Severe Acute Respiratory

Syndrome
DADAM REVATHI REDDY ,

ASST .PROFESSOR ,

DEPT .OF OBG ,

NARAYANA COLLEGE OF NURSING

 SARS and Caro Urbani
 Carlo Urbani (Castelplanio, Italy
October 19, 1956 –
Bangkok, Thailand March
29, 2003) was an Italian physician
and the first to identify severe
acute respiratory syndrome
(SARS) as a new and
dangerously contagious disease.
Although he became infected and
died, his early warning to the
World Health Organization
(WHO) touched off a massive
response that probably helped
save the lives of millions of
people around the world.
2
 Severe acute respiratory
Syndrome

 Severe acute respiratory syndrome (SARS) is a

respiratory disease in humans which is caused by the
SARS coronavirus Between November 2002 and
July 2003 an outbreak of SARS in Hong Kong nearly
became a pandemic, with 8,422 cases and 916
deaths worldwide (10.9% fatality) according to the
WHO. Within weeks SARS spread from Hong Kong to
infect individuals in 37 countries in early 2003.
3
 SARS belongs to Corona virus
 Coronaviruses are
positive-
strand, enveloped RNA
viruses that are
important pathogens of
mammals and birds.
This group of viruses
cause enteric or
respiratory tract
infections in a variety of
animals including
4 huDrmV.T.aR. noasM,D livestock
SARS - Coronavirus
 SARS coronavirus is a
positive and single
stranded RNA virus
belonging to a family of
enveloped coronaviruses.
Its genome is about
29.7kb, which is one of the
largest among RNA
viruses. SARS is similar to
other coronaviruses in that
its genome expression
starts with translation of
two large ORFs 1a and
1b, which are two
polyproteins.
 SARS belong to Corona Virus

 SARS (Severe Acute Respiratory Syndrome) is a viral disease

caused by a virus of Corona respiratory viruses affecting mostly
respiratory organs which is characterized by a fever (more than
38°C), cough, shortage of breath and underlying atypical pneumo
(inflammation of the lungs). This is a disease which spreads ve
easily and affecting many people worldwide (over 5,000 people
worldwide).
When to suspect SARS
 SARS may be suspected in a patient who has:
 Any of the symptoms, including a fever of 38 °C
(100.4 °F) or higher, and
 Either a history of:
 Contact (sexual or casual) with someone with a
diagnosis of SARS within the last 10 days OR
 Travel to any of the regions identified by the WHO
as areas with recent local transmission of SARS
(affected regions as of 10 May 2003[13] were parts
of China, Hong Kong, Singapore and the province
of Ontario, Canada).
 CDC guidelines for Confirmatory
testing

Positive RT-PCR test results should be

confirmed in a reference laboratory.
Confirmatory testing is particularly
important in areas with a low prevalence of
SARS-CoV disease, where the positive
predictive value of the assay is likely to be
quite low. CDC will conduct confirmatory
testing during the early phases of an
outbreak.
 Symptoms & Signs

• Usually begins with a sudden onset of a high fever

o Greater than 100.4 degrees
• Headache, overall discomfort, body/muscle aches, chills,
shivering, sore throat, runny nose
• 10%-20% of patients get diarrhea
• Dry cough, breathing difficulties (after 2-7 days)
o Oxygen levels in the blood are low
• Most patients will develop pneumonia (3-4 days)
• Traveled recently to a SARS-affected area
• Been in close contact with someone diagnosed with
SARS
• May not be infectious until symptoms begin to appear
o Usually 2-7 days, can be up to 10 days
 Incubation Period
 Symptoms and Signs Continued...

• Acute
o Sudden onset of a high fever
• Can be lethal for severe cases
o 11% average death rate in the most severe cases
• Not lethal for mildly affected people
o With time, relief of symptoms, and no complications
• Difficult to make an accurate prognosis because there is no
cure
o Based on statistics of SARS patients with similar
symptoms and conditions
 Pathogen

• Infectious Agent = Severe Acute Respiratory Virus

o Newly discovered coronavirus
 Coronavirus = group of viruses that have a halo/crown-like
appearance
 Caused by mild to moderate upper respiratory illness in
humans or respiratory, gastrointestinal, liver, and neurologic
diseases in animals
 Sometimes linked to pneumonia
 especially in weak immune systems
Can usually survive in an environment for a couple of days
• Other viruses may have a role in some cases of SARS as well
 Pathogenesis

• Transmitted through:
o Close contact with an infected person
oContaminated air and surfaces
• Virus infected respiratory system
o Causes all the respiratory
symptoms
 Diagnosis

• Doctor will ask questions (travels), perform a physical exam and

tests
o PCR test
 Polymerase Chain Reaction Test - an essential test that
detects the genetic material of the SARS virus in specimens
of a patient's blood, stool, or nasal secretions
o Serologic Testing
 Laboratory test that searches for antibodies (substances
made by the body's immune system to fight a specific
infection) to the SARS virus in the patient's blood
o Viral Culture
 A small sample of the patient's tissue or fluid that may be
infected is placed in a container along with cells in which the
SARS virus can grow and if the SARS virus grows in the
culture, it will cause changes in the cells that can be seen
under a microscope
 Transmission

• Close person to person contact

o Coughs
o Sneezes
• If a person touches a contaminated surface and then
touches their eyes mouth or nose
 Epidemiology

• Began in Guangdong, China in 2002

• Fairly well contained once it spread around the globe
• Only one outbreak so far
• Spread from China to North America, South America,
Europe and other parts of Asia
o Major outbreak in Toronto, Canada
• Airplanes and business men
 Management of SARS
 Antibiotics are ineffective as SARS is a viral disease.
Treatment of SARS so far has been largely
supportive with antipyretics, supplemental oxygen
and ventilatory support as needed.
 Suspected cases of SARS must be
isolated, preferably in negative pressure rooms, with
complete barrier nursing precautions taken for any
necessary contact with these patients.
 There was initially anecdotal support for steroids and
the antiviral drug ribavirin, but no published evidence
has supported this therapy
 Treatment

• No uniform treatment for SARS-CoV

• Can easily be confused with other lung related illnesses so
patients are usually given:
o Broadspectrum antibiotics
o Antiviral agents
o Immunomodulatory therapy
o Supportive care
• Requires intensive care and observation
 Prevention

• Quarantine and Isolation

• Good hand hygene
• Pay attention to what surfaces you touch
• Infected must remember to effectively cover their mouths
when they sneeze or cough
• Surgical masks
• Gloves
 Isolation and Quarantine the best
options
 SARS needs to be
regarded as a
particularly serious
threat for several
reasons. The disease
has no vaccine and no
treatment, forcing health
authorities to resort to
control tools dating back
to the earliest days of
empirical microbiology:
isolation and quarantine
 Protect Healthcare Personnel During
Aerosol-Generating Procedures

 Limit personnel to those essential for

performing procedure
 Wear appropriate personal protective
equipment
Gowns and gloves
Sealed eye protection (i.e.,
goggles)
Respiratory protection device
 Citations

• http://diseases.emedtv.com/sars/sars-prognosis.html
• http://www.cdc.gov/ncidod/SARS/factsheet.htm
• http://www.cdc.gov/ncidod/sars/
• http://www.aseansec.org/sars_symptoms.htm
• http://www.sarsreference.com/sarsref
• www.absa.org/pdf/090911DHHS_SARS
_Select_Agent_Co mments.pdf
•