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Temporal-Spatial Analysis of Severe Acute Respiratory Syndrome among Hospital Inpatients

Identifieur interne : 001217 ( Pmc/Checkpoint ); précédent : 001216; suivant : 001218

Temporal-Spatial Analysis of Severe Acute Respiratory Syndrome among Hospital Inpatients

Auteurs : Ignatius T. S. Yu [République populaire de Chine] ; Tze Wai Wong [République populaire de Chine] ; Yuk Lan Chiu [République populaire de Chine] ; Nelson Lee [République populaire de Chine] ; Yuguo Li [République populaire de Chine]

Source :

Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2005.

RBID : PMC:7107882

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.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107882

DOI: 10.1086/428735
PubMed: 15825024
PubMed Central: 7107882

Affiliations:

République populaire de Chine

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PMC:7107882

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<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>
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. 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.</p>
<p><bold><italic>Methods</italic>
</bold>
. 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.</p>
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. 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 (<italic>P</italic>
 = .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.</p>
<p><bold><italic>Conclusions</italic>
</bold>
. 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.</p>
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  <front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Clin. Infect. Dis</journal-id>
<journal-id journal-id-type="hwp">cid</journal-id>
<journal-id journal-id-type="publisher-id">cid</journal-id>
<journal-title-group><journal-title>Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</journal-title>
</journal-title-group>
<issn pub-type="ppub">1058-4838</issn>
<issn pub-type="epub">1537-6591</issn>
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<article-categories><subj-group subj-group-type="heading"><subject>Major Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Temporal-Spatial Analysis of Severe Acute Respiratory Syndrome among Hospital Inpatients</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Yu</surname>
<given-names>Ignatius T. S.</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="cor1"></xref>
<pmc-comment>iyu@cuhk.edu.hk</pmc-comment>
        </contrib>
<contrib contrib-type="author"><name><surname>Wong</surname>
<given-names>Tze Wai</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chiu</surname>
<given-names>Yuk Lan</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>Nelson</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Li</surname>
<given-names>Yuguo</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
<institution>Department of Community and Family Medicine, Chinese University of Hong Kong</institution>
,<addr-line>Hong Kong, China</addr-line>
</aff>
<aff id="aff2"><label>2</label>
<institution>Department of Medicine and Therapeutics, Prince of Wales Hospital</institution>
,<addr-line>Hong Kong, China</addr-line>
</aff>
<aff id="aff3"><label>3</label>
<institution>Department of Mechanical Engineering, University of Hong Kong</institution>
,<addr-line>Hong Kong, China</addr-line>
</aff>
<author-notes><corresp id="cor1">Reprints or correspondence: Dr. Ignatius Yu, Dept. of Community and Family Medicine, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong SAR, China (<email>iyu@cuhk.edu.hk</email>
).</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>1</day>
<month>5</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="epub" iso-8601-date="2005-05-01"><day>1</day>
<month>5</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>5</month>
<year>2005</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
      <volume>40</volume>
<issue>9</issue>
<fpage>1237</fpage>
<lpage>1243</lpage>
<history><date date-type="received"><day>25</day>
<month>10</month>
<year>2004</year>
</date>
<date date-type="accepted"><day>3</day>
<month>12</month>
<year>2004</year>
</date>
</history>
<permissions><copyright-statement>© 2005 by the Infectious Diseases Society of America</copyright-statement>
<copyright-year>2005</copyright-year>
<license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p>
</license>
</permissions>
<self-uri xlink:href="40-9-1237.pdf"></self-uri>
<abstract><title>Abstract</title>
<p><bold><italic>Background</italic>
</bold>
. 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.</p>
<p><bold><italic>Methods</italic>
</bold>
. 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.</p>
<p><bold><italic>Results</italic>
</bold>
. 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 (<italic>P</italic>
 = .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.</p>
<p><bold><italic>Conclusions</italic>
</bold>
. 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.</p>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>République populaire de Chine</li>
</country>
</list>
<tree><country name="République populaire de Chine"><noRegion><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>
</noRegion>
<name sortKey="Chiu, Yuk Lan" sort="Chiu, Yuk Lan" uniqKey="Chiu Y" first="Yuk Lan" last="Chiu">Yuk Lan Chiu</name>
<name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name>
<name sortKey="Li, Yuguo" sort="Li, Yuguo" uniqKey="Li Y" first="Yuguo" last="Li">Yuguo Li</name>
<name sortKey="Wong, Tze Wai" sort="Wong, Tze Wai" uniqKey="Wong T" first="Tze Wai" last="Wong">Tze Wai Wong</name>
</country>
</tree>
</affiliations>
</record>

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Temporal-Spatial Analysis of Severe Acute Respiratory Syndrome among Hospital Inpatients

Temporal-Spatial Analysis of Severe Acute Respiratory Syndrome among Hospital Inpatients

Source :

Abstract

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