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      Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong

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          Summary

          Background

          Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong.

          Methods

          We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients’age and the time from onset to admission.

          Findings

          After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% Cl 5.2–7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8–16.8) for patients younger than 60 years and 43.3% (35.2–52.4) for patients aged 60 years or older assuming a parametric γ distribution. A non-parametric method yielded estimates of 6.8% (4.0–9.6) and 55.0% (45.3–64.7), respectively. Case clusters have played an important part in the course of the epidemic.

          Interpretation

          Patients’age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine.

          Published online May 7, 2003 http://image.thelancet.com/extras/03art4453web.pdf

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          Author and article information

          Contributors
          Journal
          Lancet
          Lancet
          Lancet (London, England)
          Elsevier Ltd.
          0140-6736
          1474-547X
          22 May 2003
          24 May 2003
          22 May 2003
          : 361
          : 9371
          : 1761-1766
          Affiliations
          [a ]Department of Infectious Disease Epidemiology, Imperial College London, UK
          [b ]Department of Community Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
          [c ]Department of Health, Hong Kong Special Administrative Region, China
          [d ]Hong Kong Hospital Authority, Hong Kong Special Administrative Region, China
          [e ]Department of Community and Family Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
          Author notes
          [* ]Correspondence to: Prof C A Donnelly, Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK c.donnelly@ 123456imperial.ac.uk
          Article
          S0140-6736(03)13410-1
          10.1016/S0140-6736(03)13410-1
          7112380
          12781533
          351c0c46-8da7-4876-957c-f93ac7d55678
          Copyright © 2003 Elsevier Ltd. All rights reserved.

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          Categories
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          Medicine

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