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

Updated: March 26, 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 Guangdong Province; 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 26, 2003, the World Health Organization (WHO) reports:

China - 792 cases (31 deaths), France -1 case, Germany - 4 cases, Hong Kong Special Administrative Region of China - 316 cases (10 deaths), Italy - 3 cases, Republic of Ireland - 2 cases, Singapore - 74 cases (1 death), Switzerland - 2 cases, Taiwan - 6 cases, Thailand - 3 cases, UK - 3 cases, USA - 40 cases, and Vietnam - 58 cases (4 deaths).

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

No link has so far been made between these outbreaks of SARS and the cases of a "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].

Source: World Health Organization

As of 26 March 2003, Health Canada has received reports of 28 individuals who have become ill with SARS in Ontario and British Columbia. Three deaths have occurred due to SARS in Canada. All Canadian cases have occurred in persons who have travelled to Asia or had contact with SARS cases in the household or in a health-care setting.

• Ontario: 27 total cases
  To date, all cases have occurred in persons returning from Asia or having had contact with SARS cases in the household or in a health-care setting.

• British Columbia: total of 1 case
  The one person hospitalized with SARS was a traveller from Hong Kong.

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

Due to the mounting concern about transmission of the SARS agent in non-hospital and community settings in the City of Hanoi, Vietnam; Hong Kong Special Administrative Region and Guangdong Province in China; and Singapore, Health Canada recommends that persons planning to travel to these areas should defer all travel until further notice. Health Canada recommends alternate routing be considered, when possible, if a traveller is transiting through Hong Kong Special Administrative Region; City of Hanoi, Vietnam; or 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.

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. For example, Health Canada has been informed that adequate hospital care for a traveller who develops SARS in the City of Hanoi may not be available due to closure of the only adequate hospital in that City. 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 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.