At the time the Epi-Log went to print, there was one confirmed, and two suspect SARS cases reported in Guangdong Province in southern China. No signs and symptoms of SARS-like illness have been reported among close contacts of these cases. In light of these reports, the CDC is recommending that U.S. physicians maintain a greater index of suspicion of SARS in patients who require hospitalization for radiographically confirmed pneumonia or acute respiratory distress syndrome (ARDS) AND who have a history of travel to Guangdong Province (or close contact with an ill person with a history of recent travel to Guangdong Province) in the 10 days before onset of symptoms. Such cases should be reported promptly and SARS isolation precautions should be used.

On January 8, 2004, the CDC released an update to the "Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)". This Supplement consolidates and updates the previous guidelines and provides new information to guide evaluation and management of potential SARS patients in hospitals and outpatient settings. This document can be found at: www.cdc.gov/ncidod/sars/clinicalguidance.htm. Some changes since the last version was released include:

• Healthcare facilities are highly encouraged to coordinate SARS preparedness activities with public health, including surveillance, reporting, monitoring, and management of exposed patients and healthcare workers, including implementation of out-of-hospital isolation for patients and activity restrictions for exposed health care workers.
  
• The term "universal respiratory etiquette" has been changed to "respiratory hygiene/cough etiquette." The recommendation to identify persons with respiratory infections early in the clinical encounter and screen for SARS risk factors remains a priority. Because patients with respiratory infections may not present with fever, the document clarifies that the recommended practices apply to all patients with symptoms of a respiratory infection.
  
• Current screening recommendations state that children hospitalized for radiographically confirmed pneumonia need not be screened for potential SARS-CoV disease, unless circumstances suggest that a child might be at high risk for exposure to SARS-CoV. Should person-to-person SARS transmission be reported in the world, screening for children should as for adults.

CDC also updated the recommendations in "Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease among Persons Presenting with Community-Acquired Illness" (www.cdc.gov/ncidod/sars/clinicalguidance.htm). During the 2003 global epidemic, SARS-CoV caused high levels of morbidity and mortality among healthcare personnel and disrupted healthcare delivery systems, leading in some instances to closure of hospitals. Rapid implementation and adherence to infection control measures proved essential for controlling transmission in healthcare settings. This document is designed to assist healthcare providers in controlling SARS-CoV transmission.