Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients
Identifieur interne : 000557 ( PascalFrancis/Checkpoint ); précédent : 000556; suivant : 000558Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients
Auteurs : Ignatius T. S. Yu [Hong Kong] ; TZE WAI WONG [Hong Kong] ; YUK LAN CHIU [Hong Kong] ; Nelson Lee [Hong Kong] ; YUGUO LI [Hong Kong]Source :
- Clinical infectious diseases [ 1058-4838 ] ; 2005.
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- Pascal (Inist)
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Abstract
Background. We report the temporal-spatial spread of severe acute respiratory syndrome (SARS) among inpatients in a hospital ward during a major nosocomial outbreak and discuss possible mechanisms for the outbreak. Methods. All inpatients who had stayed in the same ward as the initial index case patient for any duration before isolation were recruited into a cohort and followed up to document the occurrence of SARS. The normalized concentration of virus-laden aerosols at different locations of the ward was estimated by use of computational fluid dynamics modeling. The attack rates in the various subgroups stratified by bed location were calculated. Multivariate Cox proportional hazards regression was used to document important risk factors. Results. The overall attack rate of SARS was 41% (30 of 74 subjects). It was 65%, 52%, and 18% in the same bay, adjacent bay, and distant bays, respectively (P = .001). Computation fluid dynamics modeling indicated that the normalized concentration of virus-laden aerosols was highest in the same bay and lowest in the distant bays. Cox regression indicated that staying in the ward on 6 or 10 March entailed higher risk, as well as staying in the same or adjacent bays. The epidemic curve showed 2 peaks, and stratified analyses by bed location suggested >1 generation of spread. Conclusions. The temporal-spatial spread of SARS in the ward was consistent with airborne transmission, as modeled by use of computational fluid dynamics. Infected health care workers likely acted as secondary sources in the latter phase of the outbreak.
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Yu</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Tze Wai Wong" sort="Tze Wai Wong" uniqKey="Tze Wai Wong" last="Tze Wai Wong">TZE WAI WONG</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Yuk Lan Chiu" sort="Yuk Lan Chiu" uniqKey="Yuk Lan Chiu" last="Yuk Lan Chiu">YUK LAN CHIU</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine and Therapeutics, Prince of Wales Hospital, University of Hong Kong</s1><s3>HKG</s3><sZ>4 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine and Therapeutics, Prince of Wales Hospital, University of Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Yuguo Li" sort="Yuguo Li" uniqKey="Yuguo Li" last="Yuguo Li">YUGUO LI</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Mechanical Engineering, University of Hong Kong</s1><s3>HKG</s3><sZ>5 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Mechanical Engineering, University of Hong Kong</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">05-0330389</idno><date when="2005">2005</date><idno type="stanalyst">PASCAL 05-0330389 INIST</idno><idno type="RBID">Pascal:05-0330389</idno><idno type="wicri:Area/PascalFrancis/Corpus">000641</idno><idno type="wicri:Area/PascalFrancis/Curation">000349</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000557</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000557</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients</title><author><name sortKey="Yu, Ignatius T S" sort="Yu, Ignatius T S" uniqKey="Yu I" first="Ignatius T. S." last="Yu">Ignatius T. S. Yu</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Tze Wai Wong" sort="Tze Wai Wong" uniqKey="Tze Wai Wong" last="Tze Wai Wong">TZE WAI WONG</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Yuk Lan Chiu" sort="Yuk Lan Chiu" uniqKey="Yuk Lan Chiu" last="Yuk Lan Chiu">YUK LAN CHIU</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Hong Kong</country><placeName><settlement type="city">Sha Tin</settlement></placeName><orgName type="university">Université chinoise de Hong Kong</orgName></affiliation></author><author><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine and Therapeutics, Prince of Wales Hospital, University of Hong Kong</s1><s3>HKG</s3><sZ>4 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine and Therapeutics, Prince of Wales Hospital, University of Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Yuguo Li" sort="Yuguo Li" uniqKey="Yuguo Li" last="Yuguo Li">YUGUO LI</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Mechanical Engineering, University of Hong Kong</s1><s3>HKG</s3><sZ>5 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Mechanical Engineering, University of Hong Kong</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Clinical infectious diseases</title><title level="j" type="abbreviated">Clin. infect. dis.</title><idno type="ISSN">1058-4838</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Clinical infectious diseases</title><title level="j" type="abbreviated">Clin. infect. dis.</title><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Hospital</term><term>Severe acute respiratory syndrome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term><term>Hôpital</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background. We report the temporal-spatial spread of severe acute respiratory syndrome (SARS) among inpatients in a hospital ward during a major nosocomial outbreak and discuss possible mechanisms for the outbreak. Methods. All inpatients who had stayed in the same ward as the initial index case patient for any duration before isolation were recruited into a cohort and followed up to document the occurrence of SARS. The normalized concentration of virus-laden aerosols at different locations of the ward was estimated by use of computational fluid dynamics modeling. The attack rates in the various subgroups stratified by bed location were calculated. Multivariate Cox proportional hazards regression was used to document important risk factors. Results. The overall attack rate of SARS was 41% (30 of 74 subjects). It was 65%, 52%, and 18% in the same bay, adjacent bay, and distant bays, respectively (P = .001). Computation fluid dynamics modeling indicated that the normalized concentration of virus-laden aerosols was highest in the same bay and lowest in the distant bays. Cox regression indicated that staying in the ward on 6 or 10 March entailed higher risk, as well as staying in the same or adjacent bays. The epidemic curve showed 2 peaks, and stratified analyses by bed location suggested >1 generation of spread. Conclusions. The temporal-spatial spread of SARS in the ward was consistent with airborne transmission, as modeled by use of computational fluid dynamics. Infected health care workers likely acted as secondary sources in the latter phase of the outbreak.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>1058-4838</s0></fA01><fA02 i1="01"><s0>CIDIEL</s0></fA02><fA03 i2="1"><s0>Clin. infect. dis.</s0></fA03><fA05><s2>40</s2></fA05><fA06><s2>9</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients</s1></fA08><fA11 i1="01" i2="1"><s1>YU (Ignatius T. S.)</s1></fA11><fA11 i1="02" i2="1"><s1>TZE WAI WONG</s1></fA11><fA11 i1="03" i2="1"><s1>YUK LAN CHIU</s1></fA11><fA11 i1="04" i2="1"><s1>LEE (Nelson)</s1></fA11><fA11 i1="05" i2="1"><s1>YUGUO LI</s1></fA11><fA14 i1="01"><s1>Department of Community and Family Medicine, Chinese University of Hong Kong</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Medicine and Therapeutics, Prince of Wales Hospital, University of Hong Kong</s1><s3>HKG</s3><sZ>4 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Mechanical Engineering, University of Hong Kong</s1><s3>HKG</s3><sZ>5 aut.</sZ></fA14><fA20><s1>1237-1243</s1></fA20><fA21><s1>2005</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>18407</s2><s5>354000124691370040</s5></fA43><fA44><s0>0000</s0><s1>© 2005 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>17 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>05-0330389</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Clinical infectious diseases</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Background. We report the temporal-spatial spread of severe acute respiratory syndrome (SARS) among inpatients in a hospital ward during a major nosocomial outbreak and discuss possible mechanisms for the outbreak. Methods. All inpatients who had stayed in the same ward as the initial index case patient for any duration before isolation were recruited into a cohort and followed up to document the occurrence of SARS. The normalized concentration of virus-laden aerosols at different locations of the ward was estimated by use of computational fluid dynamics modeling. The attack rates in the various subgroups stratified by bed location were calculated. Multivariate Cox proportional hazards regression was used to document important risk factors. Results. The overall attack rate of SARS was 41% (30 of 74 subjects). It was 65%, 52%, and 18% in the same bay, adjacent bay, and distant bays, respectively (P = .001). Computation fluid dynamics modeling indicated that the normalized concentration of virus-laden aerosols was highest in the same bay and lowest in the distant bays. Cox regression indicated that staying in the ward on 6 or 10 March entailed higher risk, as well as staying in the same or adjacent bays. The epidemic curve showed 2 peaks, and stratified analyses by bed location suggested >1 generation of spread. Conclusions. The temporal-spatial spread of SARS in the ward was consistent with airborne transmission, as modeled by use of computational fluid dynamics. 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S." last="Yu">Ignatius T. S. Yu</name></noRegion><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><name sortKey="Tze Wai Wong" sort="Tze Wai Wong" uniqKey="Tze Wai Wong" last="Tze Wai Wong">TZE WAI WONG</name><name sortKey="Yuguo Li" sort="Yuguo Li" uniqKey="Yuguo Li" last="Yuguo Li">YUGUO LI</name><name sortKey="Yuk Lan Chiu" sort="Yuk Lan Chiu" uniqKey="Yuk Lan Chiu" last="Yuk Lan Chiu">YUK LAN CHIU</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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