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Xinghuo Pang, MD; Zonghan Zhu, MD; Fujie Xu, MD, PhD; Jiyong Guo, MD, MS; Xiaohong Gong, MD; Donglei Liu, MS; Zejun Liu, MD; Daniel P. Chin, MD; Daniel R. Feikin, MD, MSPH

JAMA. 2003;290:3215-3221.

Context  Beijing, China, experienced the world's largest outbreak of severe acute respiratory syndrome (SARS) beginning in March 2003, with the outbreak resolving rapidly, within 6 weeks of its peak in late April. Little is known about the control measures implemented during this outbreak.

Objective  To describe and evaluate the measures undertaken to control the SARS outbreak.

Design, Setting, and Participants  Data were reviewed from standardized surveillance forms from SARS cases (2521 probable cases) and their close contacts observed in Beijing between March 5, 2003, and May 29, 2003. Procedures implemented by health authorities were investigated through review of official documents and discussions with public health officials.

Main Outcome Measures  Timeline of major control measures; number of cases and quarantined close contacts and attack rates, with changes in infection control measures, management, and triage of suspected cases; and time lag between illness onset and hospitalization with information dissemination.

Results  Health care worker training in use of personal protective equipment and management of patients with SARS and establishing fever clinics and designated SARS wards in hospitals predated the steepest decline in cases. During the outbreak, 30 178 persons were quarantined. Among 2195 quarantined close contacts in 5 districts, the attack rate was 6.3% (95% confidence interval [CI], 5.3%-7.3%), with a range of 15.4% (95% CI, 11.5%-19.2%) among spouses to 0.36% (95% CI, 0%-0.77%) among work and school contacts. The attack rate among quarantined household members increased with age from 5.0% (95% CI, 0%-10.5%) in children younger than 10 years to 27.6% (95% CI, 18.2%-37.0%) in adults aged 60 to 69 years. Among almost 14 million people screened for fever at the airport, train stations, and roadside checkpoints, only 12 were found to have probable SARS. The national and municipal governments held 13 press conferences about SARS. The time lag between illness onset and hospitalization decreased from a median of 5 to 6 days on or before April 20, 2003, the day the outbreak was announced to the public, to 2 days after April 20 (P<.001).

Conclusions  The rapid resolution of the SARS outbreak was multifactorial, involving improvements in management and triage in hospitals and communities of patients with suspected SARS and the dissemination of information to health care workers and the public.

Author Affiliations: Beijing Center for Disease Prevention and Control (Drs Pang, Gong, and Z. Liu, and Mr D. Liu), Beijing Municipal Health Bureau (Drs Zhu and Guo), and World Health Organization, China Office (Drs Xu, Chin, and Feikin), Beijing, People's Republic of China; and US Centers for Disease Control and Prevention, Atlanta, Ga (Drs Xu and Feikin).

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