Beijing, China, experienced the largest outbreak of SARS in the world with a total of 2,521 reported probable cases, according to background information in the article. The outbreak began March 5, 2003, with the importation of several cases among travelers from other SARS-affected areas and soon accelerated as multiple SARS cases occurred in health care facilities, peaking in late April when more than 100 new patients with SARS were being hospitalized daily. During the first week of May, the number of new cases dropped steeply and then declined steadily during the next few weeks, with the onset of the last probable case on May 29, 2003. The onset of the last case occurred only 6 weeks after the peak of the outbreak.
Xinghuo Pang, M.D., of the Beijing Center for Disease Prevention and Control, and colleagues evaluated the measures taken to rapidly control the SARS outbreak in Beijing and assess the effectiveness of some of these measures. The researchers reviewed data from standardized surveillance forms from SARS cases (2,521 probable cases) and their close contacts observed in Beijing between March 5, 2003, and May 29, 2003. Procedures implemented by health authorities were investigated through review of official documents and discussions with public health officials.
The researchers found that healthcare worker training in use of personal protective equipment and management of patients with SARS and establishing fever clinics and designated SARS wards in hospitals predated the steepest decline in cases. During the outbreak, 30,178 persons were quarantined. Among 2,195 quarantined close contacts in 5 districts, the attack rate was 6.3 percent, with a range of 15.4 percent among spouses to 0.36 percent among work and school contacts. The attack rate among quarantined household members increased with age from 5.0 percent in children younger than 10 years to 27.6 percent in adults aged 60 to 69 years. Among almost 14 million people screened for fever at the airport, train stations, and roadside checkpoints, only 12 were found to have probable SARS. The national and municipal governments held 13 press conferences about SARS. The time lag between illness onset and hospitalization decreased from a median of 5 to 6 days on or before April 20, 2003, the day the outbreak was announced to the public, to 2 days after April 20.
"The multiple control measures implemented in Beijing likely led to the rapid resolution of the SARS outbreak. Improvements in infection control practices, use of personal protective equipment, grouping of patients with SARS in the hospital, establishment of designated fever clinics, quarantine of high-risk close contacts, and improved public information and awareness of SARS likely played important roles in controlling the outbreak. Some interventions, in retrospect, such as quarantine of low-risk contacts and fever checks at transportation sites, seemed to have less direct impact in curbing the outbreak. The lessons learned from controlling this outbreak can hopefully serve to inform future responses to SARS, if it were to reemerge in Beijing or elsewhere," the authors conclude. (JAMA. 2003;290:3215-3221. Available post-embargo at jama.com)
Editor's Note: The SARS control measures implemented in Beijing were funded by the Beijing municipal government. The Beijing municipal health bureau, Beijing Center for Disease Prevention and Control, the World Health Organization, and the U.S. Centers for Disease Control and Prevention provided financial support for the participation of their respective staff in this study. No additional funding for this study was obtained.
Editorial: The SARS Response--Building and Assessing an Evidence-Based Approach to Future Global Microbial Threats
In an accompanying editorial, James M. Hughes, M. D., Director of the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, discusses the SARS articles in this week's JAMA.
"The successful control of the 2003 SARS outbreak is a testament to the heroic, collaborative efforts of clinicians, laboratory scientists, and public health officials worldwide, all done in the absence of diagnostic tests, effective therapies, and a vaccine. The response also emphasized the importance as well as the effectiveness of stringent infection control precautions, including respiratory and hand hygiene; patient isolation; appropriate use of personal protective equipment; and implementation of quarantine strategies when faced with a new infectious agent," Dr. Hughes writes.
"As the last decade and, especially, the last year have demonstrated, newly recognized pathogens will continue to emerge, requiring preparedness planning, a vigilant health system, a commitment to timely reporting of disease, and strong interdisciplinary partnerships to contain their spread. It is essential to continue to evaluate and learn from recent experiences. Applying the lessons learned from SARS will serve us well in responding to a recurrence and to future microbial threats, whether naturally occurring (e.g., the next influenza pandemic) or the result of a terrorist attack," Dr. Hughes concludes.
(JAMA. 2003;290:3251-3253. Available post-embargo at jama.com)
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