Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report

doi:10.1136/bmj.326.7394.850

BMJ 2003;326:850-852 ( 19 April )

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Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report

Moira Chan-Yeung, professor, ^a W C Yu, consultant physician. ^b

^a Division of Respiratory and Critical Care Medicine, 4/F, Professorial Block, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China, ^b Department of Medicine, Princess Margaret Hospital, Hong Kong, SAR, China

Correspondence to: M Chan-Yeung mmwchan{at}hkucc.hku.hk

Objective: To describe the outbreak of severe acute respiratorysyndrome in Hong Kong.
Design: Descriptive caseseries.
Setting: Hong Kong, Special Administrative Region,China
Results: The outbreak started with a visitor from southernChina on 21 February. At the hospitals where the first cases weretreated the disease spread quickly among healthcare workers, andthen out into the community as family members became infected.By 1 April, 685 cases had been reported with 16 deaths. Symptomsinclude high fever and one or more respiratory symptoms (includingcough, shortness of breath, and difficulty breathing). Changesin lung tissue suggest that part of the lung damage is due tocytokines induced by the microbial agent, which has led to empiricaltreatment with corticosteroids, broad spectrum antiviral agent,and antibacterial cover. There is strong evidence that a novelcoronavirus is the pathogen. Precautions for droplet infectionshould be instituted, including the wearing of masks and rigorousdisinfection and hygiene procedures. On 27 March the Departmentof Health announced drastic measures, including vigorous contacttracing and examination, quarantine of contacts in their homes,and closure of all schools anduniversities.
Conclusion: The rapidity of the spread of the diseaseand the morbidity indicate that the agent responsible is highlyinfectious and virulent. Strict infection control measures fordroplet and contact transmission by healthcare workers, a vigilanthealthcare profession, and public education are essential fordiseaseprevention.

What is already known on this topic
Severe acute respiratory syndrome is a form of atypical pneumonia that originated in southern China and spread globally in a few weeks

The clinical picture, empirical treatment, and the possible mode of disease transmission have been described. The agent responsible is probably a novel coronavirus

What this study adds
This report gives an account of the daily reported number of cases in Hong Kong, showing how the disease has spread rapidly from healthcare workers to the community, and of the drastic measures the government has finally introduced to attempt to control the disease

A vigilant healthcare profession, strict infection control measures, and public education are essential to prevent disease dissemination

Early introduction of quarantine procedures for this disease by health authorities should be considered.

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