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Article: The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: An analysis of all 1755 patients

TitleThe epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: An analysis of all 1755 patients
Authors
Issue Date2004
PublisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.org
Citation
Annals Of Internal Medicine, 2004, v. 141 n. 9, p. 662-673 How to Cite?
Abstract
Background: As yet, no one has written a comprehensive epidemiologic account of a severe acute respiratory syndrome (SARS) outbreak from an affected country. Objective: To provide a comprehensive epidemiologic account of a SARS outbreak from an affected territory. Design: Epidemiologic analysis. Setting: The 2003 Hong Kong SARS outbreak. Participants: All 1755 cases and 302 deaths. Measurements: 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. Results: 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. Limitations: 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. Conclusions: 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.
Persistent Identifierhttp://hdl.handle.net/10722/86633
ISSN
2013 Impact Factor: 16.104
ISI Accession Number ID
References

 

Author Affiliations
  1. The University of Hong Kong
DC FieldValueLanguage
dc.contributor.authorLeung, GMen_HK
dc.contributor.authorMedley, AJen_HK
dc.contributor.authorHo, LMen_HK
dc.contributor.authorChau, Pen_HK
dc.contributor.authorWong, IOLen_HK
dc.contributor.authorThach, TQen_HK
dc.contributor.authorGhani, ACen_HK
dc.contributor.authorDonnelly, CAen_HK
dc.contributor.authorFraser, Cen_HK
dc.contributor.authorRiley, Sen_HK
dc.contributor.authorFerguson, NMen_HK
dc.contributor.authorAnderson, RMen_HK
dc.contributor.authorTsang, Ten_HK
dc.contributor.authorLeung, PYen_HK
dc.contributor.authorWong, Ven_HK
dc.contributor.authorChan, JCKen_HK
dc.contributor.authorTsui, Een_HK
dc.contributor.authorLo, SVen_HK
dc.contributor.authorLam, THen_HK
dc.date.accessioned2010-09-06T09:19:26Z-
dc.date.available2010-09-06T09:19:26Z-
dc.date.issued2004en_HK
dc.identifier.citationAnnals Of Internal Medicine, 2004, v. 141 n. 9, p. 662-673en_HK
dc.identifier.issn0003-4819en_HK
dc.identifier.urihttp://hdl.handle.net/10722/86633-
dc.description.abstractBackground: As yet, no one has written a comprehensive epidemiologic account of a severe acute respiratory syndrome (SARS) outbreak from an affected country. Objective: To provide a comprehensive epidemiologic account of a SARS outbreak from an affected territory. Design: Epidemiologic analysis. Setting: The 2003 Hong Kong SARS outbreak. Participants: All 1755 cases and 302 deaths. Measurements: 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. Results: 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. Limitations: 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. Conclusions: 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.en_HK
dc.languageengen_HK
dc.publisherAmerican College of Physicians. The Journal's web site is located at http://www.annals.orgen_HK
dc.relation.ispartofAnnals of Internal Medicineen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAge Distributionen_HK
dc.subject.meshAgeden_HK
dc.subject.meshCluster Analysisen_HK
dc.subject.meshDemographyen_HK
dc.subject.meshDisease Outbreaksen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHealth Personnelen_HK
dc.subject.meshHong Kong - epidemiologyen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInfectious Disease Transmission, Patient-to-Professionalen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshOdds Ratioen_HK
dc.subject.meshSevere Acute Respiratory Syndrome - epidemiology - transmissionen_HK
dc.subject.meshSex Distributionen_HK
dc.subject.meshTime Factorsen_HK
dc.titleThe epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: An analysis of all 1755 patientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4819&volume=141&issue=9&spage=662&epage=673&date=2004&atitle=The+epidemiology+of+Severe+Acute+Respiratory+Syndrome+in+the+2003+Hong+Kong+epidemic:+An+analysis+of+all+1755+patientsen_HK
dc.identifier.emailLeung, GM: gmleung@hkucc.hku.hken_HK
dc.identifier.emailHo, LM: lmho@hkucc.hku.hken_HK
dc.identifier.emailWong, IOL: iolwong@hku.hken_HK
dc.identifier.emailThach, TQ: thach@hku.hken_HK
dc.identifier.emailRiley, S: sriley@hkucc.hku.hken_HK
dc.identifier.emailLam, TH: hrmrlth@hkucc.hku.hken_HK
dc.identifier.authorityLeung, GM=rp00460en_HK
dc.identifier.authorityHo, LM=rp00360en_HK
dc.identifier.authorityWong, IOL=rp01806en_HK
dc.identifier.authorityThach, TQ=rp00450en_HK
dc.identifier.authorityRiley, S=rp00511en_HK
dc.identifier.authorityLam, TH=rp00326en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid15520422en_HK
dc.identifier.scopuseid_2-s2.0-3242687609en_HK
dc.identifier.hkuros96367en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-3242687609&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume141en_HK
dc.identifier.issue9en_HK
dc.identifier.spage662en_HK
dc.identifier.epage673en_HK
dc.identifier.isiWOS:000224839600002-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLeung, GM=7007159841en_HK
dc.identifier.scopusauthoridMedley, AJ=8050103400en_HK
dc.identifier.scopusauthoridHo, LM=7402955625en_HK
dc.identifier.scopusauthoridChau, P=34876162600en_HK
dc.identifier.scopusauthoridWong, IOL=7102513940en_HK
dc.identifier.scopusauthoridThach, TQ=6602850066en_HK
dc.identifier.scopusauthoridGhani, AC=7006814439en_HK
dc.identifier.scopusauthoridDonnelly, CA=35468127900en_HK
dc.identifier.scopusauthoridFraser, C=35460815100en_HK
dc.identifier.scopusauthoridRiley, S=7102619416en_HK
dc.identifier.scopusauthoridFerguson, NM=7103246319en_HK
dc.identifier.scopusauthoridAnderson, RM=7408244444en_HK
dc.identifier.scopusauthoridTsang, T=7101832378en_HK
dc.identifier.scopusauthoridLeung, PY=7401749022en_HK
dc.identifier.scopusauthoridWong, V=8503496500en_HK
dc.identifier.scopusauthoridChan, JCK=23090202000en_HK
dc.identifier.scopusauthoridTsui, E=9240752200en_HK
dc.identifier.scopusauthoridLo, SV=8426498400en_HK
dc.identifier.scopusauthoridLam, TH=7202522876en_HK

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