Severe Acute Respiratory Infection (SARI) Case Definition

Revised April 12, 2013

The Public Health Agency of Canada requests that confirmed cases be reported within 24 hours of being classified as such.

The case definition for reporting SARI is applicable to any person meeting all of the following five criteria (I, II, III, IV and V)

SARI case (A)

A person admitted to hospital with the following:

1. Respiratory symptoms, i.e.
   
   • Fever^{Footnote 1} (over 38 degrees Celsius) AND new onset of (or exacerbation of chronic) cough or breathing difficulty

   AND

2. Evidence of severe illness progression, i.e.
   
   • Either radiographic evidence of infiltrates consistent with pneumonia, or a diagnosis of acute respiratory distress syndrome (ARDS) or severe ILI^{Footnote 2}, which may also include complications such as encephalitis, myocarditis or other severe and life-threatening complications

   AND

3. Either admission to the ICU/other area of the hospital where critically ill patients are cared for OR mechanical ventilation

   AND

4. No alternate diagnosis within the first 72 hours of hospitalisation, i.e.
   
   • Results of preliminary clinical and/or laboratory investigations, within the first 72 hours of hospitalisation, cannot ascertain a diagnosis that reasonably explains the illness.

   AND

5. One or more of the following exposures/conditions:

   • Residence, recent travel (within ≤ 10 days of illness onset) to a country where human cases of novel influenza virus or other emerging /re-emerging pathogens have recently been detected or are known to be circulating in animals^{Footnote 3}.
   • Close contact^{Footnote 4} with an ill person who has been to an affected area/site within 10 days prior to onset of symptoms.
   • Exposure to settings in which there have been mass die-offs or illness in domestic poultry or swine in the previous six weeks.
   • Occupational exposure involving direct health care, laboratory or animal exposure:
     • Health care exposure involving health care workers who work in an environment where patients with severe acute respiratory infections are being cared for, particularly patients requiring intensive care; OR
     • Laboratory exposure in a person who works directly with Laboratory biological specimens; OR
     • Animal exposure in a person employed as one of the following:
       - Poultry/swine farm worker
       - Poultry/swine processing plant worker
       - Poultry/swine culler (catching, bagging, transporting, or disposing of dead birds/swine)
       - Worker in live animal market
       - Dealer or trader of pet birds, pigs or other potentially affected animals
       - Chef working with live or recently killed domestic poultry, swine or other potentially affected animals
       - Veterinarian worker
       - Public health inspector/regulator

SARI case (B)

A deceased person with the following:

1. A history of respiratory symptoms, i.e.
   • History of unexplained acute respiratory illness (including fever, and new onset of (or exacerbation of chronic) cough or breathing difficulty) resulting in death

   AND

2. Autopsy performed with findings consistent with SARI, i.e.
   • autopsy findings consistent with the pathology of ARDS without an identifiable cause

   AND

3. No alternate diagnosis that reasonably explains the illness

   AND

4. One or more of exposures/conditions, as listed above.