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. 2004 Feb;10(2):269-76.
doi: 10.3201/eid1002.030452.

Cluster of SARS among medical students exposed to single patient, Hong Kong

Tze-wai Wong  1 , Chin-kei Lee, Wilson Tam, Joseph Tak-fai Lau, Tak-sun Yu, Siu-fai Lui, Paul K S Chan, Yuguo Li, Joseph S Bresee, Joseph J Y Sung, Umesh D Parashar; Outbreak Study Group
Affiliations

Cluster of SARS among medical students exposed to single patient, Hong Kong

Tze-wai Wong et al. Emerg Infect Dis. 2004 Feb.

Abstract

We studied transmission patterns of severe acute respiratory syndrome (SARS) among medical students exposed exclusively to the first SARS patient in the Prince of Wales Hospital in Hong Kong, before his illness was recognized. We conducted a retrospective cohort study of 66 medical students who visited the index patient's ward, including 16 students with SARS and 50 healthy students. The risk of contracting SARS was sevenfold greater among students who definitely visited the index case's cubicle than in those who did not (10/27 [41%] versus 1/20 [5%], relative risk 7.4; 95% confidence interval 1.0 to 53.3). Illness rates increased directly with proximity of exposure to the index case. However, four of eight students who were in the same cubicle, but were not within 1 m of the index case-patient, contracted SARS. Proximity to the index case-patient was associated with transmission, which is consistent with droplet spread. Transmission through fomites or small aerosols cannot be ruled out.

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Figures

Figure 1
Figure 1
Distribution of initial symptoms in 16 students.
Figure 2
Figure 2
Dates of onset of illness of 16 students with severe acute respiratory syndrome and date of their visit to the index patient’s hospital ward. An asterisk indicates the dates of the visit in March 2003.
Figure 3
Figure 3
Incubation period by onset dates in 11 students.
Figure 4
Figure 4
Floor plan of index patient’s hospital ward. Numbers with and without a suffix indicate the bed numbers of patients. The bed of the index patient is shaded. 0, students assigned to examine the patient in this bed who became ill with severe acute respiratory syndrome; x, students assigned to examine the patient in this bed who remained healthy.
Figure 5
Figure 5
Airflow rates (L/s) through all air supply diffusers and exhaust grilles in the index patient's hospital ward. formula image, air supply diffuser; formula image, exhaust grille; formula image, extraction fan.
Figure 6
Figure 6
Dispersion of hypothetical aerosols that originated from the index patient’s bed in the ward. Three levels of normalized concentrations are shown (0.03, 0.015, and 0.05) because the source strength of the virus-laden aerosols is unknown.
See this image and copyright information in PMC

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