Global Alert and Response (GAR)

WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS). Updated recommendations, October 2004



This document sets out revised guidelines for the global surveillance and reporting of SARS as an ongoing strategy for rapidly detecting cases and preventing further national or international spread. Addressed to national health authorities, the guidelines respond to the need for a sustainable long-term approach to SARS surveillance that maintains an adequate level of sensitivity yet does not overburden health system capacity. With this objective in mind, the document adopts a phased approach to surveillance and preparedness, with different levels of activity recommended for each of four phases. These phases move from the absence of evidence that the SARS coronavirus (SARS-CoV) is circulating in human populations, to the detection of human chains of transmission, to evidence of international spread, to the post-epidemic period.

The revised guidelines, which replace a previous document issued in August 2003, draw on experiences during four recent incidents in which cases of SARS occurred following breaches in laboratory biosafety, or human exposure to an animal reservoir or other environmental source. Apart from demonstrating the importance of continued vigilance, these incidents revealed the need for more precise guidance on laboratory testing and on the requirements for official reporting to WHO. Throughout the document, specific recommendations take into account the high demands of a disease with non-specific symptoms and a diagnosis that requires multiple test results and rigorous procedures for quality assurance. Particular emphasis is given to the prevention of secondary transmission from sporadic cases and common source outbreaks as a strategy for reducing the risk of another international outbreak.


- Executive summary
- 1. Introduction
- 2. Clinical and laboratory criteria for the global surveillance of SARS
- 3. The inter-epidemic period – The SARS Alert
- 4. The global surveillance of SARS during an outbreak
- 5. International reporting of SARS
- Annex 1. Summary of the essential aspects of the SARS Risk Assessment and Preparedness Framework
- Annex 2. Clinical case description of SARS
- Annex 3. Guidance regarding the diagnosis of SARS in the inter-epidemic period
- Annex 4. WHO focal points for SARS
- References