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Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions (Text with EEA relevance)
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Any person with fever or a history of fever
AND
At least one of the following three:
Cough
Difficulty in breathing
Shortness of breath
AND
At least one of the following four:
Radiographic evidence of pneumonia
Radiographic evidence of acute respiratory distress syndrome
Autopsy findings of pneumonia
Autopsy findings of acute respiratory distress syndrome
AND
No alternative diagnosis which can fully explain the illness
At least one of the following three:
Isolation of virus in cell culture from any clinical specimen and identification of SARS-CoV using method such as RT-PCR
Detection SARS-CoV nucleic acid in at least one of the following three:
At least two different clinical specimens (for example, nasopharyngeal swab and stool)
The same clinical specimen collected on two or more occasions during the course of the illness (for example, sequential nasopharyngeal aspirates)
Two different assays or repeat RT-PCR using a new RNA extract from the original clinical sample on each occasion of testing
SARS-CoV specific antibody response by one of the following two:
Seroconversion by ELISA or IFA in acute and convalescent phase serum tested in parallel
Four-fold or greater rise in antibody titre between acute and convalescent phase sera tested in parallel
At least one of the following two:
A single positive antibody test for SARS-CoV
A positive PCR result for SARS-CoV on a single clinical specimen and assay
At least one of the following three:
Any person with at least one of the following three:
Employed in an occupation associated with an increased risk of SARS-CoV exposure (for example, staff in a laboratory working with live SARS-CoV/SARS-CoV-like viruses or storing clinical specimens infected with SARS-CoV; persons with exposure to wildlife or other animals considered a reservoir of SARS-CoV, their excretions or secretions, etc.)
Close contact(1) of one or more persons with confirmed SARS or under investigation for SARS
History of travel to, or residence in, an area experiencing an outbreak of SARS
Two or more health-care workers(2) with clinical evidence of SARS in the same health-care unit with onset of illness in the same 10-day period
Three or more persons (health-care workers and/or patients and/or visitors) with clinical evidence of SARS with onset of illness in the same 10-day period and epidemiologically linked to a healthcare facility
Also applies during an outbreak in a non-affected country or area
Possible case
Any person meeting the clinical criteria with an epidemiological link
Probable case
Any person meeting the clinical criteria with an epidemiological link and meeting the laboratory criteria for a probable case
Nationally confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a national reference laboratory
Confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a WHO SARS verification and reference laboratory
Applies during an outbreak in a country/area where at least one person has been laboratory confirmed by a WHO SARS verification and reference laboratory
Possible case
Any person meeting the clinical criteria
Probable case
Any person meeting the clinical criteria with an epidemiological link to a nationally confirmed or a confirmed case
Nationally confirmed case
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a national reference laboratory
Confirmed case
One of the following three:
Any person meeting the clinical and the laboratory criteria for case confirmation where the testing has been performed at a WHO SARS verification and reference laboratory
Any nationally confirmed case with an epidemiological link to a chain of transmission where at least one case has been independently verified by a WHO SARS Reference and Verification Laboratory
Any person meeting the clinical criteria and with laboratory criteria for probable case with an epidemiological link to a chain of transmission where at least one case has been independently verified by a WHO SARS Reference and Verification Laboratory
A close contact is a person who has cared for, lived with, or having had direct contact with the respiratory secretions, body fluids and/or excretions (e.g. faeces) of cases of SARS.
In this context the term ‘health-care worker’ includes all hospital staff. The definition of the health care unit in which the cluster occurs will depend on the local situation. Unit size may range from an entire health care facility if small, to a single department or ward of a large tertiary hospital.
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