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Severe Acute Respiratory Syndrome in the City of
7 C* c O, \# q. ?Hanoi, Vietnam; 3 B( [( l+ Q5 r6 K# S" E3 Q2 j
the People's Republic of China including the Hong Kong' }4 t# O/ W: ~ t1 i9 ~ f
Special Administrative Region; Singapore and Taiwan
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At this time, Health Canada is monitoring recent
+ U& z I2 r' {: E! T+ Q5 wconfirmed reports of outbreaks of severe acute/ `* m; U' Y' `& F
respiratory syndrome (SARS) in the City of Hanoi,
' m; s) m, n* Q3 t0 nVietnam; the People's Republic of China including the
3 E3 s N2 s1 H! `5 l$ V2 rHong Kong Special Administrative Region; Singapore and( p; X. ?. o* @
Taiwan, and the occurrence of isolated cases in other
& M3 X! Y. o( @- k8 gcountries. Health Canada's recommendations for
+ H/ I4 v9 J* l! ?8 v" x) }" S! M/ J) ntravellers are based on the best available information
4 s9 p8 s. C I. p: x' c8 d' Mat this time and are subject to change as more9 S+ E- F A" A% y% w/ ^5 K5 p$ }
information becomes available. & h" U8 c+ M0 K
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As of April 2, 2003, the World Health Organization
+ y! ~$ U, Y$ o0 S' L(WHO) reports:- W( P" ~0 c( w0 R9 J$ z: k' V
0 b5 L# N: N/ ]: |0 m% p7 r4 P
; p/ K/ Q5 D. r2 }1 U( mAustralia - 1 case, Belgium - 1 case, France - 1 case,* n+ h- R: u, n! T
Germany - 5 cases, Hong Kong Special Administrative
, z3 `/ s& h2 B+ d* [Region of the People's Republic of China - 708 cases
/ y& K" B0 |1 E4 R8 S" E(16 deaths), Italy - 3 cases, People's Republic of! p! B0 ]+ V9 a4 s! t
China - 1190 cases (46 deaths), Republic of Ireland -
2 m- j$ g A+ z8 L2 cases, Romania - 3 cases, Singapore - 95 cases (4; M( D; @' l; r3 x% N
deaths), Spain - 1 case, Switzerland - 2 cases, Taiwan! N \) M% \4 a/ m7 a+ E
- 13 cases, Thailand - 7 cases (2 deaths), UK - 3
* `1 ~6 n4 m* l- M+ dcases, USA - 72 cases, and Vietnam - 58 cases (4
& ]' \2 j. B/ G) e# w/ M. Q9 sdeaths).5 t8 L& y; p& R7 N, h. f0 L: a
3 T+ h: I% Q9 I/ R, V/ mWhile the cause(s) of these illnesses and the source5 B6 D& D: e8 |- [' \6 w0 a
of the outbreaks have not been fully established,
- _& ~: i {' G# Y4 w( `0 O" xhealth authorities report that, to date:( x9 |* j( S2 g H" k
+ D/ j* [/ N5 q7 f6 \' k0 A
No link has so far been made between these outbreaks# e7 M# Q% F0 \: C$ J- E
of SARS and the cases of a "bird flu", the avian) f2 i, ]' D/ b- ]
influenza A (H5N1), in Hong Kong Special. J# Y X0 e7 s' F% l- F
Administrative Region reported on February 19 [see' h8 z$ Z" ` Z( M6 B+ O3 k0 c
previous advisory at* Y' X- [" {$ h+ f7 v
.]http://www.hc-sc.gc.ca/pphb-dgspsp/tmp-pmv/2003/h5n1hk_e.html].2 f2 j& T' H4 a% V& h
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Source: World Health Organization9 p6 Z$ {: @* X, p' q* A: X
" Z: `& ^; r1 C/ i" c, H4 v% wAs of 2 April 2003, Health Canada has received reports' S7 G) i, w6 f3 [6 ?5 k
of approximately 160 cases of SARS (62 probable and 98% _* S+ |' Q. d
suspect cases) in Canada. Six deaths have occurred due
* x* j& j+ c5 h; u$ P5 n; dto SARS in Canada. All Canadian cases have occurred in! [; s6 t! H V- l8 O7 O
persons who have travelled to Asia or had contact with
+ i; N, N4 h4 I; e: v8 \) p, ^SARS cases in the household or in a health-care
: k- s8 |* w+ ~$ j4 Ssetting.
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Ontario: 60 probable and 69 suspect cases 1 U4 L; C6 {& V+ F5 J* |
To date, all cases have occurred in persons returning5 Q8 u) B( d. e2 z
from Asia or having had contact with SARS cases in the' j. y& L; v% }
household or in a health-care setting.
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British Columbia: 2 probable and 16 suspect cases8 [" \' y; N: w6 u: p. [% s
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New Brunswick: 1 suspect case
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, z2 v9 A' G3 _, K- h2 RSaskatchewan : 1 suspect case
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' U3 |+ E) Z7 E/ C+ @5 Z- ZAlberta: 7 suspect cases' Y( j( n% x! i( A/ }+ v
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% X, t: ~4 l3 @$ W. YPrince Edward Island: 4 suspect cases * E+ z" {* f0 ]
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A "suspect" case of SARS is a person who fits into one8 a2 l5 u4 [* {, C4 `
of the following two categories: a person who develops
+ Z; c) {, y4 w: Dfever and one or more respiratory symptoms, including2 d0 e! L6 ]# n7 N: M5 ]1 v' Z; d
cough, shortness of breath or difficulty breathing,' ] a" `* Z+ t" |4 K
within 10 days of returning from travel to areas in2 d, B, Z3 i8 [' N T
Asia where SARS cases are being reported, or a person' ~* z* @ V0 r) u3 l$ o" t
who develops fever and one or more respiratory
6 c, a* J( h/ P- L4 C7 Fsymptoms, including cough, shortness of breath or& l* X! w% V; x4 N" O9 y
difficulty, breathing, within 10 days of having had
' i2 C' A- u; A/ H! q5 N; {close contact with a "probable " case of SARS (i.e./ T: Y8 i; L5 }' j: R
within one meter).8 G1 ]( P: C4 A2 p
" W% p- ]$ ~9 x: Q( K9 N- E, LA "probable case of SARS is similar to a suspect case,
, {$ ]- S! | `% f* Tbut often the case has a more severe illness, with9 `, s$ C( A* ]. e( w9 P
progressive shortness of breath and difficulty
6 K" w( R* w% }1 _breathing, and in some cases, chest x-rays shows signs
2 s( P. S8 ]. E1 M Bof atypical pneumonia.* V. g; d9 O# M9 W+ K8 _. `
[The above descriptions of a probable and suspect case* d1 r) d) S6 L( `6 _* s
are provided for communication purposes and not for+ _+ e# S b8 q c' b$ j5 s4 ^8 M
scientific purposes]
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9 D( ~3 V D: fAt this time, the cause of the illness remains
" y" T( c4 ^. ^8 J# j2 K; c% |unknown, however national and international laboratory
- Z) M4 d/ o G* {$ z$ ^% ttesting and collaboration are ongoing.8 A& M8 |* \# U$ v/ h4 N
- j9 O$ G6 ~3 Z! M5 _ [+ n
No link has been established between cases of SARS in
' x1 @$ R1 p7 h$ v; V S' sCanada and cases of H5N1 influenza in Hong Kong.
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Recommendations , d. E$ o* c8 r2 k4 h" B6 B
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Due to the mounting concern about transmission of the# Y4 I+ I7 F& [: x
SARS agent in non-hospital and community settings in
~; c8 [" o p8 M; ?$ e* g, V- l4 cthe City of Hanoi, Vietnam; the People's Republic of
2 Z3 A; \* ^+ i; p1 R% ?China including the Hong Kong Special Administrative
& C' B& _ O1 h {, f2 V, D4 @( U& L! |Region; Singapore and Taiwan, Health Canada recommends( J4 z9 ^ I' q2 P) z6 X
that persons planning to travel to these areas should7 c3 v" _3 y* H/ w1 C% G, }2 Q' f! g
defer all travel until further notice.( r; q8 A' p* ?7 e. h
3 I- Q" Y$ L# @( H& y* TAlso, Health Canada recommends alternate routing be; O, a, a* y+ H y3 D0 h/ Y+ p
considered, when possible, if a traveller is. C: h" t5 X; U8 c& d0 Q
transiting through City of Hanoi, Vietnam; the% v2 J- }" I& ~4 l5 G
People's Republic of China including the Hong Kong+ ]9 N8 H8 Y5 r- o6 l) R% z
Special Administrative Region; Singapore or Taiwan. ! R- D% m2 Z3 @ w2 W0 K. `
6 F) A" s, N% V f) O7 w8 JHealth Canada is aware that health authorities in6 v7 N0 B; I( ]
these affected areas are making concerted efforts to
( |: G8 {! ^/ E, f4 z; p$ V& {contain the spread of SARS in their populations. Given
# D( W) Z% j% v8 R6 z r lthe uncertainties of the current situation, Health
( Z I l+ z0 u- J! ^2 NCanada believes it is prudent to await the outcome of
! g+ |" V5 v" M$ K& I& vnational and international control measures before
' e( q# X. j8 T9 K5 Uundertaking travel to these destinations.4 ?3 b# g1 Q. r, `3 V5 I
6 s# y3 _9 t! p- y" G- Q tTravellers are advised that they will have to depend
! j2 [0 J C- _upon the local medical services in the countries where
+ b) |- z8 Z' `# d% q" L7 Tthey reside or visit and are reminded that the health; e! Y' G p+ X6 [6 c/ [0 k
care services may be inadequate for the appropriate1 m# r5 J* P. @- m7 I
management of SARS. For example, Health Canada has0 B+ }5 W8 {3 V+ e: [
been informed that adequate hospital care for a- ^/ u0 {4 l; _% u. A
traveller who develops SARS in the City of Hanoi may
- r8 w, b' j' [1 z) b; tnot be available due to closure of the only adequate
8 e( ?% n; V, J/ A' f# Xhospital in that City. In addition, medical evacuation2 x& J9 @- X! F. x
of a patient with SARS may be very difficult. Canadian$ W Z& Y* D! V6 D
Missions may not be able to assist Canadians with SARS" b7 V7 T% y% }" `
with medical transportation out of the region or back
/ }/ t/ L$ f5 M; | hto Canada.* b$ G: \7 L; R3 @1 t
. I1 |% R1 q2 Y+ Y, Q9 P5 u( kPersons who are travelling or have travelled to these7 j: ]/ a7 [, A+ c$ P
areas should monitor their health for 10 days
* @+ [0 B' b) T5 f9 bfollowing their departure from these areas. Should a: O. H- Z3 C* F) K0 A _3 g
fever and one or more of the following respiratory
8 i$ w3 j( y3 f" ~5 i+ Msymptoms - cough, shortness of breath or difficulty9 C$ ?4 z1 d7 k* S- z/ ?/ F, w% U
breathing - occur, Health Canada recommends that
% z; k) R" N; Q! n! ]% i" J) Z& g# amedical advice be sought as soon as possible. Ill8 _; \% g1 j) A! r# V) W) b- @
persons should call ahead to their personal physician.
2 y( t& h) k6 V1 n5 Q8 wTravellers should inform their personal physician when4 `8 U+ ^8 p, Y2 w7 n1 t& y- K
and where they travelled, and indicate whether there2 S5 Z* b, K, S5 [( }& q: H% c
was contact with someone who had these symptoms.
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; m* F& H$ Y9 v+ o' f0 i+ [' uIndependent of the current international SARS
* c* f7 v! q# p+ Qoutbreak, Health Canada routinely recommends that8 W4 f: P+ M- @* t% k
Canadian travellers seek an individual risk assessment3 H4 z- ~8 M" n+ D9 a
consultation with their personal physician or a travel
' E1 z4 m4 F' }( K7 b5 V+ D. Hmedicine clinic to determine their individual risks
5 R- x6 ]; N! j! ifor illness. 4 ~5 W7 h3 h5 X( {
3 h) l; W. | g7 @: ~% rCanadian travellers are reminded to practice good
6 R: q2 O2 }4 Ypersonal hygiene (e.g., good hand-washing practices)
4 e7 w4 q# ~3 p3 Q' e5 i$ ?while travelling. Disease-causing micro-organisms can
0 @8 e* O4 n8 ?frequently be found on the hands. Hand-washing is the, ~' ]& W1 j' q5 R1 M
single most important procedure for preventing
# D' o4 o+ O( D. vinfections. 6 a* P9 L3 v& @( ` Z8 i
, d {, m0 v2 f. G& _# \+ z/ \8 j7 WApril 2, 2003 |
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