Confronting the New Challenge in Travel Medicine: SARS

J Travel Med 2003; 10:257–258. SARS, travel and travel medicine are intricately interlinked. It was a traveler who became the vector that turned a newly emergent local virus into a global outbreak.An American businessman traveling from China via Hong Kong exported the disease to Vietnam on 23 February 2003. The resulting nosocomial outbreak of severe atypical pneumonia in a Vietnamese hospital led the World Health Organization (WHO) to issue a global alert on SARS on 12 March.Besides this business traveler, at least 10 other travelers to Hong Kong had stayed on the same hotel floor as the index case of SARS, an ill traveler from Guangdong Province China.Together, they unmasked this mysterious disease, ongoing in southern China since November 2002,by the act of traveling home and spreading it in their home countries. From then on, SARS spread to multiple countries, always in the respiratory tract of a traveler. And finally, travel itself became the victim. By 15 March 2003, the WHO had begun to issue an unprecedented series of travel alerts and recommendations. The full political, economic and social impacts of these are just beginning to be measured.SARS has created international anxiety because of its novelty, its ease of transmission in certain settings, and the speed of its spread through jet travel. The instantaneous communication and information exchange that has supported every aspect of dealing with the epidemic has led to a speed of scientific discovery that has set a new standard for disease response.A new coronavirus has been isolated and its entire genome sequenced and made publicly accessible in weeks. The dynamics of this epidemic are becoming apparent.The frightening prospect of airborne transmission now seems unlikely. Intense shoe leather epidemiology has clearly proven transmission to be almost exclusively person to person, through direct respiratory droplets, hand contamination, and fomites. Fecal–oral transmission has been implicated in one well-publicized cluster in Hong Kong, but seems to be the exception, although the SARS virus is hardy enough to last in the environment for several days under experimental conditions. The main message, however, is that the new coronavirus is sufficiently transmissible to cause a very large epidemic if unchecked,but not so contagious as to be uncontrollable with good, basic public health measures. SARS was sudden; SARS is novel; SARS is frightening to many. Travel medicine practitioners have different roles in containing the epidemic. They play a central role in educating not only their own patients,but also the public, the press, the government and local businesses and institutions in a level-headed, factual way about SARS. Governments and press,especially in non-SARS-affected areas,have been slow to strike the right balance between timely and frequent risk communication and placing risk in the proper context. For example, the risk of SARS acquisition on an airliner,while not zero,was extremely small before current screening procedures were instituted, and is now close to zero. Communicating clearly the content and meaning of changing travel alerts, recommendations and bulletins from the WHO and national authorities is a primary task.Many countries issue alerts or bulletins to provide accurate information about the status of SARS at a destination, and these need to be distinguished from outright travel advisories against nonessential travel to the area.Pretravel advice for persons traveling to areas with SARS also includes education