Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport
Identifieur interne : 001220 ( Pmc/Corpus ); précédent : 001219; suivant : 001221Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport
Auteurs : Annelies Wilder-Smith ; Kee Tai Goh ; Nicholas I. PatonSource :
- Journal of Travel Medicine [ 1195-1982 ] ; 2006.
Abstract
The importation of SARS was responsible for the outbreaks in Singapore, Hong Kong, Vietnam and Canada at a time when this new disease had not been identified. We report the incidence and impact of cases of SARS imported to Singapore between 25 February and 31 May 2003, and describe national measures to prevent further importation.
Information on imported cases of SARS and measures taken at entry points to Singapore was retrieved from the Ministry of Health and the Civil Aviation Authority of Singapore.
Of the 6 imported cases, which all occurred before screening measures were implemented at the airport, only the first resulted in extensive secondary transmission. Of 442,973 air passengers screened after measures were implemented, 136 were sent to a designated hospital for further SARS screening; none was diagnosed as having SARS.
The SARS outbreak in Singapore can be traced to the first imported case. The absence of transmission from the other imported cases was probably a result of relatively prompt identification and isolation of cases, together with a low potential for transmission. New imported SARS cases therefore need not lead to major outbreaks if systems are in place to identify and isolate them early. Screening at entry points is costly, has a low yield and is not sufficient in itself, but may be justified in light of the major economic, social and international impact which even a single imported SARS case may have.
Url:
DOI: 10.2310/7060.2003.2676
PubMed: 14531977
PubMed Central: 7107530
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport</title><author><name sortKey="Wilder Smith, Annelies" sort="Wilder Smith, Annelies" uniqKey="Wilder Smith A" first="Annelies" last="Wilder-Smith">Annelies Wilder-Smith</name></author><author><name sortKey="Goh, Kee Tai" sort="Goh, Kee Tai" uniqKey="Goh K" first="Kee Tai" last="Goh">Kee Tai Goh</name></author><author><name sortKey="Paton, Nicholas I" sort="Paton, Nicholas I" uniqKey="Paton N" first="Nicholas I" last="Paton">Nicholas I. Paton</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">14531977</idno><idno type="pmc">7107530</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107530</idno><idno type="RBID">PMC:7107530</idno><idno type="doi">10.2310/7060.2003.2676</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">001220</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001220</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport</title><author><name sortKey="Wilder Smith, Annelies" sort="Wilder Smith, Annelies" uniqKey="Wilder Smith A" first="Annelies" last="Wilder-Smith">Annelies Wilder-Smith</name></author><author><name sortKey="Goh, Kee Tai" sort="Goh, Kee Tai" uniqKey="Goh K" first="Kee Tai" last="Goh">Kee Tai Goh</name></author><author><name sortKey="Paton, Nicholas I" sort="Paton, Nicholas I" uniqKey="Paton N" first="Nicholas I" last="Paton">Nicholas I. Paton</name></author></analytic><series><title level="j">Journal of Travel Medicine</title><idno type="ISSN">1195-1982</idno><idno type="eISSN">1708-8305</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Background</title><p>The importation of SARS was responsible for the outbreaks in Singapore, Hong Kong, Vietnam and Canada at a time when this new disease had not been identified. We report the incidence and impact of cases of SARS imported to Singapore between 25 February and 31 May 2003, and describe national measures to prevent further importation.</p></sec><sec><title>Methods</title><p>Information on imported cases of SARS and measures taken at entry points to Singapore was retrieved from the Ministry of Health and the Civil Aviation Authority of Singapore.</p></sec><sec><title>Results</title><p>Of the 6 imported cases, which all occurred before screening measures were implemented at the airport, only the first resulted in extensive secondary transmission. Of 442,973 air passengers screened after measures were implemented, 136 were sent to a designated hospital for further SARS screening; none was diagnosed as having SARS.</p></sec><sec><title>Conclusions</title><p>The SARS outbreak in Singapore can be traced to the first imported case. The absence of transmission from the other imported cases was probably a result of relatively prompt identification and isolation of cases, together with a low potential for transmission. New imported SARS cases therefore need not lead to major outbreaks if systems are in place to identify and isolate them early. Screening at entry points is costly, has a low yield and is not sufficient in itself, but may be justified in light of the major economic, social and international impact which even a single imported SARS case may have.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lee, N" uniqKey="Lee N">N Lee</name></author><author><name sortKey="Hui, D" uniqKey="Hui D">D Hui</name></author><author><name sortKey="Wu, A" uniqKey="Wu A">A Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Poutanen, Sm" uniqKey="Poutanen S">SM Poutanen</name></author><author><name sortKey="Low, De" uniqKey="Low D">DE Low</name></author><author><name sortKey="Henry, B" uniqKey="Henry B">B Henry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hsu, Lylc" uniqKey="Hsu L">LYLC Hsu</name></author><author><name sortKey="Green, Ja" uniqKey="Green J">JA Green</name></author><author><name sortKey="Ang, B" uniqKey="Ang B">B Ang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilder Smith, A" uniqKey="Wilder Smith A">A Wilder-Smith</name></author><author><name sortKey="Paton, Ni" uniqKey="Paton N">NI Paton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan Yeung, M" uniqKey="Chan Yeung M">M Chan-Yeung</name></author><author><name sortKey="Yu, Wc" uniqKey="Yu W">WC Yu</name></author></analytic></biblStruct><biblStruct></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></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, Ca" uniqKey="Donnelly C">CA Donnelly</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">J Travel Med</journal-id><journal-id journal-id-type="iso-abbrev">J Travel Med</journal-id><journal-id journal-id-type="hwp">jtm</journal-id><journal-id journal-id-type="publisher-id">jtm</journal-id><journal-title-group><journal-title>Journal of Travel Medicine</journal-title></journal-title-group><issn pub-type="ppub">1195-1982</issn><issn pub-type="epub">1708-8305</issn><publisher><publisher-name>Oxford University Press</publisher-name><publisher-loc>Oxford, UK</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">14531977</article-id><article-id pub-id-type="pmc">7107530</article-id><article-id pub-id-type="doi">10.2310/7060.2003.2676</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wilder-Smith</surname><given-names>Annelies</given-names></name><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Goh</surname><given-names>Kee Tai</given-names></name></contrib><contrib contrib-type="author"><name><surname>Paton</surname><given-names>Nicholas I</given-names></name></contrib></contrib-group><aff id="a1"><italic>Annelies Wilder-Smith, MD, MIH, PhD</italic> and<italic>Nicholas I Paton, MD:</italic> Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore</aff><aff id="a2"><italic>Kee Tai Goh, MD:</italic> Ministry of Health, Singapore.</aff><author-notes><corresp id="cor1">Reprint requests: <italic>Dr Annelies Wilder-Smith</italic>, Head, Travellers' Health & Vaccination Centre, Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 308433 Singapore.</corresp></author-notes><pub-date pub-type="collection"><day>01</day><month>10</month><year>2003</year></pub-date><pub-date pub-type="epub" iso-8601-date="2006-03-08"><day>08</day><month>3</month><year>2006</year></pub-date><volume>10</volume><issue>5</issue><fpage>259</fpage><lpage>262</lpage><permissions><copyright-statement>© 2003 International Society of Travel Medicine</copyright-statement><copyright-year>2003</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="jtm10-0259.pdf"></self-uri><abstract><title>Abstract</title><sec><title>Background</title><p>The importation of SARS was responsible for the outbreaks in Singapore, Hong Kong, Vietnam and Canada at a time when this new disease had not been identified. We report the incidence and impact of cases of SARS imported to Singapore between 25 February and 31 May 2003, and describe national measures to prevent further importation.</p></sec><sec><title>Methods</title><p>Information on imported cases of SARS and measures taken at entry points to Singapore was retrieved from the Ministry of Health and the Civil Aviation Authority of Singapore.</p></sec><sec><title>Results</title><p>Of the 6 imported cases, which all occurred before screening measures were implemented at the airport, only the first resulted in extensive secondary transmission. Of 442,973 air passengers screened after measures were implemented, 136 were sent to a designated hospital for further SARS screening; none was diagnosed as having SARS.</p></sec><sec><title>Conclusions</title><p>The SARS outbreak in Singapore can be traced to the first imported case. The absence of transmission from the other imported cases was probably a result of relatively prompt identification and isolation of cases, together with a low potential for transmission. New imported SARS cases therefore need not lead to major outbreaks if systems are in place to identify and isolate them early. Screening at entry points is costly, has a low yield and is not sufficient in itself, but may be justified in light of the major economic, social and international impact which even a single imported SARS case may have.</p></sec></abstract></article-meta></front><back><fn-group><fn id="n-fnt-1"><p>The authors had no financial or other conflicts of interest to disclose.</p></fn></fn-group><ref-list><title>Reference</title><ref id="b1"><label>1</label><mixed-citation publication-type="journal"><article-title>Outbreak of severe acute respiratory syndrome - worldwide, 2003</article-title>. <source>MMWR</source><year>2003</year>; <volume>52</volume> (<issue>11</issue>): <fpage>226</fpage>–<lpage>228</lpage>.<pub-id pub-id-type="pmid">12665115</pub-id></mixed-citation></ref><ref id="b2"><label>2</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>N</given-names></name><name><surname>Hui</surname><given-names>D</given-names></name><name><surname>Wu</surname><given-names>A</given-names></name></person-group><italic>et al.</italic><article-title>A major outbreak of severe acute respiratory syndrome in Hong Kong</article-title>. <source>N Engl J Med</source><year>2003</year>; <volume>348</volume> (<issue>20</issue>): <fpage>1986</fpage>–<lpage>1994</lpage>. 12682352<pub-id pub-id-type="pmid">12682352</pub-id></mixed-citation></ref><ref id="b3"><label>3</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Poutanen</surname><given-names>SM</given-names></name><name><surname>Low</surname><given-names>DE</given-names></name><name><surname>Henry</surname><given-names>B</given-names></name></person-group><italic>et al.</italic><article-title>Identification of severe acute respiratory syndrome in Canada</article-title>. <source>N Engl J Med</source><year>2003</year>; <volume>348</volume> (<issue>20</issue>): <fpage>1995</fpage>–<lpage>2005</lpage>. 12671061<pub-id pub-id-type="pmid">12671061</pub-id></mixed-citation></ref><ref id="b4"><label>4</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsu</surname><given-names>LYLC</given-names></name><name><surname>Green</surname><given-names>JA</given-names></name><name><surname>Ang</surname><given-names>B</given-names></name></person-group><italic>et al.</italic><article-title>Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts</article-title>. <source>Emerg Infect Dis</source><year>2003</year>; <volume>9</volume> (<issue>06</issue>): <fpage>713</fpage>–<lpage>717</lpage>. 12781012<pub-id pub-id-type="pmid">12781012</pub-id></mixed-citation></ref><ref id="b5"><label>5</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wilder-Smith</surname><given-names>A</given-names></name><name><surname>Paton</surname><given-names>NI</given-names></name></person-group><article-title>Severe acute respiratory syndrome: imported cases of severe acute respiratory syndrome to Singapore had impact on national epidemic</article-title>. <source>BMJ</source><year>2003</year>; <volume>326</volume>: <fpage>1393</fpage>–<lpage>1394</lpage>. 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