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Evaluation of control measures implemented in the severe acute respiratory syndrome outbreak in Beijing, 2003.
Journal of the American Medical Association 2003;290:3215-3221.
Pang X, Zhu X, Xu F, Guo J, Gong X, Liu D, Liu Z, Chin D, Feikin D.
Abstract
CONTEXT: Beijing, China, experienced the world's largest outbreak of severe
acute respiratory syndrome (SARS) beginning in March 2003, with the outbreak
resolving rapidly, within 6 weeks of its peak in late April. Little is known
about the control measures implemented during this outbreak. OBJECTIVE: To
describe and evaluate the measures undertaken to control the SARS outbreak.
DESIGN, SETTING, AND PARTICIPANTS: Data were reviewed from standardized surveillance
forms from SARS cases (2521 probable cases) and their close contacts observed
in Beijing between March 5, 2003, and May 29, 2003. Procedures implemented
by health authorities were investigated through review of official documents
and discussions with public health officials. MAIN OUTCOME MEASURES: Timeline
of major control measures; number of cases and quarantined close contacts
and attack rates, with changes in infection control measures, management,
and triage of suspected cases; and time lag between illness onset and hospitalization
with information dissemination. RESULTS: Health care worker training in use
of personal protective equipment and management of patients with SARS and
establishing fever clinics and designated SARS wards in hospitals predated
the steepest decline in cases. During the outbreak, 30 178 persons were quarantined.
Among 2195 quarantined close contacts in 5 districts, the attack rate was
6.3% (95% confidence interval [CI], 5.3%-7.3%), with a range of 15.4% (95%
CI, 11.5%-19.2%) among spouses to 0.36% (95% CI, 0%-0.77%) among work and
school contacts. The attack rate among quarantined household members increased
with age from 5.0% (95% CI, 0%-10.5%) in children younger than 10 years to
27.6% (95% CI, 18.2%-37.0%) in adults aged 60 to 69 years. Among almost 14
million people screened for fever at the airport, train stations, and roadside
checkpoints, only 12 were found to have probable SARS. The national and municipal
governments held 13 press conferences about SARS. The time lag between illness
onset and hospitalization decreased from a median of 5 to 6 days on or before
April 20, 2003, the day the outbreak was announced to the public, to 2 days
after April 20 (P<.001). CONCLUSIONS: The rapid resolution of the SARS
outbreak was multifactorial, involving improvements in management and triage
in hospitals and communities of patients with suspected SARS and the dissemination
of information to health care workers and the public.