Severe Acute Respiratory Syndrome in the City of Hanoi, Vietnam; Hong Kong Special Administrative Region; and Singapore

March 19, 2003

At this time, Health Canada is monitoring recent confirmed reports of outbreaks of severe acute respiratory syndrome (SARS) in the City of Hanoi, Vietnam; Hong Kong Special Administrative Region; and Singapore, 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 March 18, 2003, the World Health Organization (WHO) reports the following:

• In Hanoi, Vietnam, 57 cases have been reported. Thirteen of the 57 cases are showing signs of clinical improvement.

• In Hong Kong Special Administrative Region on March 12, the Department of Health reported an outbreak of cases of SARS in one of its public hospitals. A total of 145 cases have now been reported, including cases reported from three hospitals and the community.

• On March 13th, the Ministry of Health in Singapore reported three cases of SARS in people who had recently returned to Singapore after travelling to Hong Kong Special Administrative Region. A total of 31 cases have now been reported.

• Other countries are reporting sporadic cases, including Germany (2), Thailand (1), Taiwan (3), Slovenia (1), and United Kingdom (1).

• In mid February, the government of China reported 305 cases of atypical pneumonia, with five deaths, occurring in Guangdong province. No further cases have been reported from this Province.

• A total of 4 deaths due to SARS have been reported worldwide.

While the cause(s) of these illnesses and the source of the outbreaks have not been fully established, health authorities report that, to date:

1. No link has been established between the outbreak reported in Hanoi, Vietnam, and the outbreak first reported in the public hospital in Hong Kong Special Administrative Region.

2. No link has so far been made between these outbreaks of SARS and the cases of "bird flu", the avian influenza A (H5N1), in Hong Kong Special Administrative Region reported on February 19 [see previous advisory at http://www.phac-aspc.gc.ca/tmp-pmv/2003/h5n1hk_e.html].

3. The cases of SARS in Hanoi appear to be confined to the hospital environment and the close contacts of cases. In Hong Kong Special Administrative Region, there is some evidence suggesting that transmission may not be limited to the hospital environment.

Sources: World Health Organization, Hong Kong Department of Health.

As of 19 March 2003, Health Canada has received reports of 9 cases who have become ill with SARS in Ontario and British Columbia. These cases have either recently travelled to Hong Kong or have had close contact with these individuals.

• Ontario: 8 total cases
  In a single family, 3 people have been hospitalized with severe pneumonia of unknown cause, 2 other family members have died. In addition, individuals (2) with close contact with this family have been hospitalized. A separate, unrelated case (1) with recent travel to Hong Kong has also been identified.

• British Columbia: 1 total case
  One person has been hospitalized with SARS.

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

No link has been established between cases of SARS in Canada and cases of H5N1 influenza in Hong Kong.

Recommendations

The overall risk for travellers appears to be low at this time. However, because of recent increases in cases of SARS in these areas and that transmission is not limited to the hospital setting, Health Canada advises that persons planning elective or nonessential travel to the City of Hanoi, Vietnam; Hong Kong Special Administrative Region; and Singapore may wish to postpone their trips until further notice.

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 high fever and one or more of the following respiratory symptoms - cough, shortness of breath or difficulty breathing - occur, Health Canada recommends that medical advice be sought as soon as possible. Ill persons should call ahead to their personal physician. Travellers should inform their personal physician when and where they travelled, and indicate whether there was contact with someone who had these symptoms.

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.