Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan

Jien Wei Liu, Sheng Nan Lu, Shun Sheng Chen, Kuender D. Yang, Meng Chih Lin, Chao Chien Wu, Peter B. Bloland, Sarah Y. Park, William Wong, Kuo Chien Tsao, Tzou Yien Lin, Chao Long Chen

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community. METHODS. We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures. SETTING. A 2,300-bed medical center in Kaohsiung, Taiwan. RESULTS. A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later. CONCLUSIONS. Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.

Original languageEnglish
Pages (from-to)466-472
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume27
Issue number5
DOIs
Publication statusPublished - May 2006
Externally publishedYes

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Severe Acute Respiratory Syndrome
Taiwan
Disease Outbreaks
Epidemiologic Studies
Thorax

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan. / Liu, Jien Wei; Lu, Sheng Nan; Chen, Shun Sheng; Yang, Kuender D.; Lin, Meng Chih; Wu, Chao Chien; Bloland, Peter B.; Park, Sarah Y.; Wong, William; Tsao, Kuo Chien; Lin, Tzou Yien; Chen, Chao Long.

In: Infection Control and Hospital Epidemiology, Vol. 27, No. 5, 05.2006, p. 466-472.

Research output: Contribution to journalArticle

Liu, JW, Lu, SN, Chen, SS, Yang, KD, Lin, MC, Wu, CC, Bloland, PB, Park, SY, Wong, W, Tsao, KC, Lin, TY & Chen, CL 2006, 'Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan', Infection Control and Hospital Epidemiology, vol. 27, no. 5, pp. 466-472. https://doi.org/10.1086/504501
Liu, Jien Wei ; Lu, Sheng Nan ; Chen, Shun Sheng ; Yang, Kuender D. ; Lin, Meng Chih ; Wu, Chao Chien ; Bloland, Peter B. ; Park, Sarah Y. ; Wong, William ; Tsao, Kuo Chien ; Lin, Tzou Yien ; Chen, Chao Long. / Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan. In: Infection Control and Hospital Epidemiology. 2006 ; Vol. 27, No. 5. pp. 466-472.
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abstract = "OBJECTIVE. We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community. METHODS. We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures. SETTING. A 2,300-bed medical center in Kaohsiung, Taiwan. RESULTS. A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later. CONCLUSIONS. Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.",
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AU - Lu, Sheng Nan

AU - Chen, Shun Sheng

AU - Yang, Kuender D.

AU - Lin, Meng Chih

AU - Wu, Chao Chien

AU - Bloland, Peter B.

AU - Park, Sarah Y.

AU - Wong, William

AU - Tsao, Kuo Chien

AU - Lin, Tzou Yien

AU - Chen, Chao Long

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N2 - OBJECTIVE. We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community. METHODS. We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures. SETTING. A 2,300-bed medical center in Kaohsiung, Taiwan. RESULTS. A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later. CONCLUSIONS. Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.

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