Skip to the content

SARS Fact Sheet

SARS in Humans at CECDP

Synopsis of SARS
Severe Acute Respiratory Syndrome (SARS), the first severe and readily transmissible new disease to emerge in the 21st century, is caused by a previously unknown type of coronavirus. Coronaviruses are a frequent cause of mild to moderate respiratory illness in humans, such as the common cold. This previously unknown coronavirus, however, causes an atypical pneumonia. The first reported cases of SARS occurred in the Guangdong Province of China in November 2002. The SARS virus was spread to Hong Kong by an infected medical doctor who had treated SARS-infected patients in the Guangdong Province in February 2003. Several international travelers staying at the same Hong Kong hotel as this physician contracted the disease. The disease then began spreading around the world along international travel routes as these international travelers traveled to Toronto and elsewhere. Hong Kong, Hanoi, Singapore, and Toronto became the initial “hot zones” of SARS due to the rapid increases in the number of cases, especially in health care workers and their close contacts. Over the next three months, SARS spread to 29 countries and caused over 8,000 cases and 774 deaths. Transmission occurs through close person-to-person contact (i.e., respiratory droplets), by fomites (e.g., contaminated surfaces and objects), and, possibly, by airborne spread. The SARS virus is believed to have originated in animals. Some scientists believe that human consumption of exotic animals, specifically civet cats, led to the first cases of SARS. SARS can now be found in North America, South America, Europe and Asia. A wide range of animal species are susceptible to SARS infection, including rodents, non-human primates, cats and humans.
  • SARS can be spread by close person-to-person contact via respiratory droplets and contact with contaminated surfaces or objects.
  • High risk groups: Those who have cared for or lived with someone with SARS, especially family members and health care personnel.
back to top
Clinical Signs and Symptoms
Humans:
  • Incubation: 2 to 7 days
  • Clinical signs and symptoms (early phase):
    • High fever (greater than 100.4°F [38°C])
    • Chills and rigors
    • Headache
    • Feelings of discomfort
    • Body aches
    • Diarrhea in 10-20% of patients
    • No associated rash
    • No neurologic symptoms
  • Clinical signs and symptoms (lower respiratory phase):
    • Symptoms occur 2-7 days after the early phase
    • Dry, nonproductive cough
    • Dyspnea
    • Hypoxemia
    • 10-20% of patients require ventilatory support
  • Chest radiography:
    • Can be normal during early phase of illness
    • Most common presentation has been patchy, interstitial infiltrates
  • Chest CT:
    • May show infiltrates earlier in the clinical course than chest radiography
  • Laboratory finidings:
    • Decreased absolute lymphocyte count
    • Leucopenia and thrombocytopenia have been seen in 50% of cases
    • Markedly elevated creatine phosphokinase (as high as 3000 IU/L) has been reported
    • Elevation of hepatic transaminases has been seen in some patients
  • Click here for more human-related information on anthrax posted on the UAB Website for Bioterrorism and Emerging Infectious Education.4
back to top
Diagnosis and Treatment
Diagnostic Samples:
  • Samples for diagnostic purposes for humans include blood and respiratory secretions.
Differential Diagnosis:
  • In humans, the differential diagnoses include respiratory syncytial virus, influenza A and B, Legionella, and S. pneumoniae.
Clinical Diagnosis:
  • In the absence of laboratory tests, the following criteria may be used to diagnose SARS:
    • Recent travel to affected areas in Asia or close contact with people diagnosed with SARS and
    • A fever greater than 38°C and
    • One or more of the following respiratory symptoms: cough, shortness of breath or difficulty breathing.
  • Click here for more information on clinical guidelines from the CDC.14
Laboratory Tests:
  • Initial tests:
    • Chest x-ray
    • Complete blood count
    • Comprehensive chemistry panel (including CPK)
    • Pulse oximetry or arterial blood gas
    • Sputum gram stain and culture
    • Blood cultures
  • Specific pathologic tests currently recommended by the CDC:
    • Enzyme immunoassay (EIA) to detect serum antibody to SARS-CoV
    • Reverse transcription polymerase chain reaction (RT-PCR) to detect SARS-CoV RNA
  • Click here for more information on laboratory guidelines from the CDC.11
Treatment:
  • In humans:
    • Intensive and supportive care is the primary therapy since no specific treatment has been shown to consistently improve patient outcome
    • Antiviral agents and steroids have been shown to be somewhat effective
back to top
Economic Consequences and Disease Eradication
Economic Consequences:
  • Medical costs associated with treatment.
  • Costs associated with eradication efforts.
  • Loss of income generated by international travel and tourism.
Disease Eradication:
  • Immediate notification of state and federal health officials
  • Early Recognition:
    • Knowing the signs and symptoms of SARS
    • Appropriately isolating affected individuals
    • Seek medical attention immediately/alert healthcare facility so that proper precautions can be taken
      • Patients suspected of SARS infection should wear a surgical mask and have appropriate isolation to prevent the spread of infection
  • Procedures to prevent the spread of disease:
    • Frequent hand washing
    • Avoid direct contact with body fluids of SARS patients
    • Person protective equipment (PPE)
    • Airborne infection isolation (i.e., an isolation room with negative pressure relative to the surrounding area and use of an N-95 filtering disposable respirator for persons entering the room)
    • Clean/disinfect contaminated surfaces, equipment, and clothing items
      • Compressed air should not be used for cleaning these areas
  • Control measures in livestock in endemic areas:
    • Safe disposal of carcasses (incineration in a manner that ensures heat sterilization of the underlying soil)
    • Vaccination of all at-risk herds
  • Response procedures (collaborative effort between the CDC and WHO)
  • Viability: The SARS coronavirus may survive in the environment for several days, especially in feces
  • Inactivation: 100°C/10 minutes; calcium hypochlorite; sodium hypochlorite; hydrogen peroxide; formaldehyde; glutaraldehyde; ethylene oxide; chlorine dioxide; methylene bromide; UV radiation; and gamma irradiation.
back to top
Outbreaks
  • The SARS Outbreak of 2003: According to the World Health Organization (WHO), there were more than 8,000 probable cases of SARS worldwide during the 2003 outbreak; of these 774 died (9% mortality). Of the 774 deaths attributed to SARS, more than 50% occurred in people 65 years of age of older. Eight confirmed cases of SARS (no deaths) were identified in the United States (all of these people had traveled to other parts of the world were SARS was more prominent).
  • Since this outbreak, there have been three confirmed and one probable case of SARS, all from the Guangdong Province of China. The source of their exposure is under investigation. There has been no other evidence of SARS anywhere in the world.
  • Click on the following hyperlink for the most recent outbreak information located at the World Health Organization Website.1
back to top
Sources and Related Articles
Sources:
  1. WHO, October 2004. Severe Acute Respiratory Syndrome (SARS) (main page). Available at http://www.who.int/csr/sars/en/.←
  2. CDC, January 13, 2004. CDC Severe Acute Respiratory Syndrome. Fact Sheet: Basic Information about SARS. Available at http://www.cdc.gov/ncidod/sars/pdf/factsheet.pdf.
  3. NIAID, September 2005. NIAID Research on Severe Acute Respiratory Syndrome (SARS). Available at http://www.niaid.nih.gov/factsheets/sars.htm.
  4. UAB: Bioterrorism and Emerging Infections Education. SARS Summary. Available at http://www.bioterrorism.uab.edu/EI/sars/sars.pdf.←
  5. CIDRAP. Anthrax: Severe Acute Respiratory Syndrome (main page). Available at http://www.cidrap.umn.edu/cidrap/content/other/sars/index.html.
    6. Related Articles:
  6. Anonymous January 8, 2004. CDC Severe Acute Respiratory Syndrome. Supplement A: Command and Control. http://www.cdc.gov/ncidod/sars/guidance/A/pdf/a.pdf.←
  7. Anonymous, January 8, 2004. CDC Severe Acute Respiratory Syndrome. Supplement B: SARS Surveillance. http://www.cdc.gov/ncidod/sars/guidance/B/pdf/b.pdf.←
  8. Anonymous, January 8, 2004. CDC Severe Acute Respiratory Syndrome. Supplement C: Preparedness and Response in Healthcare Facilities. http://www.cdc.gov/ncidod/sars/guidance/C/pdf/c.pdf.←
  9. Anonymous, January 8, 2004. CDC Severe Acute Respiratory Syndrome. Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine. http://www.cdc.gov/ncidod/sars/guidance/D/pdf/d.pdf.←
  10. Anonymous, July 20, 2004. CDC Severe Acute Respiratory Syndrome. Supplement E: Managing International Travel-Related Transmission Risk. http://www.cdc.gov/ncidod/sars/guidance/E/pdf/e.pdf.←
  11. Anonymous, May 21, 2004. CDC Severe Acute Respiratory Syndrome. Supplement F: Laboratory Guidance. http://www.cdc.gov/ncidod/sars/guidance/f/pdf/f.pdf.←
  12. Anonymous, December 29, 2003. CDC Severe Acute Respiratory Syndrome. Supplement G: Communication and Education. http://www.cdc.gov/ncidod/sars/guidance/G/pdf/g.pdf.←
  13. Anonymous, January 8, 2004. CDC Severe Acute Respiratory Syndrome. Supplement I: Infection Control in Healthcare, Home, and Community Settings. http://www.cdc.gov/ncidod/sars/guidance/I/pdf/occupational.pdf.←
  14. Anonymous, January 8, 2004. Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease among Persons Presenting with Community-Acquired Illness, Volume 2. http://www.cdc.gov/ncidod/sars/pdf/clinicalguidance.pdf.←
back to top