohol-based handwipes, using tissues or handkerchiefs to cover one's nose or mouth if next to a visibly unwell person and to ensure frequent handwashing.

What information is provided to travellers?
Both incoming and outgoing travellers are receiving health alert cards about the spread, symptoms and contact details for further advice. Look for these at Australian Customs.

What is happening at Australia's borders?
All flights and ships arriving in Australia need to report whether any person on board is ill. This will help ensure that the adequate medical action is taken upon arrival.

Is SARS a quarantinable illness in Australia?
SARS is not quarantinable (at this time) in Australia.

If I feel mildly unwell during an overseas trip, can I travel home?
If you are unwell you may be asked at the airport to delay your flight home. If you develop a cough while you are in transit you should expect to be asked to wear a mask. Depending on your symptoms you may be required to meet health staff when you arrive at the destination airport.

If I did get SARS overseas how would I be managed?
People who are ill enough to be hospitalised are being placed in infection control wards. Good supportive health care is all that most people require, with treatment for fever and pains and additional oxygen to make breathing easier. Nurses or doctors caring for them, along with all visitors would wear masks, gloves and gowns. This can distress some ill people but it is important to realise that it is just a precaution. Australians being treated overseas would have access to consular assistance and advice from Australian health authorities if required.

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Further information

New Information Hotline established:

The Commonwealth Department of Health and Ageing has established a national information phone line for enquires from the public.
The phone line will be staffed seven days a week from 8.30 am to 8 pm EST.

Call 1800 004 599

If overseas, contact + 61 2 6200 1141
(charges apply for the international call)

Further information is available at World Health Organisation website:

SARS frequently asked questions
www.who.int/csr/sars/sarsfaq/en/

SARS case definitions
www.who.int/csr/sars/casedefinition/en/

Guidelines for global surveillance of SARS
www.who.int/csr/resources/publications/

Hospital Infection Control Guidance
www.who.int/csr/sars/infectioncontrol/en/

Other useful links:

Australian Department of Health and Ageing
www.health.gov.au

Centers for Disease Control and Prevention (USA)
www.cdc.gov

World Health Organisation
www.who.int/en/

Health Protection Agency (UK)
www.hpa.org.uk/

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Information for medical practitioners

The World Health Organisation has received reports of more than 2223 suspected cases of Severe Acute Respiratory Syndrome (SARS), an atypical pneumonia for which cause has not yet been determined. Countries at risk are Canada (Province of Ontario), China, Hong Kong Special Administrative Region of China, Singapore, Taiwan and Viet Nam (Hanoi). The exact nature of the infection is still under investigation and this guidance is based on the early information available.

A suspected case is a person presenting with history of:

• High fever (greater than 38°C)

AND

• One or more respiratory symptoms including cough, shortness of breath, difficulty breathing

AND one or more of the following:

• Close contact* with a person who has been diagnosed with SARS
• Recent history of travel within the last 10 days to areas reporting cases of SARS

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A probable case is:

• A suspect case with chest x-ray findings of pneumonia or 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.

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 diarrhoea.

It is recommended that patients with SARS be isolated with standard precautions and additional respiratory precautions and treated as clinically indicated.

Laboratory samples that should be collected include:

• Dry swabs of both nostrils and the throat placed in Viral Transport Medium for respiratory pathogen PCR
• Sputum for culture and a baseline blood (serum) for respiratory pathogen serology.

Laboratory samples should be forwarded to the Victorian Infectious Diseases Reference Laboratory (10 Wreckyn St, North Melbourne) and marked "Suspected SARS Case".

Please report all suspected cases to the Communicable Diseases Section on 1300 651 160.

Further updates will be provided as more information becomes available. Information from the WHO is available at: www.who.int/en/

Dr Robert Hall
Chief Health Officer

*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.

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