Other clinical guidance has also been developed but again is probably only applicable to the adult population. 40 The case definition for clinical SARS used by Leung et al. in Hong Kong was: fever (rectal temperature of 38.58C or oral temperature of 388C); chest radiograph (CXR) findings of pulmonary infiltrates or acute respiratory distress syndrome; and suspected or probable contact with a person under investigation for SARS or exposure to a locality with suspected or documented community transmission of SARS through either travel or residence within 10 days of the onset of symptoms, as well as 1 of the following: chills, malaise, myalgia, muscle fatigue, cough, dyspnoea, tachypnoea, hypoxia, lymphopenia, decreasing lymphocyte count, or failure to respond, in terms of fever and general well-being, to antibiotics covering the usual pathogens of community-acquired pneumonia (e.g. a broad-spectrum lactam plus a macrolide) after 2 days of therapy. This case definition had a sensitivity and specificity of 97.8% and 92.7% respectively in identifying paediatric SARS during the SARS outbreak. 36 While almost all reported patients with laboratory evidence of SARS have radiographic evidence of pneumonia at some point during their illness, paediatric SARS have non-specific radiographic features, making it difficult for radiological differentiation. 41 A private general clinic participating in the SARS-screening programme in Hong Kong during the SARS epidemic -by using telephone triage followed by chest radiograph of cases with 'flu-like' illness, the author successfully and safely screened 1161 attendees, X-rayed 151 patients and diagnosed one case of SARS. Therefore, a chest X-ray (CXR) would be a useful screening tool during outbreaks. 42 A SARS and avian influenza algorithm for early recognition and investigation of potential paediatric cases, modified from the UK Health Protection Agency's algorithm, is suggested in the Appendix. 40