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ABSTRACT

Background There is uncertainty about the mode of transmission of the severe acute respiratory syndrome (SARS) virus. We analyzed the temporal and spatial distributions of cases in a large community outbreak of SARS in Hong Kong and examined the correlation of these data with the three-dimensional spread of a virus-laden aerosol plume that was modeled using studies of airflow dynamics.

Methods We determined the distribution of the initial 187 cases of SARS in the Amoy Gardens housing complex in 2003 according to the date of onset and location of residence. We then studied the association between the location (building, floor, and direction the apartment unit faced) and the probability of infection using logistic regression. The spread of the airborne, virus-laden aerosols generated by the index patient was modeled with the use of airflow-dynamics studies, including studies performed with the use of computational fluid-dynamics and multizone modeling.

Results The curves of the epidemic suggested a common source of the outbreak. All but 5 patients lived in seven buildings (A to G), and the index patient and more than half the other patients with SARS (99 patients) lived in building E. Residents of the floors at the middle and upper levels in building E were at a significantly higher risk than residents on lower floors; this finding is consistent with a rising plume of contaminated warm air in the air shaft generated from a middle-level apartment unit. The risks for the different units matched the virus concentrations predicted with the use of multizone modeling. The distribution of risk in buildings B, C, and D corresponded well with the three-dimensional spread of virus-laden aerosols predicted with the use of computational fluid-dynamics modeling.

Conclusions Airborne spread of the virus appears to explain this large community outbreak of SARS, and future efforts at prevention and control must take into consideration the potential for airborne spread of this virus.

Source Information

From the Department of Community and Family Medicine, Chinese University of Hong Kong (I.T.S.Y., T.W.W., W.T., T.H.); and the Departments of Mechanical Engineering (Y.L., A.T.C., D.Y.C.L.) and Civil Engineering (J.H.W.L.), University of Hong Kong — both in Hong Kong, China.

Address reprint requests to Dr. Yu at the Department of Community and Family Medicine, 4th Fl., School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong, China, or at iyu{at}cuhk.edu.hk.

Full Text of this Article

Related Letters:

Evidence of Airborne Transmission of SARS
Tong T. R., Liang C., Nicastri E., Petrosillo N., Puro V., Fowler R. A., Scales D. C., Ilan R., Yu I. T.S., Li Y.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:609-611, Aug 5, 2004. Correspondence

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