gms | German Medical Science

Background: In the August 14, 2003 document "Alert, verification and public health management of SARS in the post-outbreak period" [Ref. 1], WHO recommends to survey for clusters of "alert" cases among healthcare workers (HCW) in low risk area (i.e. never reported cases, reported only imported cases or experienced only limited local transmission during the previous outbreak). A SARS alert case is defined as the occurrence of two or more HCW in the same health care unit fulfilling the clinical case definition of SARS (i.e. unexplained pneumonia), and with onset of illness in the same 10-day period.

Objective: To evaluate the feasibility of the recommended surveillance system, and to determine the value of routinely collected sickness absence data in the context of this surveillance.

Methods: Administrators of 6 Italian hospitals (3 General, 2 University and 1 Research hospital), all with at least an infectious disease (ID) and a respiratory tract diseases unit, were contacted to find out whether diagnoses of pneumonia in HCW were available from routinely collected sickness absence data. Of note, 3 of the 4 imported cases of probable SARS observed in Italy during 2003 were cared for in two of these hospitals.

The same question was made to ID or Public Health experts in France (7 imported cases of SARS, 2 of whom in HCW), Spain (1 case), and Denmark (no case).

In two of the Italian hospitals (an ID Research Hospital with 180 beds including 20 dedicated to respiratory tract infections, and a University Hospital with 400 medical ward beds, 60 of which for infectious diseases), we also checked how many episodes of sickness absence longer than 7 days, were recorded in 2003 among HCW assigned to the same adult medical health care unit and with onset of illness in the same 10-day period, regardless of diagnosis.

Results: In all the Italian hospitals sickness certificates, provided by the general practitioners, are recorded only for administrative purposes, and do not specify the diagnosis. In the other European Countries the situation is similar. A total of 11 clusters of absences longer than 7 days involving 28 HCW were identified in the ID hospital; the findings were 3 clusters and 6 HCW in the University Hospital.

Conclusions: In Italy as in several other European Countries, no data are routinely available in hospitals that could be used for an early detection of cases and clusters of severe unexplained respiratory infections that might signal the re-emergence of SARS. To overcome this lack of data, we suggest that an active assessment of diagnosis could be performed in selected circumstances of HCW sickness absences. Assuming that a case of pneumonia determines at least 7 days of absence, our data show that the number of episodes that would need an active assessment are infrequent. Thus, a surveillance based on these criteria appears to be feasible and would not significantly affect the right of HCW to privacy.

Performed within Ministero della Salute Ricerca Finalizzata and Ricerca Corrente IRCCS.

We thank all the colleagues who answered to our interview