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ful follow-up, including daily health checks and possible voluntary home isolation.

Together, these activities limit the daily number of contacts possible for each potentially infectious case. They also work to shorten the amount of time that lapses between the onset of illness and isolation of the patient, thus reducing the opportunities for the virus to spread to other patients (WHO WER 20/2003).

International Coordination

The World Health Organization (WHO) played a vital role in the containment of the first global outbreak of SARS.

After issuing a global alert about cases of severe atypical pneumonia following reports of cases among staff in the Hanoi and Hong Kong hospitals on March 12, the WHO received additional reports of more cases. Three days later, the WHO issued emergency travel recommendations to alert health authorities, physicians, and the traveling public to what was now perceived to be a worldwide threat to health. The alert included the first WHO emergency travel advisory to international travelers, healthcare professionals and health authorities, advising all individuals traveling to affected areas to be watchful for the development of symptoms for a period of 10 days after returning (http://www.who.int/csr/sarsarchive/2003_03_15/en/).

The decision was based on five different but related factors (WHO, Status of the Outbreak):

1.The causative agent, and therefore the potential for continued spread, of this new disease were not yet known.

2.The outbreaks appeared to pose a great risk to health workers who managed patients, and to the family members and other close contacts of patients.

3.Many different antibiotics and antiviral therapies had been tried empirically and did not seem to have an effect.

4.Though the numbers were initially small, a significant percentage of patients (25 of 26 hospital staff in Hanoi, and 24 of 39 hospital staff in Hong Kong) had rapidly progressed to respiratory failure,

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requiring intensive care and causing some deaths in previously healthy persons.

5.The disease had moved out of its initial focus in Asia and appeared to have spread to North America and Europe.

Within less than two weeks, a collaborative network of laboratories set up by the WHO identified a novel coronavirus as the probable etiologic agent of SARS (see Chapter 2: Virology).

Early in April, travel advisories became more specific. On April 2, the WHO recommended that persons traveling to Hong Kong and the Guangdong Province of China consider postponing all but essential travel. (http://www.who.int/csr/sarsarchive/2003_04_02/en/). On April 23, the WHO extended its travel advice to Beijing and the Shanxi Province in China and to Toronto, Canada, http://www.who.int/csr/sarsarchive/2003_04_23/en/, and on May 8 to Tianjin, Inner Mongolia, and Taipei in Taiwan (WHO Update 50).

The global alert and the global effort coordinated by the WHO achieved its purpose. All countries with imported cases, with the exception of provinces in China, were able through

1.prompt detection of cases

2.immediate isolation, strict infection control, and

3.vigorous contact tracing

to either prevent further transmission or to keep the number of additional cases very low. The early management of the SARS epidemic may well serve as a model for the containment of future epidemics and pandemics.

At the beginning of July, all travel restrictions were lifted (WHO Update 96).

Advice to travelers

The most important message for international travelers concerning SARS is to be aware of the main symptoms of SARS: high fever (> 38° C or 100.4° F), dry cough, shortness of breath or breathing difficulties. Persons who experience these symptoms and who have been

Kamps and Hoffmann (eds.)