Salmonelózy

SEVERE ACUTE RESPIRATORY SYNDROME – SARS
(SARS-coronavirus, SARS-CoV)

Clinical Criteria
Any person with fever or a history of fever
AND
At least one of the following three:
– Cough
– Difficulty in breathing
– Shortness of breath
AND
At least one of the following four:
– Radiographic evidence of pneumonia
– Radiographic evidence of acute respiratory distress syndrome
– Autopsy findings of pneumonia
– Autopsy findings of acute respiratory distress syndrome
AND
No alternative diagnosis which can fully explain the illness

Laboratory Criteria
– Laboratory criteria for case confirmation
At least one of the following three:
– Isolation of virus in cell culture from any clinical specimen and identification of SARSCoV
using method such as RT-PCR
– Detection SARS-CoV nucleic acid in at least one of the following three:

– At least two different clinical specimens (e.g. nasopharyngeal swab and stool)
– The same clinical specimen collected on two or more occasions during the course
of the illness (e.g. sequential nasopharyngeal aspirates)
– Two different assays or repeat RT-PCR using a new RNA extract from the
original clinical sample on each occasion of testing

– SARS-CoV specific antibody response by one of the following two:

– Seroconversion by ELISA or IFA in acute and convalescent phase serum tested in
parallel
– Fourfold or greater rise in antibody titre between acute and convalescent phase
sera tested in parallel

Laboratory criteria for a probable case
At least one of the following two:
– A single positive antibody test for SARS-CoV
– A positive PCR result for SARS-CoV on a single clinical specimen and assay

Epidemiological Criteria
At least one of the following three:
– Any person with at least one of the following three:

– Employed in an occupation associated with an increased risk of SARS-CoV
exposure (e.g. staff in a laboratory working with live SARS-CoV/SARS-CoV-like
viruses or storing clinical specimens infected with SARS-CoV; persons with
exposure to wildlife or other animals considered a reservoir of SARS-CoV, their
excretions or secretions, etc.)
– Close contact¹⁷ of one or more persons with confirmed SARS or under
investigation for SARS
– History of travel to, or residence in, an area experiencing an outbreak of SARS

– Two or more health-care workers¹⁸ with clinical evidence of SARS in the same health-care
unit and with onset of illness in the same 10-day period
– Three or more persons (health-care workers and/or patients and/or visitors) with clinical
evidence of SARS with onset of illness in the same 10-day period and epidemiologically
linked to a healthcare facility

Case Classification for the inter-epidemic period
Also applies during an outbreak in a non-affected country or area
A. Possible case
Any person meeting the clinical criteria and with an epidemiological link
B. Probable case
Any person meeting the clinical criteria AND with an epidemiological link AND meeting the
laboratory criteria for a probable case
C. Nationally confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the
testing has been performed at a national reference laboratory
D. Confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the
testing has been performed at a WHO SARS verification and reference laboratory

Case Classification during an outbreak
Applies during an outbreak in a country/area where at least one person has been laboratory
confirmed by a WHO SARS verification and reference laboratory
A. Possible case
Any person meeting the clinical criteria
B. Probable case
Any person meeting the clinical criteria and with an epidemiological link to a nationally
confirmed or a confirmed case
C. Nationally confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the
testing has been performed at a national reference laboratory
D. Confirmed case
One of the following three:
– Any person meeting the clinical and the laboratory criteria for case confirmation where the
testing has been performed at a WHO SARS verification and reference laboratory
– Any nationally confirmed case with an epidemiological link to a chain of transmission
where at least one case has been independently verified by a WHO SARS Reference and
Verification Laboratory
– Any person meeting the clinical criteria and with laboratory criteria for probable case with
an epidemiological link to a chain of transmission where at least one case has been
independently verified by a WHO SARS Reference and Verification Laboratory

¹⁷ A close contact is a person who has cared for, lived with, or having had direct contact with the
respiratory secretions, body fluids and/or excretions (e.g. faeces) of cases of SARS.
¹⁸ In this context the term “health-care worker” includes all hospital staff. The definition of the health care
unit in which the cluster occurs will depend on the local situation. Unit size may range from an entire
health care facility if small, to a single department or ward of a large tertiary hospital.