Beijing, China, experienced the world's largest outbreak of severe acute
respiratory syndrome (SARS) beginning in March 2003, with the outbreak resolving
rapidly, within 6 weeks of its peak in late April. Little is known about the
control measures implemented during this outbreak.
To describe and evaluate the measures undertaken to control the SARS
Design, Setting, and Participants
Data were reviewed from standardized surveillance forms from SARS cases
(2521 probable cases) and their close contacts observed in Beijing between
March 5, 2003, and May 29, 2003. Procedures implemented by health authorities
were investigated through review of official documents and discussions with
public health officials.
Main Outcome Measures
Timeline of major control measures; number of cases and quarantined
close contacts and attack rates, with changes in infection control measures,
management, and triage of suspected cases; and time lag between illness onset
and hospitalization with information dissemination.
Health care worker training in use of personal protective equipment
and management of patients with SARS and establishing fever clinics and designated
SARS wards in hospitals predated the steepest decline in cases. During the
outbreak, 30 178 persons were quarantined. Among 2195 quarantined close
contacts in 5 districts, the attack rate was 6.3% (95% confidence interval
[CI], 5.3%-7.3%), with a range of 15.4% (95% CI, 11.5%-19.2%) among spouses
to 0.36% (95% CI, 0%-0.77%) among work and school contacts. The attack rate
among quarantined household members increased with age from 5.0% (95% CI,
0%-10.5%) in children younger than 10 years to 27.6% (95% CI, 18.2%-37.0%)
in adults aged 60 to 69 years. Among almost 14 million people screened for
fever at the airport, train stations, and roadside checkpoints, only 12 were
found to have probable SARS. The national and municipal governments held 13
press conferences about SARS. The time lag between illness onset and hospitalization
decreased from a median of 5 to 6 days on or before April 20, 2003, the day
the outbreak was announced to the public, to 2 days after April 20 (P<.001).
The rapid resolution of the SARS outbreak was multifactorial, involving
improvements in management and triage in hospitals and communities of patients
with suspected SARS and the dissemination of information to health care workers
and the public.