Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong.
Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong.
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DOI：
10.1016/s0140-6736(03)13410-1
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发表时间：
2003-05-24
期刊：
影响因子：
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通讯作者：
Anderson RM
中科院分区：
文献类型：
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作者：
Donnelly CA;Ghani AC;Leung GM;Hedley AJ;Fraser C;Riley S;Abu-Raddad LJ;Ho LM;Thach TQ;Chau P;Chan KP;Lam TH;Tse LY;Tsang T;Liu SH;Kong JH;Lau EM;Ferguson NM;Anderson RM
世界各地，特别是亚太地区的卫生当局正在寻求有效的公共卫生干预措施，以应对严重急性呼吸系统综合症（SARS）的持续流行。我们评估了SARS在香港的流行病学。我们纳入了截至2003年4月28日报告的1425例病例。从几个来源构建了一个综合数据库，其中包含流行病学、人口统计学和临床变量的信息。我们估计了关键的流行病学分布：感染至发病、发病至入院、入院至死亡和入院至出院。我们测量了估计病死率与患者年龄和发病至入院时间之间的关系。经过初期的指数增长，到4月28日，确诊病例下降到每天不到20例。公共卫生干预措施包括鼓励在出现临床症状后迅速向医院报告，追踪确诊和疑似病例的接触者，以及隔离、监测和限制接触者的旅行。该病的平均潜伏期估计为6.4天（95% Cl 5.2-7.7）。从出现临床症状到入院的平均时间在3至5天之间，在流行早期时间更长。假设参数γ分布，60岁以下患者的估计病死率为13.2%(9.8-16.8)，60岁或以上患者的估计病死率为43.3%（35.2-52.4）。非参数方法的估计值分别为6.8%（4.0-9.6）和55.0%（45.3-64.7）。聚集性病例在疫情过程中发挥了重要作用。患者的年龄与预后密切相关。出现症状和入院之间的时间没有改变结果，但缩短间隔对更广泛的人群很重要，因为它限制了患者被隔离之前的感染期。2003年5月7日在线发布http://image.thelancet.com/extras/03art4453web.pdf
Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong. We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients’age and the time from onset to admission. After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% Cl 5.2–7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8–16.8) for patients younger than 60 years and 43.3% (35.2–52.4) for patients aged 60 years or older assuming a parametric γ distribution. A non-parametric method yielded estimates of 6.8% (4.0–9.6) and 55.0% (45.3–64.7), respectively. Case clusters have played an important part in the course of the epidemic. Patients’age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine. Published online May 7, 2003 http://image.thelancet.com/extras/03art4453web.pdf