1. SARS outbreak

2. SARS Outbreak March 107 MDs and 4 nurses reported sick March 1150 staff screened, 23 admitted, ward closed March 12Clinical teaching suspended March 13 Index case identified March 17Medical school moved back to campus

3. 156 patients 138 traceable to the index case 20 doctors 34 nurses 15 allied health 16 medical students

4. SARS: a triphasic disease Max. daily body temperature ( o C) Days after onset of disease Viral replicative phase Immune hyperactive phase Pulmonary-destruction phase

5. Treatment Protocol Broad spectrum antibiotics IV Ribavirin High dose steroids Convalescent serum Supportive care

6. Response to Rx Board-spectrum Antimicrobial * (%) N=138 Ribavirin + Corticosteroid # (%) N=138 IV Methyl- prednisolone + (%) N=107 Sustained response0 (0)16 (11.6)50 (46.7) Partial response0 (0)9 (6.5)45 (42.1) No response138 (100)113 (81.9)12 (11.2)

7. All patients in PWH N=277 Discharged: 147 (53%) ICU admission: 51 (18.4%) Died: 18 (6.5%) Mortality : median age 76 (44-84) years

8. Convalescent Plasma

9. Convalescent Plasma vs more MP 3 MP + CS (n = 19) 4 or more MP (n = 21) P values Age38.747.90.087 Admission LDH258.1247.70.7 Discharge rate by 21 days 73.7%19%0.001 No. of deaths050.049

10. Outcome of patients who received CS before day 16 vs later date ≤ Day 16 (n = 36) Day 16 (n = 14) P values Discharge rate by day 21 51.6%0%0.02 Death rate0%28.6%0.02

14. 女人 Female 男人 Male The index patient and his family at PWH 母親 Mom 哥哥 Brother 姐夫 Brother- in-law 嫂 Sister- In-law

15. 5 1 2 3 4 5 6 7 Mom 母親 9 Time 時間

17. 1 2 3 5 5 6 7 Mom 4 母親 9 10 11 8

18. PolS E MN MAKING VACCINES AGAINST SARS VIRUS Gene organization of SARS virus

19. Set up in the first week of outbreak > 233,000 hits (average 4,000 day) Translated to Chinese, Russian, Portuguese, Czech Linked to HA, WHO, CDC, HKMA and other major infectious disease websites Radiology website

20. Tele-Conference with Canada & Singapore 29-4-03

22. Outbreak modelling Susceptible S t Infectious I t Recovered / immune R t SIR RoRo 1/D Susceptible meets susceptible (S - S, no transmission) Susceptible meets infectious (S - I, transmission) Susceptible meets resistant (immune) (S-R, no transmission) Infectious meets infectious (I-I, no transmission) Infectious meets resistant (I-R, no transmission) Resistant meets resistant (R -R, no transmission)

23. SARS in Hong Kong Number of cases

24. School of Public Health

25. Centre for Health Education and Health Promotion Training in health education and health promotion “Healthy Cities” “Health Promoting Schools” Research in health education & health promotion Partnership with community in health promotion

26. Hygiene Charter

27. Schools against SARS