Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003
Open accessAbstract
BACKGROUND: In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community. METHODS: We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection. RESULTS: One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with < 3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1-97.1, 3.6-55.3, respectively). CONCLUSION: This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza.
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Estimates for secondary attack rates displayed a very wide range; a range of 0-100% was observed for health-care workers in one study and 18.5-66.7% for individuals under investigation in another.
“Estimates for secondary attack rates displayed a very wide range; a range of 0-100% was observed for health-care workers in one study 64 and a range of 18⋅5-66⋅7% was observed for individuals under investigation in another study.62”
From Severe acute respiratory syndrome (SARS) mathematical models and disease parameters: a systematic review (2025) · cites this paper as [64]
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- Authors
- Reynolds, M. G., Anh, B. H., Thu, V. H., Montgomery, J. M., Bausch, D. G., Shah, J. J., Maloney, S., Leitmeyer, K. C., Huy, V. Q., Horby, P., Plant, A. J., & Uyeki, T. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Hanoi Medical University (VN)
- Tulane University (US)
- Robert Koch Institute (DE)
- World Health Organization (CH)
- Curtin University (AU)
- Corresponding author
- Reynolds, Mary G
- ORCID
- Venue
- BMC Public Health
- Published
- 2006-08-14
- Volume
- 6
- Issue
- 1
- Pages
- 207-207
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC1562405
- OpenAlex
- W2151129696
- Semantic Scholar
- c97a22115060205ae8789d2ccd0c5a09d668611f
- Cited by
- 65
- References
- 16
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 17 · 2019: 6 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 1 · 2013: 1
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Publication server of the Robert Koch Institute (Robert Kock Institute) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- SARS, SARS-CoV, nosocomial transmission, healthcare workers, occupational exposure, nurses, risk factors, hospital outbreak, seroprevalence, hospital wards, infection control, Hanoi
- MeSH terms
- Adult, Antibodies, Viral, Disease Outbreaks, Hong Kong, Hospital Units, Humans, Middle Aged, Nursing Staff, Hospital, Personnel, Hospital, Risk Factors, Travel, Vietnam, Cohort Studies, Case-Control Studies, Seroepidemiologic Studies, Occupational Exposure, Infectious Disease Transmission, Patient-to-Professional, Risk Assessment, Severe Acute Respiratory Syndrome, Severe acute respiratory syndrome-related coronavirus
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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