SARS Severe Acute Respiratory Syndrome

“A GLOBAL ALERT”

The much talked about ‘SARS’ , has created panic all over the world. It is hyped by the media who pour voluminous material on SARS everyday in the newspapers. It is mandatory now for every clinician, health care providers and common man to know everything about SARS.

What is SARS all about ?

SARS is an emerging viral infectious disease. A flu-like illness, followed by a typical pneumonia and a high case fatality rate have been its characteristics. It was first reported in Guangdong province, China, in November 2002. the largest outbreak to date began in Singapore in mid March 2003 and was traced to a traveler returning from Hong Kong.

The syndrome needs to be addressed to for multiple reasons viz;

	Firstly, it’s a new entity.
	It’s a highly communicable disease with high case fatality and is manifest as a trans-continental Epidemic.
	It has proven a major occupational hazard for health care providers
	It has potential to tax hospital services beyond their capacity.

 
Thus its emergence promoted the WHO to issue the first "GLOBAL HEALTH ALERT" for over a decade, on March 15th 2003. an emergency travel advisory was set up. The Director general of WHO, Dr. Gro Harlem Brund Hand, stated that 'This syndrome is now a world-wide health threat and the world needs to work together to find its cause, cure the sick stop its spread”. More than 7,956 cases have been reported from 28 countries taking a toll of 666 people. Areas with current documented or suspected community transmission of SARS include China, Hong Kong, Singapore, Taiwan, Canada & Vietnam. India was also an affected country with 3 probable cases including 2 cases in Bangalore. It is believed by some workers in India, that Indians have some immunity against this virus, thus preventing widespread transmission. Even though many people have traveled and returned from these countries, so far no case is definitely proved to be a case of SARS in India.

'THE CLINICAL PICTURE OF SARS'

	Definition
	SARS is a condition of unknown etiology probably caused by a corona virus, that has been described in patients in Asia, Canada & Europe.
	Etiological Agent
	A novel corona virus, for which CDC recently completed genome sequencing is believed to be responsible for global Epidemic of SARS. (This virus is different from the known bird and pig corona virus.)
	How SARS Spreads?
	The primary way that SARS appears to spread is by close person-to- person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching their own eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It is also possible that SARS can spread by other ways that are currently not known.
	Age of Onset
	Identified in adults aged 25-70 years. Few cases have been reported among children < 15 years.
	Clinical Features
	Incubation period is typically 2-7 days. The illness begins with prodrome of Fever (>100.4% /38o C). Fever is often high, sometimes associated with chills & rigors. There may be other accompanying symptoms like headache, malaise & myalgia. At the onset of illness, some persons have mild respiratory symptoms. Typically, rash neurological or gastrointestinal symptoms are absent; however some patients have reported diarrhea during the febrile prodrome. After 3-7 days, a lower respiratory phase begins with the onset of dry, nonproductive cough, dyspnoea, which may be accompanied by or progress to hypoxemia. In 10-20% of cases, respiratory illness is severe enough to require intubation and mechanical ventilation.
	Case Fatality Rate
	Defined by WHO is approx 3%.
	The latest case definition criteria is as follows
	Clinical criteria
	Lab Criteria
	Epidemiologic Criteria