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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.

Original publication

DOI

10.1126/science.1086478

Type

Journal article

Journal

Science (New York, N.Y.)

Publication Date

06/2003

Volume

300

Pages

1961 - 1966

Addresses

Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK. s.riley@imperial.ac.uk

Keywords

Humans, SARS Virus, Cross Infection, Severe Acute Respiratory Syndrome, Hospitalization, Patient Isolation, Epidemiologic Methods, Contact Tracing, Cluster Analysis, Models, Statistical, Probability, Stochastic Processes, Disease Outbreaks, Public Health Practice, Infection Control, Quarantine, Mathematics, World Health, Hong Kong