A hospital outbreak of severe acute respiratory syndrome in Guangzhou,China

• Published in: Chinese medical journal Vol. 116; no. 6; pp. 811 - 818
• Main Author: 伍卫 王景峰 刘品明 陈为宪 尹松梅 江山平 严励 詹俊 陈锡龙 李建国 黄子通 黄洪章
• Format: Journal Article
• Language: English
• Published: China The SARS Working Group, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China 01.06.2003
• Subjects: Adult; China - epidemiology; Cross Infection - diagnosis; Cross Infection - epidemiology; Cross Infection - therapy; Disease Outbreaks; Female; Humans; Male; Severe Acute Respiratory Syndrome - diagnosis; Severe Acute Respiratory Syndrome - epidemiology; Severe Acute Respiratory Syndrome - therapy; 严重急性呼吸综合征; 临床特征; 医院感染; 治疗方案; China; treatment; clinical features; severe acute respiratory syndrome
• ISSN: 0366-6999; 2542-5641

Objective To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.Methods The outbreak started with a SARS patient from the community, and a total of 96 people(76 women and 20 men, mean age (29. 5 ±10.3) years, 93. 8% of whom were health care workers)who had exposure to this source patient became infected in a short time. Clinical data in this cohort were collected prospectively as they were identified.Results (1) The incubation period ranged from 1 to 20 ( mean: 5. 9±3. 5) days. The duration of hospitalization was ( 17. 2 ±8.0 ) days. (2) The initial temperature was ( 38.3± 0.6 )℃, while the highest was (39. 2±0. 6)℃ (P<0. 001 ), with fever duration of (9. 0 ±4.2) days. (3) Other most common symptoms included fatigue (93. 8% ), cough (85. 4% ), mild sputum production (66. 7% ),chills (55.2%), headache (39.6%), general malaise (35. 4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2±0.8 on presentation, which increased to 2.9 ± 1.4 after admission( P<0. 001 ). The interval from the beginning of fever to the onset of abnormal chest radiographs was(3.5 ±2.3) days, which increased in size, extent, and severity to the maximum (6. 7 ±3. 5) days later. The time before the lung opacities were basically absorbed was (14. 9 ± 7. 8) days. (5)Leukopenia was observed in 67. 7% of this cohort. The time between the onset of fever and leukopenia was (4. 4 ± 2. 3) days, with the lowest white blood cell count of (2.80 ± 0.72)× 10^9/L.(6) The lowest arterial oxygen saturation was (94. 8 ± 3. 1 )% with supplementary oxygen. (7)Antibiotical therapies included tetracyclines ( 91.0%), aminoglycosides ( 83. 3%), quinolones(79. 2% ) ; 18. 8% of the patients received a combination of tetracyclines and aminoglycosides, while11.5% received a combination of tetracyclines and quinolones, and 63. 5% received a combination oftetracyclines, aminoglycosides and quinolones. Vancomycin was used in 13. 5% of the patients. (8)68. 8% of the patients were treated with methylprednisolones for a mean interval of (4. 9±2. 4) days.The initial dose was (67.3 ± 28.2 ) mg/d and the maximal dose was (82.4 ±30.5 ) mg/d. (9)Human γ-globulin, interferon-α, antiviral drugs (oral ribavirin or oseltamivir) were used respectively in 68.6%, 46.9% and 92.7% of the patients. (10) Ninety-five patients (99. 0%) had a complete clinical recovery, and only 1 patient (1.0%) died,Conclusions SARS appears to be quickly infectious and potentially lethal among health care workers, characterized by acute onset and rapid progression, and mostly bilateral lung involvement on chest radiographs. Proper administration of glucocorticosteroids seems to be of some benefits. Antibiotics, human γ-globulin, interferon-α, and antiviral drugs,although empirically, might be useful to shorten the clinical course.