A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong

doi:10.1056/NEJMoa030685

Volume 348:1986-1994		May 15, 2003		Number 20

A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong

Nelson Lee, M.D., David Hui, M.D., Alan Wu, M.D., Paul Chan, M.D., Peter Cameron, M.D., Gavin M. Joynt, M.D., Anil Ahuja, M.D., Man Yee Yung, B.Sc., C.B. Leung, M.D., K.F. To, M.D., S.F. Lui, M.D., C.C. Szeto, M.D., Sydney Chung, M.D., and Joseph J.Y. Sung, M.D.

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ABSTRACT

Background There has been an outbreak of the severe acute respiratorysyndrome (SARS) worldwide. We report the clinical, laboratory,and radiologic features of 138 cases of suspected SARS duringa hospital outbreak in Hong Kong.

Methods From March 11 to 25, 2003, all patients with suspectedSARS after exposure to an index patient or ward were admittedto the isolation wards of the Prince of Wales Hospital. Theirdemographic, clinical, laboratory, and radiologic characteristicswere analyzed. Clinical end points included the need for intensivecare and death. Univariate and multivariate analyses were performed.

Results There were 66 male patients and 72 female patients inthis cohort, 69 of whom were health care workers. The most commonsymptoms included fever (in 100 percent of the patients); chills,rigors, or both (73.2 percent); and myalgia (60.9 percent).Cough and headache were also reported in more than 50 percentof the patients. Other common findings were lymphopenia (in69.6 percent), thrombocytopenia (44.8 percent), and elevatedlactate dehydrogenase and creatine kinase levels (71.0 percentand 32.1 percent, respectively). Peripheral air-space consolidationwas commonly observed on thoracic computed tomographic scanning.A total of 32 patients (23.2 percent) were admitted to the intensivecare unit; 5 patients died, all of whom had coexisting conditions.In a multivariate analysis, the independent predictors of anadverse outcome were advanced age (odds ratio per decade oflife, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009),a high peak lactate dehydrogenase level (odds ratio per 100U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42;P=0.003), and an absolute neutrophil count that exceeded theupper limit of the normal range on presentation (odds ratio,1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04).

Conclusions SARS is a serious respiratory illness that led tosignificant morbidity and mortality in our cohort.

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From the Departments of Medicine and Therapeutics (N.L., D.H., A.W., C.B.L., S.F.L., C.C.S., J.J.Y.S.), Microbiology (P. Chan), Emergency Medicine (P. Cameron), Anesthesia and Intensive Care (G.M.J.), Diagnostic Radiology and Organ Imaging (A.A.), Surgery (M.Y.Y., S.C.), and Anatomical and Cellular Pathology (K.F.T.), Chinese University of Hong Kong, Hong Kong, China.

This article was published at www.nejm.org on April 7, 2003.

Address reprint requests to Dr. Sung at the Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China, or at joesung{at}cuhk.edu.hk.

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