Wu Wei, Wang Jing-feng, Liu Pin-ming, Jiang Shan-ping, Chen Qing-yu, Chen Wei-xian, Yin Song-mei, Yan Li, Zhan Jun, Chen Xi-long, Li Jian-guo
The SARS Working Group, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Chin Med J (Engl). 2004 Jan;117(1):14-8.
Severe acute respiratory syndrome (SARS) is characterized by both an atypical pneumonia and efficient nosocomial transmission. However, it remains unknown whether the infectivity and the virulence of the pathogen will change throughout the successive transmission. This study was conducted to compare the clinical features and management regimens of patients with SARS among the multiple generations from nosocomial transmission initiated by a super-spreader.
The clinical data of 84 epidemiologically-linked SARS patients from a hospital outbreak were retrospectively studied. All patients, in whom a clear-cut transmission generation could be noted, had a direct or indirect exposure to the index patient and the epidemic successively propagated through the multiple generations of cases within a short period of time.
There were 66 women and 18 men with mean age of (29.2 +/- 10.3) years in this cluster; and 96.4% of whom were health care workers. Detailed contact tracing identified 35 (41.7%) first-generation cases, 34 (40.5%) second-generation cases, and 15 (17.8%) third-generation cases. No statistical differences among the multiple generations of transmission were found in terms of age, gender, incubation period and length of hospital stay. With the advanced transmission generations, the initial temperature lowered, the number of cases with dry cough decreased. There were no statistical differences in the peak temperature and duration of fever, other accompanying symptoms, leucopenia; however, the time from initial pulmonary infiltrates to radiographic recovery shortened (P < 0.05). No differences were found in maximum number of lung fields involved, duration from the onset of fever to the occurrence of pulmonary infiltrates and time from the initial pulmonary infiltrate to its peak among the multiple transmission generations (P > 0.05). No statistical differences were found in modes of oxygen therapy and sorts of antibiotics prescribed among the various transmission generations (P > 0.05); however, as with the advanced transmission generations, the number of cases prescribed with methylprednisolone, human gamma-globulin, interferon-alpha, antiviral drugs (oral ribavirin or oseltamivir) increased (P < 0.05) and time from admission to starting these medication shortened (P < 0.05).
There is no evidence that SARS infection will evolve or transmit within a fashion that permits it to become less powerful throughout the successive transmission within a short time.
严重急性呼吸综合征（SARS）的特征是出现非典型肺炎以及高效的医院内传播。然而，病原体的传染性和毒力在连续传播过程中是否会发生变化仍不清楚。本研究旨在比较由一名超级传播者引发的医院内传播多代SARS患者的临床特征和治疗方案。
回顾性研究了一家医院暴发的84例有流行病学关联的SARS患者的临床资料。所有能明确传播代数的患者均直接或间接接触过首例患者，疫情在短时间内通过多代病例相继传播。
该群体中有66名女性和18名男性，平均年龄为（29.2±10.3）岁；其中96.4%为医护人员。详细的接触者追踪确定了35例（41.7%）第一代病例、34例（40.5%）第二代病例和15例（17.8%）第三代病例。在年龄、性别、潜伏期和住院时间方面，多代传播之间未发现统计学差异。随着传播代数的增加，初始体温降低，干咳病例数减少。发热峰值温度和持续时间、其他伴随症状、白细胞减少症方面无统计学差异；然而，从最初肺部浸润到影像学恢复的时间缩短（P<0.05）。在多代传播中，累及的最大肺野数、从发热开始到出现肺部浸润的时间以及从最初肺部浸润到其峰值的时间无差异（P>0.05）。在不同传播代中，氧疗方式和使用的抗生素种类无统计学差异（P>0.05）；然而，随着传播代数的增加，使用甲泼尼龙、人血丙种球蛋白、干扰素-α、抗病毒药物（口服利巴韦林或奥司他韦）的病例数增加（P<0.05），从入院到开始使用这些药物的时间缩短（P<0.05）。
没有证据表明SARS感染会在短时间内连续传播过程中以使其变得不那么强大的方式演变或传播。
