Global Spread 73

sleeping quarters in the hospital’s basement and spent off-duty time socializing in the emergency department. On April 16, because of worsening symptoms, the patient was admitted to the hospital with a diagnosis of infectious enteritis (MMWR 52;461-6). On April 18, the patient became short of breath. A chest radiograph showed bilateral infiltrates, and the patient was transferred to an isolation room in the intensive care unit with suspected SARS (MMWR 52;461-6).

Because the index patient had been symptomatic for 6 days before SARS was diagnosed, the number of potentially exposed persons was estimated at 10,000 patients and visitors and 930 staff. On April 24, hospital A was contained, and all patients, visitors, and staff were quarantined within the building (MMWR 52;461-6).

Healthcare worker clusters at eight additional hospitals in Taiwan have been linked to the initial outbreak at hospital A. Preliminary data suggest that many of these clusters occurred when pre-symptomatic patients or patients with SARS symptoms attributed to other causes were discharged or transferred to other healthcare facilities. SARS later extended to multiple cities and regions of Taiwan, including several university and private hospitals. Four of these hospitals, including a 2,300-bed facility in southern Taiwan, discontinued emergency and routine services. Sporadic community cases also were reported in Taipei and southern Taiwan (MMWR 52;461-6).

The April outbreak in Taiwan may serve as an example of the farreaching consequences of one single unrecognized SARS case.

On July 5, Taiwan was removed from the list of areas with recent local transmission (WHO Update 96).

Other Countries

The number of probable SARS cases reported from other countries over the time period November 1, 2002 to July 2, 2003, is shown in the following table.

Kamps and Hoffmann (eds.)

74 Epidemiology

Country	Cumulative number	Number of	Case fatality
	of case(s)	deaths	ratio (%)
Australia	6	0	0
Canada	251	43	17
China	5327	349	7
France	7	1	14
Germany	9	0	0
Hong Kong	1755	299	17
India	3	0	0
Indonesia	2	0	0
Italy	4	0	0
Kuwait	1	0	0
Macao	1	0	0
Malaysia	5	2	40
Mongolia	9	0	0
New Zealand	1	0	0
Philippines	14	2	14
Republic of Ireland	1	0	0
Republic of Korea	3	0	0
Romania	1	0	0
Russian Federation	1	0	0
Singapore	238	33	14
South Africa	1	1	100
Spain	1	0	0
Sweden	5	0	0
Switzerland	1	0	0
Taiwan	346	37	11
Thailand	9	2	22
United Kingdom	4	0	0
United States	29	0	9
Vietnam	63	5	8
Total	8098	774	9.6

Notes:

The cumulative number of cases includes the number of deaths. Updated data are available at http://www.who.int/csr/sars/en/

www.SARSreference.com