Hindsight: A re-analysis of the severe acute respiratory syndrome outbreak in Beijing
Identifieur interne : 003692 ( Main/Exploration ); précédent : 003691; suivant : 003693Hindsight: A re-analysis of the severe acute respiratory syndrome outbreak in Beijing
Auteurs : W. Liang [République populaire de Chine] ; M.-L. Mclaws [Australie] ; M. Liu [République populaire de Chine] ; J. Mi [République populaire de Chine] ; D. K. Y. Chan [Australie]Source :
- Public Health [ 0033-3506 ] ; 2007.
Abstract
To review the severe acute respiratory syndrome (SARS) epidemic in Beijing using basic epidemiological principles omitted from the original analysis.
Analysis of Prospective surveillance data for Beijing collected during the outbreak.
Surveillance data were reclassified according to World Health Organization criteria. Cases previously excluded without date of onset of illness were included in the epidemic curve from estimates using the average time between date of onset and date of hospitalization for cases with both dates. Cases who failed to give a contact history were now included; 7% (
The spot map effectively illustrated clusters by residency, with the inner-city sustaining the highest attack rate (33.42 per 100,000), followed by an easterly distribution 5–30 km away (21.62 per 10,000), and lowest in districts 60–160 km away (9.21 per 100,000). The new epidemic curve shows the outbreak commencing 10 days earlier than initially reported, with a three-fold greater increase in cases during the escalation phase than previously estimated.
In hindsight, the investigation of the Beijing SARS would have benefited from the use of spot maping as an essential outbreak tool for early identification of specific geographical area(s) for quarantining. If a spot map of incidence density rates was used during the early phase of the outbreak, the inner city might have been identified as a major risk factor requiring rapid quarantining. Contact history became uncommon as the outbreak progressed, suggesting that hospitals were over-burdened or pathogenesis and environment risk factors changed, strengthening the usefulness of early spot mapping and the need to modify risk factors included as contact history as the epidemic progresses.
Url:
DOI: 10.1016/j.puhe.2007.02.023
PubMed: 17555781
PubMed Central: 7111616
Affiliations:
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Mclaws</name><affiliation wicri:level="1"><nlm:aff id="aff2">Hospital Infection, Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, 2nd Floor Samuels Building, The University of New South Wales, Sydney, NSW, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Hospital Infection, Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, 2nd Floor Samuels Building, The University of New South Wales, Sydney, NSW</wicri:regionArea><wicri:noRegion>NSW</wicri:noRegion></affiliation></author><author><name sortKey="Liu, M" sort="Liu, M" uniqKey="Liu M" first="M." last="Liu">M. Liu</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Medicine, Beijing University, Beijing, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Faculty of Medicine, Beijing University, Beijing</wicri:regionArea><placeName><settlement type="city">Pékin</settlement></placeName></affiliation></author><author><name sortKey="Mi, J" sort="Mi, J" uniqKey="Mi J" first="J." last="Mi">J. Mi</name><affiliation wicri:level="3"><nlm:aff id="aff4">Capital Pediatric Research Institute, Beijing, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Capital Pediatric Research Institute, Beijing</wicri:regionArea><placeName><settlement type="city">Pékin</settlement></placeName></affiliation></author><author><name sortKey="Chan, D K Y" sort="Chan, D K Y" uniqKey="Chan D" first="D. K. Y." last="Chan">D. K. Y. 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Liang</name><affiliation wicri:level="3"><nlm:aff id="aff1">Beijing Health Bureau, Capital University of Medical Sciences, Beijing</nlm:aff><country>République populaire de Chine</country><placeName><settlement type="city">Pékin</settlement></placeName><wicri:orgArea>Beijing Health Bureau, Capital University of Medical Sciences</wicri:orgArea></affiliation></author><author><name sortKey="Mclaws, M L" sort="Mclaws, M L" uniqKey="Mclaws M" first="M.-L." last="Mclaws">M.-L. Mclaws</name><affiliation wicri:level="1"><nlm:aff id="aff2">Hospital Infection, Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, 2nd Floor Samuels Building, The University of New South Wales, Sydney, NSW, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Hospital Infection, Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, 2nd Floor Samuels Building, The University of New South Wales, Sydney, NSW</wicri:regionArea><wicri:noRegion>NSW</wicri:noRegion></affiliation></author><author><name sortKey="Liu, M" sort="Liu, M" uniqKey="Liu M" first="M." last="Liu">M. Liu</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Medicine, Beijing University, Beijing, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Faculty of Medicine, Beijing University, Beijing</wicri:regionArea><placeName><settlement type="city">Pékin</settlement></placeName></affiliation></author><author><name sortKey="Mi, J" sort="Mi, J" uniqKey="Mi J" first="J." last="Mi">J. Mi</name><affiliation wicri:level="3"><nlm:aff id="aff4">Capital Pediatric Research Institute, Beijing, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Capital Pediatric Research Institute, Beijing</wicri:regionArea><placeName><settlement type="city">Pékin</settlement></placeName></affiliation></author><author><name sortKey="Chan, D K Y" sort="Chan, D K Y" uniqKey="Chan D" first="D. K. Y." last="Chan">D. K. Y. Chan</name><affiliation wicri:level="1"><nlm:aff id="aff5">Beijing Hospital, School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Beijing Hospital, School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW</wicri:regionArea><wicri:noRegion>NSW</wicri:noRegion></affiliation></author></analytic><series><title level="j">Public Health</title><idno type="ISSN">0033-3506</idno><idno type="eISSN">1476-5616</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec><title>Objective</title><p>To review the severe acute respiratory syndrome (SARS) epidemic in Beijing using basic epidemiological principles omitted from the original analysis.</p></sec><sec><title>Study design</title><p>Analysis of Prospective surveillance data for Beijing collected during the outbreak.</p></sec><sec><title>Methods</title><p>Surveillance data were reclassified according to World Health Organization criteria. Cases previously excluded without date of onset of illness were included in the epidemic curve from estimates using the average time between date of onset and date of hospitalization for cases with both dates. Cases who failed to give a contact history were now included; 7% (<inline-formula><mml:math id="M1" altimg="si1.gif" overflow="scroll"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>5</mml:mn></mml:mrow></mml:math></inline-formula>) of cases during the import phase and 61% (<inline-formula><mml:math id="M2" altimg="si2.gif" overflow="scroll"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>365</mml:mn></mml:mrow></mml:math></inline-formula>) during the peak phase. Previously excluded cases were included for plotting on an epidemic curve, and basic spot mapping for distribution of cases was used from attack rates recalculated for age, gender, occupation, residential location, date of onset of illness and demographics.</p></sec><sec><title>Results</title><p>The spot map effectively illustrated clusters by residency, with the inner-city sustaining the highest attack rate (33.42 per 100,000), followed by an easterly distribution 5–30 km away (21.62 per 10,000), and lowest in districts 60–160 km away (9.21 per 100,000). The new epidemic curve shows the outbreak commencing 10 days earlier than initially reported, with a three-fold greater increase in cases during the escalation phase than previously estimated.</p></sec><sec><title>Conclusion</title><p>In hindsight, the investigation of the Beijing SARS would have benefited from the use of spot maping as an essential outbreak tool for early identification of specific geographical area(s) for quarantining. If a spot map of incidence density rates was used during the early phase of the outbreak, the inner city might have been identified as a major risk factor requiring rapid quarantining. Contact history became uncommon as the outbreak progressed, suggesting that hospitals were over-burdened or pathogenesis and environment risk factors changed, strengthening the usefulness of early spot mapping and the need to modify risk factors included as contact history as the epidemic progresses.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Zhong, N S" uniqKey="Zhong N">N.S. Zhong</name></author><author><name sortKey="Zheng, B J" uniqKey="Zheng B">B.J. Zheng</name></author><author><name sortKey="Li, Y M" uniqKey="Li Y">Y.M. Li</name></author><author><name sortKey="Poon, L L M" uniqKey="Poon L">L.L.M. Poon</name></author><author><name sortKey="Xie, Z H" uniqKey="Xie Z">Z.H. Xie</name></author><author><name sortKey="Chan, K H" uniqKey="Chan K">K.H. 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Hedley</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C. Fraser</name></author><author><name sortKey="Riley, S" uniqKey="Riley S">S. Riley</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>République populaire de Chine</li></country><settlement><li>Pékin</li></settlement></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Liang, W" sort="Liang, W" uniqKey="Liang W" first="W." last="Liang">W. Liang</name></noRegion><name sortKey="Liu, M" sort="Liu, M" uniqKey="Liu M" first="M." last="Liu">M. Liu</name><name sortKey="Mi, J" sort="Mi, J" uniqKey="Mi J" first="J." last="Mi">J. Mi</name></country><country name="Australie"><noRegion><name sortKey="Mclaws, M L" sort="Mclaws, M L" uniqKey="Mclaws M" first="M.-L." last="Mclaws">M.-L. Mclaws</name></noRegion><name sortKey="Chan, D K Y" sort="Chan, D K Y" uniqKey="Chan D" first="D. K. Y." last="Chan">D. K. Y. 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