Note to users. If you're seeing this message, it means that your browser cannot find this page's style/presentation instructions -- or possibly that you are using a browser that does not support current Web standards. Find out more about why this message is appearing, and what you can do to make your experience of our site the best it can be.
Invitrogen Webinar

Site Tools

  • AAAS
  • Subscribe
  • Feedback

Site Search

Search Advanced

Originally published in Science Express on 23 May 2003
Science 20 June 2003:
Vol. 300. no. 5627, pp. 1961 - 1966
DOI: 10.1126/science.1086478
Prev | Table of Contents | Next

Reports

Transmission Dynamics of the Etiological Agent of SARS in Hong Kong: Impact of Public Health Interventions

Steven Riley,1*{dagger} Christophe Fraser,1* Christl A. Donnelly,1 Azra C. Ghani,1 Laith J. Abu-Raddad,1 Anthony J. Hedley,2 Gabriel M. Leung,2 Lai-Ming Ho,2 Tai-Hing Lam,2 Thuan Q. Thach,2 Patsy Chau,2 King-Pan Chan,2 Su-Vui Lo,3 Pak-Yin Leung,4 Thomas Tsang,4 William Ho,5 Koon-Hung Lee,5 Edith M. C. Lau,6 Neil M. Ferguson,1 Roy M. Anderson1

We present an analysis of the first 10 weeks of the severe acute respiratory syndrome (SARS) epidemic in Hong Kong. The epidemic to date has been characterized by two large clusters—initiated by two separate "super-spread" events (SSEs)—and by ongoing community transmission. By fitting a stochastic model to data on 1512 cases, including these clusters, we show that the etiological agent of SARS is moderately transmissible. Excluding SSEs, we estimate that 2.7 secondary infections were generated per case on average at the start of the epidemic, with a substantial contribution from hospital transmission. Transmission rates fell during the epidemic, primarily as a result of reductions in population contact rates and improved hospital infection control, but also because of more rapid hospital attendance by symptomatic individuals. As a result, the epidemic is now in decline, although continued vigilance is necessary for this to be maintained. Restrictions on longer range population movement are shown to be a potentially useful additional control measure in some contexts. We estimate that most currently infected persons are now hospitalized, which highlights the importance of control of nosocomial transmission.

1 Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK.
2 Department of Community Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
3 Research Office, Health, Welfare and Food Bureau, Government of the Hong Kong Special Administrative Region, 19th Floor, Murray Building, Garden Road, Hong Kong.
4 Department of Health, Government of the Hong Kong Special Administrative Region, Wu Chung House, 213 Queen's Road East, Wanchai, Hong Kong.
5 Hong Kong Hospital Authority, 147B Argyle Street, Kowloon, Hong Kong.
6 Department of Community and Family Medicine, Chinese University of Hong Kong, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong.


* These authors contributed equally to this work.

{dagger} To whom correspondence should be addressed. E-mail: s.riley{at}imperial.ac.uk

Read the Full Text


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
Data-driven exploration of 'spatial pattern-time process-driving forces' associations of SARS epidemic in Beijing, China.
J.-F. Wang, G. Christakos, W.-G. Han, and B. Meng (2008)
J. Public Health Med.
   Abstract »    Full Text »    PDF »
Estimation of multiple transmission rates for epidemics in heterogeneous populations.
A. R. Cook, W. Otten, G. Marion, G. J. Gibson, and C. A. Gilligan (2007)
PNAS 104, 20392-20397
   Abstract »    Full Text »    PDF »
Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection.
V. C. C. Cheng, S. K. P. Lau, P. C. Y. Woo, and K. Y. Yuen (2007)
Clin. Microbiol. Rev. 20, 660-694
   Abstract »    Full Text »    PDF »
Estimating Variability in the Transmission of Severe Acute Respiratory Syndrome to Household Contacts in Hong Kong, China.
V. E. Pitzer, G. M. Leung, and M. Lipsitch (2007)
Am. J. Epidemiol. 166, 355-363
   Abstract »    Full Text »    PDF »
Behaviour change in generalised HIV epidemics: impact of reducing cross-generational sex and delaying age at sexual debut.
T B Hallett, S Gregson, J J C Lewis, B A Lopman, and G P Garnett (2007)
Sex. Transm. Inf. 83, i50-i54
   Abstract »    Full Text »    PDF »
Cell-based Angiopoietin-1 Gene Therapy for Acute Lung Injury.
S. D. McCarter, S. H. J. Mei, P. F. H. Lai, Q. W. Zhang, C. H. Parker, R. S. Suen, R. D. Hood, Y. D. Zhao, Y. Deng, R. N. N. Han, et al. (2007)
Am. J. Respir. Crit. Care Med. 175, 1014-1026
   Abstract »    Full Text »    PDF »
Optimizing the control of disease infestations at the landscape scale.
G. A. Forster and C. A. Gilligan (2007)
PNAS 104, 4984-4989
   Abstract »    Full Text »    PDF »
Uncertainty in predictions of disease spread and public health responses to bioterrorism and emerging diseases.
B. D. Elderd, V. M. Dukic, and G. Dwyer (2006)
PNAS 103, 15693-15697
   Abstract »    Full Text »    PDF »
Estimating in Real Time the Efficacy of Measures to Control Emerging Communicable Diseases.
S. Cauchemez, P.-Y. Boelle, G. Thomas, and A.-J. Valleron (2006)
Am. J. Epidemiol. 164, 591-597
   Abstract »    Full Text »    PDF »
Stat3 Is Required for Cytoprotection of the Respiratory Epithelium during Adenoviral Infection.
Y. Matsuzaki, Y. Xu, M. Ikegami, V. Besnard, K.-S. Park, W. M. Hull, S. E. Wert, and J. A. Whitsett (2006)
J. Immunol. 177, 527-537
   Abstract »    Full Text »    PDF »
Risk-Stratified Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus Among Children in Hong Kong.
P. P.W. Lee, W. H.S. Wong, G. M. Leung, S. S. Chiu, K.-H. Chan, J. S.M. Peiris, T.-H. Lam, and Y.-L. Lau (2006)
Pediatrics 117, e1156-e1162
   Abstract »    Full Text »    PDF »
Paediatric emergency department staff perceptions of infection control measures against severe acute respiratory syndrome.
M J Parker and R D Goldman (2006)
Emerg. Med. J. 23, 349-353
   Abstract »    Full Text »    PDF »
Predictability and preparedness in influenza control..
D. J. Smith (2006)
Science 312, 392-394
   Abstract »    Full Text »    PDF »
Complex Causal Process Diagrams for Analyzing the Health Impacts of Policy Interventions.
M. Joffe and J. Mindell (2006)
Am J Public Health 96, 473-479
   Abstract »    Full Text »    PDF »
When Is Quarantine a Useful Control Strategy for Emerging Infectious Diseases?.
T. Day, A. Park, N. Madras, A. Gumel, and J. Wu (2006)
Am. J. Epidemiol. 163, 479-485
   Abstract »    Full Text »    PDF »
A Novel Small-World Model: Using Social Mirror Identities for Epidemic Simulations.
C.-Y. Huang, C.-T. Sun, J.-L. Hsieh, Y.-M. A. Chen, and H. Lin (2005)
SIMULATION 81, 671-699
   Abstract »    PDF »
Single Amino Acid Substitutions in the Severe Acute Respiratory Syndrome Coronavirus Spike Glycoprotein Determine Viral Entry and Immunogenicity of a Major Neutralizing Domain.
C. E. Yi, L. Ba, L. Zhang, D. D. Ho, and Z. Chen (2005)
J. Virol. 79, 11638-11646
   Abstract »    Full Text »    PDF »
Multiscale, resurgent epidemics in a hierarchical metapopulation model.
D. J. Watts, R. Muhamad, D. C. Medina, and P. S. Dodds (2005)
PNAS 102, 11157-11162
   Abstract »    Full Text »    PDF »
RAPID AWARENESS AND TRANSMISSION OF SEVERE ACUTE RESPIRATORY SYNDROME IN HANOI FRENCH HOSPITAL, VIETNAM.
H. NISHIURA, T. KURATSUJI, T. QUY, N. C. PHI, V. VAN BAN, L. D. HA, H. T. LONG, H. YANAI, N. KEICHO, T. KIRIKAE, et al. (2005)
Am J Trop Med Hyg 73, 17-25
   Abstract »    Full Text »    PDF »
Protective Role of Urinary Trypsin Inhibitor in Acute Lung Injury Induced by Lipopolysaccharide.
K.-I. Inoue, H. Takano, R. Yanagisawa, M. Sakurai, A. Shimada, S. Yoshino, H. Sato, and T. Yoshikawa (2005)
Experimental Biology and Medicine 230, 281-287
   Abstract »    Full Text »    PDF »
An initial investigation of the association between the SARS outbreak and weather: with the view of the environmental temperature and its variation.
J. Tan, L. Mu, J. Huang, S. Yu, B. Chen, and J. Yin (2005)
J. Epidemiol. Community Health 59, 186-192
   Abstract »    Full Text »    PDF »
Recombinant Modified Vaccinia Virus Ankara Expressing the Spike Glycoprotein of Severe Acute Respiratory Syndrome Coronavirus Induces Protective Neutralizing Antibodies Primarily Targeting the Receptor Binding Region.
Z. Chen, L. Zhang, C. Qin, L. Ba, C. E. Yi, F. Zhang, Q. Wei, T. He, W. Yu, J. Yu, et al. (2005)
J. Virol. 79, 2678-2688
   Abstract »    Full Text »    PDF »
Duration of RT-PCR positivity in severe acute respiratory syndrome.
C. M. Chu, W. S. Leung, V. C. C. Cheng, K. H. Chan, A. W. N. Lin, V. L. Chan, J. Y. M. Lam, K. S. Chan, and K. Y. Yuen (2005)
Eur. Respir. J. 25, 12-14
   Abstract »    Full Text »    PDF »
SARS related preventive and risk behaviours practised by Hong Kong-mainland China cross border travellers during the outbreak of the SARS epidemic in Hong Kong.
J. T F Lau, X. Yang, H Y Tsui, and E. Pang (2004)
J. Epidemiol. Community Health 58, 988-996
   Abstract »    Full Text »    PDF »
The Epidemiology of Severe Acute Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 Patients.
G. M. Leung, A. J. Hedley, L.-M. Ho, P. Chau, I. O.L. Wong, T. Q. Thach, A. C. Ghani, C. A. Donnelly, C. Fraser, S. Riley, et al. (2004)
Ann Intern Med 141, 662-673
   Abstract »    Full Text »    PDF »
Forecast and control of epidemics in a globalized world.
L. Hufnagel, D. Brockmann, and T. Geisel (2004)
PNAS 101, 15124-15129
   Abstract »    Full Text »    PDF »
Predicting Super Spreading Events during the 2003 Severe Acute Respiratory Syndrome Epidemics in Hong Kong and Singapore.
Y. Li, I. T. S. Yu, P. Xu, J. H. W. Lee, T. W. Wong, P. L. Ooi, and A. C. Sleigh (2004)
Am. J. Epidemiol. 160, 719-728
   Abstract »    Full Text »    PDF »
Severe Acute Respiratory Syndrome: Prognostic Implications of Chest Radiographic Findings in 52 Patients.
S.-F. Ko, T.-Y. Lee, C.-C. Huang, Y.-F. Cheng, S.-H. Ng, Y.-L. Kuo, M.-C. Lin, J.-W. Liu, K. D. Yang, M.-C. Chen, et al. (2004)
Radiology 233, 173-181
   Abstract »    Full Text »    PDF »
Different Epidemic Curves for Severe Acute Respiratory Syndrome Reveal Similar Impacts of Control Measures.
J. Wallinga and P. Teunis (2004)
Am. J. Epidemiol. 160, 509-516
   Abstract »    Full Text »    PDF »
Severe acute respiratory syndrome: review and lessons of the 2003 outbreak.
U. D Parashar and L. J Anderson (2004)
Int. J. Epidemiol. 33, 628-634
   Full Text »    PDF »
Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus.
I. T.S. Yu, Y. Li, T. W. Wong, W. Tam, A. T. Chan, J. H.W. Lee, D. Y.C. Leung, and T. Ho (2004)
N. Engl. J. Med. 350, 1731-1739
   Abstract »    Full Text »    PDF »
Factors that make an infectious disease outbreak controllable.
C. Fraser, S. Riley, R. M. Anderson, and N. M. Ferguson (2004)
PNAS 101, 6146-6151
   Abstract »    Full Text »    PDF »
Modelling potential responses to severe acute respiratory syndrome in Japan: the role of initial attack size, precaution, and quarantine.
H Nishiura, K Patanarapelert, M Sriprom, W Sarakorn, S Sriyab, and I Ming Tang (2004)
J. Epidemiol. Community Health 58, 186-191
   Abstract »    Full Text »    PDF »
Mosaic Evolution of the Severe Acute Respiratory Syndrome Coronavirus.
J. Stavrinides and D. S. Guttman (2004)
J. Virol. 78, 76-82
   Abstract »    Full Text »    PDF »
Detection of SARS Coronavirus in Patients with Severe Acute Respiratory Syndrome by Conventional and Real-Time Quantitative Reverse Transcription-PCR Assays.
L. L.M. Poon, K. H. Chan, O. K. Wong, T. K.W. Cheung, I. Ng, B. Zheng, W. H. Seto, K. Y. Yuen, Y. Guan, and J. S.M. Peiris (2004)
Clin. Chem. 50, 67-72
   Abstract »    Full Text »    PDF »
The Severe Acute Respiratory Syndrome.
J. S.M. Peiris, K. Y. Yuen, A. D.M.E. Osterhaus, and K. Stohr (2003)
N. Engl. J. Med. 349, 2431-2441
   Full Text »    PDF »
Infection control and anesthesia: lessons learned from the Toronto SARS outbreak: [La lutte anti-infectieuse et l'anesthesie : les lecons de l'eclosion du SRAS a Toronto].
P. W.H. Peng, D. T. Wong, D. Bevan, and M. Gardam (2003)
Can J Anesth 50, 989-997
   Abstract »    Full Text »    PDF »
Are We Ready for Pandemic Influenza?.
R. J. Webby and R. G. Webster (2003)
Science 302, 1519-1522
   Abstract »    Full Text »    PDF »
Monitoring community responses to the SARS epidemic in Hong Kong: from day 10 to day 62.
J T F Lau, X Yang, H Tsui, and J H Kim (2003)
J. Epidemiol. Community Health 57, 864-870
   Abstract »    Full Text »    PDF »
An Outbreak of Severe Acute Respiratory Syndrome among Hospital Workers in a Community Hospital in Hong Kong.
A. S. Ho, J. J.Y. Sung, and M. Chan-Yeung (2003)
Ann Intern Med 139, 564-567
   Abstract »    Full Text »    PDF »
Out of the woods or in the eye of the storm?.
R A Chotani (2003)
J. Epidemiol. Community Health 57, 776-777
   Full Text »    PDF »
Severe acute respiratory syndrome.
G Rezza (2003)
J. Epidemiol. Community Health 57, 643
   Full Text »    PDF »
SARS By the Numbers.
(2003)
Journal Watch Infectious Diseases 2003, 2
   Full Text »


ADVERTISEMENT
Click Me!

ADVERTISEMENT
Click Me!

To Advertise     Find Products