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## Complete Summary

#### GUIDELINE TITLE

Public health guidance for community-level preparedness and response to
severe acute respiratory syndrome (SARS). Version 3. Supplement E:
managing international travel-related transmission risk.

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention (CDC). Public health guidance
for community-level preparedness and response to severe acute
respiratory syndrome (SARS). Version 3. Supplement E: managing
international travel-related transmission risk. Atlanta (GA): Centers
for Disease Control and Prevention (CDC); 2004 Jul 20. 15 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention (CDC). Public health guidance for community-level
preparedness and response to severe acute respiratory syndrome (SARS).
Version 2. Supplement E: managing international travel-related
transmission risk. Atlanta (GA): Centers for Disease Control and
Prevention (CDC); 2003 Dec 29. 14 p.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Severe acute respiratory syndrome (SARS)

#### GUIDELINE CATEGORY

Management\
Prevention

#### CLINICAL SPECIALTY

Preventive Medicine

#### INTENDED USERS

Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To present recommendations for managing international travel-related
severe acute respiratory syndrome (SARS) transmission risk

#### TARGET POPULATION

-   Inbound travelers to the United States from areas affected by severe
    acute respiratory syndrome (SARS)

-   Outbound travelers from the United States going to areas affected by
    SARS

-   Potentially exposed passengers and crew members on conveyances with
    SARS patients

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Inbound Travelers/Conveyance of Patient with Severe Acute Respiratory
Syndrome (SARS)**

1.  Traveler/patient education (e.g., health alert notices)

2.  Passive/active monitoring

3.  Symptom screening

4.  Collection of contact information

5.  Surveillance

6.  Quarantine protocol

7.  Medical evaluation as appropriate

8.  Minimize/prohibit non-essential travel

**Outbound Travelers**

1.  Travel health precautions/health warnings/prohibitions
    (domestic/international)

2.  Minimize/prohibit non-essential travel

3.  Medical screening/assessment at all exit points

4.  Require health certificate for exit

#### MAJOR OUTCOMES CONSIDERED

The effectiveness of travel-related control strategies used to modify
the risk of severe acute respiratory syndrome-associated coronavirus
(SARS-CoV) disease during the 2003 epidemic

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The guideline was prepared by the Centers for Disease Control and
Prevention\'s (CDC) Severe Acute Respiratory Syndrome (SARS)
Preparedness Committee, which was assembled to prepare for the
possibility of future SARS outbreaks. The Committee includes eight
working groups, each of which addressed a component of SARS preparedness
and response. The working groups derived the guidance document from
lessons learned during the 2003 epidemic, other CDC preparedness and
response plans, and the advice, suggestions, and comments of state and
local health officials and representatives of professional
organizations, convened by means of teleconferences and meetings.
Meetings were held on August 12-13, 2003 (public health preparedness and
response), September 12, 2003 (preparedness in healthcare facilities),
and September 18, 2003 (laboratory diagnostics).

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This is an updated version of the draft guidance document issued by the
Centers for Disease Control and Prevention (CDC) on November 3, 2003.
CDC revised the draft based on comments received from public health
partners, healthcare providers, professional organizations, and others.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Priority Activities**

-   Screen incoming travelers from severe acute respiratory syndrome
    (SARS)-affected areas for SARS, and provide guidance about
    monitoring their health and reporting illness.

-   Provide guidance to outbound travelers about active SARS-affected
    areas and measures to reduce the risk of acquiring SARS-associated
    coronavirus (SARS-CoV) disease during travel.

-   If SARS-CoV transmission in the United States presents an increased
    risk of exporting SARS-CoV to other countries, then screen outbound
    travelers to prevent such exportation.

-   Ensure the appropriate evaluation and management of SARS cases and
    potentially exposed passengers and crew members on conveyances.

**Activities Directed to Inbound Travelers**

The nature and scope of activities related to travelers entering or in
the United States will differ depending on the extent of SARS-CoV
transmission in the United States and in the country or countries from
which the passenger has traveled (see Appendix E1 in the original
guideline document). When SARS-CoV transmission is absent or limited in
the United States, then efforts will focus on promptly identifying cases
imported from SARS-affected areas and preventing further spread from
such cases. Guidelines have been developed for various groups who might
be arriving from areas affected by SARS-CoV
(<http://www.cdc.gov/ncidod/sars/hostingarrivals.htm>;
<http://www.cdc.gov/ncidod/sars/business_guidelines.htm>). If active
transmission of SARS-CoV is occurring in a U.S. city or area, then it
will be important to prevent spread to other areas in the United States,
possibly by limiting or restricting non-essential travel into or from
the affected area.

**Objective**: Prevent spread from SARS-CoV-infected travelers entering
the United States.

**Basic Activities**

-   Inform incoming travelers about SARS, and provide guidance on
    monitoring their health and reporting illness to the appropriate
    authorities. This may be accomplished by use of:

    -   Videos or public announcements on the conveyance just before
        arrival

    -   Distribution of health alert notices before or upon arrival
        (<http://www.cdc.gov/ncidod/sars/travel_alert.htm>)

    -   Posters or public announcements in airports

-   Evaluate travelers who report SARS-like symptoms (e.g., fever or
    respiratory symptoms) during travel, and collect locating
    information for the other passengers and crew (See \"Activities
    Related to SARS on Conveyances,\" below).

-   Respond to reports of ill passengers on airplanes or other
    conveyances arriving from areas with SARS-CoV disease.

**Enhanced Activities**

-   If the level of transmission in another country is high, incoming
    passengers from that country might require enhanced screening and
    evaluation through:

    -   Visual inspection of all travelers as they disembark

    -   Screening of travelers for symptoms of SARS-CoV disease and
        recent high-risk exposures to SARS-CoV (e.g., SARS-CoV patients
        or high-risk settings) through a self-administered questionnaire

    -   Temperature screening

-   Quarantine inspectors at CDC quarantine stations and public health
    workers in locations near other ports of entry may be required to
    meet all airplanes or other conveyances arriving from areas with
    SARS to question crew members about any ill passengers and to
    visually inspect passengers upon disembarkation.

-   If the level of SARS-CoV transmission in a U.S. area is sufficiently
    high to present a substantial risk to travelers, then non-essential
    travel to this area may be limited, cancelled, or subjected to
    increased surveillance measures.

-   Other activities that may be considered but whose effectiveness is
    unclear (especially given the resources required for implementation)
    include:

    -   Ten-day quarantine of all passengers arriving from SARS-affected
        areas

    -   Collection of locating information on all arriving passengers

**Activities Directed to Outbound Travelers**

Activities related to outbound travelers will vary based on the extent
of SARS-CoV transmission in the United States and at the destination
(see Appendix E1 in the original guideline document). If there is little
SARS-CoV transmission in the United States, the goal is to inform
travelers about the risk of SARS and appropriate measures to reduce the
risk of acquiring SARS-CoV infection during travel
(<http://www.cdc.gov/ncidod/sars/travel_advice.htm>). If there is
extensive SARS-CoV transmission in the United States, then preventing
the exportation of SARS-CoV will be an added objective.

**Objective**: Minimize outbound travelers\' risk for exposure to
SARS-CoV during travel or the risk of spreading SARS-CoV to other
localities.

**Basic Activities**

-   Issue travel notifications (see Table below).

-   Provide educational materials to travelers on measures to reduce the
    risk of SARS-CoV disease.

**Enhanced Activities**

-   If there are locations with extensive SARS-CoV transmission where
    control measures do not appear to be effective, further travel
    restrictions (e.g., cancellation of flights) to those locations may
    be considered (see \"Roles and Responsibilities\" in the
    Implementation field).

-   If the level of SARS-CoV transmission in the United States presents
    an increased risk for exportation, then some or all of the following
    might be implemented:

    -   Pre-departure screening (e.g., temperature screening, visual
        screening) of outbound travelers

    -   Health certifications (i.e., requiring travelers to have a
        medical examination before departure, with a doctor\'s statement
        that they are free of SARS-CoV symptoms and have not had close
        contact to a SARS-CoV patient in the past 10 days)

    -   Stop lists (i.e., maintaining lists of SARS cases and close
        contacts at ports of departure against which travelers\' names
        can be checked to prevent them from traveling)

**Table: Travel Notice Definitions**

The Centers for Disease Control and Prevention (CDC) issues different
types of notices for international travelers. On May 20, 2004, these
definitions were refined to make the announcements more easily
understood by travelers, health care providers, and the general public
<http://www.cdc.gov/travel/outbreaks.htm#noticekey>. The definitions
provided below describe both the levels of risk for the traveler and the
recommended preventive measures for each level of risk.

  ----------------------------------------------------------------------------
  **Notice**     **Scope^1^**    **Risk for             **Preventive
                                 travelers^2^**         measures^3^**
  -------------- --------------- ---------------------- ----------------------
  **In the       Reports of      No increased risk over Keep travelers
  News**         sporadic cases  baseline for travelers informed, and
                                 observing standard     reinforce standard
                                 recommendations        prevention
                                                        recommendations

  **Outbreak     Outbreak in a   Increased but          Remind travelers about
  Notice**       limited         definable risk that is standard and enhanced
                 geographic area limited to specific    recommendations for
                 or setting      settings               the region

  **Travel       Outbreak of     Increased risk in some Inform travelers about
  Health         greater scope   settings, along with   specific precautions
  Precaution**   affecting a     risk for spread to     to reduce risk during
                 larger          other areas            the stay and what to
                 geographic area                        do before and after
                                                        travel

  **Travel       Evidence that   Increased risk because In addition to the
  Health         outbreak is     of evidence of         specific precautions
  Warning**      expanding       transmission outside   cited above,
                 outside the     defined settings       **postpone
                 area or         and/or inadequate      nonessential travel**
                 populations     containment measures   
                 initially                              
                 affected                               
  ----------------------------------------------------------------------------

^1^The term \"scope\" incorporates the size, magnitude, and rapidity of
spread of an outbreak.

^2^Risk for travelers is dependent on patterns of transmission, as well
as severity of illness.

^3^Preventive measures other than the standard advice for the region may
be recommended depending on the circumstances (e.g., travelers may be
requested to monitor their health for a certain period after their
return, or arriving passengers may be screened at ports of entry).

**Activities Related to SARS on Conveyances**

A SARS patient on a conveyance presents a risk of transmission to other
passengers and crew and to non-passengers on arrival and a risk of
further spread from passengers who become infected. Many of the
activities listed below are performed by CDC staff at the eight current
quarantine stations and by public health workers in locations near other
ports of entry with assistance by CDC quarantine station staff from that
region.

**Objective**: Protect co-passengers and crew members from
SARS-CoV-infected passengers and from transmission associated with
passengers exposed to the index case.

**Activities**

[Management of a Potential SARS Patient on a Conveyance]{.underline}

-   Separate the potential SARS patient as completely as possible from
    other passengers and the crew. The ill passenger should wear a
    surgical mask.

-   Ensure that persons caring for the ill passenger follow infection
    control measures recommended for cases of SARS (see the National
    Guideline Clearinghouse \[NGC\] summary [Supplement I: Infection
    Control in Healthcare, Home and Community
    Settings](http://www.guideline.gov/summary/summary.aspx?doc_id=4593&nbr=3383)
    and <http://www.cdc.gov/ncidod/sars/airpersonnel.htm>).

-   If possible, designate a separate toilet for the exclusive use of
    the ill passenger.

-   Notify the airport or land port authorities at the destination so
    that health authorities are informed and prepared to meet the
    conveyance upon arrival, to manage the ill passenger, and to
    evaluate other passengers.

[Management on Arrival]{.underline}

-   Separate the ill passenger from exposed, well co-passengers at the
    soonest moment, both in transit and after arrival.

-   Place the ill passenger in an isolation facility (if available), and
    assess.

-   Assess other passengers for illness, types of exposures to the ill
    passenger, and other potential SARS-CoV exposures. Emergency medical
    services (EMS) personnel and local emergency department staff can
    perform these evaluations using appropriate precautions (see the NGC
    summary [Supplement I: Infection Control in Healthcare, Home and
    Community
    Settings](http://www.guideline.gov/summary/summary.aspx?doc_id=4593&nbr=3383)
    and <http://www.cdc.gov/ncidod/sars/airpersonnel.htm>).

-   Transfer the ill passenger to a local health care facility for
    further evaluation, if needed. Protocols and memoranda of agreement
    with ambulance services and hospitals with appropriate infection
    control measures in place should be established in advance (see
    \"Preparedness Planning,\" below.)

[Management of Passengers and Crew on the Same Conveyance]{.underline}

-   Collect locating information for all passengers and crew. This
    information should be obtained directly from passengers, if
    possible. If a potential SARS case on a conveyance is not detected
    until after arrival, this information can be obtained from passenger
    manifests, staff lists, and/or customs forms.

-   Inform all passengers on board about SARS, and advise them to seek
    immediate medical attention if fever or respiratory symptoms develop
    within 10 days of the flight. Pay particular attention to close
    contacts of the case.

-   Consider temporary detention of the plane and arrangements for
    monitoring and quarantine of all passengers and crew in some
    circumstances (e.g., if the ill passenger had contact with a
    laboratory-confirmed SARS case and had significant respiratory
    symptoms during a prolonged flight). Home quarantine may be used for
    persons who live in or near the port of arrival; a designated
    facility should be arranged for the others (see the NGC summary
    [Supplement D: Community Containment Measures, Including
    Non-hospital Isolation and
    Quarantine](http://www.guideline.gov/summary/summary.aspx?doc_id=4589&nbr=3379)).

**De-escalation of Control Measures**

**Objective 1**: Downgrade or remove travel notifications as
appropriate.

**Activities**

-   CDC will downgrade a travel health warning to a travel health
    precaution when there is:

    -   Adequate and regularly updated reporting of surveillance data
        from the area

    -   No evidence of ongoing transmission outside defined settings for
        20 days (two incubation periods) after date of onset of symptoms
        for the last confirmed case without an epidemiologic link, as
        reported by public health authorities

-   CDC will remove a travel health precaution when there is:

    -   Adequate and regularly updated reporting of surveillance data
        from the area

    -   No evidence of new cases for 30 days (three incubation periods)
        after the date of onset of symptoms for the last case, as
        reported by public health authorities

    -   Limited or no recent instances of exported cases from the area.
        An exported case is an ill person who meets the definition for a
        probable or confirmed case of SARS-CoV disease and who acquired
        SARS-CoV infection in the area in question and then traveled
        outside the affected area to another region and was diagnosed
        there (i.e., the person was not identified as a part of contact
        tracing activities, and travel was not restricted). This
        criterion excludes intentional or planned evacuations.

**Objective 2**: Reduce measures used for inbound travelers as
appropriate.

**Activities**

[For All Passengers Arriving from Areas with SARS-CoV
Transmission]{.underline}:

-   Continue general education for passengers from a particular area
    until the travel health precaution has been lifted (30 days after
    the onset of symptoms for the last case in that area). Because
    travel patterns may make it difficult to determine passengers\'
    points of origin, it may be more practical to continue general
    education until travel health precautions have been lifted for all
    areas.

-   Continue evaluating travelers who report symptoms of SARS during
    travel until the travel health precaution for that area has been
    lifted (30 days after the onset of symptoms for the last case from
    that area).

[For Passengers Arriving from Areas Under a Travel Health
Warning]{.underline}:

-   Continue the use of screening questionnaires until the area of
    origin is downgraded from a travel health warning to a travel health
    precaution.

-   Continue meeting conveyances from SARS-affected areas and visually
    inspecting passengers until the area of origin is downgraded from a
    travel health warning to a travel health precaution.

**Objective 3**: Reduce other measures used for outbound travelers as
appropriate.

**Activities**

-   Continue pre-departure fever and symptom screening for passengers
    departing from areas with ongoing unlinked transmission, but
    consider discontinuing these activities 20 days after the onset of
    symptoms for the last unlinked case.

-   Continue stop lists until there are no longer any cases under
    isolation or contacts under quarantine.

**Objective 4**: Reduce measures for management of passengers with
SARS-CoV disease on conveyances as appropriate.

**Activities**

-   Continue meeting any flight with an ill passenger on board who has
    SARS-like symptoms. If the passenger is seriously ill, evaluate and
    follow-up according to established protocols.

-   Continue to collect locating information as long as the passenger
    has symptoms compatible with SARS-CoV disease and has traveled from
    an area with ongoing unlinked transmission (under a travel
    advisory). For areas that have been downgraded to a travel health
    precaution, locating information may not be needed unless the ill
    passenger meets the epidemiologic criteria for likely exposure to
    SARS-CoV (see the NGC summary [Supplement B: SARS
    Surveillance](http://www.guideline.gov/summary/summary.aspx?doc_id=4587&nbr=3377),
    Appendix B1).

-   The need for monitoring and quarantine of contacts of a passenger
    from an area on travel health precaution should be determined after
    the ill passenger has been fully evaluated.

**Roles and Responsibilities**

Refer to the original guideline document for a discussion on the roles
and responsibilities related to managing international travel-related
SARS transmission risk.

**Preparedness Planning**

**Legal Authority for Restricting Movement**

In advance of the possible reappearance of SARS-CoV, public health
officials should:

-   Work closely with their legal counterparts to ensure that the legal
    authority for movement restrictions at the local, state, and federal
    levels is known and understood and to establish boundaries of
    authority and processes to address multi-jurisdictional issues (see
    the NGC summary [Supplement A: Command and
    Control](http://www.guideline.gov/summary/summary.aspx?doc_id=4586&nbr=3376)).

-   Develop plans for making decisions on movement restrictions, such
    as: 1) requirements for pre-departure screening, 2) requirements for
    arrival screening and/or quarantine, 3) travel prohibitions on cases
    and contacts, 4) restrictions related to use of mass transit
    systems, and 5) cancellation of non-essential travel.

-   Work closely with local, state, and federal law enforcement to
    develop plans for enforcement of these restrictions.

**Engagement of Key Partners**

In advance of the possible reappearance of SARS-CoV, public health
officials should:

-   Begin preparedness planning by identifying key partners
    representing: 1) law enforcement (local, state, and federal), 2)
    legal community, 3) emergency medical services (for evaluation of
    ill arriving passengers and transportation to the hospital), 4)
    hospital personnel, 5) transportation industry personnel, and 6)
    other emergency management personnel. The partners should be
    involved in the planning process.

-   Develop plans for the training, mobilization, and deployment of
    pertinent public health and other staff.

-   Conduct training programs and drills.

-   Provide respirator fit-testing and training in use of personal
    protective equipment (PPE) for persons at risk for exposure to
    possible SARS cases.

-   Plan for the diversion of conveyances carrying supplies for
    maintenance of critical infrastructure around key transportation
    hubs that may be affected by SARS-CoV.

**Protocols for Management of Ill Arriving Passengers**

Public health officials and CDC quarantine staff, in collaboration with
legal and law enforcement authorities, should develop protocols for the
management of ill arriving passengers at ports of entry, including
provisions for:

-   Meeting flights with a reported ill passenger

-   Establishing notification procedures and communications links

-   Separating the ill passenger during assessment

-   Assessing the ill passenger and referring for evaluation and care

-   Transporting the ill passenger to a designated health care facility
    (see the NGC summary [Supplement D: Community Containment Measures,
    Including Non-hospital Isolation and
    Quarantine](http://www.guideline.gov/summary/summary.aspx?doc_id=4589&nbr=3379))

-   Collecting locating information on other passengers and crew

-   Collecting the flight manifest, customs declarations, and other
    information for contact tracing

-   Identifying any other ill passengers and separating them from well
    passengers

-   Quarantining contacts if necessary, including transportation to a
    quarantine facility

-   Providing enforcement for uncooperative ill passengers or contacts

See the NGC summary [Supplement A: Command and
Control](http://www.guideline.gov/summary/summary.aspx?doc_id=4586&nbr=3376).

**Memoranda of Agreement (MOA) with Health Care Facilities, Transport
Services, Emergency Medical Systems, and Physicians**

-   State and local public health officials should work with federal
    quarantine staff to develop memoranda of agreement (MOAs) with
    hospitals near ports of entry; these facilities must be equipped to
    isolate, evaluate, and manage possible SARS patients (see the NGC
    summary [Supplement C: Preparedness and Response in Healthcare
    Facilities](http://www.guideline.gov/summary/summary.aspx?doc_id=4588&nbr=3378)).

-   Agreements should include arrangements with a designated emergency
    medical service for on-site assessment of ill passengers and
    transportation to a hospital for evaluation.

See the NGC summary [Supplement A: Command and
Control](http://www.guideline.gov/summary/summary.aspx?doc_id=4586&nbr=3376).

**Designation of Quarantine Facility**

State and local public health officials should identify a facility for
travelers who are designated as contacts and who require quarantine but
cannot be quarantined at home.

**Roles and Responsibilities**

Roles and responsibilities should be outlined for the various partners
and the various levels of jurisdiction (local, state, and federal) for
each component of the response.

For additional information and material on prevention of SARS
travel-related risks, see <http://www.cdc.gov/ncidod/sars/travel.htm>.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation. The working groups derived the guidance document from
lessons learned during the 2003 epidemic, other Centers for Disease
Control and Prevention (CDC) preparedness and response plans, and the
advice, suggestions, and comments of state and local health officials
and representatives of professional organizations.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Prevention of the introduction of severe acute respiratory
    syndrome-associated coronavirus (SARS-CoV)(and spread from an
    introduction) into the United States from SARS-affected areas

-   Prevention of the exportation of SARS-CoV from the United States

-   Reduction in the risk of SARS among outbound travelers to
    SARS-affected areas

-   Prevention of the spread of SARS-CoV to passengers on a conveyance
    with a SARS patient

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

\"Appendix E1: Travel Related Severe Acute Respiratory Syndrome (SARS)
Matrices\" in the original guideline document provides information to
assist in implementing recommended interventions depending on the extent
of severe acute respiratory syndrome-associated coronavirus (SARS-CoV)
transmission.

#### IMPLEMENTATION TOOLS

Chart Documentation/Checklists/Forms\
Patient Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention (CDC). Public health guidance
for community-level preparedness and response to severe acute
respiratory syndrome (SARS). Version 3. Supplement E: managing
international travel-related transmission risk. Atlanta (GA): Centers
for Disease Control and Prevention (CDC); 2004 Jul 20. 15 p.

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2003 Nov 3 (revised 2004 Jul 20)

#### GUIDELINE DEVELOPER(S)

Centers for Disease Control and Prevention - Federal Government Agency
\[U.S.\]

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

Centers for Disease Control and Prevention Severe Acute Respiratory
Syndrome (SARS) Preparedness Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention (CDC). Public health guidance for community-level
preparedness and response to severe acute respiratory syndrome (SARS).
Version 2. Supplement E: managing international travel-related
transmission risk. Atlanta (GA): Centers for Disease Control and
Prevention (CDC); 2003 Dec 29. 14 p.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the Centers for Disease Control and
Prevention (CDC) Web site:

-   [HTML Format](http://www.cdc.gov/ncidod/sars/guidance/E/index.htm)

-   [Portable Document Format
    (PDF)](http://www.cdc.gov/ncidod/sars/guidance/E/pdf/e.pdf)

-   [Microsoft
    Word](http://www.cdc.gov/ncidod/sars/guidance/E/word/e.doc)

Print copies: Available from the Centers for Disease Control and
Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased
from the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402-9325; (202) 783-3238.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   In the absence of SARS-CoV transmission worldwide: guidance for
    surveillance, clinical and laboratory evaluation, and reporting.
    Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2004
    Jan 8. 15 p. Electronic copies: Available from the [CDC Web
    site](http://www.cdc.gov/ncidod/sars/absenceofsars.htm).

-   Clinical guidance on the identification and evaluation of possible
    SARS-CoV disease among persons presenting with community-acquired
    illness. Atlanta (GA): Centers for Disease Control and Prevention
    (CDC); 2004 Jan 8. 15 p. Electronic copies: Available from the [CDC
    Web site](http://www.cdc.gov/ncidod/sars/clinicalguidance.htm).

-   Guidance on air medical transport for SARS patients. Atlanta (GA):
    Centers for Disease Control and Prevention (CDC); 2004 Apr 23. 5 p.
    Electronic copies: Available from the [CDC Web
    site](http://www.cdc.gov/ncidod/sars/airtransport-sarspatients.htm).

-   Guidance about SARS for airline flight crews, cargo and cleaning
    personnel, and personnel interacting with arriving passengers.
    Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2004
    Apr 23. 7 p. Electronic copies: Available from the [CDC Web
    site](http://www.cdc.gov/ncidod/sars/airpersonnel.htm).

The following is also available:

-   Appendix E1: Travel-Related SARS Response Matrices. Electronic
    copies: Available from the [CDC Web
    site](http://www.cdc.gov/ncidod/sars/guidance/E/index.htm) in PDF
    format and as Microsoft Word downloads.

Print copies: Available from the Centers for Disease Control and
Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased
from the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402-9325; (202) 783-3238.

#### PATIENT RESOURCES

The following is available:

-   Information for SARS patients and their close contacts. Atlanta
    (GA): Centers for Disease Control and Prevention (CDC); 2004 Feb 6.

-   Infection control precautions for SARS patients and their close
    contacts in households. Atlanta (GA): Centers for Disease Control
    and Prevention (CDC); 2004 Jan 8.

Electronic copies: Available from the [Centers for Disease Control and
Prevention (CDC) Web
site](http://www.cdc.gov/ncidod/sars/closecontacts.htm).

Print copies: Available from the Centers for Disease Control and
Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased
from the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402-9325; (202) 783-3238.

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on February 11, 2004. This NGC
summary was updated by ECRI on March 8, 2005.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### DISCLAIMER

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Date Modified: 11/3/2008