Transmission Dynamics of the Etiological Agent of SARS in Hong Kong: Impact of Public Health Interventions

TLDR

The SARS epidemic in Hong Kong was driven by two large super‑spread events and ongoing community transmission. The study analyzed the first 10 weeks of the SARS outbreak in Hong Kong. A stochastic model indicates SARS is moderately transmissible (≈2.7 secondary cases per person excluding super‑spread events), with hospital transmission a major contributor; reductions in contact rates, improved infection control, and earlier hospital presentation lowered transmission, leading to a current decline that still requires vigilance and suggests that restricting long‑range movement can further help control the epidemic.

Abstract

We present an analysis of the first 10 weeks of the severe acute respiratory syndrome (SARS) epidemic in Hong Kong. The epidemic to date has been characterized by two large clusters—initiated by two separate “super-spread” events (SSEs)—and by ongoing community transmission. By fitting a stochastic model to data on 1512 cases, including these clusters, we show that the etiological agent of SARS is moderately transmissible. Excluding SSEs, we estimate that 2.7 secondary infections were generated per case on average at the start of the epidemic, with a substantial contribution from hospital transmission. Transmission rates fell during the epidemic, primarily as a result of reductions in population contact rates and improved hospital infection control, but also because of more rapid hospital attendance by symptomatic individuals. As a result, the epidemic is now in decline, although continued vigilance is necessary for this to be maintained. Restrictions on longer range population movement are shown to be a potentially useful additional control measure in some contexts. We estimate that most currently infected persons are now hospitalized, which highlights the importance of control of nosocomial transmission.