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Abstract
As yet, no one has written a comprehensive epidemiologic account of a severe acute
respiratory syndrome (SARS) outbreak from an affected country.
To provide a comprehensive epidemiologic account of a SARS outbreak from an affected
territory.
Epidemiologic analysis.
The 2003 Hong Kong SARS outbreak.
All 1755 cases and 302 deaths.
Sociodemographic characteristics; infection clusters by time, occupation, setting,
and workplace; and geospatial relationships were determined. The mean and variance
in the time from infection to onset (incubation period) were estimated in a small
group of patients with known exposure. The mean and variance in time from onset to
admission, from admission to discharge, or from admission to death were calculated.
Logistic regression was used to identify important predictors of case fatality.
49.3% of patients were infected in clinics, hospitals, or elderly or nursing homes,
and the Amoy Gardens cluster accounted for 18.8% of cases. The ratio of women to men
among infected individuals was 5:4. Health care workers accounted for 23.1% of all
reported cases. The estimated mean incubation period was 4.6 days (95% CI, 3.8 to
5.8 days). Mean time from symptom onset to hospitalization varied between 2 and 8
days, decreasing over the course of the epidemic. Mean time from onset to death was
23.7 days (CI, 22.0 to 25.3 days), and mean time from onset to discharge was 26.5
days (CI, 25.8 to 27.2 days). Increasing age, male sex, atypical presenting symptoms,
presence of comorbid conditions, and high lactate dehydrogenase level on admission
were associated with a greater risk for death.
Estimates of the incubation period relied on statistical assumptions because few patients
had known exposure times. Temporal changes in case management as the epidemic progressed,
unavailable treatment information, and several potentially important factors that
could not be thoroughly analyzed because of the limited sample size complicate interpretation
of factors related to case fatality.
This analysis of the complete data on the 2003 SARS epidemic in Hong Kong has revealed
key epidemiologic features of the epidemic as it evolved.
[1
]From University of Hong Kong, Government of the Hong Kong Special Administrative Region,
and Hong Kong Hospital Authority, Hong Kong, China, amd Imperial College, University
of London, London, United Kingdom.