【作者】 谢淑云； 曾光； 雷杰； 李群； 李海贝； 贾绮宾；

【Author】 XIE Shu-yun,ZENG Guang,LEI Jie,LI Qun,LI Hai-bei,JIA Qi-bin Chinese Field Epidemiology Training Program,Beijing,100050,China

【机构】 中国现场流行病学培训项目； 积水潭医院；

【摘要】 目的了解SARS暴发案例的传播过程和相关特征,为预防和控制SARS流行决策提供科学依据。方法设计统一调查表,用查阅病历、面对面调查和电话调查相结合的方式进行,以指征病例为起点进行线索追踪和个案调查。用传播链示意图分析传播关系,用接触史分析示意图分析传染性。结果共追查到与本案例传播链相关的接触者207人,发病36人,死亡1人,总罹患率为17%。其中指征病例和1名二代病例分别直接传播了12例和13例续发病例,其传播过程可以用清晰的传播链加以描述;所有36例病例均与前代病例的症状期有密切接触史,其中家族传播链中85%的病例都接触了前代病例症状期的第3-5天,发病前后均接触和仅发病后接触的罹患率分别为70%和67%,无显著性差异;仅与前代病人潜伏期接触的15名同事、29名同学无发病,38名与医护人员发病前或发病初期密切接触的家属无发病;结论本案例所有的续发病例都有与症状期病人密切接触史;未观察到SARS病人在其潜伏期内存在传染性。更多还原

【Abstract】 Background On 25th March 2003, a 91 year old man was admitted to Hospital J in Beijing with stroke and fever. He died on 30th March. From 31st March, there was an outbreak of SARS among his contacts in the family and in the hospital, including his relatives, other co-patients and health care workers in Hospital J. Chinese Field Epidemiology Training Program trainees conducted an investigation of the outbreak. Objectives To investigate the transmission process of SARS and evaluate infectiveness of SARS patients in different periods of disease development. Methods Using standardized questionnaires, we conducted case investigation and contact tracing by a combination of field investigation and telephone interview. We studied the transmission process and infectiousness of SARS by analyzing the transmission chain and the contact history. Results Among the 207 contacts of the index cases, there were 36 cases of SARS (attack rate 17%) and one death. There are 12 cases who directly contact with index case and 13 cases with one secondary case. The transmission chains of this outbreak can be clearly delineated. All the cases had close contacts within the symptomatic period of their infectors. Among the relatives, 85% of the cases had contacts with their infectors for 3 to 5 days after onsets of the infectors’ illnesses. There is no significant difference between attack rate 70% (who contact with the patient before and after illness onset) and attack rate 67% (only contact after illness onset). All the 44 social acquaintances and 38 of the family members who had contacts with their infectors during the incubation period were not ill. Among the close contacts at the hospital who have no any protection to take care the patient, the attack rate was over 80%. Conclusions All the secondary cases of this outbreak had history of directly close contacts with their infectors after illness onset. There is no evidence that SARS cases were infectious during their incubation period.更多还原