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PENNSYLVANIA DEPARTMENT OF HEALTH develop a fever

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					              PENNSYLVANIA DEPARTMENT OF HEALTH
                      HEALTH ALERT #43

                             Date: March 27, 2003
            Subject: SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
                            To: Health Alert Network
             From: Robert S. Muscalus, DO, Acting Secretary of Health

     This transmission is a "Health Alert", conveys the highest level of
                                importance;
                 warrants immediate action or attention.

 HOSPITALS: PLEASE SHARE THIS WITH ALL YOUR EMERGENCY PREPAREDNESS
                               STAFF
     NURSING HOMES: PLEASE SHARE THIS WITH ALL YOUR EMERGENCY
                        PREPAREDNESS STAFF

    LOCAL HEALTH JURISDICTIONS: PLEASE DISTRIBUTE AS APPROPRIATE

             EMS COUNCILS: PLEASE DISTRIBUTE AS APPROPRIATE

   PROFESSIONAL HEALTH ORGANIZATIONS: PLEASE DISTRIBUTE TO YOUR
                    MEMBERSHIP AS APPROPRIATE

                  Severe Acute Respiratory Syndrome (SARS)

This is an update to previous Pennsylvania Health Alerts issued March 17, 19, 21 and
                                      25, 2003

                                    1. Case Count
      CDC and WHO continue to issue updates on the national and international
investigation of possible cases of SARS. The daily international summary is available
  at http://www.who.int/csr/sars/en/, and the national summary via the CDC main
                 SARS web page at http://www.cdc.gov/ncidod/sars/.

  This week, the WHO international case count jumped dramatically. The latest WHO
numbers now include almost 800 cases from Guangdong Province, China, going back
   to November 2002. It is certainly true that the number of new SARS cases under
investigation continues to grow, including especially in Hong Kong. However, persons
 observing the increase in cases reported by WHO are cautioned to take into account
                the difference between reported date and onset date.

 As of March 26, CDC is reporting 45 “Suspected Cases Under Investigation” in the
     U.S., from 20 states including Pennsylvania. As of this update, two cases in
 Pennsylvania meeting the CDC surveillance case definition have been reported and
investigated, and are now well. Additional reports of possible SARS cases are under
   investigation. No cases of severe illness nor secondary transmission of SARS in
                        Pennsylvania are evident at this time.
 We thank Pennsylvania clinicians for continuing to contact their local public health
                   authorities to report patients of concern.

                      2. Infection Control Update from CDC
              You attention is called to the following message from CDC:

 Interim Domestic Guidance for Management of Exposures to Severe Acute
    Respiratory Syndrome (SARS) for Healthcare and Other Institutional
                               Settings

                                       Healthcare Settings
Several healthcare workers have been reported to develop Severe Acute Respiratory
  Syndrome (SARS) after caring for patients with SARS. Although the infectivity and
etiology of SARS currently are unknown, transmission to healthcare workers appears
to have occurred after close contact with symptomatic individuals (e.g., persons with
  fever or respiratory symptoms) before recommended infection control precautions
    for SARS were implemented (i.e., unprotected exposures). Personal protective
  equipment appropriate for standard, contact, and airborne precautions (e.g., hand
hygiene, gown, gloves, and N95 respirator), in addition to eye protection, have been
 recommended for healthcare workers to prevent transmission of SARS in healthcare
settings (http://www.cdc.gov/ncidod/sars/ic.htm). More general information on infection control
     in healthcare workers is available at http://www.cdc.gov/ncidod/hip/GUIDE/infectcont98.htm.

    CDC, in collaboration with state and local health departments, is developing a
 systematic approach for surveillance of SARS exposures and infection in healthcare
    workers for use by healthcare facilities. Additional information on surveillance
   materials will be forthcoming. Given the currently available information on the
 epidemiology of SARS in the United States, the following outlines interim guidance
         for the management of exposures to SARS in a healthcare facility.

 Exclusion from duty is recommended for a healthcare worker if fever or respiratory
symptoms develop during the 10 days following an unprotected exposure to a SARS
patient. Exclusion from duty should be continued for 10 days after the resolution of
 fever and respiratory symptoms. During this period, infected workers should avoi d
            contact with persons both in the facility and in the community

                         (http://www.cdc.gov/ncidod/sars/infectioncontrol.htm).

Exclusion from duty is not recommended for an exposed healthcare worker if they do
 not have either fever or respiratory symptoms; however, the worker should report
   any unprotected exposure to SARS patients to the appropriate facility point of
         contact (e.g., infection control or occupational health) immediately.

Active surveillance for fever and respiratory symptoms (e.g., daily screening) should
   be conducted on healthcare workers with unprotected exposure, and the worker
should be vigilant for onset of illness. Workers with unprotected exposure developing
     such symptoms should not report for duty, but should stay home and report
symptoms to the appropriate facility point of contact immediately. Recommendations
 for appropriate infection control for SARS patients in the home or residential setting
                are available at http://www.cdc.gov/ncidod/sars/infectioncontrol.htm.
Passive surveillance (e.g., review of occupational health or other sick leave records)
should be conducted among all healthcare workers in a facility with a SARS patient,
and all healthcare facility workers should be educated concerning the symptoms of
                                        SARS.

  Close contacts (e.g., family members) of SARS patients are at risk for infection.
 Close contacts with either fever or respiratory symptoms should not be allowed to
 enter the healthcare facility as visitors and should be educated about this policy. A
system for screening SARS close contacts who are visitors to the facility for fever or
  respiratory symptoms should be in place. Healthcare facilities should educate all
 visitors about use of infection control precautions when visiting SARS patients and
                      their responsibility for adherence to them.

                             Other Institutional Settings

   To date, all patients with SARS reported to CDC in the United States have been
either persons with a history of foreign travel to countries with SARS transmission or
 close contacts (e.g., family members or healthcare workers) to other SARS cases.
     Transmission has not been reported at schools, other institutions, or public
    gatherings in the United States. However, these recommendations concerning
 management of exposed healthcare workers could be adapted and applied to other
 settings, including schools and other institutional settings, as deemed appropriate.

                                        3. Etiology
 CDC and a number of other investigators worldwide continue to work on finding an
etiology or etiologies for SARS. At this time, we are unable to offer more information
    than is being reported directly from CDC and by sources such as ProMED Mail
  (www.promedmail.org). It is not yet possible to resolve the discrepancy between
  some investigators who suggest a novel coronavirus as the agent of SARS, while
    others suggest a novel paramyxovirus. Until an agent is clearly established, a
                  specific clinical diagnostic test will not be available.

                             4. EMS Infection Control
The Pennsylvania Department of Health reminds all public safety personnel that the
 current practice in responding to a call involving respiratory distress or suspected
  pneumonia (including tuberculosis) is to follow contact and airborne precautions
         including gloves, N95/ HEPA filter respirators, and eye protection.

  In addition to current practices, EMS providers should question patients with the
symptoms listed above as to any travel through Southeast Asia (or other areas with
  confirmed SARS cases) since February 1, 2003 and as to whether they have had
              contact with anyone who has been diagnosed with SARS.

 If a patient is suspected of having SARS, especially if there are confirmed cases of
  SARS in the region, gowns should be added to the above contact precautions. If
           practical, the patient should also wear a mask during transport.

   Following transport of a suspected SARS patient, providers should report their
                  suspicions to the Emergency Department staff.


                      Categories of Health Alert messages:
 Health Alert: conveys the highest level of importance; warrants immediate action
                                   or attention.
Health Advisory: provides important information for a specific incident or situation;
                        may not require immediate action.
Health Update: provides updated information regarding an incident or situation; no
                          immediate action necessary.

This information is current as of March 27, 2003, but may be modified in the future.
We will continue to post updated information regarding the most common questions
                                  about this subject.

				
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