Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic.

This paper reviews current understanding of the epidemiology, transmission dynamics and control of the aetiological agent of severe acute respiratory syndrome (SARS). We present analyses of data on key parameters and distributions and discuss the processes of data capture, analysis and public health policy formulation during the SARS epidemic are discussed. The low transmissibility of the virus, combined with the onset of peak infectiousness following the onset of clinical symptoms of disease, transpired to make simple public health measures, such as isolating patients and quarantining their contacts, very effective in the control of the SARS epidemic. We conclude that we were lucky this time round, but may not be so with the next epidemic outbreak of a novel aetiological agent. We present analyses that help to further understanding of what intervention measures are likely to work best with infectious agents of defined biological and epidemiological properties. These lessons learnt from the SARS experience are presented in an epidemiological and public health context.

[1]  P. Kaye.  Infectious diseases of humans: Dynamics and control , 1993 .

[2]  Christl A. Donnelly,et al.  Transmission intensity and impact of control policies on the foot and mouth epidemic in Great Britain , 2001, Nature.

[3]  Christl A. Donnelly,et al.  The Foot-and-Mouth Epidemic in Great Britain: Pattern of Spread and Impact of Interventions , 2001, Science.

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

[5]  W. Getz,et al.  Curtailing transmission of severe acute respiratory syndrome within a community and its hospital† , 2003, Proceedings of the Royal Society of London. Series B: Biological Sciences.

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

[7]  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.

[8]  Obi L. Griffith,et al.  The Genome Sequence of the SARS-Associated Coronavirus , 2003, Science.

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

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

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

[12]  Christian Drosten,et al.  Identification of a novel coronavirus in patients with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[13]  H. Bekedam,et al.  Role of China in the Quest to Define and Control Severe Acute Respiratory Syndrome , 2003, Emerging infectious diseases.

[14]  C. Fraser,et al.  Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong , 2003, The Lancet.

[15]  A. Xu,et al.  Profile of specific antibodies to the SARS-associated coronavirus. , 2003, The New England journal of medicine.

[16]  Use of quarantine to prevent transmission of severe acute respiratory syndrome--Taiwan, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

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

[18]  M. Chan-yeung,et al.  A cluster of cases of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.

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

[20]  C. Fraser,et al.  Seroprevalence of IgG antibody to SARS coronavirus (SARS-CoV) in a population-based sample of close contacts of all 1,755 cases in Hong Kong , 2004 .

[21]  K. Soo,et al.  Healthcare Worker Seroconversion in SARS Outbreak , 2004, Emerging infectious diseases.

[22]  C. Fraser,et al.  Public Health Risk from the Avian H5N1 Influenza Epidemic , 2004, Science.

[23]  China: towards “xiaokang”, but still living dangerously , 2004, The Lancet.

[24]  Sung Keun Kang,et al.  Molecular evolution of the SARS coronavirus during the course of the SARS epidemic in China. , 2004, Science.

[25]  SARS returns to China , 2004, The Lancet Infectious Diseases.

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

[27]  J. Watts.  China culls wild animals to prevent new SARS threat , 2004, The Lancet.

[28]  C. Fraser,et al.  Factors that make an infectious disease outbreak controllable. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[29]  Christophe Fraser,et al.  The Epidemiology of Severe Acute Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 Patients , 2004, Annals of Internal Medicine.

[30]  R. Webster.  Wet markets—a continuing source of severe acute respiratory syndrome and influenza? , 2004, The Lancet.