Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-05T01:01:00.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiologic Study and Containment of a Nosocomial Outbreak of Severe Acute Respiratory Syndrome in a Medical Center in Kaohsiung, Taiwan

Published online by Cambridge University Press:  21 June 2016

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  and
Kuo-Chien Tsao
...Show all authors
Jien-Wei Liu
Affiliation:
Committee of Infection Control and Division of Infectious Diseases, Chang Gung University College of Medicine, Taiwan
Sheng-Nan Lu
Affiliation:
Division of Hepatogastroenterology, Chang Gung University College of Medicine, Taiwan
Shun-Sheng Chen
Affiliation:
Department of Internal Medicine, Department of Neurology, Chang Gung University College of Medicine, Taiwan
Kuender D. Yang
Affiliation:
Department of Pediatrics, Chang Gung University College of Medicine, Taiwan
Meng-Chih Lin
Affiliation:
Division of Pulmonary and Critical Care, Chang Gung University College of Medicine, Taiwan
Chao-Chien Wu
Affiliation:
Division of Pulmonary and Critical Care, Chang Gung University College of Medicine, Taiwan
Peter B. Bloland
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah Y. Park
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
William Wong
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Kuo-Chien Tsao
Affiliation:
Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Clinical Virology Laboratory, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Lin-Kou, Chang Gung University College of Medicine, Taiwan
Tzou-Yien Lin
Affiliation:
Department of Pediatrics, Chang Gung Children's Hospital, Kweishan, Chang Gung University College of Medicine, Taiwan
Chao-Long Chen*
Affiliation:
Department of General Surgery, Chang Gung University College of Medicine, Taiwan
*
Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 466 - 472
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Twu, SJ, Chen, TJ, Chen, CJ, et al. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg Infect Dis 2003; 9:718–720.Google Scholar
2.Lee, ML, Chen, CJ, Su, IJ, et al. Severe acute respiratory syndrome— Taiwan, 2003. MMWR Morb Morbtal Wkly Rep 2003; 52:461–466.Google Scholar
3.World Health Organization (WHO). Case definitions for surveillance of severe acute respiratory syndrome (SARS). Geneva, Switzerland: WHO; 2003.Google Scholar
4.Fouchier, RAM, Kuiken, T, Schutten, M, et al. Kock's postulates fulfilled for SARS virus. Nature 2003; 423.Google Scholar
5.World Health Organization (WHO). Hospital infection control guidance for severe acute respiratory syndrome (SARS). Geneva, Switzerland: WHO; 2003.Google Scholar
6.Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS) version 2. Supplement D: Community containment measures, including non-hospital isolation quarantine. Available at: http: //www.cdc.gov/ncidod/sars/guidance/D/lessons.htm. Accessed November 22, 2004.Google Scholar
7.Meltzer, MI, Damon, I, LeDuc, JW, Millar, JD. Modeling potential responses to smallpox as a bioterrorist weapon. Emerg Infect Dis 2001; 7:959–969.Google Scholar
8.Tee, AK, Oh, HM, Lien, CT, Narendran, K, Heng, BH, Ling, AE. Atypical SARS in geriatric patient. Emerg Infect Dis 2004; 10:261–264.Google Scholar
9.Tan, TT, Tan, BH, Kurup, A, et al. Atypical SARS and Escherichia coli bacteremia. Emerg Infect Dis 2004; 10:349–352.Google Scholar
10.Gopalakrishna, G, Choo, P, Leo, YS, et al. SARS transmission and hospital containment. Emerg Infect Dis 2004; 10:389–394.Google Scholar
11.McDonald, LC, Simor, AE, Su, IJ, et al. SARS in healthcare facilities, Toronto and Taiwan. Emerg Infect Dis 2004; 10:777–781.Google Scholar
12.Lam, MF, Ooi, GC, Lam, B, et al. An indolent case with severe acute respiratory syndrome. Am J Respir Crit Care Med 2004; 169:125–128.Google Scholar
13.Lee, N, Hui, D, Wu, A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348:1986–1994.Google Scholar
14.Booth, CM, Matukas, LM, Tomlinson, GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA 2003; 289:2801–2809.CrossRefGoogle ScholarPubMed
15.Hong Kong Department of Health Report. Main findings of an investigation into the outbreak of severe respiratory syndrome at Amoy Gardens. Available at: http://www.info.gov.hk/dh/ap.htm. Accessed April 19, 2003.Google Scholar
16.Lee, NE, Siriarayapon, P, Tappero, J, et al. Infection control practice for SARS in Lao People's Democratic Republic, Taiwan, and Thailand: experience from mobile SARS containment teams, 2003. Am J Infect Control 2004; 32:377–383.Google Scholar
17.Fung, CP, Hsieh, TL, Tan, KH, et al. Rapid creation of a temporary isolation ward for patients with severe acute respiratory syndrome in Taiwan. Infect Control Hosp Epidemiol 2004; 25:1026–1032.Google Scholar
18.Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS). Supplement C: preparedness and response in health facilities. Available at: http://www.cdc.gov/ncidod/sars/guidance/C/index.htm. Accessed May 30, 2004.Google Scholar
19.Peiris, JSM, Chu, CM, Cheng, VCC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003; 361:1767–1772.Google Scholar
20.Hsueh, PR, Hsiao, CH, Yeh, SH, et al. Microbiologic characteristics, serologic response, and clinical manifestations in severe acute respiratory syndrome, Taiwan. Emerg Infect Dis 2003; 9:1163–1167.Google Scholar
21.Guan, Y, Zheng, BJ, He, YQ, et al. Isolation and characterization of viruses related to the SARS Coronavirus from animals in southern China. Science 2003; 302:276–278.Google Scholar
22.Li, W, Shi, Z, Yu, M, et al. Bats are natural reservoirs of SARS-like coronaviruses. Science 2005; 310:676–679.Google Scholar
23.Riley, S, Fraser, C, Donnelly, CA, et al. Transmission dynamics of the etiological agents of SARS in Hong Kong: impact of public health interventions. Science 2003; 300:1961–1966.Google Scholar