0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
From the Centers for Disease Control and Prevention |

Update: Severe Acute Respiratory Syndrome—Worldwide and United States, 2003 FREE

JAMA. 2003;290(8):1022-1023. doi:10.1001/jama.290.8.1022.
Text Size: A A A
Published online

UPDATE: SEVERE ACUTE RESPIRATORY SYNDROME—WORLDWIDE AND UNITED STATES, 2003

MMWR. 2003;52:664-665

1 table omitted

This report updates reported cases of severe acute respiratory syndrome (SARS) worldwide and in the United States, describes a change in the recommended timing of collection of a convalescent-phase serum specimen to test for antibody to SARS-associated coronavirus (SARS-CoV), and introduces a new case exclusion criterion based on negative SARS-CoV serology.1 In addition, this report also summarizes changes in travel alerts for Beijing and mainland China, Hong Kong, Toronto, and Taiwan.

During November 1, 2002–July 11, 2003, a total of 8,427 probable SARS cases were reported to the World Health Organization (WHO) from 29 countries; 813 deaths (case fatality rate: 9.6%) have been reported, with no SARS-related deaths in the United States.2 On July 5, WHO announced that all known person-to-person transmission of SARS-CoV had ceased.3

CDC has revised the laboratory criteria in the SARS case definition to require that convalescent serum be collected >28 days after symptom onset, instead of >21 days after symptom onset. This change reflects data that some persons with SARS-CoV infection might not mount a detectable antibody response until >28 days after illness onset.4 Because most persons without immune-compromising conditions are thought to mount an immune response within 28 days, test results from serum collected previously 22-28 days after symptom onset will be considered definitive. However, state and local health officials can choose to collect a later specimen on a case-by-case basis if they consider it to be indicated clinically.

On June 26, the Council of State and Territorial Epidemiologists changed the U.S. SARS case definition to allow exclusion of cases with a negative convalescent serum specimen. This change reflects data indicating that >95% of patients with SARS mount a detectable convalescent antibody response.4,5 The U.S. case numbers in this report reflect this exclusion criterion.

As of July 15, a total of 418 SARS cases were reported in the United States, with 344 (82%) classified as suspect SARS and 74 (18%) classified as probable SARS (i.e., more severe illnesses characterized by the presence of pneumonia or acute respiratory distress syndrome). A total of 169 reported suspect cases and 38 reported probable cases were excluded because the convalescent serum specimen was negative for SARS-CoV antibodies. None of the reported suspect cases and eight reported probable SARS cases had a convalescent serum specimen that was positive for SARS-CoV antibodies; these eight laboratory-confirmed SARS cases have been reported previously.6-8 Convalescent serum specimens have not been obtained for the other 28 reported probable cases and 175 reported suspect cases; therefore, it is not known whether these persons had SARS.

Serologic testing results suggest that a small proportion of persons who had illness consistent with the clinical and epidemiologic criteria for a U.S. case of suspect or probable SARS actually had SARS. The case definition captures an array of respiratory illnesses that cannot be easily distinguished from SARS until laboratory testing results for SARS and other agents are performed. However, this sensitive case definition allowed for rapid investigation of persons who might have had SARS and for public health intervention to prevent person-to-person transmission.

CDC lifted the travel alerts for Beijing and mainland China, Hong Kong, Toronto, and Taiwan during July 1-15, 20039; CDC's criteria for lifting an alert for SARS include the absence of new cases for three incubation periods (i.e., 30 days) after the date of onset of symptoms for the last reported case (http://www.cdc.gov/ncidod/sars/travel_alertadvisory.htm). For traveler's illness to meet the case definition for SARS, the travel should have occurred on or before the last date the travel alert was in place. In addition, the last date for illness onset is 10 days (i.e., one incubation period) after removal of a CDC travel alert.1 With removal of all SARS travel alerts and completion of an incubation period, U.S. travelers with respiratory illness will no longer meet the case definition for SARS; reports of suspect or probable cases are expected to end by the end of July 2003.

References: 9 available

Figures

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles