Preparing to prevent severe acute respiratory syndrome and other respiratory infections

Abstract

Globalisation and its effect on human development has rendered an environment that is conducive for the rapid international spread of severe acute respiratory syndrome (SARS), and other new infectious diseases yet to emerge. After the unprecedented multi-country outbreak of avian influenza with human cases in the winter of 2003-2004, an influenza pandemic is a current threat. A critical review of problems and solutions encountered during the 2003-2004 SARS epidemics will serve as the basis for considering national preparedness steps that can be taken to facilitate the early detection of avian influenza, and a rapid response to an influenza pandemic should it occur.

Figure 1

Map of China and Taiwan with stars representing cities from where the 80 imported SARS cases (30 probable and 50 suspected) in Taiwan originated during the initial phase of importation; nearly all cases travelled via Hong Kong.

Figure 2

A typical infrared body-temperature screening device used in airports and at the entrance of office buildings in Taipei. Passengers walk through at a usual pace. The faces of passengers whose body temperatures are higher than 38°C show up as a red image on the screen.

Figure 3

According to the timing of a patient's infectivity in relation to the timing of symptoms onset, infectious diseases are broadly divided into two categories: (A) depicts infections, such as SARS and smallpox, where patients develop apparent symptoms before the infectivity begins, and (B) depicts infections, such as chickenpox, measles, and possibly influenza, where patients are infectious before they develop apparent symptoms. Quarantine and isolation are far more effective in category A than category B.

Figure 4

Algorithm to triage fever patients during a period when there are no known SARS transmissions occurring in the world. Elderly patients with other co-morbidity factors should seek health care early. †All those otherwise healthy individuals with fever should take antipyretics, stay home, and monitor their fever for 2 days before attending a physician.

Figure 5

Non-hospital acquired SARS patients by time of isolation after onset of fever, and the rate of their secondary transmission to social and household contacts.