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Severe acute respiratory syndrome (SARS)

1 What is SARS?

Severe acute respiratory syndrome (SARS) is the term being used to describe a new serious respiratory illness that emerged from South-East Asia in 2003.

2 How many people have been affected?

SARS has killed more than 770 people and infected over 8,000 worldwide since it surfaced in southern China late in 2002. Four cases of probable SARS were reported in the UK.

The Health Protection Agency and World Health Organisation give up-to-date information on the situation.

3 What causes SARS?

The causative agent has been identified as a coronavirus, although it is possible other infectious agents are associated with some cases. The World Health Organisation (WHO) is investigating the suggestion that the virus is of animal origin, from domestic or wild animals (possibly used as food) located in Guangdong Province (in South China).

4 Do you have other general questions about SARS that are not work-related?

The Department of Health is responsible for public health, and they have already issued guidance via their own website and that of the Health Protection Agency -

These websites should provide answers to any general questions you have.

5 How is the agent that causes SARS classified under COSHH?

The SARS Working Group of the Advisory Committee on Dangerous Pathogens (ACDP) has considered the appropriate hazard grouping for the SARS agent. They have agreed the agent should be classified as Hazard Group (HG) 3 but stressed the need to review this classification once further information becomes available, for example:

Any employer doing a risk assessment for work with the agent should use this classification information. The ACOP and guidance* accompanying the Control of Substances Hazardous to Health (COSHH) Regulations 2002 gives further guidance on assessing the risks of working with hazardous substances.

* Control of Substances Hazardous to Health (Fourth edition). The Control of Substances Hazardous to Health Regulations 2002. Approved Code of Practice and Guidance (L5)

6 What advice does HSE have for health care workers?

HSE has the following advice, which complements that provided by the Health Protection Agency.

If a patient fitting the definition for a suspect or probable case of SARS is admitted to the hospital, clinicians should notify infection control personnel immediately. A risk assessment must be done for all work with the person who has suspect or probable SARS, and appropriate control measures put in place to reduce the risk of any healthcare worker who comes into contact with the patient being exposed to the SARS virus. Until the cause and route of transmission are known, in addition to standard precautions (sometimes known as universal precautions), infection control measures for inpatients should include:

(This information is also consistent with the guidance provided by WHO.)

The Department of Health has also issued some guidance for Health Care Workers (http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1191942170467/), which covers managing SARS cases, sampling suspected individuals, infection control etc.

7 What advice does HSE have for laboratory workers?

ACDP has classified the SARS agent as HG3 (see question 5). Those who intend to work with SARS should use this classification information as part of a full risk assessment, taking into account the activities to be performed.

In addition to the prevention and/or control measures you decide to take/use as a result of the risk assessment you should consider the following advice:

The ACDP has issued further guidance to clarify the containment measures required for particular types of work with the SARS agent in order to assist dutyholders in complying with the requirements of Regulation 7(1) of COSHH:

8 What advice does HSE have for education establishments taking in students who have travelled from abroad?

The Health Protection Agency has already produced guidance for schools and other educational institutions that have large numbers of students who have travelled to risk areas or who have been in contact with those who have - http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733840013?p=1191942170463, which should cover any queries you have.

You are only at risk from SARS if in close contact with someone who has the disease, and under normal teaching circumstances this type of exposure is unlikely.

However, some employees e.g. school nurses, may be at higher risk if during the course of their normal work they have close contact with infectious people. An employer should already have carried out a COSHH risk assessment that takes into account potential exposure to biological agents in general - and put preventative measures or controls in place as appropriate. We recommend that employers review these risk assessments in light of information currently available on SARS (see question 9) and amend their assessment and measures required to control the risk appropriately.

In exceptional circumstances employees may be sharing quarantine with students returning from SARS affected areas. We recommend, as best practice, that their employers carry out a risk assessment using the criteria above.

For further guidance on case and contact management see: http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1191942170456/

9 What advice does HSE have for other employers/employees concerned about exposure to SARS at work?

HSE does not have the remit to provide advice to the general public about their risk of being exposed to SARS, so you need to refer to the

It has been suggested that there is a potential for workers (in addition to health care workers (HCWs) and laboratory staff) to be exposed to the SARS agent as they come into contact with infectious members of the public, eg immigration officials in airports, customs staff at docks.

An individual is only at risk from SARS if they are in close contact with someone who has the disease or the body fluids from infectious individuals. Therefore, employees with the highest risk of exposure will be HCWs and those handling infected clinical samples (as well as people intentionally working with the SARS agent) - advice for these workers is covered in questions 6 and 7.

COSHH should also be applied for workers (such as cleaners on aircraft, custom officials conducting intimate body searches) who come into contact with human body excretions/secretions that could contain any infectious agent. Where there is direct contact with such infectious people (or excretions/secretions) employers should already have carried out a risk assessment and put preventative measures or controls in place as appropriate. We recommend that employers review these risk assessments in light of the information currently available on SARS, eg.

Further advice on conducting a risk assessment, prevention or control measures etc can be found in the COSHH ACOP (see question 5 for details of this guidance document).

10. What if a member of staff is returning from a SARS-affected area?

There is no evidence that symptomless people returning from SARS-affected areas should be excluded from the work place. However, an individual who has returned from such an area should remain vigilant about their own health for 10 days after they return. If during this time they develop suspicious symptoms (eg high fever accompanied by cough, shortness of breath or difficulty breathing) they should seek immediate medical attention.

11. What if I have been sent goods from a SARS-affected area?

The WHO concluded that "goods, products or animals arriving from SARS-affected areas [do not] pose a risk to public health". HSE, therefore, advises that there is no need to quarantine goods etc from a SARS-affected area that are being brought into the work place.

Updated 2013-07-09