Report Immediately by Phone
Also known as: SARS
Hospital: Immediately by phone
Infection Preventionist: Interview patient for risk factors
Lab: Report immediately by phone. Specimens should be sent to the State Hygienic Laboratory (SHL)
Physician: Report immediately by phone
Local Public Health Agency (LPHA): Immediate follow-up required
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
SARS is caused by a member of the family coronaviridae, called SARS–associated coronavirus (SARS-CoV). The disease was first reported in Asia in 2003.
B. Clinical Description
Symptoms: SARS begins with a flu-like syndrome characterized by fever (>100.4o F), fatigue, headache, chills, myalgia, malaise, anorexia and, in some cases, diarrhea.
Onset of SARS occurs 3-10 days after infection with acute onset of fever. Dry cough and respiratory symptoms may begin 2 –7 days later.
Complications: Most patients develop pneumonia.
Cave-dwelling bats in the genus Rhinolophus (Chinese horseshoe bats) are a reservoir of SARS-like coronaviruses closely related to those responsible for the SARS epidemic.
D. Modes of Transmission
Person-to-person: The virus that causes SARS is thought to be transmitted most readily by respiratory droplets produced when an infected person coughs or sneezes.
Fomite: The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eyes.
Airborne: It is possibly spread more broadly through the air or by other ways that are not currently known.
E. Incubation Period
The incubation period for SARS is typically 3 –10 days, although in some cases it may be as long as 10 days. In a very small proportion of cases, incubation periods of up to 14 days have been reported.
F. Period of Communicability or Infectious Period
Persons with SARS are most likely to be contagious only when they have symptoms, such as fever or cough. Patients are most contagious during the second week of illness. Maximum period of communicability is less than 21 days.
SARS is a viral respiratory illness recognized as a global threat in March 2003, after first appearing in Southern China in November 2002. During November 2002 through July 2003, 8,098 people worldwide became sick with SARS. Of these, 774 died. In the U.S., eight cases of SARS were laboratory-confirmed during the 2003 outbreak. The cases all had either a history of travel to countries where SARS was occurring or close contact to a confirmed case.
H. Bioterrorism Potential
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for SARS can be found at:
CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
MMWR December 12, 2003/52 (49) 1202-1206, Revised U.S. Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS) and Update on SARS Cases ---United States and Worldwide, December 2003
Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.
CDC SARS web site, www.cdc.gov/ncidod/sars/index.htm
WHO SARS web site, www.who.int/csr/sars/en/