Gabriel M. Leung, MD, MPH; Anthony J. Hedley, MD, FRCP; Lai-Ming Ho, PhD; Patsy Chau, MStat; Irene O.L. Wong, MPhil, MMedSc; Thuan Q. Thach, PhD; Azra C. Ghani, PhD; Christl A. Donnelly, ScD; Christophe Fraser, PhD; Steven Riley, DPhil; Neil M. Ferguson, DPhil; Roy M. Anderson, PhD; Thomas Tsang, MBBS, FHKAM; Pak-Yin Leung, MBBS, FFPH; Vivian Wong, MBBS, FHKAM; Jane C.K. Chan, MD, FHKAM; Eva Tsui, MStat; Su-Vui Lo, MBChB, FFPH; Tai-Hing Lam, MD, FFPH
Acknowledgments: The authors thank P.C. Lai for the geographic information system analysis, all their colleagues in the Hong Kong Department of Health and Hong Kong Hospital Authority who were involved with the public health control of the SARS epidemic and data collection and processing, the Hong Kong Hospital Authority SARS Collaborative Group for supplying some of the data fields in the regression model, and Marie Chi for her expert secretarial assistance in the preparation of the manuscript.
Grant Support: By the University of Hong Kong SARS Research Fund, a special commissioned project grant from the Research Fund for the Control of Infectious Disease, Government of the Hong Kong Special Administrative Region, and a European Union specific targeted research or innovation project contract (SARSTRANS). Drs. Ghani and Ferguson acknowledge fellowship support from The Royal Society, and Drs. Fraser and Ferguson acknowledge research funding from the Medical Research Council. Drs. Riley and Ferguson thank the Howard Hughes Medical Institute, and Dr. Anderson thanks the Wellcome Trust and the European Union.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Tai-Hing Lam, MD, FFPH, Department of Community Medicine, 21 Sassoon Road, Faculty of Medicine Building, University of Hong Kong, Pokfulam, Hong Kong, China; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. G.M. Leung, Hedley, Ho, Thach, and Lam, Ms. Chau, and Ms. I.O.L. Wong: Department of Community Medicine and School of Public Health, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
Drs. Ghani, Fraser, Anderson, Donnelly, Riley, and Ferguson: Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom.
Drs. Tsang and P.-Y. Leung: Department of Health, Government of the Hong Kong Special Administrative Region, Wu Chung House, Wanchai, Hong Kong, China.
Drs. V. Wong and Chan and Ms. Tsui: Hong Kong Hospital Authority, 147 Argyle Street, Kowloon, Hong Kong, China.
Dr. Lo: Health, Welfare and Food Bureau, Government of the Hong Kong Special Administrative Region, Murray Building, Central, Hong Kong, China.
Author Contributions: Conception and design: G.M. Leung, A.J. Hedley, T.-H. Lam.
Analysis and interpretation of the data: G.M. Leung, A.J. Hedley, L.-M. Ho, T.Q. Thach, A.C. Ghani, C.A. Donnelly, C. Fraser, S. Riley, N.M. Ferguson, R.M. Anderson, T.-H. Lam.
Drafting of the article: G.M. Leung.
Critical revision of the article for important intellectual content: A.C. Ghani, C.A. Donnelly, C. Fraser, S. Riley, N.M. Ferguson, R.M. Anderson, V. Wong, J.C.K. Chan, E. Tsui, S.-V. Lo.
Final approval of the article: G.M. Leung, A.J. Hedley, L.-M. Ho, I.O.L. Wong, A.C. Ghani, C.A. Donnelly, C. Fraser, S. Riley, N.M. Ferguson, R.M. Anderson, S.-V. Lo, T.-H. Lam.
Provision of study materials or patients: T. Tsang, P.-Y. Leung, V. Wong, J.C.K. Chan, E. Tsui.
Statistical expertise: L.-M. Ho, P. Chau, I.O.L. Wong, T.Q. Thach.
Obtaining of funding: G.M. Leung, A.J. Hedley, T.-H. Lam.
Administrative, technical, or logistic support: P. Chau, T. Tsang, P.-Y. Leung, V. Wong, J.C.K. Chan, S.-V. Lo.
Collection and assembly of data: P. Chau, I.O.L. Wong, T.Q. Thach, T. Tsang, P.-Y. Leung, E. Tsui.
Leung GM, Hedley AJ, Ho L, Chau P, Wong IO, Thach TQ, et al. The Epidemiology of Severe Acute Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 Patients. Ann Intern Med. 2004;141:662-673. doi: 10.7326/0003-4819-141-9-200411020-00006
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Published: Ann Intern Med. 2004;141(9):662-673.
Few comprehensive studies describe the 2003 outbreak of severe acute respiratory syndrome (SARS).
This epidemiologic analysis of 1755 cases from Hong Kong found that most cases clustered in hospitals and residential buildings. Close human contact and spread by a sewage system probably explain the clustering. The outbreak lasted about 3 months. The estimated mean incubation period was 4.6 days, and the case-fatality ratio was 17%. Factors associated with increased risk for death included older age and male sex.
The observed patterns suggested that SARS had low transmissibility, except in settings of intimate contact or clinically significant environmental contamination.
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