sars outbreak. sars outbreak march 107 mds and 4 nurses reported sick march 1150 staff screened, 23...
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SARS outbreak
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
156 patients138 traceable to the index case
20 doctors34 nurses15 allied health16 medical students
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
Treatment Protocol
Broad spectrum antibiotics
IV Ribavirin
High dose steroids
Convalescent serum
Supportive care
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)
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
Convalescent Plasma
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
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
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
5
1
2
3
4
5
6
7
Mom 母親
9Time
時間
1
2
3
55
6
7
Mom
4
母親
910
11
8
Pol S E M N
MAKING VACCINES AGAINST SARS VIRUS
Gene organization of SARS virus
• 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
Tele-Conference with Canada & Singapore 29-4-03
Tele-Conference with Canada & Singapore 29-4-03
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)
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
School of Public Health
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
Hygiene Charter
Schools against SARS