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Transcript Respirology (2003) 8 , S9âS14 Blackwell Science, LtdOxford, UKRESRespirology1323-77992003 Blackwell Science Asia Pty LtdNovember 20038S1S9S14Original Article SARS: epidemiologyM Chan-Yeung and R-H Xu Correspondence: Moira Chan-Yeung, University Depa- rtment of Medicine, 4/F, Professorial Block, Queen Mary Hospital, Hong Kong, SAR, China, Tel. 852-2855-4385; Fax: 852-2855-1143; E-mail: [email protected] SARS: epidemiology Moira CHAN-YEUNG 1 AND Rui-Heng XU 2 1 The University of Hong Kong, Hong Kong, SAR, 2 Centre for Diseases Control, Guangzhou, China SARS: epidemiology M CHAN-YEUNG, R-H XU. Respirology 2003; 8 : S9âS14 Severe acute respiratory syndrome (SARS) originated in Southern China in November 2002, and was brought to Hong Kong in February 2003. From Hong Kong, the disease spread rapidly worldwide but mostly to Asian countries. At the end of the epidemic in June, the global cumulative total was 8422 cases with 916 deaths (case fatality rate of 11%). People of all ages were affected, but predom- inantly females. Health care workers were at high risk and accounted for one-fifth of all cases. Risk factors for death included old age and comorbid illnesses, especially diabetes. The disease is caused by a novel coronavirus and is transmitted by droplets or direct inoculation from contact with infected surfaces. Contaminated sewage was found to be responsible for the outbreak in a housing estate in Hong Kong affecting over 300 residents. The mean incubation period was 6.4 days (range 2â10). The duration between onset of symptoms and hospitalisation was from 3 to 5 days. The relatively pro- longed incubation period allowed asymptomatic air travellers to spread the disease globally. The number of individuals infected by each case has been estimated to be 2.7. Effective control of nosocomial transmission included early detection of disease, strict isolation of patients, practice of drop- let and contact precautions and compliance with the use of personal protective equipment. Effective control of disease spread in the community included tracing and quarantine of contacts. Develop- ment of a validated diagnostic test and an effective vaccine as well as elimination of possible animal reservoirs are measures needed to prevent another epidemic. Key words: epidemiology, fatality rate, risk factors, severe acute respiratory syndrome, transmission. INTRODUCTION Severe acute respiratory syndrome (SARS) is the first new disease of the 21st century that poses a threat to international health with global epidemic potential. The disease first emerged in mid November 2002 in Guangdong Province, China. 1 Once it reached Hong Kong in late February, the disease spread very rapidly to other parts of the world by international air travel. 1 The rapidity with which the disease has spread indicated that the causative agent is infectious and viru- lent. The relatively long incubation period of up to 10 days 2 allows the virus to be transported globally by air travellers, many of whom did not show any symp- toms of illness prior to their travel. The World Health Organization (WHO) named this atypical pneumonia âSevere Acute Respiratory Syndrome (SARS)â because of its severity. 3 The cost to the economy has been esti- mated to be US$30 billion in the Far East alone. 4 The WHO and several governments issued travel advice to hard-hit areas. Hospitals, schools and borders were closed. In addition to the thousands of individuals who contracted the disease and the hundreds who died from it, thousands were quarantined and iso- lated. Severe acute respiratory syndrome affected every aspect of living for the citizens in hard-hit areas. The purpose of this article is to examine the history of the outbreak and the epidemiology of the disease. HISTORY OF THE OUTBREAK AND THE CUMULATIVE NUMBER OF CASES AND DEATHS IN VARIOUS COUNTRIES IN THE ASIAN-PACIFIC REGION Table 1 shows the global cumulative total cases of probable SARS and the number of deaths from it at the conclusion of the epidemic. 5 The epidemic curves of probable cases of SARS by week of onset worldwide and the various Asian-Pacific countries are shown in Fig. 1. In China, the epidemic curve was by the week of reporting rather than by the week of onset of disease. S10 M Chan-Yeung and R-H Xu China This disease could be traced to the province of Guangdong, China in midNovember, 2002. On February 11, the WHO received reports from the Chi- nese Ministry of Health of an outbreak of 305 cases with five deaths of acute respiratory syndrome in Guangdong, China. 1 No further information was provided until March 26, 2003 when China updated its numbers; there were a total of 792 cases and 31 deaths. 6 China began daily reporting of SARS cases in early April. By April, the epidemic has spread and reached its peak in Beijing and several parts of China without the central government recognizing the seri- ousness of the situation. On April 20, China removed the national health minister and the city mayor of Beijing for their poor handling of the SARS crisis and pledged full cooperation with the WHO. 7 Control measures including isolation, contact tracing and quarantine, supported by the highest level of govern- ment, resulted in a rapid decline of cases in that country. The WHO removed their travel advice and the list of areas with recent local transmission from Beijing on June 24. 8 China accumulated a total of 5327 probable cases with 349 deaths at the conclusion of the epidemic. It has a case fatality ratio of 7%. Hong Kong Severe acute respiratory syndrome was brought to Hong Kong on February 21 2003 by an infected med- ical doctor from Guangdong, China who checked into Hotel M. From Hong Kong it spread rapidly to Hanoi, Toronto and Singapore. It has been estimated that at least 12 guests and visitors to the ninth floor of Hotel M in Hong Kong became infected through contact with this medical doctor, in ways that remain as yet unknown, and initiated outbreaks in these places. The index case of Hong Kongâs first outbreak visited another guest on the same floor of this hotel. The index case was admitted to the Prince of Wales Hos- pital where he infected directly and indirectly 138 hospital staff, patients and visitors from March 11 to March 25, 2003. 9 At that time, SARS had not yet been recognized as a highly infectious disease. The disease involving health care workers initially was spread very rapidly to the community by visitors to the ward. The major SARS outbreak in the community occurred in Amoy Gardens, a high-rise apartment complex, infecting 329 residents in late March. This outbreak could be traced back to a patient discharged from the same ward of Prince of Wales Hospital. 10 A high proportion of patients with SARS in Hong Kong could be linked with the first index case but the exact proportion is not known at present. The porous bor- der between Hong Kong and southern China ren- dered the epidemic hard to control. Vietnam Severe acute respiratory syndrome was first identified in Vietnam on February 28 by Dr Carlo Urbani, a WHO epidemiologist, who died of the disease later in Thai- land. 11 Dr Urbani examined a ChineseâAmerican who travelled to Hanoi via Hong Kong and stayed in Hotel M on the same floor as the medical doctor from Guangdong. The Vietnamese Government collabo- rated very closely with the WHO to bring the disease under control very quickly. In Hanoi, the cumulative number of cases was only 63 and it was removed from the list of areas with local transmission as early as April 28. 11 Singapore Three guests from Hotel M returned to Singapore in late February. On March 6, 2003, the Ministry of Health was notified of three persons with pneumonia; these included two of the three travellers. The out- Table 1 Cumulative number of cases of SARS and deaths globally and in Asian-Pacific Region, November , 2002âAugust 7, 2003 Country Cumulative number of cases Number of deaths Case-fatality rate % Australia 5 0 â Canada 251 41 17 China 5327 349 7 Hong Kong, SAR, China 1755 300 17 Taiwan 346 37 11 Indonesia 2 0 â Malaysia 5 2 â New Zealand 1 0 â Philippines 14 2 â Korea 3 0 â Singapore 238 33 14 Thailand 9 2 â Vietnam 63 5 8 Global 8098 774 9.6 SARS: epidemiology S11 break in Singapore had been characterized by noso- comial transmission caused by persons who were not immediately recognized as having SARS. 12 The first major extension of the illness outside the health care setting was from a SARS patient to two taxi drivers and the patientâs coworkers in a wholesale market. Swift action by health authorities in conducting con- tact tracing, enforcing isolation and quarantine limited the spread of the disease. 12 Canada Toronto was among the first areas affected when one of the guests from Hotel M in Hong Kong returned home in late February. 13 The outbreak in Toronto occurred early, as in Hong Kong and Singapore, when the nature of the disease was not known. Severe acute respiratory syndrome

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Mathematical Modeling of SARS Transmission in Singapore: from a Public Health Perspective Stefan Ma 1, Marc Lipsitch 2 1 Epidemiology & Mathematical Modeling of SARS Transmission Disease Control. in Singapore: from a Public Health Perspective Stefan Ma1, Marc Lipsitch2 1Epidemiology & (/documents/mathematical-modeling-of-sars-transmission-inDisease Control Division Ministry… singapore-from-a-public-health.html)

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SARS MUDr. Vladimír Moravec SARS MUDr. Vladimír Moravec. Smrtelná nemoc SARS, která se stává první nejzávažnější epidemií 21. Století. Její postup (/documents/sars-mudr-vladimir-moravec.html) je rychlý a obtížně kontrolovatelný.…

Responding to SARS Responding to SARS. John Watson Health Protection Agency Communicable Disease Surveillance Centre, London. November 2002. (/documents/responding-to-sars.html) Outbreak of pneumonic illness in Guangdong province… Total SARs: 78,491 Suspicious Activity Report Filing Trend for the State of South Dakota For the Period January 1, 2002 through December 31, 2011. Total (/documents/total-sars-78491.html) SARs: 78,491. - PowerPoint PPT Presentation

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SARS: The Toronto Experience SARS: The Toronto Experience. SARS Toronto: Phase I & II. Case Distribution by Age Group. Case Fatality by Age Group. SARS (/documents/sars-the-toronto-experience.html) Toronto: Phase I & II. The Problem:. The…

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