Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China.
Severe acute respiratory syndrome (SARS), now known to be caused by a coronavirus, probably originated in Guangdong province in southern China in late 2002. The first major outbreak occurred in Guangzhou, the capital of Guangdong, between January and March 2003. This study reviews the clinical presentation, laboratory findings and response to four different treatment protocols. Case notes and laboratory findings were analysed and outcome measures were collected prospectively. The SARS outbreak in Guangdong province and the outbreak in Guangzhou associated with hospitals in the city are described, documenting clinical and laboratory features in a cohort of 190 patients randomly allocated to four treatment regimens. Patients were infected by close contact in either family or health-care settings, particularly following procedures likely to generate aerosols of respiratory secretions (e.g. administration of nebulized drugs and bronchoscopy). The earliest symptom was a high fever followed, in most patients, by dyspnoea, cough and myalgia, with 24 % of patients complaining of diarrhoea. The most frequent chest X-ray changes were patchy consolidation with progression to bilateral bronchopneumonia over 5-10 days. Thirty-six cases developed adult respiratory distress syndrome (ARDS), of whom 11 died. There was no response to antibiotics. The best response (no deaths) was seen in the group of 60 patients receiving early high-dose steroids and nasal CPAP (continuous airway positive pressure) ventilation; the other three treatment groups had significant mortality. Cross-infection to medical and nursing staff was completely prevented in one hospital by rigid adherence to barrier precautions during contact with infected patients. The use of rapid case identification and quarantine has controlled the outbreak in Guangzhou, in which more than 350 patients have been infected. Early administration of high-dose steroids and CPAP ventilation appears to offer the best supportive treatment with a reduced mortality compared with other treatment regimens.
Zhao
Z
Z
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Zhang
F
F
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Xu
M
M
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Huang
K
K
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Zhong
W
W
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Cai
W
W
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Yin
Z
Z
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Huang
S
S
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Deng
Z
Z
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Wei
M
M
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Xiong
J
J
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Hawkey
P M
PM
Departments of Respiratory Disease and Laboratory Medicine, First Municipal People's Hospital of Guangzhou, 1 Panfu Road, Guangzhou, People's Republic of China 2Eighth Municipal People's Hospital of Guangzhou, 627 Dongfeng Dong Road, Guangzhou, 510180, People's Republic of China 3Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong Road, Guangzhou, 510655, People's Republic of China 4Guangzhou Red-Cross Hospital, 396 Tongfu Zhong Road, Guangzhou, 510220, China 5Sixth Municipal People's Hospital of Guangzhou, 19 Yuanchu Xijie, Tianhe Guangzhou, 510260, People's Republic of China 6Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002681:China; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011790:Quarantine; D045473:Severe acute respiratory syndrome-related coronavirus; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D016898:Interferon-alpha; D008775:Methylprednisolone