Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong

We studied transmission patterns of severe acute respiratory syndrome (SARS) among medical students exposed exclusively to the first SARS patient in the Prince of Wales Hospital in Hong Kong, before his illness was recognized. We conducted a retrospective cohort study of 66 medical students who visited the index patient’s ward, including 16 students with SARS and 50 healthy students. The risk of contracting SARS was sevenfold greater among students who definitely visited the index case’s cubicle than in those who did not (10/27 [41%] versus 1/20 [5%], relative risk [RR] 7.4; 95% confidence interval [CI] 1.0 to 53.3). Illness rates increased directly with proximity of exposure to the index case. However, four of eight students who were in the same cubicle, but were not within 1 m of the index case-patient, contracted SARS. Proximity to the index case-patient was associated with transmission, which is consistent with droplet spread. Transmission through fomites or small aerosols cannot be ruled out.

[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]  J. A. Comer,et al.  A novel coronavirus associated with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[3]  J. Gerberding,et al.  Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[4]  Y. Guan,et al.  Coronavirus as a possible cause of severe acute respiratory syndrome , 2003, The Lancet.

[5]  Peter Cameron,et al.  A major outbreak of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.

[6]  S. Halstead,et al.  Rubella in an immunized island population. , 1973, Journal of the American Medical Association (JAMA).

[7]  Arthur S Slutsky,et al.  Identification of severe acute respiratory syndrome in Canada. , 2003, The New England journal of medicine.

[8]  S. Twu,et al.  Update: outbreak of severe acute respiratory syndrome--worldwide, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[9]  Warren J. Smith.  The Problem Of The , 1988 .

[10]  L. Poon,et al.  Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia : a prospective study , 2003 .

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

[12]  M. Hamburger,et al.  The problem of the dangerous carrier of hemolytic streptococci; spread of infection by individuals with strongly positive nose cultures who expelled large numbers of hemolytic streptococci. , 1945, The Journal of infectious diseases.

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

[14]  C. Peters,et al.  Hemorrhagic fever in Cochabamba, Bolivia, 1971. , 1974, American journal of epidemiology.

[15]  B. Henderson,et al.  Lassa fever. Epidemiological aspects of the 1970 epidemic, Jos, Nigeria. , 1972, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[16]  A. Sanchez,et al.  The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit. , 1999, The Journal of infectious diseases.

[17]  O. Chay,et al.  Severe acute respiratory syndrome in Singapore , 2004, Archives of Disease in Childhood.