Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study
Identifieur interne : 000616 ( Pmc/Corpus ); précédent : 000615; suivant : 000617Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study
Auteurs : Khuan Yew Chow ; Chien Earn Lee ; Moi Lin Ling ; Derrick Mok Kwee Heng ; Soon Ghee YapSource :
- BMJ : British Medical Journal [ 0959-8138 ] ; 2004.
Abstract
Url:
DOI: 10.1136/bmj.37939.465729.44
PubMed: 14726369
PubMed Central: 318482
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study</title><author><name sortKey="Chow, Khuan Yew" sort="Chow, Khuan Yew" uniqKey="Chow K" first="Khuan Yew" last="Chow">Khuan Yew Chow</name><affiliation><nlm:aff id="aff1"> Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</nlm:aff></affiliation></author><author><name sortKey="Lee, Chien Earn" sort="Lee, Chien Earn" uniqKey="Lee C" first="Chien Earn" last="Lee">Chien Earn Lee</name><affiliation><nlm:aff id="aff2"> Casemix Project Office, Planning and Development Division, Ministry of Health Singapore, College of Medicine Building, 16 College Road, Singapore 169854</nlm:aff></affiliation></author><author><name sortKey="Ling, Moi Lin" sort="Ling, Moi Lin" uniqKey="Ling M" first="Moi Lin" last="Ling">Moi Lin Ling</name><affiliation><nlm:aff id="aff3"> Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</nlm:aff></affiliation></author><author><name sortKey="Heng, Derrick Mok Kwee" sort="Heng, Derrick Mok Kwee" uniqKey="Heng D" first="Derrick Mok Kwee" last="Heng">Derrick Mok Kwee Heng</name><affiliation><nlm:aff id="aff5"> Clinical Trials and Epidemiology Research Unit, 226 Outram Road Blk A #03-01, Singapore 169039</nlm:aff></affiliation></author><author><name sortKey="Yap, Soon Ghee" sort="Yap, Soon Ghee" uniqKey="Yap S" first="Soon Ghee" last="Yap">Soon Ghee Yap</name><affiliation><nlm:aff id="aff4"> Ear, Nose, and Throat Department, Singapore General Hospital</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">14726369</idno><idno type="pmc">318482</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC318482</idno><idno type="RBID">PMC:318482</idno><idno type="doi">10.1136/bmj.37939.465729.44</idno><date when="2004">2004</date><idno type="wicri:Area/Pmc/Corpus">000616</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000616</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study</title><author><name sortKey="Chow, Khuan Yew" sort="Chow, Khuan Yew" uniqKey="Chow K" first="Khuan Yew" last="Chow">Khuan Yew Chow</name><affiliation><nlm:aff id="aff1"> Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</nlm:aff></affiliation></author><author><name sortKey="Lee, Chien Earn" sort="Lee, Chien Earn" uniqKey="Lee C" first="Chien Earn" last="Lee">Chien Earn Lee</name><affiliation><nlm:aff id="aff2"> Casemix Project Office, Planning and Development Division, Ministry of Health Singapore, College of Medicine Building, 16 College Road, Singapore 169854</nlm:aff></affiliation></author><author><name sortKey="Ling, Moi Lin" sort="Ling, Moi Lin" uniqKey="Ling M" first="Moi Lin" last="Ling">Moi Lin Ling</name><affiliation><nlm:aff id="aff3"> Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</nlm:aff></affiliation></author><author><name sortKey="Heng, Derrick Mok Kwee" sort="Heng, Derrick Mok Kwee" uniqKey="Heng D" first="Derrick Mok Kwee" last="Heng">Derrick Mok Kwee Heng</name><affiliation><nlm:aff id="aff5"> Clinical Trials and Epidemiology Research Unit, 226 Outram Road Blk A #03-01, Singapore 169039</nlm:aff></affiliation></author><author><name sortKey="Yap, Soon Ghee" sort="Yap, Soon Ghee" uniqKey="Yap S" first="Soon Ghee" last="Yap">Soon Ghee Yap</name><affiliation><nlm:aff id="aff4"> Ear, Nose, and Throat Department, Singapore General Hospital</nlm:aff></affiliation></author></analytic><series><title level="j">BMJ : British Medical Journal</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><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></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>BMJ Publishing Group Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">14726369</article-id><article-id pub-id-type="pmc">318482</article-id><article-id pub-id-type="publisher-id">el-ppr195</article-id><article-id pub-id-type="doi">10.1136/bmj.37939.465729.44</article-id><article-categories><subj-group subj-group-type="heading"><subject>Papers</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"><name><surname>Chow</surname><given-names>Khuan Yew</given-names></name><role>registrar</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Chien Earn</given-names></name><role>head</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ling</surname><given-names>Moi Lin</given-names></name><role>director</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Heng</surname><given-names>Derrick Mok Kwee</given-names></name><role>head of epidemiology</role><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Yap</surname><given-names>Soon Ghee</given-names></name><role>nursing officer</role><xref ref-type="aff" rid="aff4">4</xref></contrib></contrib-group><aff id="aff1"><label>1</label> Health Screening Department, Adult Health Division, Health Promotion Board, 3 Second Hospital Avenue #06-00, Singapore 168937</aff><aff id="aff2"><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="aff3"><label>3</label> Quality Management, Singapore General Hospital, Outram Road, Singapore 169608</aff><aff id="aff4"><label>4</label> Ear, Nose, and Throat Department, Singapore General Hospital</aff><aff id="aff5"><label>5</label> Clinical Trials and Epidemiology Research Unit, 226 Outram Road Blk A #03-01, Singapore 169039</aff><author-notes><fn><p> Correspondence to: Moi Lin Ling <email>gptlml@sgh.com.sg</email></p></fn></author-notes><pub-date pub-type="ppub"><day>24</day><month>1</month><year>2004</year></pub-date><volume>328</volume><issue>7433</issue><fpage>195</fpage><lpage>195</lpage><history><date date-type="accepted"><day>6</day><month>11</month><year>2003</year></date></history><copyright-statement>Copyright © 2004, BMJ Publishing Group Ltd.</copyright-statement><copyright-year>2004</copyright-year><abstract><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></article-meta><notes><fn-group><fn><p>Contributors: KYC wrote first draft of the paper. MLL, LCE, DMKH, and SGY subsequently edited the paper. MLL is the guarantor. All authors were actively involved in managing the outbreak.</p></fn><fn><p>Funding: None.</p></fn><fn><p>Competing interests: None declared.</p></fn><fn><p>Ethical approval: Professor Tay Boon Keng, chairman Medical Board and SARS Task Force Singapore General Hospital.</p></fn></fn-group></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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