title: Public health implications of using various case definitions in The Netherlands during the worldwide SARS outbreak.
abstract: This study analysed the consequences of deviation from the WHO case definition for the assessment of patients with suspected severe acute respiratory syndrome (SARS) in The Netherlands during 2003. Between 17 March and 7 July 2003, as a result of dilemmas in balancing sensitivity and specificity, five different case definitions were used. The patients referred for SARS assessment were analysed from a public health perspective. None of the patients referred had SARS, based on serological and virological criteria. Nevertheless, all 72 patients required thorough assessment and, depending on the results of the assessment, institution of appropriate prevention and control measures. Changing case definitions caused confusion in classifying cases. A centralised assessment of the reported cases by a team with clinical and public health expertise (epidemiological and geographical risk assessment) is a practical solution for addressing differences in applying case definitions. The burden of managing non-cases is an important issue when allocating public health resources, and should be taken into account during the preparation phase, rather than during an outbreak. This applies not only to SARS, but also to other public health threats, such as pandemic influenza or a bioterrorist episode.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Aura.Timen@rivm.nl
authors.forename: A
authors.initials: A
authors.lastname: Timen
authors.forename: G J J
authors.initials: GJ
authors.lastname: van Doornum
authors.forename: M
authors.initials: M
authors.lastname: Schutten
authors.forename: M A E
authors.initials: MA
authors.lastname: Conyn-van Spaendonck
authors.forename: J W M
authors.initials: JW
authors.lastname: van der Meer
authors.forename: A D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: J E
authors.initials: JE
authors.lastname: van Steenbergen
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D003140:Communicable Disease Control / Q000379:methods; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011634:Public Health / Q000592:standards*; D012015:Reference Standards; D040841:Resource Allocation; D012189:Retrospective Studies; D045473:Severe acute respiratory syndrome-related coronavirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D000914:Antibodies, Viral