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. 2004 Mar;58(3):186–191. doi: 10.1136/jech.2003.014894

Modelling potential responses to severe acute respiratory syndrome in Japan: the role of initial attack size, precaution, and quarantine

H Nishiura 1, K Patanarapelert 1, M Sriprom 1, W Sarakorn 1, S Sriyab 1, T Ming 1
PMCID: PMC1732706  PMID: 14966229

Abstract

Background: There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. With the use of detailed epidemiological data from other countries, this article describes the possible reason for the SARS epidemic not appearing in Japan, and simulates the impact of different control strategies that can break the transmission cycle of SARS associated coronavirus.

Method: Mathematical modelling is used for predicting the epidemiological outcome and simultaneously for evaluating the effect of interventions on SARS. The study estimates the initial attack size that would result in failed invasion. Three different interventions have been incorporated into the public health response policies; precautionary public health measures, isolation of infected people, and quarantine of exposed humans.

Results: The maximum number of humans newly infected could be roughly estimated on the basis of the initial attack size, using simple formulas. It is seen that the introduction of only a few cases into certain communities would not lead easily to an epidemic. The possible trajectories of SARS epidemic depend on the levels of public health interventions as quarantine and precautionary public health measures greatly affected the transmissibility of the disease. It is shown that there exist threshold levels of interventions at which the SARS epidemic settles down.

Conclusion: Initial attack size is one of the determinants of whether SARS can successfully invade the community or not. Two of the most effective policy procedures to prevent new infections would be to apply stringent precautionary measures and to impose quicker and more effective quarantine of the exposed populace.

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Selected References

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

  1. Abdullah A. S. M. Virus pathogens suggest an autumn return. J Epidemiol Community Health. 2003 Oct;57(10):770–771. doi: 10.1136/jech.57.10.770-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Abdullah Abu S. M., Tomlinson Brian, Cockram Clive S., Thomas G. Neil. Lessons from the severe acute respiratory syndrome outbreak in Hong Kong. Emerg Infect Dis. 2003 Sep;9(9):1042–1045. doi: 10.3201/eid0909.030366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Choi B. C. K., Pak A. W. P. A simple approximate mathematical model to predict the number of severe acute respiratory syndrome cases and deaths. J Epidemiol Community Health. 2003 Oct;57(10):831–835. doi: 10.1136/jech.57.10.831. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. 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]
  5. Dwosh Hy A., Hong Harry H. L., Austgarden Douglas, Herman Stanley, Schabas Richard. Identification and containment of an outbreak of SARS in a community hospital. CMAJ. 2003 May 27;168(11):1415–1420. [PMC free article] [PubMed] [Google Scholar]
  6. Dye Chris, Gay Nigel. Epidemiology. Modeling the SARS epidemic. Science. 2003 May 23;300(5627):1884–1885. doi: 10.1126/science.1086925. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Gerberding Julie Louise. Faster... but fast enough? Responding to the epidemic of severe acute respiratory syndrome. N Engl J Med. 2003 Apr 2;348(20):2030–2031. doi: 10.1056/NEJMe030067. [DOI] [PubMed] [Google Scholar]
  9. Lee A., Abdullah A. S. M. Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong. J Epidemiol Community Health. 2003 Sep;57(9):655–658. doi: 10.1136/jech.57.9.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lee Nelson, Hui David, Wu Alan, Chan Paul, Cameron Peter, Joynt Gavin M., Ahuja Anil, Yung Man Yee, Leung C. B., To K. F. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003 Apr 7;348(20):1986–1994. doi: 10.1056/NEJMoa030685. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. Poutanen Susan M., Low Donald E., Henry Bonnie, Finkelstein Sandy, Rose David, Green Karen, Tellier Raymond, Draker Ryan, Adachi Dena, Ayers Melissa. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003 Mar 31;348(20):1995–2005. doi: 10.1056/NEJMoa030634. [DOI] [PubMed] [Google Scholar]
  13. Rainer Timothy H., Cameron Peter A., Smit DeVilliers, Ong Kim L., Hung Alex Ng Wing, Nin David Chan Po, Ahuja Anil T., Si Louis Chan Yik, Sung Joseph J. Y. Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study. BMJ. 2003 Jun 21;326(7403):1354–1358. doi: 10.1136/bmj.326.7403.1354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. 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]
  15. Seto W. H., Tsang D., Yung R. W. H., Ching T. Y., Ng T. K., Ho M., Ho L. M., Peiris J. S. M., Advisors of Expert SARS group of Hospital Authority Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet. 2003 May 3;361(9368):1519–1520. doi: 10.1016/S0140-6736(03)13168-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Song Baojun, Castillo-Chavez Carlos, Aparicio Juan Pablo. Tuberculosis models with fast and slow dynamics: the role of close and casual contacts. Math Biosci. 2002 Nov-Dec;180:187–205. doi: 10.1016/s0025-5564(02)00112-8. [DOI] [PubMed] [Google Scholar]
  17. 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]

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