北京市SARS隔离医学观察效果评价

Efficiency of the quarantine system during the epidemic of severe acute respiratory syndrome in Beijing,2003

目的 了解北京市严重急性呼吸综合征 (SARS)流行期间被隔离医学观察人群的构成及发病情况 ,为科学合理地隔离SARS病例的接触者提供依据。方法 把海淀区按地理方位分为东、西、南、北、中 5个区域 ,每个区域从有隔离观察人群的街道 (乡镇 )中抽取 1个街道 (乡镇 ) ,通过街道(乡镇 )“非典”防治办公室 ,布置有被隔离医学观察对象的居委会把统一的调查表发给被隔离观察者 ,让其自己填写调查表。若无法自己填写 ,则请他人代为填写。结果 共调查被隔离者 10 2 8名 ,发现2 4例SARS病例 ,罹患率 2 .3% ;6 1% (6 30 /10 2 8)的人是因为接触SARS病例而被隔离的 ,其中 6 1%(383/6 30 )的人在SARS病例的症状期与其接触 ;2 4例病例均在SARS病例的症状期与其接触 ;未在SARS病例症状期与其接触的人均未发病 ,这部分人占被隔离人数的 6 3% (6 4 5 /10 2 8) ;16 7名在SARS病例潜伏期与其接触的人均未发病。结论 只有在SARS病例发病后与其接触的人员才需要隔离 ,如果以此标准对SARS的直接接触者进行隔离 ,则可以节省 6 3%的费用。未发现SARS病例在潜伏期有传染性。

Objective An epidemic of severe acute respiratory syndrome (SARS) hit Beijing, China, between March and July 2003 with an attack rate of 1.9 per 10 thousand. ( 2 521 cases). To control the epidemic of SARS, a total of 30 173 residents were quarantined either in their residence or in quarantine sites. In order to understand the personal need of being quarantined and to estimate the risk of developing SARS during the quarantine period, a survey on the quarantined residents of Haidian District, Beijing, China was carried out.Methods 33 precincts in Haidian District divided into five groups (7 in north, 6 in south, 7 in west, 6 in east and 7 in central of Haidian District) according to the location of the precincts were involved. The director of Center of Disease Control and Prevention of Haidian District was asked to select 1 precinct from each group according to the workload of the precinct quarantine officers. From those 5 precincts we obtained lists of all quarantined persons from the precinct quarantine officers. All quarantinees were asked to complete a self-administered questionnaire. The SARS patients were diagnosed and verified according to the diagnosis criteria released by Chinese Ministry of Health which was equivalent to the SARS 'probable case' definition of WHO. All SARS cases had been reported to the relative authorities.Results By May 23,2003, 5 186 persons had been quarantined in Haidian district,accounting for 0.23 % of all residents. 1 028 of sampled quarantined residents completed the questionnaire. Of those who completed the questionnaire, 2.3 %(95% CI : 1.5%- 3.5 %) developed SARS while under quarantine. The median quarantine period was 14 days (range 1 day to 28 days). 61% of the quarantinees had a direct contact history with SARS patients, and all secondary SARS patients developed through contact to these quarantinees. The remaining 39% quarantinees who did not have a direct contact history with SARS patients had not developed SARS during the period under quarantine. 37% of the quarantees had direct contact during original patients' symptomatic period with an AR of 6.3 %. Persons who looked after the illed SARS patient(s) during their symptomatic period, had an highest attack rate of 31%(95% CI : 20%- 44%). 63%(95% CI : 60%- 66%) of the total quarantined persons did not have direct contact with a SARS patient during his/her symptomatic period, with an attack rate of 0%(95% CI : 0%- 0.73 %).Conclusion Only those persons having direct contact with ill SARS patients need to be under quarantine. The overall cost for quarantine on SARS prevention could be reduced by as much as 63% if the quarantine program was limited to this group. No evidence was found that SARS patient was infective during the incubation period.