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Volume 10, Number 2—February 2004
THEME ISSUE
2004 SARS Edition

Clinical Study

Combining Clinical and Epidemiologic Features for Early Recognition of SARS

John A. Jernigan*Comments to Author , Donald E. Low†, and Rita F. Helfand*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †University of Toronto, Ontario, Canada

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Table 2

Combination of clinical and epidemiologic factors that raise suspicion for SARS among patients with community-acquired illnessa

Level of worldwide SARS activity Clinical features Epidemiologic features
No documented SARS activity

Patients with severe pneumonia of unknown cause
Recent exposure to other persons with unexplained pneumonia
Recent travel to previously SARS-affected area or close contact with ill persons with a history of travel to such areasb
Healthcare workerc
SARS activity documented

All patients with fever, especially accompanied by headache, myalgias, rigor
Any patient with lower respiratory tract symptoms
Close contact with a person with known or suspected SARS
Exposure to any place in which active transmission of SARS is documented or suspected
Patients with severe pneumonia of unknown cause Close contact with a person with known or suspected SARS
Exposure to any place in which active transmission of SARS is documented or suspected
If none of the above:
Recent exposure to other persons with unexplained pneumonia
Recent travel to previously SARS-affected area or close contact with ill persons with a history of travel to such areas
Healthcare worker

aThe possibility of severe acute respiratory syndrome (SARS) should be considered for any patient with both the clinical and epidemiologic features described, depending upon the level of worldwide SARS activity. Final decisions on the need for SARS isolation precautions or testing for SARS-associated coronavirus infection should be made in conjunction with local health authorities. Examples of epidemiologic factors that may raise a higher index of suspicion for SARS, even in the absence of known SARS activity, include clusters of pneumonia among healthcare workers, or exposure to persons with pneumonia while traveling in a previously SARS-affected area.
bPreviously SARS-affected areas include areas in Southeast Asia in which SARS may originate and neighboring areas that may be at risk for early spread because of importations, including China, Hong Kong, and Taiwan.
cHealthcare worker defined as one who has direct patient care responsibilities.

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