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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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“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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Mehta, S., Sashindran, V., Kumar, K., & Gupta, A. (2007) · Medical Journal Armed Forces India · doi:10.1016/s0377-1237(07)80110-9 · Cited by 4
“The frequency of occurrence of various clinical features (a meta-analysis of 4 major clinical reports) is shown in Table 2 [10-13].”
BackgroundDas schwere akute Atemwegssyndrom (SARS)
Gillissen, A., & Ruf, B. (2003) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-003-1271-z · Cited by 4
Olowokure, B., Merianos, A., Leitmeyer, K. C., & Mackenzie, J. S. (2004) · Nature Reviews Microbiology · doi:10.1038/nrmicro824 · Cited by 4
Modeling of networked populations when data is sampled or missing
Fellows, I. E., & Handcock, M. S. (2023) · METRON · doi:10.1007/s40300-023-00246-3 · Cited by 4
“Contact tracing has also been applied in many recent epidemics, including COVID-19 [1, 4, 5, 27].”
MethodImportancia de la transmisión nosocomial en el síndrome respiratorio agudo grave y su prevención
Vaqué, J., & Armadans, L. (2004) · Enfermedades Infecciosas y Microbiología Clínica · doi:10.1016/s0213-005x(04)73043-8 · Cited by 4
On the origin of the super-spreading events in the SARS epidemic
Fang, H., Chen, J., Hu, J., & Xu, L. X. (2004) · Europhysics Letters (EPL) · doi:10.1209/epl/i2004-10163-0 · Cited by 4
Modes of transmission of COVID-19 outbreak- a mathematical studyPreprint
Maji, C. (2020) · medRxiv · doi:10.1101/2020.05.16.20104315 · Cited by 4
Assessing Legal Responses to COVID-19
Burris, S., de Guia, S., Gable, L., Levin, D. E., Parmet, W. E., Terry, N. P., Solutions, C., Law, & William, S. (2020) · TUScholarShare (Temple University) · doi:10.34944/dspace/6237 · Cited by 4
“About 27 percent of SARS patients have diarrhea and since full-length genome sequences identified that SARS-CoV-2 is 79.5% identical to SARS-CoV and share the same receptor angiotensin-converting enzyme 2 (ACE2), it is estimated that rate of gastrointestinal symptoms would be higher in patients with COVID-19 [5] .”
BackgroundInfluentialWagner, M. G., Kombe, I. K., Kiti, M. C., Aziza, R., Barasa, E., & Nokes, D. J. (2020) · Wellcome Open Research · doi:10.12688/wellcomeopenres.16264.1 · Cited by 3
The Significance of Angiotensin-Converting Enzyme-2 (ACE2) in SARSCov- 2 Infection and COVID-19
Restini, C. B. A., Belavek, T., Bernal, R., Ibrahim, V., Irwin, K., Kim, M., & Merlo, C. (2020) · Coronaviruses · doi:10.2174/2666796701999201218141035 · Cited by 3
Changes in hematological and other laboratory parameters in COVID-19 infection
Mandal, P. K., & Vidhatri, R. (2022) · Journal of Hematology and Allied Sciences · doi:10.25259/jhas_5_2022 · Cited by 3
Nojiri, S., Kawakami, Y., Nakamoto, D., Kuroki, M., & Nishizaki, Y. (2023) · IJID Regions · doi:10.1016/j.ijregi.2023.04.013 · Cited by 3
SRAS : 2. La modélisation de l'épidémie
Flahault, A. (2003) · médecine/sciences · doi:10.1051/medsci/200319111161 · Cited by 3
Metadata
- 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
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