Supplement B: Surveillance

Footnote *

This version of Supplement B includes the revised U.S. SARS surveillance case definition and an updated domestic case reporting form. The revised surveillance case definition reflects changes in the interim position statement on SARS surveillance adopted by the Council of State and Territorial Epidemiologists (CSTE) in November 2003.

The current version of Supplement B clarifies and revises questions to be used by healthcare providers to screen persons requiring hospitalization for radiographically confirmed pneumonia. The screening question related to travel now includes specific geographic locations that are likely sites for a reappearance of SARS-CoV. Employment in a laboratory that contains live SARS-CoV has been added as an epidemiologic risk factor for SARS-CoV exposure.

The revised Supplement clarifies that, in the absence of SARS-CoV transmission in the world, children hospitalized for radiographically confirmed pneumonia need not be screened for potential SARS-CoV disease, unless circumstances suggest that a child might be at high risk for exposure to SARS-CoV.

The recommendations for surveillance in healthcare settings have been revised for consistency with the recommendations in Supplement C.  The guidance clarifies that, in a setting of ongoing SARS-CoV transmission in a facility or community, the presence of either fever or lower respiratory symptoms should prompt further evaluation.   In addition, in accordance with the new SARS case definition, when persons have a high risk of exposure to SARS-CoV (e.g., persons previously identified through contact tracing or self-identified as close contacts of a laboratory-confirmed case of SARS-CoV disease; persons who are epidemiologically linked to a laboratory-confirmed case of SARS-CoV disease), the clinical screening criteria should be expanded to include, in addition to fever or lower respiratory symptoms, the presence of any early symptoms of SARS-CoV disease.

The current version provides some guidance for prioritization of contacts for monitoring if health department resources become overburdened during an ongoing outbreak. General reporting requirements have also been clarified.