The SARS outbreak in a general hospital in Tianjin, China -- the case of super-spreader

Abstract

Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a high case-fatality rate and devastating socio-economic impact. In this report we summarized the results from an epidemiological investigation of a SARS outbreak in a hospital in Tianjin, between April and May 2003. We collected epidemiological and clinical data on 111 suspect and probable cases of SARS associated with the outbreak. Transmission chain and outbreak clusters were investigated. The outbreak was single sourced and had eight clusters. All SARS cases in the hospital were traced to a single patient who directly infected 33 people. The patients ranged from 16 to 82 years of age (mean age 38.5 years); 38.7% were men. The overall case fatality in the SARS outbreak was 11.7% (13/111). The outbreak lasted around 4 weeks after the index case was identified. SARS is a highly contagious condition associated with substantial case fatality; an outbreak can result from one patient in a relatively short period. However, stringent public health measures seemed to be effective in breaking the disease transmission chain.

Fig. 1

Infection chain associated with the SARS outbreak in Hospital P, Tianjin. New generation of cases in boxes with colour fill (yellow=secondary cases; green=tertiary cases). Detailed contact history is unknown for P55, P56, P58, P78, P79, P85, P86, P88 and P89.

Fig. 2

The epidemic curve of the SARS outbreak in Hospital C, Tianjin, China. □, Suspect cases; ■, probable cases.

Fig. 3

The generation of SARS cases in Hospital P, Tianjin China (according to contact history). –○–, First generation; –■–, second generation; –▲–, third generation.