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Case Reports
. 2004 Jan 24;328(7433):195.
doi: 10.1136/bmj.37939.465729.44. Epub 2004 Jan 15.

Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study

Khuan Yew Chow  1 , Chien Earn Lee, Moi Lin Ling, Derrick Mok Kwee Heng, Soon Ghee Yap
Affiliations
Case Reports

Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study

Khuan Yew Chow et al. BMJ. .

Abstract

Objective: To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it.

Design: Descriptive study.

Setting: A tertiary hospital in Singapore.

Participants: Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital.

Main outcome measures: Probable SARS as defined by the World Health Organization.

Results: The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset.

Conclusions: Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.

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Figures

Fig 1
Fig 1
Map of contact tracing for the SARS cluster at Singapore General Hospital by SARS task force
Fig 2
Fig 2
Epidemic curve of the SARS outbreak at Singapore General Hospital
Fig 3
Fig 3
Incubation of probable SARS cases in the outbreak at Singapore General Hospital
Fig 4
Fig 4
Infectious period of the probable SARS cases from Singapore General Hospital
See this image and copyright information in PMC

References

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