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SARS outbreak
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SARS Outbreak
March 10 7 MDs and 4 nurses reported sick
March 11 50 staff screened, 23 admitted, ward closed
March 12 Clinical teaching suspended
March 13 Index case identified
March 17 Medical school moved back to campus
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156 patients138 traceable to the index case
20 doctors34 nurses15 allied health16 medical students
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SARS: a triphasic disease
Max. daily body temperature (oC)
Days after onset of disease
36
37
38
39
40
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Viral replicative phase Immune hyperactive
phasePulmonary-destruction phase
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Treatment Protocol
Broad spectrum antibiotics
IV Ribavirin
High dose steroids
Convalescent serum
Supportive care
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Response to Rx
Board-spectrumAntimicrobial* (%)
N=138
Ribavirin + Corticosteroid# (%)
N=138
IV Methyl-prednisolone+ (%)
N=107
Sustained response 0 (0) 16 (11.6) 50 (46.7)
Partial response 0 (0) 9 (6.5) 45 (42.1)
No response 138 (100) 113 (81.9) 12 (11.2)
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All patients in PWH
• N=277
• Discharged: 147 (53%)
• ICU admission: 51 (18.4%)
• Died: 18 (6.5%)
• Mortality : median age 76 (44-84) years
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Convalescent Plasma
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Convalescent Plasma vs more MP
3 MP + CS
(n = 19)
4 or more MP
(n = 21)
P values
Age 38.7 47.9 0.087
Admission LDH 258.1 247.7 0.7
Discharge rate by 21 days
73.7% 19% 0.001
No. of deaths 0 5 0.049
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Outcome of patients who received CS before day 16 vs later date
≤ Day 16
(n = 36)
Day 16
(n = 14)
P values
Discharge rate by day 21
51.6% 0% 0.02
Death rate 0% 28.6% 0.02
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女人 Female
男人 Male
The index patient and his family at PWH
母親Mom
哥哥Brother
姐夫Brother-
in-law
嫂 Sister-In-law
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5
1
2
3
4
5
6
7
Mom 母親
9Time
時間
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1
2
3
55
6
7
Mom
4
母親
910
11
8
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Pol S E M N
MAKING VACCINES AGAINST SARS VIRUS
Gene organization of SARS virus
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• Set up in the first week of outbreak
• > 233,000 hits (average 4,000 day)• Translated to Chinese, Russian,
Portuguese, Czech• Linked to HA, WHO, CDC, HKMA
and other major infectious disease
websites
Radiology website
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Tele-Conference with Canada & Singapore 29-4-03
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Tele-Conference with Canada & Singapore 29-4-03
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Outbreak modelling
Susceptible St Infectious It Recovered / immune Rt SIRRo 1/D
Susceptible meets susceptible (S - S, no transmission)
Susceptible meets infectious (S - I, transmission)
Susceptible meets resistant (immune) (S-R, no transmission)
Infectious meets infectious (I-I, no transmission)
Infectious meets resistant (I-R, no transmission)
Resistant meets resistant (R -R, no transmission)
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SARS in Hong Kong
0
10
20
30
40
50
60
70
Days of epidemic
Stage 1: Control started on day 10, R0=1.8Stage 2: More effective control started on day 20, R0=0.91
Nu
mb
er o
f ca
ses
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School of Public Health
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Centre for Health Education and Health Promotion
Training in health education and health promotion
“Healthy Cities” “Health Promoting Schools”
Research in health education & health promotion
Partnership with community in health promotion
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Hygiene Charter
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Schools against SARS
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