Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong
Open accessAbstract
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% CI 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 gamma 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.
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There were substantial variations among studies in symptom onset-to-hospitalisation delay, with no clear indication of what factors might drive such heterogeneity, except that the delay reduced over time because of improved population awareness.
“However, there were substantial variations among studies, with no clear indication of what factors might drive such heterogeneity (appendix 1 pp 58, 65), except that the delay reduced over time because of improved population awareness.75”
From Severe acute respiratory syndrome (SARS) mathematical models and disease parameters: a systematic review (2025) · cites this paper as [75]
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- Authors
- Donnelly, C. A., Ghani, A. C., Leung, G. M., Hedley, A. J., Fraser, C., Riley, S., Abu-Raddad, L. J., Ho, L.-M., Thach, T.-Q., Chau, P., Chan, K.-P., Lam, T.-H., Tse, L.-Y., Tsang, T., Liu, S.-H., Kong, J. H., Lau, E. M., Ferguson, N. M., & Anderson, R. M.
- Affiliations
- Imperial College London (GB)
- University of Hong Kong (HK)
- Department of Health (CN)
- Hospital Authority (HK)
- Chinese University of Hong Kong (HK)
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2003-05
- Volume
- 361
- Issue
- 9371
- Pages
- 1761-1766
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7112380
- OpenAlex
- W1990049863
- Cited by
- 940
- References
- 3
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 15 · 2023: 18 · 2022: 39 · 2021: 93 · 2020: 154 · 2019: 18 · 2018: 5 · 2017: 10 · 2016: 15 · 2015: 17 · 2014: 15 · 2013: 20 · 2012: 9
- FWCI
- 71.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Howard Hughes Medical Institute
- Wellcome Trust
- Royal Society
- Medical Research Council
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- SARS, Hong Kong SARS outbreak, incubation period, case fatality rate, age and mortality, contact tracing, quarantine, public health interventions, case clusters, infectious period
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Disease Outbreaks, Female, Hong Kong, Humans, Infant, Male, Middle Aged, Quarantine, Incidence, Survival Rate, Likelihood Functions, Age Distribution, Disease Progression, Severe Acute Respiratory Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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