Outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong

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Outbreak of Severe Acute Respiratory Syndrome
(SARS) in Hong Kong

• The Hong Kong Medical Association

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Types of Pneumonia

• Bacterial Pneumonia
• Atypical Pneumonia - Mycoplasma
• Viral
• Chemical

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Severe Acute Respiratory Syndrome (SARS)

• First recognised in Feb 2003 (case in Hanoi)
• A form of Atypical Pneumonia
• characteristics - high fever (gt38C or 100.4 F)
• - dry cough
• - breathing difficulties
• - rapid deterioration

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No. of case of SARS worldwide (1)

• From 1 Nov 2002 To 12 May 2003, 1700 GMT2

Country Cumulative no. of case(s) No. of deaths No. recovered Local transmission
Australia 6 0 6 None
Brazil 2 0 2 None
Bulgaria 1 0 0 None
Canada 143 22 98 Yes
China 5,013 252 1,693 Yes
China, Hong Kong Special Administrative Region 1,683 218 1,066 Yes
China, Macao Special Administrative Region 1 0 0 None
China, Taiwan 184 20 26 Yes
Colombia 1 0 1 None
Finland 1 0 0 None
France 7 0 4 None
Germany 9 0 9 None
India 1 0 0 None
Indonesia 2 0 1 None
Italy 9 0 8 None
Kuwait 1 0 1 None
Malaysia 7 2 4 None
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No. of case of SARS worldwide (2)

• From 1 Nov 2002 To 12 May 2003, 1700 GMT2

Country Cumulative no. of case(s) No. of deaths No. recovered Local transmission
Mongolia 9 0 6 Yes
New Zealand 1 0 1 None
Philippines 10 2 3 Yes
Poland 1 0 0 None
Republic of Ireland 1 0 1 None
Republic of Korea 1 0 1 None
Romania 1 0 1 None
Singapore 205 28 156 Yes
South Africa 1 1 0 None
Spain 1 0 1 None
Sweden 3 0 2 None
Switzerland 1 0 1 None
Thailand 7 2 5 None
United Kingdom 6 0 6 None
United States 64 0 34 None
Viet Nam 63 5 58 None
Total 7,447 552 3,195
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Figures on Atypical Pneumonia in HK

• From The Department of Health website as at 100
  pm, 12 May 2003

Nature Cumulative Number Total No. of Discharged Patients Total No. of Deaths
Health care workers of Hospitals/Clinics and medical students 372 (? 2) 274 (? 1) 218 (? 3)
Patients, family members visitors 1,311 (? 3) 792 (? 6) 218 (? 3)
Total 1,683 (? 5) 1,066 (? 7) 218 (? 3)
There are 76 recovering patients in
convalescence.
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Epidemiological linkage
Metropole Hotel
1 Mainland visitor Onset 21 Feb 03
PWH index patient Onset 21 Feb 03
Succumbed at KWH
1 American Chinese
3 Singapore visitors
2 Canadian visitors
Outbreak in Singapore
Hanoi outbreak index case
A private hospital outbreak on Hong Kong Island
Outbreak in Toronto, Canada
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Symptoms of Respiratory Illness
Symptoms Frequency
Fever 100
Chills 92
Malaise 90
Headache 84
Myalgia 67
Cough 50
Dizziness 49
Rigors 44
Sore throat 43
Runny nose 39
Productive cough 36
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Known Facts about SARS

• Less infectious than influenza
• Incubation 2 to 7 days
• Infective period?
• A new virus?
• Any treatment?
• Mortality?

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How does SARS spread?

• NOT airborne
• Droplets
• - via close contact with an infected person
• Contaminated working surfaces
• (e.g. formites, stainless steel)
• survival up to 6 hours

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The wearing of face masks

• Healthcare workers looking after
  suspected/confirmed cases of SARS
• Family members of suspected/ confirmed case
• Wearing in public area?
• N95? Surgical mask?

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Guideline for wearing facemask
posted on the Department of Health website on
28/03/2003

• Wash hands before wearing a facemask.
• Follow the instructions on the packet carefully,
  if available.
• In general, when wearing a surgical facemask, the
  following should be noted
• the facemask should fit snugly over the face
• the coloured side of the facemask should face
  outside
• tie all the strings that keep the facemask in
  place or fix the rubber bands of the facemask
  round the ears properly
• the facemask should fully cover the nose, mouth
  as well as the chin
• the metallic wire part of the facemask should be
  fixed securely over the bridge of the nose to
  prevent leakage
• under general circumstances, the surgical mask
  should be changed daily.

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Guideline for wearing facemask
posted on the Department of Health website on
28/03/2003

1. Put the facemask into a plastic bag and tie it
   properly before putting it into a rubbish bin.
   You may dispose a used facemask concealed in a
   separate bag with the rest of your domestic
   wastes.
2. Replace the facemask immediately if it is damaged
   or soiled.

Wearing a facemask is just one of the ways to
prevent respiratory tract infections. The most
important thing a person should do is to observe
good personal hygiene. For example, wash hands
frequently with liquid soap, especially after
sneezing, coughing or cleaning the nose.
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Prevention of Respiratory Tract Infection (1)

• Building good body immunity by having a proper
  diet, regular exercise and adequate rest,
  reducing stress and avoiding smoking
• Maintain good personal hygiene, and wash hands
  after sneezing, coughing or cleaning the nose
• Maintain good ventilation

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Prevention of Respiratory Tract Infection (2)

• Avoid visiting crowded places with poor
  ventilation
• Put on a mask if taking care of a patient with
  respiratory symptoms and wash hands thoroughly
  afterwards
• Put on a mask if suffering from respiratory tract
  infection to reduce the chance of spreading the
  infection to people around them.

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Statistics on community-acquired pneumonia (CAP)
Disease 2001 2002 2003 (till 15/3/2003)
Pneumonia 24,400 18,000 3,646

• There is no unusual rise in the number of CAP
• The causes of CAP are similar to previous years
• (50 each of known causes and unknown causes)

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The End

• The Hong Kong Medical Association