SARS outbreak

SARS Outbreak

March 10 7 MDs and 4 nurses reported sick

March 11 50 staff screened, 23 admitted, ward closed

March 12 Clinical teaching suspended

March 13 Index case identified

March 17 Medical school moved back to campus

156 patients138 traceable to the index case

20 doctors34 nurses15 allied health16 medical students

SARS: a triphasic disease

Max. daily body temperature (oC)

Days after onset of disease

36

37

38

39

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Viral replicative phase Immune hyperactive

phasePulmonary-destruction phase

Treatment Protocol

Broad spectrum antibiotics

IV Ribavirin

High dose steroids

Convalescent serum

Supportive care

Response to Rx

Board-spectrumAntimicrobial* (%)

N=138

Ribavirin + Corticosteroid# (%)

N=138

IV Methyl-prednisolone+ (%)

N=107

Sustained response 0 (0) 16 (11.6) 50 (46.7)

Partial response 0 (0) 9 (6.5) 45 (42.1)

No response 138 (100) 113 (81.9) 12 (11.2)

All patients in PWH

• N=277

• Discharged: 147 (53%)

• ICU admission: 51 (18.4%)

• Died: 18 (6.5%)

• Mortality : median age 76 (44-84) years

Convalescent Plasma

Convalescent Plasma vs more MP

3 MP + CS

(n = 19)

4 or more MP

(n = 21)

P values

Age 38.7 47.9 0.087

Admission LDH 258.1 247.7 0.7

Discharge rate by 21 days

73.7% 19% 0.001

No. of deaths 0 5 0.049

Outcome of patients who received CS before day 16 vs later date

≤ Day 16

(n = 36)

Day 16

(n = 14)

P values

Discharge rate by day 21

51.6% 0% 0.02

Death rate 0% 28.6% 0.02

http://www.bcgsc.ca/

女人 Female

男人 Male

The index patient and his family at PWH

母親Mom

哥哥Brother

姐夫Brother-

in-law

嫂 Sister-In-law

5

1

2

3

4

5

6

7

Mom 母親

9Time

時間

1

2

3

55

6

7

Mom

4

母親

910

11

8

Pol S E M N

MAKING VACCINES AGAINST SARS VIRUS

Gene organization of SARS virus

• Set up in the first week of outbreak

• > 233,000 hits (average 4,000 day)• Translated to Chinese, Russian,

Portuguese, Czech• Linked to HA, WHO, CDC, HKMA

and other major infectious disease

websites

Radiology website

Tele-Conference with Canada & Singapore 29-4-03

Tele-Conference with Canada & Singapore 29-4-03

Outbreak modelling

Susceptible St Infectious It Recovered / immune Rt SIRRo 1/D

Susceptible meets susceptible (S - S, no transmission)

Susceptible meets infectious (S - I, transmission)

Susceptible meets resistant (immune) (S-R, no transmission)

Infectious meets infectious (I-I, no transmission)

Infectious meets resistant (I-R, no transmission)

Resistant meets resistant (R -R, no transmission)

SARS in Hong Kong

0

10

20

30

40

50

60

70

Days of epidemic

Stage 1: Control started on day 10, R0=1.8Stage 2: More effective control started on day 20, R0=0.91

Nu

mb

er o

f ca

ses

School of Public Health

Centre for Health Education and Health Promotion

Training in health education and health promotion

“Healthy Cities” “Health Promoting Schools”

Research in health education & health promotion

Partnership with community in health promotion

Hygiene Charter

Schools against SARS