Public Health Interventions and SARS Spread, 2003

David M. Bell; World Health Organization Working Group on Prevention of International and Community Transmission of SARS


Emerging Infectious Diseases. 2004;10(11) 

In This Article

Abstract, Introduction, and Methods

The 2003 outbreak of severe acute respiratory syndrome (SARS) was contained largely through traditional public health interventions, such as finding and isolating patients, quarantining close contacts, and enhanced infection control. The independent effectiveness of measures to "increase social distance" and wearing masks in public places requires further evaluation. Limited data exist on the effectiveness of providing health information to travelers. Entry screening of travelers through health declarations or thermal scanning at international borders had little documented effect on detecting SARS cases; exit screening appeared slightly more effective. The value of border screening in deterring travel by ill persons and in building public confidence remains unquantified. Interventions to control global epidemics should be based on expert advice from the World Health Organization and national authorities. In the case of SARS, interventions at a country's borders should not detract from efforts to identify and isolate infected persons within the country, monitor or quarantine their contacts, and strengthen infection control in healthcare settings.

The 2003 outbreak of severe acute respiratory syndrome (SARS) is a modern example of containing a global epidemic through traditional or nonmedical public health interventions. The interventions included finding and isolating patients; quarantining contacts; measures to "increase social distance," such as canceling mass gatherings and closing schools; recommending that the public augment personal hygiene and wear masks; and limiting the spread of infection by domestic and international travelers, by issuing travel advisories and screening travelers at borders. Some measures were implemented pursuant to recommendations of the World Health Organization (WHO); others were implemented by governments on their own initiative. A novel technology, infrared scanning, was used extensively in some countries to try to identify persons with fever at international borders and in public places. After the outbreaks, WHO sought information to help assess the effectiveness of interventions in preventing the transmission of SARS in the community and internationally. Of particular interest was information on the effectiveness of thermal scanning of travelers.

Information was obtained by reviewing scientific literature and surveying members of an informal WHO working group about preventing community and international transmission of SARS. Members were surveyed with standardized questionnaires regarding measures taken in their countries and evaluation studies known to them. Preventing transmission in healthcare settings was not addressed but had a major impact on preventing the transmission of SARS into the community and internationally.[1,2]


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