title: Clinical and epidemiological predictors of transmission in Severe Acute Respiratory Syndrome (SARS).
abstract: BACKGROUND
  Only a minority of probable SARS cases caused transmission. We assess if any epidemiological or clinical factors in SARS index patients were associated with increased probability of transmission.
  
  
  METHODS
  We used epidemiological and clinical data on probable SARS patients admitted to Tan Tock Seng Hospital. Using a case-control approach, index patients who had probable SARS who subsequently transmitted the disease to at least one other patient were analysed as "cases" against patients with no transmission as "controls", using multivariate logistic regression analysis.
  
  
  RESULTS
  98 index patients were available for analysis (22 with transmission, 76 with no transmission). Covariates positively associated with transmission in univariate analysis at p < 0.05 included delay to isolation (Day 7 of illness or later), admission to a non-isolation facility, pre-existing chronic respiratory disease and immunosuppressive disease, need for oxygen, shortness of breath, vomiting, and higher lactate dehydrogenase levels and higher neutrophil counts. In the multivariate analysis, only three factors were significant: delay to isolation, admission to a non-isolation facility and higher lactate dehydrogenase levels of >650 IU/L (OR 6.4, 23.8 and 4.7 respectively).
  
  
  CONCLUSIONS
  Clinical and epidemiological factors can help us to explain why transmission was observed in some instances but not in others.
authors.affiliation: Clinical Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore. mark.chen@lshtm.ac.uk
authors.forename: Mark I C
authors.initials: MI
authors.lastname: Chen
authors.forename: Angela L P
authors.initials: AL
authors.lastname: Chow
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Hoe Nam
authors.initials: HN
authors.lastname: Leong
authors.forename: Yee Sin
authors.initials: YS
authors.lastname: Leo
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D012846:Singapore / Q000453:epidemiology
chemical_list: D007770:L-Lactate Dehydrogenase