ARCHIVED - Severe Acute Respiratory Syndrome (SARS)

Nationally notifiable since 2004

1.0 National Notification

Confirmed and probable cases of disease should be notified.

2.0 Type of Surveillance

Routine case-by-case notification to the federal level

Immediate notification to PHAC is required if any jurisdiction is investigating a probable case of severe acute respiratory syndrome (SARS) as per the national Severe Respiratory Illness Surveillance Protocol (http://www.phac-aspc.gc.ca/eri-ire/pdf/02-SRI-Surveillance-Protocol_e.pdf).

3.0 Case Classification

3.1 Confirmed case

A person with:

• early clinical presentation of SARS, i.e. fever (over 38° C) AND cough or breathing difficulty
  AND
• radiographic evidence consistent with SARS, i.e. radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome (RDS)
  AND
• laboratory evidence* of SARS-associated coronavirus (SARS-CoV) infection, i.e. detection of SARS-CoV RNA OR seroconversion OR virus isolation
  OR

A deceased person with:

• a history of early clinical presentation of SARS, i.e. fever AND cough or difficulty breathing resulting in death
  AND
• autopsy findings consistent with SARS, i.e. evidence of pneumonia or RDS without an alternative identifiable cause
  AND
• laboratory evidence* of SARS-CoV infection, detection of SARS-CoV RNA OR seroconversion OR virus isolation

3.2 Probable case

A person with:

• early clinical presentation of SARS
  AND
• radiographic evidence consistent with SARS
  AND
• epidemiologic link to a person or place linked to SARS, i.e.
  • close contact† with a confirmed SARS case within 10 days of onset of symptoms
    OR
  • close contact† with a symptomatic person who has laboratory evidence of SARS-CoV infection within 10 days of onset of symptoms
    OR
  • residence in, or recent travel or visit to an "area with recent local transmission of SARS" within the 10 days prior to onset of symptoms
    OR
  • close contact (including health care providers) with a probable case who has been to an "area with recent local transmission of SARS"" within the 10 days prior to onset of symptoms
    OR

A deceased person with:

• a history of early clinical presentation of SARS
  AND
• autopsy findings consistent with SARS
  AND
• epidemiologic link to a person or place linked to SARS
  OR

A deceased person with:

• a history of early clinical presentation of SARS
  AND
• laboratory evidence* of SARS coronavirus infection

4.0 Laboratory Comments

Laboratory confirmation should involve the following:

• detection of SARS-CoV RNA in appropriate samples (with the caveat of confirmation by NML or a designated laboratory)
  OR
• serologic detection of SARS-CoV in a convalescent sample taken > 28 days after onset of illness
  OR
• seroconversion between acute and convalescent blood samples collected at least 4 weeks apart

5.0 Clinical Evidence

6.0 ICD Code(s)

6.1 ICD-10 Code(s)

U04

Severe acute respiratory syndrome [ SARS]

U04.9

Severe acute respiratory syndrome, unspecified

6.2 ICD-9/ICD-9CM Code(s)

7.0 Type of International Reporting

Notification of any case of SARS is required under the International Health Regulations (2005).

8.0 Comments

During an outbreak period, persons without x-ray changes (i.e. those who are not severely ill) may have laboratory evidence of SARS-CoV infection if tested as part of an outbreak. These individuals will be considered as "confirmed SARS-CoV infections", while not meeting the clinical criteria for confirmed cases of "Severe Acute Respiratory Syndrome (SARS)".

9.0 References

10.0 Previous Case Definitions

Public Health Agency of Canada. 2003. National Case Defi nitions for the SARS Outbreak Period. Retrieved May 29, 2007, from http://www.phac-aspc.gc.ca/sars-sras/sarscasedef_e.html .

Date of Last Revision/Review:

May 2008

†Close contact means having cared for, lived with or had face-to-face (within 1 metre) contact with, or having had direct contact with respiratory secretions and/or body fluids of, a person with SARS.

* Laboratory results must be verified by a provincial public health laboratory and/or the National Microbiology Laboratory.