Leung Gabriel M, Hedley Anthony J, Ho Lai-Ming, Chau Patsy, Wong Irene O L, Thach Thuan Q, Ghani Azra C, Donnelly Christl A, Fraser Christophe, Riley Steven, Ferguson Neil M, Anderson Roy M, Tsang Thomas, Leung Pak-Yin, Wong Vivian, Chan Jane C K, Tsui Eva, Lo Su-Vui, Lam Tai-Hing
University of Hong Kong, Government of the Hong Kong Special Administrative Region, and Hong Kong Hospital Authority, Hong Kong, China.
Ann Intern Med. 2004 Nov 2;141(9):662-73. doi: 10.7326/0003-4819-141-9-200411020-00006.
As yet, no one has written a comprehensive epidemiologic account of a severe acute respiratory syndrome (SARS) outbreak from an affected country.
To provide a comprehensive epidemiologic account of a SARS outbreak from an affected territory.
Epidemiologic analysis.
The 2003 Hong Kong SARS outbreak.
All 1755 cases and 302 deaths.
Sociodemographic characteristics; infection clusters by time, occupation, setting, and workplace; and geospatial relationships were determined. The mean and variance in the time from infection to onset (incubation period) were estimated in a small group of patients with known exposure. The mean and variance in time from onset to admission, from admission to discharge, or from admission to death were calculated. Logistic regression was used to identify important predictors of case fatality.
49.3% of patients were infected in clinics, hospitals, or elderly or nursing homes, and the Amoy Gardens cluster accounted for 18.8% of cases. The ratio of women to men among infected individuals was 5:4. Health care workers accounted for 23.1% of all reported cases. The estimated mean incubation period was 4.6 days (95% CI, 3.8 to 5.8 days). Mean time from symptom onset to hospitalization varied between 2 and 8 days, decreasing over the course of the epidemic. Mean time from onset to death was 23.7 days (CI, 22.0 to 25.3 days), and mean time from onset to discharge was 26.5 days (CI, 25.8 to 27.2 days). Increasing age, male sex, atypical presenting symptoms, presence of comorbid conditions, and high lactate dehydrogenase level on admission were associated with a greater risk for death.
Estimates of the incubation period relied on statistical assumptions because few patients had known exposure times. Temporal changes in case management as the epidemic progressed, unavailable treatment information, and several potentially important factors that could not be thoroughly analyzed because of the limited sample size complicate interpretation of factors related to case fatality.
This analysis of the complete data on the 2003 SARS epidemic in Hong Kong has revealed key epidemiologic features of the epidemic as it evolved.
迄今为止，尚无一人针对受影响国家的严重急性呼吸综合征（SARS）疫情撰写全面的流行病学报告。
提供一份关于受影响地区SARS疫情的全面流行病学报告。
流行病学分析。
2003年香港SARS疫情。
所有1755例病例及302例死亡病例。
确定社会人口学特征；按时间、职业、场所和工作地点划分的感染聚集情况；以及地理空间关系。在一小部分有已知暴露史的患者中估计从感染到发病（潜伏期）的时间均值和方差。计算从发病到入院、从入院到出院或从入院到死亡的时间均值和方差。采用逻辑回归确定病例死亡的重要预测因素。
49.3%的患者在诊所、医院或养老院感染，淘大花园聚集性病例占病例总数的18.8%。感染人群中女性与男性的比例为5:4。医护人员占所有报告病例的23.1%。估计平均潜伏期为4.6天（95%置信区间，3.8至5.8天）。从症状出现到住院的平均时间在2至8天之间，在疫情过程中呈下降趋势。从发病到死亡的平均时间为23.7天（置信区间，22.0至25.3天），从发病到出院的平均时间为26.5天（置信区间，25.8至27.2天）。年龄增加、男性、非典型症状表现、合并症的存在以及入院时高乳酸脱氢酶水平与更高的死亡风险相关。
由于很少有患者有已知的暴露时间，潜伏期的估计依赖于统计假设。随着疫情进展病例管理的时间变化、无法获取的治疗信息以及由于样本量有限而无法彻底分析的几个潜在重要因素使与病例死亡相关因素的解释变得复杂。
对2003年香港SARS疫情完整数据的分析揭示了疫情演变过程中的关键流行病学特征。
