To reduce the risk of the spread of the Severe Acute Respiratory Syndrome (SARS) it is recommended to adopt the following precautions and procedures:

1. See a doctor if you have recently just returned from any of the affected areas and have flu-like symptoms, for example: fever,     muscle ache, headache and sore throat. However, you should note that most flu-like illnesses are mild and you will recover with     simple medication.
2. If you have recently just returned from any of the affected areas and have high fever anddifficulty in breathing, you should go     immediately to a hospital for the necessary management.
3. Inform your doctor of your recent travel history and be advised not to undertake further travel until you have fully recovered.

1. Reassure the patient. Stress that most flu-like illnesses are not serious and will resolve spontaneously or with simple     medications.
2. However in view of the current situation, certain precautions have to be taken and the patient should be advised to seek     treatment at a hospital immediately if he develops high fever and difficulty in breathing.
3. For those patients who have recently returned from the affected areas and present with high fever and difficulty in breathing     should be referred to a hospital for further management.
4. Notify the nearest Health Office of the cases that meet the definition of suspected SARS using the following procedure:
    i.  complete the notification form KKM/BKP/SARS/2003/1.
    ii. send the notification form to the District Health Office by fax on the same day. If a fax is not available inform the District Health         Office by phone.

        Passenger or crew member who has the symptoms of SARS or history of travel on the plane, the aircraft should alert the destination airport. On arrival the sick passenger shouldbe referred to the airport health authorities for assessment and management. The aircraft passengers and crew should be informed of the persons status as a suspect case of SARS.They should provide all contact details for the subsequent 14 days to the airport health authorities. Currently there are no indications to restrict the onward travel of healthy passengers,but all the passengers and crew should be advised to seek for medical attention if they havethe symptoms of SARS. There is currently no indication to provide passengers and crew with any medication or investigation unless they become ill.

       The Ministry of Health of Malaysia needs cooperation of all airlines having travel links with the affected countries in carrying
out some precautions:

Measures before boarding a flight. The airlines must ensure that all passengers have undergone pre-departure screening before boarding the flight.

• Passengers screened and and found to be free from SARS are allowed to board the flights.  
• Pre-departure screening is to be done in cooperation of national health officials and port authorities.

Measures on board the flight. The flight commander of the aircraft should make announcementson board for passengers with the symptoms to indentify themselves to the crew.

• Passengers should also be informed that upon arrival they will be subjected to health screening.
• Crew members should lookout for passengers who may have symptoms but do not identify themselves.
• The commander of the aircraft is to inform the authorities of the destination airport with regards the number of passengers with SARS symptoms.
• Those passengers that identified are to be given appropriate protective masks (N95) and if possible these passengers are to be shifted to the rear of the aircraft. Otherwise vacate 2 rows in-front and 2 rows at the back of the passenger with symptom.
• If possible a separate toilet be identified for use of such passengers only.
• The crew are to wear a protective masks and disposable gloves if they have to handle any of the passengers/utensils used by the passengers.
• The utensils that are used by these passengers are to be packed separately.
• The commander of the aircraft should identify the contacts of the passenger.The contacts are passengers sitting in the same  row or within two rows in front of or behind the ill passenger, all flight attendants on board, anyone having contact with respiratory secretions of the ill passenger , anyone on the flight living in the same household as the ill passenger and if it is a flight attendant who is a suspect or probable SARS case, all the passengers are considered as contacts.
• Contacts should provide, to the health authorities, identification and details of contact /address for the next 14 days.
• If the passenger with symptoms becomes classified as a probable case of SARS, the health authority where the case is being cared for should inform other health authorities in those areas in which the contacts reside that active surveillance of each contact ( daily temperature check and interview by health care worker) should be undertaken until 10 days after the flight.

Measures Upon Arrival ( For the passenger )

• All the passengers should hand over the health declaration card to the health officials at the airport and be subjected to health screening.
• The airlines staff and the airport authorities with the cooperation of the health authorities are to send the passengers without delay to the nearest hospital designated for the management of these cases.
• The airlines should make available details of the other passengers for follow up should theneed arise. The details required are the address while in Malaysia and the telephone contactnumber.
• The airline should make the necessary arrangements for disinfection of aircraft cabin.

Measures upon arrival (disinfection for the aircraft)

• The personnel who are involved in the disinfection of the aircraft are to wear disposable waterproof gloves and facemask.
• Compressed air should not be used for cleaning as this may re-aerosolize infectious material.
• All materials used including personal protective equipment are to be disposed off separately and labeled as ?hazardous material? This waste material should not be carried on the aircraft.
• Hygienic practices like washing of hands with water and soap or alcohol based hand sanitizers after removal of the gloves should be made mandatory.
• The disinfectant that can be used are as follows;
      i) ECO TRU 1453
      ii) ECO TRU FMD
      iii) EEE941A
      v) Hospital grade disinfectant as approved by health authorities. Other measures as outlined in the WHO Disinfection of        Aircraft Guidance.

GUIDELINES ON THE PREVENTION OF SPREAD OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) IN SCHOOLS

Ministry of Health Malaysia.

1. PREVENTIVE MEASURES
   1.1 Explain to school staff and students on the importance of personal hygiene in preventinginfection, especially in preventing the          infection of SARS.
   1.2 Mention the serious consequence of spread of the infection especially in the school environment.
   1.3 Emphasise that everyone in the schools has the responsibility to prevent the spread of SARS.
   1.4 Encourage staff and students to seek medical advice immediately, and notify the school and the nearest Health Office, in          case of any suspected infection of SARS involving themselves or their families.
   1.5 Include relevant topics of infectious disease in the learning activities.
   1.6 Staff and students should be reminded to put their knowledge into practice and observe personal hygiene in order to avoid          infection. They should also convey this message to their parents, relatives and friends.
   1.7 Disseminate the message to parents through seminars or newsletters and distribute to them leaflets or relevant materials          publisheby the Ministry of Health, Malaysia. The students and their parents will be provided with such information as the          hotlines and websites of the

Public Health Department.

2. PRECAUTIONARY MEASURES
   2.1 Schools should formulate precautionary and contingency measures as advised by the Ministry of Health.
   2.2 Children with fever should not go to school and must consult their doctors immediately.
   2.3 Students should be reminded to be aware of their own or their classmates? physical condition during assembly or class          periods. If they are unwell, they should inform their teachersand classmates immediately. Students should also be reminded          not to eat from the same lunch box or drink from the same cup to avoid infection.
   2.4 Maintain good cleanliness and ventilation in the school hall and classrooms. Windows should be kept open. Air filters should          be cleansed frequently if air conditioners are used. Objects and equipment frequently touched by students, such as          computer keyboards, should be wiped regularly with a diluted clorine-based agent (sodium hypochlorite, 0.1%-0.5% -          household bleach) and left for 5 - 10 minutes contact time. Selected personal objects of pupils should be soaked regularly          using diluted household bleach. If a school bus is used to carry pupils to the school, good cleanliness and sanitation of the          vehicle compartment should be ensured as well.
   2.5 Liquid soap should be provided in the toilets. Public towels should not be used. Noticesshould be posted to require staff and         students to use liquid soap for hand washing to avoid infection.
   2.6 In organizing internal or external group activities, good ventilation of the venue should be taken into account. Crowdedness         should be avoided. Students who are unwell should be persuaded to avoid participating in school activities.
   2.7 Keep an up-to-date sick leave record of students and staff and obtain their prior consent for the release of personal data,            such as names and telephone numbers to the health officefor investigation and follow-up action.
   2.8 If a student or staff member is unwell (including the school bus driver and school bus attendant), he (she) should be sent to         an isolated and quiet place for rest. Their family members should be contacted to take them home. In case of a student, he         (she) should be sent home with a note suggesting medical attention. If the student is with a fever or seriously ill, he (she)         should be sent to the Accident and Emergency Department of a nearby hospital if parents/guardians cannot be contacted.
   2.9 Carers of staff and students who are unwell should put on masks to avoid infection.
   2.10 In case of an unusual increase in absentees or having a large number of absentees with symptoms similar SARS, eg. fever,           cough, headache, body pain and lack of energy, the Ministry of Health and the Education Department should be notified           immediately.

3. ALERT MEASURES
   Staff member / student displays no symptom but confirmed to have contacted family member(s) or any medical staff who had    been infected with the disease.
   3.1 The name of the affected staff member/student and the school will be provided to the Education Department will request the         staff member / student to stay home for 10 days for observation (the incubation period for SARS lasts for about 10 days). No         medical certificate is required during the observation period while such absence can be recorded as sick leave by the school.
   3.2 If a school has learned from other sources that a student had contact with any family member or medical or medical staff         diagnosed with the disease, it should confirm the information with the Ministry of Health in the first place before reporting to         the Education Department for follow up action.
   3.3 The school should clean and disinfect the affected areas as specified by the Ministry ofHealth. All the students should be          reminded to take precautions accordingly.
   3.4 If the student being requested to stay home for observation suffers from mental or psychological pressure, the schooI should         offer guidance support.
   3.5 To alleviate the impact on the affected student in respect of academic performance, the school should provide support for          learning to the student during the suspension period. For instance, learning materials or assistance can be provided by          means of telephone, e-mail, fax or the school homepage with the help of his/her classmates or teachers.
 
4. CONTINGENCY MEASURES
   Staff member/student confirmed to have contracted SARS
   4.1 If the attack or hospitalization period of the infected staff member/student is less than 1 week ago, the whole school will         suspend classes for 10 days
        4.1.1 From the first day of the sick leave of the confirmed SARS case, the whole school willsuspend classes for 10 days (the                 incubation period is 10 days). In order to reduce the negative effects on the schooling of students, the number of days                 of suspension is to be deductedfrom the annual school holidays.
       4.1.2 Clean and disinfect the specified area of the school compound according to the instruction of the Ministry of Health.
       4.1.3 Inform all parents of the situation. By doing so, their anxieties may be relieved. They should also be reminded to be alert                of the physical condition of their children.
       4.1.4 Remind all staff members and students that during the suspension period, they should seek medical treatment and                inform the school and the Ministry of Health without any delay if there are any symptoms of the illness. When the                suspension period is over, staff members andstudents who are sick, especially those with symptoms such as fever,                cough, etc, should still be discouraged from attending school.
      4.1.5 If the suspension period has to be extended, the school should inform the Ministry of Health and the District Education               Office. The Ministry of Health will evaluate the situationbefore a decision is made.

   4.2 If the suspension or hospitalization period of the infected staff member/student is morethan 10 days ago, and no other person         in the school displays symptoms of the disease, normalschool should be resumed.
      4.2.1 Normal school should be resumed but the situation of all the staff members and students should be closely monitored. If               the situation worsens, the Ministry of Health and the District Education Office should be notified immediately.
      4.2.2 Clean and disinfect the specified area of the school compound according to the instruction of the Ministry of Health.                Remind all the staff members and students to take precautionary measures thoroughly.
      4.2.3 Keep all the parents informed of the situation so that their anxieties can be alleviated. They should also be reminded to               be alert to the physical health of their children.
      4.2.4 Under special circumstances the school may consider suspending classes. The Ministry of Health and the District               Education Department should be notified. The Ministry of Health will evaluate the situation before a decision is made. The               number of days of suspension is to be deducted from the annual school holiday.

5. SUPPORT / ENQUIRIES
   5.1 Ministry of Health
         Telephone numbers of the Public Health Department (PHD) are given as below:
         Public Health Department    603 2694 6601
         Disease Control Division      603 2694 6382
         Operations Room Hotline 1. 603 2694 6394
         Operations Room Hotline 2. 603 2693 8053
         Facsimile No:                     603 2694 4193 

Source from The Ministry of Health Malaysia.