Severe acute respiratory syndrome (SARS)

World Health Organization (WHO) case definitions of SARS in the post-outbreak period[29]World Health Organization: global alert and response (GAR). Alert, verification and public health management of SARS in the post-outbreak period. August 2003 [internet publication]. https://www.who.int/publications/m/item/alert-verification-and-public-health-management-of-sars-in-the-post-outbreak-period

Clinical case definition requires all of the following:

• Fever (≥38°C [100.4°F])

• One or more symptoms of lower respiratory tract illness: cough, difficulty breathing, shortness of breath

• Radiological evidence of lung infiltrates consistent with pneumonia or respiratory distress syndrome

• No alternative diagnosis that can fully explain the illness.

Laboratory case definition:

• Positive laboratory findings of SARS-CoV based on either or both of the following diagnostic criteria:

  • PCR positive from at least two different clinical specimens or the same specimen collected on two or more occasions during the course of the illness

  • Seroconversion between acute and convalescent phase sera and virus isolation.

Centers for Disease Control and Prevention (CDC) updated interim case definition for SARS[21]Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS) version 2. Supplement B: SARS surveillance. Appendix B1: revised CSTE SARS surveillance case definition. May 2005 [internet publication]. http://www.cdc.gov/sars/guidance/B-surveillance/app1.html

Clinical criteria

• Early respiratory illness

  • Two or more of the following features: fever, chills, rigors, myalgia, headache, diarrhoea, sore throat, rhinorrhoea.

• Mild to moderate respiratory illness

  • Fever (≥38°C [100.4°F]) plus one or more symptoms of lower respiratory tract illness: cough, dyspnoea, difficulty breathing.

• Severe respiratory illness

  • Mild to moderate respiratory illness plus radiological evidence of lung infiltrates consistent with pneumonia or acute respiratory distress syndrome.

Epidemiological criteria

• History of recent travel, within 10 days of the onset of symptoms, to a foreign or domestic location with documented or suspected recent transmission of SARS; or

• Close contact with a person confirmed with or suspected of having SARS.

Laboratory criteria

• Detection of serum antibodies to SARS-CoV; or

• Isolation in cell culture of SARS-CoV from a clinical specimen; or

• Detection of SARS-CoV RNA by reverse-transcription polymerase chain reaction (RT-PCR) testing with subsequent confirmation in a reference laboratory.

Probable case of SARS-CoV

• Patient meets the clinical criteria for severe respiratory illness and the epidemiological criteria for likely exposure to SARS-CoV.

Confirmed case of SARS-CoV

• Patient has a clinically compatible respiratory illness (early, mild to moderate, or severe) that is confirmed by the laboratory.