Abstract
BackgroundThe 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak infected 8,422 individuals leading to 916 deaths around the world. However, there have been few epidemiological studies of SARS comparing epidemiologic features across regions. The aim of this study is to identify similarities and differences in SARS epidemiology in three populations with similar host and viral genotype.MethodsWe present a comparative epidemiologic analysis of SARS, based on an integrated dataset with 3,336 SARS patients from Hong Kong, Beijing and Taiwan, epidemiological and clinical characteristics such as incubation, onset-to-admission, onset-to-discharge and onset-to-death periods, case fatality ratios (CFRs) and presenting symptoms are described and compared between regions. We further explored the influence of demographic and clinical variables on the apparently large differences in CFRs between the three regions.ResultsAll three regions showed similar incubation periods and progressive shortening of the onset-to-admission interval through the epidemic. Adjusted for sex, health care worker status and nosocomial setting, older age was associated with a higher fatality, with adjusted odds ratio (AOR): 2.10 (95% confidence interval: 1.45, 3.04) for those aged 51-60; AOR: 4.57 (95% confidence interval: 3.32, 7.30) for those aged above 60 compared to those aged 41-50 years. Presence of pre-existing comorbid conditions was also associated with greater mortality (AOR: 1.74; 95% confidence interval: 1.36, 2.21).ConclusionThe large discrepancy in crude fatality ratios across the three regions can only be partly explained by epidemiological and clinical heterogeneities. Our findings underline the importance of a common data collection platform, especially in an emerging epidemic, in order to identify and explain consistencies and differences in the eventual clinical and public health outcomes of infectious disease outbreaks, which is becoming increasingly important in our highly interconnected world.
Highlights
The 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak infected 8,422 individuals leading to 916 deaths around the world
SARS patients were sent to Hospital 302, a hospital specializing in infectious diseases
One-third of Taiwan SARS patients had pre-existing comorbid conditions, which was much greater than Hong Kong (20%) and Beijing (4%, based on available data), and in each region the case fatality ratios (CFRs) were markedly elevated for those patients with comorbidities
Summary
The 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak infected 8,422 individuals leading to 916 deaths around the world. The aim of this study is to identify similarities and differences in SARS epidemiology in three populations with similar host and viral genotype. The 2002-2003 SARS outbreak infected 8,422 individuals leading to 916 deaths in eight affected areas [1]. The epidemic spread within Guangdong province before a large superspreading event in Hong Kong seeded the global outbreak [3]. On 5 July 2003, the World Health Organization (WHO) announced the last affected area Taiwan to be transmission free and declared the last human-tohuman transmission chain successfully interrupted [4]. Hong Kong, mainland China and Taiwan carried the largest disease burden as well as marked the most important milestones of the global outbreak. Due to geo-political factors beyond the remit of public health, a consolidated account of their collective experience has not previously been documented
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