Hindsight: A re-analysis of the severe acute respiratory syndrome outbreak in Beijing
Identifieur interne : 000F53 ( Pmc/Checkpoint ); précédent : 000F52; suivant : 000F54Hindsight: 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.
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DOI: 10.1016/j.puhe.2007.02.023
PubMed: 17555781
PubMed Central: 7111616
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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. 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></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17555781</idno><idno type="pmc">7111616</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111616</idno><idno type="RBID">PMC:7111616</idno><idno type="doi">10.1016/j.puhe.2007.02.023</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">001452</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001452</idno><idno type="wicri:Area/Pmc/Curation">001452</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001452</idno><idno type="wicri:Area/Pmc/Checkpoint">000F53</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000F53</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hindsight: A re-analysis of the severe acute respiratory syndrome outbreak in Beijing</title><author><name sortKey="Liang, W" sort="Liang, W" uniqKey="Liang W" first="W." last="Liang">W. 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. Chan</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Meng, B" uniqKey="Meng B">B. Meng</name></author><author><name sortKey="Wang, J" uniqKey="Wang J">J. Wang</name></author><author><name sortKey="Liu, J" uniqKey="Liu J">J. Liu</name></author><author><name sortKey="Wu, J" uniqKey="Wu J">J. Wu</name></author><author><name sortKey="Zhong, E" uniqKey="Zhong E">E. Zhong</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Snow, J" uniqKey="Snow J">J. Snow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ming, W" uniqKey="Ming W">W. Ming</name></author><author><name sortKey="Du, L" uniqKey="Du L">L. Du</name></author><author><name sortKey="Hua Rei, Z" uniqKey="Hua Rei Z">Z. Hua-rei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Riley, S" uniqKey="Riley S">S. Riley</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C. Fraser</name></author><author><name sortKey="Donnelly, C A" uniqKey="Donnelly C">C.A. Donnelly</name></author><author><name sortKey="Ghani, A C" uniqKey="Ghani A">A.C. Ghani</name></author><author><name sortKey="Abu Raddad, L J" uniqKey="Abu Raddad L">L.J. Abu-Raddad</name></author><author><name sortKey="Hedley, A J" uniqKey="Hedley A">A.J. Hedley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pang, X" uniqKey="Pang X">X. Pang</name></author><author><name sortKey="Zhu, Z" uniqKey="Zhu Z">Z. Zhu</name></author><author><name sortKey="Xu, F" uniqKey="Xu F">F. Xu</name></author><author><name sortKey="Guo, J" uniqKey="Guo J">J. Guo</name></author><author><name sortKey="Gong, X" uniqKey="Gong X">X. Gong</name></author><author><name sortKey="Liu, D" uniqKey="Liu D">D. Liu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lipsitch, M" uniqKey="Lipsitch M">M. Lipsitch</name></author><author><name sortKey="Cohen, T" uniqKey="Cohen T">T. Cohen</name></author><author><name sortKey="Cooper, B" uniqKey="Cooper B">B. Cooper</name></author><author><name sortKey="Robins, J M" uniqKey="Robins J">J.M. Robins</name></author><author><name sortKey="Ma, S" uniqKey="Ma S">S. Ma</name></author><author><name sortKey="James, L" uniqKey="James L">L. James</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Donnelly, C A" uniqKey="Donnelly C">C.A. Donnelly</name></author><author><name sortKey="Ghani, A C" uniqKey="Ghani A">A.C. Ghani</name></author><author><name sortKey="Leung, G M" uniqKey="Leung G">G.M. Leung</name></author><author><name sortKey="Hedley, A J" uniqKey="Hedley A">A.J. 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><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Public Health</journal-id><journal-id journal-id-type="iso-abbrev">Public Health</journal-id><journal-title-group><journal-title>Public Health</journal-title></journal-title-group><issn pub-type="ppub">0033-3506</issn><issn pub-type="epub">1476-5616</issn><publisher><publisher-name>The Royal Institute of Public Health. Published by Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17555781</article-id><article-id pub-id-type="pmc">7111616</article-id><article-id pub-id-type="publisher-id">S0033-3506(07)00081-9</article-id><article-id pub-id-type="doi">10.1016/j.puhe.2007.02.023</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Hindsight: A re-analysis of the severe acute respiratory syndrome outbreak in Beijing</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Liang</surname><given-names>W.</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>McLaws</surname><given-names>M.-L.</given-names></name><email>m.mclaws@unsw.edu.au</email><xref rid="aff2" ref-type="aff">b</xref><xref rid="cor1" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author"><name><surname>Liu</surname><given-names>M.</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Mi</surname><given-names>J.</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Chan</surname><given-names>D.K.Y.</given-names></name><xref rid="aff5" ref-type="aff">e</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Beijing Health Bureau, Capital University of Medical Sciences, Beijing</aff><aff id="aff2"><label>b</label>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</aff><aff id="aff3"><label>c</label>Faculty of Medicine, Beijing University, Beijing, China</aff><aff id="aff4"><label>d</label>Capital Pediatric Research Institute, Beijing, China</aff><aff id="aff5"><label>e</label>Beijing Hospital, School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia</aff><author-notes><corresp id="cor1"><label>⁎</label>Corresponding author. Tel.: +61 2 93852586; fax: +61 2 93851036. <email>m.mclaws@unsw.edu.au</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>6</day><month>6</month><year>2007</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>10</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>6</day><month>6</month><year>2007</year></pub-date><volume>121</volume><issue>10</issue><fpage>725</fpage><lpage>733</lpage><history><date date-type="received"><day>28</day><month>4</month><year>2006</year></date><date date-type="rev-recd"><day>7</day><month>11</month><year>2006</year></date><date date-type="accepted"><day>23</day><month>2</month><year>2007</year></date></history><permissions><copyright-statement>Copyright © 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2007</copyright-year><copyright-holder>The Royal Institute of Public Health</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract><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></abstract><kwd-group><title>Keywords</title><kwd>SARS outbreak</kwd><kwd>Epidemic curve</kwd><kwd>Spot mapping</kwd></kwd-group></article-meta></front></pmc><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. Chan</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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