Impact of public health interventions in controlling the spread of SARS: modelling of intervention scenarios.

A variety of intervention measures exist to prevent and control diseases with pandemic potential like SARS or pandemic influenza. They differ in their approach and effectiveness in reducing the number of cases getting infected. The effects of different intervention measures were investigated by a mathematical modelling approach, with comparisons based on the effective reproduction number (R(e)). The analysis showed that early case detection followed by strict isolation could control a SARS outbreak. Tracing close contacts of cases and contacts of exposed health care workers additionally reduces the R(e). Tracing casual contacts and measures aiming to decrease social interaction were less effective in reducing the number of SARS cases. The study emphasizes the importance of early identification and isolation of SARS cases to reduce the number of people getting infected. However, doing so transfers cases to health care facilities, making infection control measures in hospitals essential to avoid nosocomial spread. The modelling approach applied in this study is useful for analysing interactions of different intervention measures for reducing the R(e) of SARS.

[1]  J. Peiris,et al.  Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) , 2003, The Lancet.

[2]  Christophe Fraser,et al.  The Effectiveness of Contact Tracing in Emerging Epidemics , 2006, PloS one.

[3]  K. Tan,et al.  Risk Perception and Impact of Severe Acute Respiratory Syndrome (SARS) on Work and Personal Lives of Healthcare Workers in Singapore: What Can We Learn? , 2005, Medical care.

[4]  Kathryn Glass,et al.  Controlling emerging infectious diseases like SARS. , 2005, Mathematical biosciences.

[5]  D. Gould,et al.  Fear and Stigma: The Epidemic within the SARS Outbreak , 2004, Emerging infectious diseases.

[6]  Shan-Chwen Chang,et al.  SARS in Hospital Emergency Room , 2004, Emerging infectious diseases.

[7]  P. E. Kopp,et al.  Superspreading and the effect of individual variation on disease emergence , 2005, Nature.

[8]  C. Fraser,et al.  Transmission Dynamics of the Etiological Agent of SARS in Hong Kong: Impact of Public Health Interventions , 2003, Science.

[9]  Troy Day,et al.  When Is Quarantine a Useful Control Strategy for Emerging Infectious Diseases? , 2006, American journal of epidemiology.

[10]  J. Robins,et al.  Transmission Dynamics and Control of Severe Acute Respiratory Syndrome , 2003, Science.

[11]  Gowri Gopalakrishna,et al.  SARS Transmission and Hospital Containment , 2004, Emerging infectious diseases.

[12]  M. Ofner,et al.  Hospital Preparedness and SARS , 2004, Emerging infectious diseases.

[13]  G. Rodier,et al.  Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases. , 2001, The Lancet. Infectious diseases.

[14]  Xinghuo Pang,et al.  Evaluation of control measures implemented in the severe acute respiratory syndrome outbreak in Beijing, 2003. , 2003, JAMA.

[15]  Nadav Davidovitch,et al.  Cost-Benefit of Stockpiling Drugs for Influenza Pandemic , 2005, Emerging infectious diseases.

[16]  Tze Wai Wong,et al.  SARS Transmission among Hospital Workers in Hong Kong , 2004, Emerging infectious diseases.

[17]  R. Maunder,et al.  The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[18]  A. Schuchat,et al.  Superspreading SARS Events, Beijing, 2003 , 2004, Emerging infectious diseases.

[19]  K. Subbarao,et al.  Emerging Respiratory Viruses: Challenges and Vaccine Strategies , 2006, Clinical Microbiology Reviews.

[20]  David M. Bell,et al.  Public Health Interventions and SARS Spread, 2003 , 2004, Emerging infectious diseases.

[21]  Markus Schwehm,et al.  The influenza pandemic preparedness planning tool InfluSim , 2007, BMC infectious diseases.

[22]  Brian Tomlinson,et al.  SARS: experience at Prince of Wales Hospital, Hong Kong , 2003, The Lancet.

[23]  K. Dietz The estimation of the basic reproduction number for infectious diseases , 1993, Statistical methods in medical research.

[24]  Elizabeth Rea,et al.  Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto. , 2004, The New England journal of medicine.

[25]  Y. Leo,et al.  Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts , 2003, Emerging infectious diseases.

[26]  Markus Schwehm,et al.  Influenza pandemic intervention planning using InfluSim: pharmaceutical and non- pharmaceutical interventions , 2007, BMC infectious diseases.

[27]  B. Tomlinson,et al.  Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong , 2003, Emerging infectious diseases.

[28]  J. Sung,et al.  Title The Severe Acute Respiratory Syndrome , 2003 .

[29]  S. Papson,et al.  “Model” , 1981 .

[30]  Shweta Bansal,et al.  A Comparative Analysis of Influenza Vaccination Programs , 2006, PLoS medicine.

[31]  Kow-Tong Chen,et al.  SARS in Healthcare Facilities, Toronto and Taiwan , 2004, Emerging infectious diseases.

[32]  E. Galanis,et al.  Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[33]  Y. Hsieh,et al.  Quarantine for SARS, Taiwan , 2005, Emerging infectious diseases.

[34]  G. Rodier,et al.  SARS: LESSONS FROM A NEW DISEASE , 2004 .

[35]  T. Rutledge,et al.  SARS assessment clinic: a rapid response to an infectious outbreak. , 2005, CJEM.

[36]  S. Chew,et al.  SARS: how a global epidemic was stopped , 2007 .

[37]  A. Fauci,et al.  The challenge of emerging and re-emerging infectious diseases , 2004, Nature.

[38]  J. Hyman,et al.  Model Parameters and Outbreak Control for SARS , 2004, Emerging infectious diseases.

[39]  Xilin Yang,et al.  SARS Transmission, Risk Factors, and Prevention in Hong Kong , 2004, Emerging infectious diseases.

[40]  M. Schutten,et al.  Public health implications of using various case definitions in The Netherlands during the worldwide SARS outbreak , 2006, Clinical Microbiology and Infection.

[41]  Martin Eichner,et al.  Case isolation and contact tracing can prevent the spread of smallpox. , 2003, American journal of epidemiology.