Original PDF Flash format guideline-on-management-of-severe-acute-respiratory-syndrome-(sars)  


Guideline On Management Of Severe Acute Respiratory Syndrome (sars)

COMMENTARY
Guideline on management of severe acute respiratory syndrome (SARS)
Published online April 8, 2003
http://image.thelancet.com/extras/03cmt89web.pdf
Severe acute respiratory syndrome (SARS) has recently
and the Department of Health are working
been recognised as a newly emerging infectious disease
collaboratively with the two universities (the Chinese
that is highly contagious with significant morbidity and
University of Hong Kong and the University of Hong
mortality. The first index case in Hong Kong was
Kong) and with international agencies to identify the
admitted on Feb 22, 2003. As of April 6, 842 cases have
aetiological agent(s).
been identified in Hong Kong, with fatal complications in
For details of management plans for patients in the
22 patients. The outbreak has prompted the Hospital
guidelines, see: http://www.ha.org.hk
Authority of Hong Kong and the Department of Health
The Hong Kong Hospital Authority Working Group on SARS and
to implement a series of public-health measures and
Central Committee on Infection Control contributed to the guidelines.
hospital policies for the diagnosis and management of
Members include physicians, microbiologists, and scientists from the
patients with SARS.
Hospital Authority, Department of Health, the Chinese University of
Hong Kong, and the University of Hong Kong.
The figures are summaries of the management
flowchart in the accident and emergency department for
The Working Group members include: Paul Chan, Y C Chan,
patients with a history of definite contact with SARS
C M Chu, David Hui, K Y Lai, S T Lai, Allan Lau, C C Lau, Y L Lau,
P W Lee, C W Leung, A C H Lit, S F Lui, Y W Mok, J S M Peiris,
patients within the past 10 days (figure 1) and for
W H Seto, Joseph J Y Sung, H K Tong, Ken Tsang, N C Tsang,
patients with no such definite contact (figure 2).
Loretta Yam, W W Yan, Wilson Yee, W C Yu, and Raymond Yung.
The Hong Kong Hospital Authority SARS Command
The Central Committee on Infection Control members include:
Centre has been established to coordinate clinical
Paul Chan, Y C Chan, Patricia Ching, David Hui, Melissa Ho, S T Lai,
activities, including identification and reporting of cases,
W M Lai, Barbara Lam, Samuel Law, W K Luk, D J Lyon, Phyllis Mak,
implementation of infection-control measures, dissem-
T K Ng, J S M Peiris, T L Que, W H Seto, W K To, N C Tsang,
Clara Yip, and Raymond Yung.
ination of information to the public, development of
diagnostic tests, and assessment of treatment regimens in
William Ho
a cluster network of hospitals. Each hospital cluster has
Hospital Authority Building, Kowloon, Hong Kong, China
designated treatment centres. The Hospital Authority
(e-mail: webmaster@ha.org.hk)
THE LANCET • Published online April 8, 2003 • http://image.thelancet.com/extras/03cmt89web.pdf
1
For personal use. Only reproduce with permission from The Lancet Publishing Group.
COMMENTARY
Definite contact
Patient with definite close
contact within past 10 days
Fever (>38ºC) and/or
Cough or shortness of breath or other
compatible symptoms†
No
Yes
Asymptomatic
Symptomatic
Health advice on droplet precaution
Medical assessment and
Observe symptom
chest radiograph
Home charting of temperature (if feverish)
for 10 days
Consult Department of Health surveillance
clinic if symptoms develop
Inform Department of Health (if case has
Normal chest radiograph‡
New pulmonary infiltrate¶
not yet been reported)
(pre-admission complete blood
count may be considered)
Admit to ward:
Paediatric if <18 years
Medical if >18 years
Health advice on droplet precaution and
home charting of temperature
Check complete blood group for
lymphocyte count
Admit to designated ward if cell count
<0·9 109/L
Follow up daily if count 0·9–1·2 109/L
(repeat complete blood group, chest
radiograph)
Follow up 2 days later if count >1·2 109/L
(repeat complete blood count, chest
radiograph)
Sick leave till follow up
Treatment§
On follow-up, discharge if lymphocyte count
>1·5 109/L, chest radiograph normal and
with clinical improvement.
*Close contact: means persons having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of person with severe acute
respiratory syndrome. Social contact means persons who have had contact with person with SARS but do not fit definition of close contact. Therefore, close contacts
are mainly household contacts and those who care for the case. All co-workers and all visitors of cases in hospitals are social contacts only. Only if these social
contacts had direct contact with respiratory secretions and body fluids of case do they become close contact. All social contacts should be advised to attend
designated medical centres only when they have one of the three symptoms: fever, cough, and shortness of breath.
†In addition to fever and respiratory symptoms, SARS may be associated with other symptoms including: headache, muscular stiffness, loss of appetite, malaise,
confusion, rash, and diarrhoea.
‡Consider admission despite normal chest radiograph if two or more family members have already been admitted for suspected SARS.
§Standard therapy including
lactam (co-amoxiclav or cefuroxime) and coverage for atypical pneumonia such as macrolide (clarithromycin or azithromycin) or
fluoroquinolone (levofloxacin).
¶Samples of chest radiographs of SARS can be found at: http://www.droid.cuhk.edu.hk
Figure 1: Accident and emergency department management for person with definite contact* with person with severe acute
respiratory syndrome (SARS) within past 10 days
2
THE LANCET • Published online April 8, 2003 • http://image.thelancet.com/extras/03cmt89web.pdf
For personal use. Only reproduce with permission from The Lancet Publishing Group.
COMMENTARY
No definite contact
Patient with no definite close contact within
past 10 days
Fever (>38°C), and/or
Cough or shortness of breath or other
compatible symptoms†
No
Yes
Asymptomatic
Clinical features suggestive
of pneumonia
Reassurance
Health advice on droplet
Chest radiograph
precaution
Health advice on droplet
Normal chest radiograph
New pulmonary
precaution and home charting
infiltrate‡
of temperature
Treatment accordingly
Advise to seek medical
reassessment if no clinical
Clinical features compatible with SARS (pre-admission complete blood count may
improvement in 2 days
be considered)
No
Yes
Yes
Admit to medical ward
Admit to designated
Admit to designated
ward if overall clinical
medical centre if overall
picture suspicious of
clinical picture highly
SARS
suspicious of SARS
*Close contact: means persons having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of person with severe acute
respiratory syndrome. Social contact means persons who have had contact with person with SARS but do not fit definition of close contact. Therefore, close contacts
are mainly household contacts, and those who care for the case. All co-workers and all visitors of cases in hospitals are social contacts only. Only if these social
contacts had direct contact with respiratory secretions and body fluids of case do they become close contact. All social contacts should be advised to attend
designated medical centres only when they have one of the three symptoms: fever, cough, and shortness of breath.
†In addition to fever and respiratory symptoms, SARS may be associated with other symptoms including: headache, muscular stiffness, loss of appetite, malaise,
confusion, rash, and diarrhoea.
‡Samples of chest radiographs of SARS can be found at: http://www.droid.cuhk.edu.hk
Figure 2: Accident and emergency department management for person with no definite contact* with person with severe acute
respiratory syndrome (SARS)
THE LANCET • Published online April 8, 2003 • http://image.thelancet.com/extras/03cmt89web.pdf
3
For personal use. Only reproduce with permission from The Lancet Publishing Group.