Interim Travel Alert: Singapore
(Updated May 6, 2003, 1:30 PM ET; Released March 13, 2003)

The Centers for Disease Control and Prevention (CDC) has been working closely with the World Health Organization (WHO) and other partners to investigate cases of Severe Acute Respiratory Syndrome (SARS). The number of cases of SARS is subject to change as surveillance increases and cases are identified and confirmed. The current case count for the United States can be found at this web site. The case count for cases outside the USA can be found at this site. CDC updates information on its website on the travel status of areas with SARS as the situation evolves.

CDC has issued two types of notices to travelers: alerts and advisories. A travel advisory recommends that nonessential travel be deferred; a travel alert, does not advise against travel, but informs travelers of a health concern and provides advice about specific precautions.

CDC is now downgrading its traveler’s notification for Singapore from a travel advisory to a travel alert.

Reasons for removal of the advisory include the following:

• Currently, SARS transmission in Singapore is limited to a small number of households and a well defined specific community setting through direct person-to-person spread.
• The onset of symptoms of the last reported case not occurring in a defined community setting was on April 14, 2003. More than 20 days, or two SARS incubation periods, have elapsed since that date.
• Monitoring by the Ministry of Health of Singapore indicates that there are no new outbreaks of illness in Singapore, and there is adequate surveillance for SARS in place.
• To view the epi curve, see: http://www.who.int/csr/sarsepicurve/epiindex/en/

CDC continues to recommend that U.S. travelers to Singapore observe precautions to safeguard their health. To minimize the possibility of infection, avoid close contact with large numbers of people as much as possible. CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.

As with many infectious diseases, the first line of defense is careful hand hygiene. As a general rule, it is good practice to wash hands frequently with soap and water; if hands are not visibly soiled, alcohol-based hand rubs may be used as an alternative. Persons planning travel to Singapore should be aware of the current SARS outbreak, stay informed daily about SARS through the various websites, including http://www.cdc.gov/ncidod/sars/ and http://www.who.int/, and closely follow recommended travel advisories and infection control guidance. CDC continues to be aware of limitations in medical evacuation services for SARS patients. Travelers and resident expatriates should continue to monitor the U.S. Department of State website for updates on availability of medical services and medical evacuations in Singapore.

CDC is distributing health alert notices about SARS to people traveling to the United States from Singapore. Travelers to Singapore should monitor their health while there and for at least 10 days after departure from Singapore. If fever or respiratory symptoms (for example, cough or shortness of breath) develop, a visit to a health-care provider is strongly recommended. The provider should be informed about the symptoms in advance so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.

For information about infection control in health-care and community settings, see this website:

• http://www.cdc.gov/ncidod/sars/infectioncontrol.htm

SARS updates will be posted as information becomes available.

Additional information on the outbreaks can be found at the following websites:

• Severe Acute Respiratory Syndrome (SARS)
• http://www.cdc.gov/mmwr/mmwr_wk.html
• http://www.who.int/csr/sars/en/