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The Outbreak of SARS at Tan Tock Seng Hospital – Relating Epidemiology to Control
Open accessAbstract
INTRODUCTION: The outbreak of severe acute respiratory syndrome (SARS) began after the index case was admitted on 1 March 2003. We profile the cases suspected to have acquired the infection in Tan Tock Seng Hospital (TTSH), focussing on major transmission foci, and also describe and discuss the impact of our outbreak control measures. MATERIALS AND METHODS: Using the World Health Organization (WHO) case definitions for probable SARS adapted to the local context, we studied all cases documented to have passed through TTSH less than 10 days prior to the onset of fever. Key data were collected in liaison with clinicians and through a team of onsite epidemiologists. RESULTS: There were 105 secondary cases in TTSH. Healthcare staff (57.1%) formed the majority, followed by visitors (30.5%) and inpatients (12.4%). The earliest case had onset of fever on 4 March 2003, and the last case, on 5 April 2003. Eighty-nine per cent had exposures to 7 wards which had cases of SARS that were not isolated on admission. In 3 of these wards, major outbreaks resulted, each with more than 20 secondary cases. Attack rates amongst ward-based staff ranged from 0% to 32.5%. Of 13 inpatients infected, only 4 (30.8%) had been in the same room or cubicle as the index case for the ward. CONCLUSIONS: The outbreak of SARS at TTSH showed the challenges of dealing with an emerging infectious disease with efficient nosocomial spread. Super-spreading events and initial delays in outbreak response led to widespread dissemination of the outbreak to multiple wards.
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“The inverse relationship between filter efficiency and TIL provides a better explanation for the higher levels of respiratory protection offered by the N95 FFRs than the SMs reported previously. (12,14,15)”
From A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks (2014) · cites this paper as [14]
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“Another study reported a dramatic decrease of SARS infection from 52 to 8 among health care staff after implementation of the use of N95 masks, gloves, and gowns. (14)”
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Identification of a novel coronavirus in patients with severe acute respiratory syndrome
Drosten, C., Günther, S., Preiser, W., van der Werf, S., Brodt, H.-R., Becker, S., Rabenau, H., Panning, M., Kolesnikova, L., Fouchier, R. A. M., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa030747 · Cited by 4,574
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Peiris, M. J. S., Lai, S., Poon, L. L. M., Guan, Y., Yam, L., Lim, W., Nicholls, J. M., Yee, W., Yan, W., Cheung, M., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13077-2 · Cited by 2,916
A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong
Lee, N. L. S., Hui, D. S. C., Wu, A. K. L., Chan, P. K. S., Cameron, P. A., Joynt, G. M., Ahuja, A. T., Yung, M. Y., Leung, C. B., To, K. F., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa030685 · Cited by 2,638
Identification of Severe Acute Respiratory Syndrome in Canada
Poutanen, S. M., Low, D. E., Henry, B., Finkelstein, S., Rose, D. E., Green, K., Tellier, R., Draker, R., Adachi, D., Ayers, M., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa030634 · Cited by 1,133
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Hsu, L. Y., Lee, C.-C., Green, J. A., Ang, B. S. P., Paton, N. I., Lee, L., Villacian, J. S., Lim, P. L., Earnest, A., & Leo, Y. (2003) · Emerging infectious diseases · doi:10.3201/eid0906.030264 · Cited by 283
Self-citationSuperspreading SARS events, Beijing, 2003
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Dwosh, H. A., Hong, H. H. L., Austgarden, D., Herman, S., & Schabas, R. (2003) · Europe PMC (PubMed Central) · Cited by 172
SARS Transmission and Hospital Containment
Gopalakrishna, G., Choo, P., Leo, Y., Tay, B. K., Lim, Y. T., Khan, A. S., & Tan, C. C. (2004) · Emerging infectious diseases · doi:10.3201/eid1003.030650 · Cited by 124
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- Centres for Disease Control and Prevention(CDC). Update: SevereAcute Respiratory Syndrome - Singapore, 2003. MMWR Morb Mortal Wkly Rev 2003;52:405-11.
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on behalf of COVID-19 Evidence and Recommendations Working Group, Zhou, Q. X., Gao, Y., Wang, X., Liu, R., Du, P., Wang, X., Zhang, X., Lu, S., Wang, Z., et al. (2020) · Annals of Translational Medicine · doi:10.21037/atm-20-3324 · Cited by 217
Protecting healthcare workers from pandemic influenza: N95 or surgical masks?
Gralton, J., & McLaws, M. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181b9e8b3 · Cited by 114
Kim, J. Y., Song, J. Y., Yoon, Y. K., Choi, S., Song, Y. G., Kim, S.-R., Son, H.-J., Jeong, S.-Y., Choi, J.-H., Kim, K. M., et al. (2015) · Infection and Chemotherapy · doi:10.3947/ic.2015.47.4.278 · Cited by 76
Richards Model: A Simple Procedure for Real-time Prediction of Outbreak Severity
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Metadata
- Authors
- Chen, M. I., Leo, Y.-S., Ang, B. S., Heng, B.-H., & Choo, P.
- Affiliations
- Tan Tock Seng Hospital (SG)
- National Healthcare Group (SG)
- Venue
- Annals of the Academy of Medicine, Singapore
- Publisher
- Academy of Medicine, Singapore
- Published
- 2006-05-15
- Volume
- 35
- Issue
- 5
- Pages
- 317-325
- ISSN
- 0304-4602 (ISSN-L)
- OpenAlex
- W2098918420
- Cited by
- 35
- References
- 18
- Citations by year
- 2025: 2 · 2023: 1 · 2021: 1 · 2020: 14 · 2017: 2 · 2016: 1 · 2015: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of the Academy of Medicine Singapore (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Singapore General Hospital
- Changi General Hospital
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Keywords
- SARS, nosocomial transmission, hospital outbreak, epidemic control, healthcare workers, superspreading events, transmission foci, attack rate, Tan Tock Seng Hospital
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross Infection, Disease Outbreaks, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Isolation, Retrospective Studies, Singapore, Severe Acute Respiratory Syndrome
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- Chen, M. I., Leo, Y.-S., Ang, B. S., Heng, B.-H., & Choo, P. (2006). The Outbreak of SARS at Tan Tock Seng Hospital – Relating Epidemiology to Control. Annals of the Academy of Medicine, Singapore. https://doi.org/10.47102/annals-acadmedsg.v35n5p317
