Severe Acute Respiratory Syndrome in the People's Republic of China including the Hong Kong Special Administrative Region; Singapore and Taiwan

April 29, 2003

At this time, Health Canada is monitoring recent confirmed reports of outbreaks of severe acute respiratory syndrome (SARS) in the People's Republic of China including the Hong Kong Special Administrative Region; Singapore and Taiwan, and the occurrence of isolated cases in other countries. Health Canada's recommendations for travellers are based on the best available information at this time and are subject to change as more information becomes available.

As of April 29, 2003, the World Health Organization (WHO) reports:

Australia - 4 cases, Brazil - 2 cases, Bulgaria - 1 case, France - 5 cases, Germany - 7 cases, Hong Kong Special Administrative Region of the People's Republic of China - 1572 cases (150 deaths), India - 1 case, Indonesia - 1 case, Italy - 9 cases, Japan - 2 cases, Kuwait - 1 case, Malaysia - 6 cases (2 deaths), Mongolia - 5 cases, People's Republic of China - 3303 cases (148 deaths), Philippines - 4 cases (2 deaths), Republic of Ireland - 1 case, Romania - 1 case, Singapore - 201 cases (24 deaths), South Africa - 1 case, Spain - 1 case, Sweden - 3 cases, Switzerland - 1 case, Taiwan - 66 cases, Thailand - 7 cases (2 deaths), UK - 6 cases, USA - 41 cases, and Vietnam - 63 cases (5 deaths).

Source: World Health Organization

As of 29 April 2003, Health Canada has received reports of approximately 346 cases of SARS (148 probable and 198 suspect cases) in Canada. Twenty-one deaths have occurred due to SARS in Canada. To date, transmission has been limited to specific transmission settings such as households, hospitals and specific community settings.

• Ontario: 144 probable and 118 suspect cases

• British Columbia: 4 probable and 67 suspect cases

• New Brunswick: 2 suspect cases

• Saskatchewan : 1 suspect case

• Alberta: 6 suspect cases

• Prince Edward Island: 4 suspect cases

A "suspect" case of SARS is a person who fits into one of the following two categories: a person who develops fever and one or more respiratory symptoms, including cough, shortness of breath or difficulty breathing, within 10 days of returning from travel to areas in Asia where SARS cases are being reported, or a person who develops fever and one or more respiratory symptoms, including cough, shortness of breath or difficulty, breathing, within 10 days of having had close contact with a "probable " case of SARS (i.e. within one meter).

A "probable" case of SARS is similar to a suspect case, but often the case has a more severe illness, with progressive shortness of breath and difficulty breathing, and in some cases, chest x-rays shows signs of atypical pneumonia.
[The above descriptions of a probable and suspect case are provided for communication purposes and not for scientific purposes]

At this time, the cause of the illness remains unknown, however national and international laboratory testing and collaboration are ongoing.

Recommendations

Due to the continued concern about transmission of the SARS agent in non-hospital and community settings in the People's Republic of China and Taiwan, Health Canada continues to recommend that Canadians planning to travel to these areas should defer all travel until further notice. As well, Health Canada recommends alternate routing be considered, when possible, if a traveller is transiting through the People's Republic of China or Taiwan.

Based on the current evidence that the SARS situation has peaked and is confined to certain well defined areas in both Hong Kong Special Administrative Region and Singapore, Health Canada recommends that Canadians defer all elective or non-essential travel to the Hong Kong Special Administrative Region and Singapore.

Health Canada is aware that health authorities in these affected areas are making concerted efforts to contain the spread of SARS in their populations. Given the uncertainties of the current situation, Health Canada believes it is prudent to await the outcome of national and international control measures before undertaking travel to these destinations.

Health Canada does not recommend any restriction on travel to the City of Hanoi, Vietnam based on the reporting from Vietnam that there have been no SARS cases since April 8 (greater than two incubation periods).

Travellers are advised that they will have to depend upon the local medical services in the countries where they reside or visit and are reminded that the health care services may be inadequate for the appropriate management of SARS. In addition, medical evacuation of a patient with SARS may be very difficult. Canadian Missions may not be able to assist Canadians with SARS with medical transportation out of the region or back to Canada.

Persons who are travelling or have travelled to these areas should monitor their health for 10 days following their departure from these areas. Should a fever AND one or more of the following respiratory symptoms occur - cough, shortness of breath or difficulty breathing - Health Canada recommends that medical advice be sought as soon as possible. Ill persons should call ahead to their personal physician or local public health unit/department for information about the appropriate Emergency Department or established SARS Centre they should visit for assessment. Travellers should inform their personal physician when and where they travelled, and indicate whether there was contact with someone who had these symptoms. While not all travellers with these symptoms have developed SARS, it is nevertheless important to ensure that if you do get these symptoms, you stay away from other people until you have been assessed for SARS. These actions are very important for stopping the spread of SARS.

Independent of the current international SARS outbreak, Health Canada routinely recommends that Canadian travellers seek an individual risk assessment consultation with their personal physician or a travel medicine clinic to determine their individual risks for illness.

Canadian travellers are reminded to practice good personal hygiene (e.g., good hand-washing practices) while travelling. Disease-causing micro-organisms can frequently be found on the hands. Hand-washing is the single most important procedure for preventing infections.

Canadian travellers are advised to continually monitor the latest Health Canada's travel advisories.