Severe Acute Respiratory Syndrome
Interim Guidelines, March 25, 2003

Biosafety Advisory

Subsequent to the recent cases of Severe Acute Respiratory Syndrome (SARS) in Canada¹, we are providing you with the following interim biosafety advisory regarding the laboratory handling of clinical specimens associated with this syndrome.

Note : Precautions for the collection of clinical specimens and other infection control measures are currently being developed by Health Canada as a separate document.

Precautions for laboratories receiving and processing clinical specimens and tissue samples from suspected SARS cases¹:

• specimens may be processed for packaging and distribution to diagnostic laboratories for further testing in a Containment Level 2 laboratory² using the additional operational practices as outlined below
• routine diagnostic testing (including routine viral culture) to rule out SARS may be performed in a Containment Level 2 laboratory² using the additional operational practices as outlined below (such conventional procedures have not yet been shown to grow the agent)
  (Note: laboratories performing routine diagnostics for atypical pneumonia should consider that they may inadvertently be working with specimens from a suspected SARS case)

• laboratory workers should wear protective clothing (e.g. protective solid-front gowns, gloves and N-95 respiratory protection) in accordance with the risk of exposure when handling specimens
• manipulations that may produce aerosols should be carried out in a certified biological safety cabinet
• centrifugation of respiratory and tissue specimens should be carried out using sealed centrifuge cups or rotors that are unloaded in a biological safety cabinet

Precautions for laboratories handling clinical specimens from known probable SARS cases¹ (ie. samples from patients meeting case definition) for characterization of the agent:

• specimens may be processed for packaging and distribution to laboratories for further testing in a Containment Level 2 laboratory² using the additional operational practices as outlined above
• culture-based attempts to characterize the agent and manipulations involving growth of the agent recovered in cultures of SARS specimens and tissues should be in a Containment Level 3 laboratory² using Containment Level 3 operational practices²
• inoculation of animals for potential recovery of the agent should be performed in a Containment Level 3 facility² using Containment Level 3 operational practices²
• PCR testing of extracted genetic material may be performed in a Containment Level 2 laboratory²

Transportation of clinical specimens:

• Packaging, shipping and transport of specimens must comply with the requirements of the Transportation of Dangerous Goods Regulations, Transport Canada³ and the Dangerous Goods Regulations, International Air Transport Association⁴.
• For air shipment, clinical specimens from known probable SARS cases (ie. samples from patients meeting case definition) must be shipped as Infectious Substance, affecting humans (Severe Acute Respiratory Syndrome)(Risk Group 3).

Further biosafety information may be obtained from the Office of Laboratory Security, Public Health Agency of Canada at (613) 957-1779, fax (613) 941-0596 or web site at: http://www.phac-aspc.gc.ca/ols-bsl/index.html

References:

1. Severe Acute Respiratory Syndrome (SARS), Health Canada
   /www.hc-sc.gc.ca/english/protection/warnings/2003/2003_11.htm
2. Laboratory Biosafety Guidelines, 3^rd Edition, Public Health Agency of Canada
   www.phac-aspc.gc.ca/ols-bsl/lbg-ldmbl/index.html
3. Transport Dangerous Goods, Transport Canada
   www.tc.gc.ca/tdg/menu.htm
4. Dangerous Goods Regulations, International Air Transport Association
   www.iataonline.com