Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study
Identifieur interne : 000975 ( Istex/Corpus ); précédent : 000974; suivant : 000976Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study
Auteurs : Chow Khuan Yew ; Chien Earn Lee ; Moi Lin Ling ; Derrick Mok Kwee Heng ; Soon Ghee YapSource :
- BMJ [ 0959-8138 ] ; 2004-01-24.
English descriptors
- Teeft :
- Acute care, April, Atypical, Atypical pneumonia, Atypical presentation, Bloody stools, Centre, Clinical features, Coli bacteraemia, Diagnostic radiology, Diagnostic radiology department, Disease control, Doctor onset date, Early introduction, Epidemic curve, Epidemiological, Epidemiological link, Family members, Family wife onset date, Foot ulcer, Good surveillance system, Healthcare, Healthcare assistant urology centre onset date, Healthcare staff, Healthcare workers, Hong kong, Hospital staff, Incubation period, Index patient, Indirect contact, Infection control measures, Infectious period, Isolation procedures, Lessons learnt, Mmwr morb, National cancer centre, Neighbouring patient, Novel coronavirus, Nurse onset date, Onset date, Outbreak, Outram road, Probable case, Probable sars cases, Radiographer, Radiology, Respiratory symptoms, Respiratory syndrome, Same time, Sars, Sars infection, Sars outbreak, Sars patients, Seng, Singapore, Syndrome, Tertiary hospital, Tock, Tock seng hospital, Visitor onset date, World health organization.
Abstract
Objective To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it. Design Descriptive study. Setting A tertiary hospital in Singapore. Participants Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. Main outcome measures Probable SARS as defined by the World Health Organization. Results The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. Conclusions Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.
Url:
DOI: 10.1136/bmj.37939.465729.44
Links to Exploration step
ISTEX:0D14268C4AC76BA14731FC3B5D16155033DC06C5Le document en format XML
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Design Descriptive study. Setting A tertiary hospital in Singapore. Participants Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. Main outcome measures Probable SARS as defined by the World Health Organization. Results The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. Conclusions Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. 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Design Descriptive study. Setting A tertiary hospital in Singapore. Participants Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. Main outcome measures Probable SARS as defined by the World Health Organization. Results The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. Conclusions Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. 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type="first">Chow</forename><surname>Khuan Yew</surname></persName><note type="biography">registrar</note><affiliation>registrar</affiliation><affiliation>Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Chien Earn</forename><surname>Lee</surname></persName><note type="biography">head</note><affiliation>head</affiliation><affiliation>Casemix Project Office, Planning and Development Division, Ministry of Health Singapore, College of Medicine Building, 16 College Road, Singapore 169854</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Moi Lin</forename><surname>Ling</surname></persName><note type="biography">director</note><affiliation>director</affiliation><affiliation>Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</affiliation><affiliation>Correspondence to: Moi 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type="local">bmj;328/7433/195</idno></analytic><monogr><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="pISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><idno type="publisher-id">BMJ</idno><idno type="PublisherID-hwp">bmj</idno><idno type="PublisherID-nlm-ta">BMJ</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2004-01-24"></date><biblScope unit="volume">328</biblScope><biblScope unit="issue">7433</biblScope><biblScope unit="page" from="195">195</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2004-01-15</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it. Design Descriptive study. Setting A tertiary hospital in Singapore. Participants Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. Main outcome measures Probable SARS as defined by the World Health Organization. Results The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. Conclusions Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>GI bleeding</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Infectious diseases</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Epidemiologic studies</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Radiology</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Clinical diagnostic tests</term></item></list></keywords></textClass><textClass><keywords 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content-type="original">Papers</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>GI bleeding</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Infectious diseases</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Epidemiologic studies</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Radiology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Clinical diagnostic tests</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Radiology (diagnostics)</subject></subj-group></article-categories><title-group><article-title>Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Khuan Yew</surname><given-names>Chow</given-names></name><role>registrar</role><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lee</surname><given-names>Chien Earn</given-names></name><role>head</role><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ling</surname><given-names>Moi Lin</given-names></name><role>director</role><email xlink:type="simple">gptlml@sgh.com.sg</email><xref ref-type="corresp" rid="COR1"></xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Heng</surname><given-names>Derrick Mok Kwee</given-names></name><role>head of epidemiology</role><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Yap</surname><given-names>Soon Ghee</given-names></name><role>nursing officer</role><xref ref-type="aff" rid="A4">4</xref></contrib></contrib-group><aff id="A1"><label>1</label>Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</aff><aff id="A2"><label>2</label>Casemix Project Office, Planning and Development Division, Ministry of Health Singapore, College of Medicine Building, 16 College Road, Singapore 169854</aff><aff id="A3"><label>3</label>Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</aff><aff id="A4"><label>4</label>Ear, Nose, and Throat Department, Singapore General Hospital</aff><aff id="A5"><label>5</label>Clinical Trials and Epidemiology Research Unit, 226 Outram Road Blk A #03-01, Singapore 169039</aff><author-notes><corresp id="COR1">Correspondence to: Moi Lin Ling</corresp></author-notes><pub-date pub-type="ppub"><day>24</day><month>1</month><year>2004</year></pub-date><pub-date pub-type="epub-original"><day>15</day><month>01</month><year>2004</year></pub-date><pub-date pub-type="epub"><day>15</day><month>1</month><year>2004</year></pub-date><volume>328</volume><volume-id pub-id-type="other">328</volume-id><volume-id pub-id-type="other">328</volume-id><issue>7433</issue><issue-id pub-id-type="other">bmj;328/7433</issue-id><issue-id pub-id-type="other">7433</issue-id><issue-id pub-id-type="other">328/7433</issue-id><fpage>195</fpage><history><date date-type="accepted"><day>6</day><month>11</month><year>2003</year></date></history><permissions><copyright-statement>© 2004 BMJ Publishing Group Ltd.</copyright-statement><copyright-year>2004</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-328-195.pdf"></self-uri><abstract><title>Abstract</title><p><bold>Objective</bold> To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it.</p><p><bold>Design</bold> Descriptive study.</p><p><bold>Setting</bold> A tertiary hospital in Singapore.</p><p><bold>Participants</bold> Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital.</p><p><bold>Main outcome measures</bold> Probable SARS as defined by the World Health Organization.</p><p><bold>Results</bold> The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset.</p><p><bold>Conclusions</bold> Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.</p></abstract><counts><page-count count="1"></page-count></counts></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study</title></titleInfo><name type="personal"><namePart type="given">Chow</namePart><namePart type="family">Khuan Yew</namePart><affiliation>Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</affiliation><description>registrar</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chien Earn</namePart><namePart type="family">Lee</namePart><affiliation>Casemix Project Office, Planning and Development Division, Ministry of Health Singapore, College of Medicine Building, 16 College Road, Singapore 169854</affiliation><description>head</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Moi Lin</namePart><namePart type="family">Ling</namePart><affiliation>Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</affiliation><affiliation>Correspondence to: Moi Lin Ling</affiliation><description>director</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Derrick Mok Kwee</namePart><namePart type="family">Heng</namePart><affiliation>Clinical Trials and Epidemiology Research Unit, 226 Outram Road Blk A #03-01, Singapore 169039</affiliation><description>head of epidemiology</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Soon Ghee</namePart><namePart type="family">Yap</namePart><affiliation>Ear, Nose, and Throat Department, Singapore General Hospital</affiliation><description>nursing officer</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2004-01-24</dateIssued><dateCreated encoding="w3cdtf">2004-01-15</dateCreated><copyrightDate encoding="w3cdtf">2004</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Objective To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it. Design Descriptive study. Setting A tertiary hospital in Singapore. Participants Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. Main outcome measures Probable SARS as defined by the World Health Organization. Results The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. Conclusions Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.</abstract><note type="author-notes">Correspondence to: Moi Lin Ling</note><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>GI bleeding</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Infectious diseases</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Epidemiologic studies</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Radiology</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Clinical diagnostic tests</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Radiology (diagnostics)</topic></subject><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">BMJ</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>328</number></detail><detail type="issue"><caption>no.</caption><number>7433</number></detail><extent unit="pages"><start>195</start><total>1</total></extent></part></relatedItem><identifier type="istex">0D14268C4AC76BA14731FC3B5D16155033DC06C5</identifier><identifier type="ark">ark:/67375/NVC-3CL2L672-V</identifier><identifier type="DOI">10.1136/bmj.37939.465729.44</identifier><identifier type="href">bmj-328-195.pdf</identifier><identifier type="ArticleID">bmj.37939.465729.44</identifier><identifier type="PMID">14726369</identifier><identifier type="local">bmj;328/7433/195</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2004 BMJ Publishing Group Ltd.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</recordContentSource><recordOrigin>© 2004 BMJ Publishing Group Ltd.</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-3CL2L672-V/record.json</uri></json:item></metadata><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-3CL2L672-V/annexes.jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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