Background

On February 21 of 2003, a nephrologist in Canton had the symptom of respiration infection and died of respiratory failure. Shortly after that, his family, medical personnel who took care of him and a few tourists who lived on the same floor in the hotel all appeared to have the same symptoms.

On February 26 of the same year, an American businessman in Vietnam was hospitalized because of fever, dry cough, muscle ache, sore throat and acute respiratory distress syndrome. Four days later, he died after his condition deteriorating and many of the medical personnel that took care of him has gotten the same symptoms.

Subsequently, Canada and other countries had reported similar cases to World Health Organization. WHO had named this disease as Severe Acute Respiratory Syndrome, also known as SARS.

While many countries around the globe had notified WHO of this disease successively, The Center for Disease Control of Taiwan had kept alert to this situation, monitored the possibility of SARS epidemic and tried to prevent SARS epidemic to Taiwan.

Unfortunately, Taiwan could not be rid of SARS invasion. On March 10, 2003, the first case of SARS had appeared on a tourist traveled from China. Subsequently, other cases from abroad had caused the second dissemination in Taiwan. It had become a difficult fight to control SARS after the cluster infectious incident in Taipei Municipal Hoping Hospital in April. There were 346 SARS CoV(+) cases during the period of March to June, 2003 in Taiwan.

World Health Organization (WHO) announced travel advisory for Taiwan on May 8 and included Taiwan in the list of travel advisory on May 21. On June 17, Taiwan was removed from WHO’s list of travel advisory. On July 5, WHO lifted Taiwan from the list of areas with recent local transmission of SARS.

Epidemiology

There were 664 SARS probable cases during the period of March to June, 2003 in Taiwan.

According to the newest SARS definition of WHO, CDC of Taiwan reclassified the SARS probable cases by the results of PCR and serological testing in order to verify the prevalence of SARS in Taiwan.

After reclassification, 346 were either SARS PCR positive or antibody positive, so called SARS CoV(+) cases. Among 346 SARS CoV(+) cases, 73 (21%) were deceased, including 37 (10.7%) were directly due to SARS and 36 were SARS related diseases.

 On December 16, 2003, Tri-Service General Hospital had notified a SARS infection case. It was caused by misconduct in the laboratory after investigation. The patient had left the hospital after treatment on December 30.

SARS Surveillance in Taiwan

Taiwan National Infectious Disease Statistics System

Prevention and Control

1.  Quarantine
   • (1)Establishing monitoring stations at harbors and airports.
   • (2) Between July 1, 2003 and March 25, 2004, a total of 2,250,835 incoming travelers filled out SARS forms and underwent temperature checks, while 2,585,983 outgoing travelers underwent temperature checks.
2.  Community Surveillance.In order to prevent the possibility of a contagious outbreak within mass-populated community institutions and to implement control measures as early as possible, monitoring operations began in these institutions in May 2003.
3. Nosocomial Infection Control
   • (1)In-patient and fever monitoring systems were put in place to track the latest conditions of patients staying in hospitals.
   • (2)A total of 330,000 individuals across 554 hospitals were examined. All patients tested negative for SARS, while seven tested positive for the flu.
4. Infection Prevention Network.The CDC has coordinated with its northern, central, southern and eastern branch offices to form infection command centers throughout the island. Each center is led by a commander and a deputy commander, who monitor the operations of the center during an outbreak.
5.  Hospital Assessment
   • (1) Health authorities visited several medical facilities above the municipality level from September to October 2003, evaluating them on 10 major criteria.
   • (2) Meanwhile, health authorities published a "personal guide to SARS prevention" handbook and completed "guidelines on the control of the bird flu”.
6. Bio-safety in Laboratories.Evaluations and assessments of island-wide BSL-3 laboratories have been conducted to ensure quality control of Biological Class-3 research facilities, in response to a SARS case reported at a research facility.
7. Body temperature monitoring
   • Schools and other organizations asked students and staff to have their temperatures taken upon entering facilities.
   • Hospitals also set up en masse temperature-taking areas to prevent diseases from spreading.

FAQs

1. How are SARS transmitted?
   • Large respiratory droplets and direct or indirect contact with bodily fluids are the most important routes of transmission from infected patients to other people.
2. What are the common symptoms of SARS?
   • High fever (>38°C) is an almost invariable early feature among reported cases. The other main symptoms of SARS are cough, malaise, myalgia, difficulty in breathing or shortness of breath.It should be severe enough to hospitalization and chest X-ray changes show pneumonia or respiratory distress syndrome.
3. What is the incubation period of SARS?
   • The incubation period is believed to be short, from two to seven days (maximum ten days).
4.  How to control SARS?
   • (1)   Surveillance: case detection and reporting.
   • (2)   Case management: infection control, isolation, treatment and follow up.
   • (3)   Management of contacts.
   • (4)   Education.
   • (5)   Travel advice.
   • (6)   Laboratory diagnosis.
   • (7)   International collaborations.
   • (8)   Research and development.

More Information

1. WHO－Severe Acute Respiratory Syndrome
2. USA CDC－Severe Acute Respiratory Syndrome