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Philosophical Transactions of the Royal Society B: Biological Sciences logoLink to Philosophical Transactions of the Royal Society B: Biological Sciences
. 2004 Jul 29;359(1447):1091–1105. doi: 10.1098/rstb.2004.1490

Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic.

Roy M Anderson 1, Christophe Fraser 1, Azra C Ghani 1, Christl A Donnelly 1, Steven Riley 1, Neil M Ferguson 1, Gabriel M Leung 1, T H Lam 1, Anthony J Hedley 1
PMCID: PMC1693389  PMID: 15306395

Abstract

This paper reviews current understanding of the epidemiology, transmission dynamics and control of the aetiological agent of severe acute respiratory syndrome (SARS). We present analyses of data on key parameters and distributions and discuss the processes of data capture, analysis and public health policy formulation during the SARS epidemic are discussed. The low transmissibility of the virus, combined with the onset of peak infectiousness following the onset of clinical symptoms of disease, transpired to make simple public health measures, such as isolating patients and quarantining their contacts, very effective in the control of the SARS epidemic. We conclude that we were lucky this time round, but may not be so with the next epidemic outbreak of a novel aetiological agent. We present analyses that help to further understanding of what intervention measures are likely to work best with infectious agents of defined biological and epidemiological properties. These lessons learnt from the SARS experience are presented in an epidemiological and public health context.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Breiman Robert F., Evans Meirion R., Preiser Wolfgang, Maguire James, Schnur Alan, Li Ailan, Bekedam Henk, MacKenzie John S. Role of China in the quest to define and control severe acute respiratory syndrome. Emerg Infect Dis. 2003 Sep;9(9):1037–1041. doi: 10.3201/eid0909.030390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chow Pierce K. H., Ooi Eng-Eong, Tan Hiang-Khoon, Ong Kong-Wee, Sil Bijon Kumar, Teo Melissa, Ng Timothy, Soo Khee-Chee. Healthcare worker seroconversion in SARS outbreak. Emerg Infect Dis. 2004 Feb;10(2):249–250. doi: 10.3201/eid1002.030397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Donnelly Christl A., Ghani Azra C., Leung Gabriel M., Hedley Anthony J., Fraser Christophe, Riley Steven, Abu-Raddad Laith J., Ho Lai-Ming, Thach Thuan-Quoc, Chau Patsy. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003 May 24;361(9371):1761–1766. doi: 10.1016/S0140-6736(03)13410-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Drosten Christian, Günther Stephan, Preiser Wolfgang, van der Werf Sylvie, Brodt Hans-Reinhard, Becker Stephan, Rabenau Holger, Panning Marcus, Kolesnikova Larissa, Fouchier Ron A. M. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003 Apr 10;348(20):1967–1976. doi: 10.1056/NEJMoa030747. [DOI] [PubMed] [Google Scholar]
  5. Ferguson N. M., Donnelly C. A., Anderson R. M. The foot-and-mouth epidemic in Great Britain: pattern of spread and impact of interventions. Science. 2001 Apr 12;292(5519):1155–1160. doi: 10.1126/science.1061020. [DOI] [PubMed] [Google Scholar]
  6. Ferguson N. M., Donnelly C. A., Anderson R. M. Transmission intensity and impact of control policies on the foot and mouth epidemic in Great Britain. Nature. 2001 Oct 4;413(6855):542–548. doi: 10.1038/35097116. [DOI] [PubMed] [Google Scholar]
  7. Ferguson Neil M., Fraser Christophe, Donnelly Christl A., Ghani Azra C., Anderson Roy M. Public health. Public health risk from the avian H5N1 influenza epidemic. Science. 2004 May 14;304(5673):968–969. doi: 10.1126/science.1096898. [DOI] [PubMed] [Google Scholar]
  8. Fraser Christophe, Riley Steven, Anderson Roy M., Ferguson Neil M. Factors that make an infectious disease outbreak controllable. Proc Natl Acad Sci U S A. 2004 Apr 7;101(16):6146–6151. doi: 10.1073/pnas.0307506101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Galvani Alison P., Lei Xiudong, Jewell Nicholas P. Severe acute respiratory syndrome: temporal stability and geographic variation in case-fatality rates and doubling times. Emerg Infect Dis. 2003 Aug;9(8):991–994. doi: 10.3201/eid0908.030334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hsu Li-Yang, Lee Cheng-Chuan, Green Justin A., Ang Brenda, Paton Nicholas I., Lee Lawrence, Villacian Jorge S., Lim Poh-Lian, Earnest Arul, Leo Yee-Sin. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis. 2003 Jun;9(6):713–717. doi: 10.3201/eid0906.030264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ksiazek Thomas G., Erdman Dean, Goldsmith Cynthia S., Zaki Sherif R., Peret Teresa, Emery Shannon, Tong Suxiang, Urbani Carlo, Comer James A., Lim Wilina. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003 Apr 10;348(20):1953–1966. doi: 10.1056/NEJMoa030781. [DOI] [PubMed] [Google Scholar]
  12. Li Gang, Chen Xuejuan, Xu Anlong. Profile of specific antibodies to the SARS-associated coronavirus. N Engl J Med. 2003 Jul 31;349(5):508–509. doi: 10.1056/NEJM200307313490520. [DOI] [PubMed] [Google Scholar]
  13. Lipsitch Marc, Cohen Ted, Cooper Ben, Robins James M., Ma Stefan, James Lyn, Gopalakrishna Gowri, Chew Suok Kai, Tan Chorh Chuan, Samore Matthew H. Transmission dynamics and control of severe acute respiratory syndrome. Science. 2003 May 23;300(5627):1966–1970. doi: 10.1126/science.1086616. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lloyd-Smith James O., Galvani Alison P., Getz Wayne M. Curtailing transmission of severe acute respiratory syndrome within a community and its hospital. Proc Biol Sci. 2003 Oct 7;270(1528):1979–1989. doi: 10.1098/rspb.2003.2481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Marra Marco A., Jones Steven J. M., Astell Caroline R., Holt Robert A., Brooks-Wilson Angela, Butterfield Yaron S. N., Khattra Jaswinder, Asano Jennifer K., Barber Sarah A., Chan Susanna Y. The Genome sequence of the SARS-associated coronavirus. Science. 2003 May 1;300(5624):1399–1404. doi: 10.1126/science.1085953. [DOI] [PubMed] [Google Scholar]
  16. Paterson Rachael. SARS returns to China. Lancet Infect Dis. 2004 Feb;4(2):64–64. doi: 10.1016/S1473-3099(04)00910-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Peiris J. S. M., Chu C. M., Cheng V. C. C., Chan K. S., Hung I. F. N., Poon L. L. M., Law K. I., Tang B. S. F., Hon T. Y. W., Chan C. S. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003 May 24;361(9371):1767–1772. doi: 10.1016/S0140-6736(03)13412-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Peiris J. S. M., Lai S. T., Poon L. L. M., Guan Y., Yam L. Y. C., Lim W., Nicholls J., Yee W. K. S., Yan W. W., Cheung M. T. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003 Apr 19;361(9366):1319–1325. doi: 10.1016/S0140-6736(03)13077-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Riley Steven, Fraser Christophe, Donnelly Christl A., Ghani Azra C., Abu-Raddad Laith J., Hedley Anthony J., Leung Gabriel M., Ho Lai-Ming, Lam Tai-Hing, Thach Thuan Q. Transmission dynamics of the etiological agent of SARS in Hong Kong: impact of public health interventions. Science. 2003 May 23;300(5627):1961–1966. doi: 10.1126/science.1086478. [DOI] [PubMed] [Google Scholar]
  20. Shen Zhuang, Ning Fang, Zhou Weigong, He Xiong, Lin Changying, Chin Daniel P., Zhu Zonghan, Schuchat Anne. Superspreading SARS events, Beijing, 2003. Emerg Infect Dis. 2004 Feb;10(2):256–260. doi: 10.3201/eid1002.030732. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Tsang Kenneth W., Ho Pak L., Ooi Gaik C., Yee Wilson K., Wang Teresa, Chan-Yeung Moira, Lam Wah K., Seto Wing H., Yam Loretta Y., Cheung Thomas M. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003 Mar 31;348(20):1977–1985. doi: 10.1056/NEJMoa030666. [DOI] [PubMed] [Google Scholar]
  22. Varia Monali, Wilson Samantha, Sarwal Shelly, McGeer Allison, Gournis Effie, Galanis Eleni, Henry Bonnie, Hospital Outbreak Investigation Team Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003 Aug 19;169(4):285–292. [PMC free article] [PubMed] [Google Scholar]
  23. Watts Jonathan. China culls wild animals to prevent new SARS threat. Lancet. 2004 Jan 10;363(9403):134–134. doi: 10.1016/S0140-6736(03)15313-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Webster Robert G. Wet markets--a continuing source of severe acute respiratory syndrome and influenza? Lancet. 2004 Jan 17;363(9404):234–236. doi: 10.1016/S0140-6736(03)15329-9. [DOI] [PMC free article] [PubMed] [Google Scholar]

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