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Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada.
CMAJ. 2003 Aug 19; 169(4):285-92.CMAJ

Abstract

BACKGROUND

Severe acute respiratory syndrome (SARS) was introduced into Canada by a visitor to Hong Kong who returned to Toronto on Feb. 23, 2003. Transmission to a family member who was later admitted to a community hospital in Toronto led to a large nosocomial outbreak. In this report we summarize the preliminary results of the epidemiological investigation into the transmission of SARS between 128 cases associated with this hospital outbreak.

METHODS

We collected epidemiologic data on 128 probable and suspect cases of SARS associated with the hospital outbreak, including those who became infected in hospital and the next generation of illness arising among their contacts. Incubation periods were calculated based on cases with a single known exposure. Transmission chains from the index family to hospital contacts and within the hospital were mapped. Attack rates were calculated for nurses in 3 hospital wards where transmission occurred.

RESULTS

The cases ranged in age from 21 months to 86 years; 60.2% were female. Seventeen deaths were reported (case-fatality rate 13.3%). Of the identified cases, 36.7% were hospital staff. Other cases were household or social contacts of SARS cases (29.6%), hospital patients (14.1%), visitors (14.1%) or other health care workers (5.5%). Of the 128 cases, 120 (93.8%) had documented contact with a SARS case or with a ward where there was a known SARS case. The remaining 8 cases without documented exposure are believed to have had exposure to an unidentified case and remain under investigation. The attack rates among nurses who worked in the emergency department, intensive care unit and coronary care unit ranged from 10.3% to 60.0%. Based on 42 of the 128 cases with a single known contact with a SARS case, the mean incubation period was 5 days (range 2 to 10 days).

INTERPRETATION

Evidence to date suggests that SARS is a severe respiratory illness spread mainly by respiratory droplets. There has been no evidence of further transmission within the hospital after the elapse of 2 full incubation periods (20 days).

Authors+Show Affiliations

Canadian Field Epidemiology Program, Health Canada, Ottawa, ON.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12925421

Citation

Varia, Monali, et al. "Investigation of a Nosocomial Outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto, Canada." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 169, no. 4, 2003, pp. 285-92.
Varia M, Wilson S, Sarwal S, et al. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169(4):285-92.
Varia, M., Wilson, S., Sarwal, S., McGeer, A., Gournis, E., Galanis, E., & Henry, B. (2003). Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 169(4), 285-92.
Varia M, et al. Investigation of a Nosocomial Outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto, Canada. CMAJ. 2003 Aug 19;169(4):285-92. PubMed PMID: 12925421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. AU - Varia,Monali, AU - Wilson,Samantha, AU - Sarwal,Shelly, AU - McGeer,Allison, AU - Gournis,Effie, AU - Galanis,Eleni, AU - Henry,Bonnie, AU - ,, PY - 2003/8/20/pubmed PY - 2003/9/17/medline PY - 2003/8/20/entrez SP - 285 EP - 92 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 169 IS - 4 N2 - BACKGROUND: Severe acute respiratory syndrome (SARS) was introduced into Canada by a visitor to Hong Kong who returned to Toronto on Feb. 23, 2003. Transmission to a family member who was later admitted to a community hospital in Toronto led to a large nosocomial outbreak. In this report we summarize the preliminary results of the epidemiological investigation into the transmission of SARS between 128 cases associated with this hospital outbreak. METHODS: We collected epidemiologic data on 128 probable and suspect cases of SARS associated with the hospital outbreak, including those who became infected in hospital and the next generation of illness arising among their contacts. Incubation periods were calculated based on cases with a single known exposure. Transmission chains from the index family to hospital contacts and within the hospital were mapped. Attack rates were calculated for nurses in 3 hospital wards where transmission occurred. RESULTS: The cases ranged in age from 21 months to 86 years; 60.2% were female. Seventeen deaths were reported (case-fatality rate 13.3%). Of the identified cases, 36.7% were hospital staff. Other cases were household or social contacts of SARS cases (29.6%), hospital patients (14.1%), visitors (14.1%) or other health care workers (5.5%). Of the 128 cases, 120 (93.8%) had documented contact with a SARS case or with a ward where there was a known SARS case. The remaining 8 cases without documented exposure are believed to have had exposure to an unidentified case and remain under investigation. The attack rates among nurses who worked in the emergency department, intensive care unit and coronary care unit ranged from 10.3% to 60.0%. Based on 42 of the 128 cases with a single known contact with a SARS case, the mean incubation period was 5 days (range 2 to 10 days). INTERPRETATION: Evidence to date suggests that SARS is a severe respiratory illness spread mainly by respiratory droplets. There has been no evidence of further transmission within the hospital after the elapse of 2 full incubation periods (20 days). SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/12925421/Investigation_of_a_nosocomial_outbreak_of_severe_acute_respiratory_syndrome__SARS__in_Toronto_Canada_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12925421 DB - PRIME DP - Unbound Medicine ER -