Open Access Highly Accessed Research article

A comparative epidemiologic analysis of SARS in Hong Kong, Beijing and Taiwan

Eric HY Lau1, C Agnes Hsiung2, Benjamin J Cowling1*, Chang-Hsun Chen3, Lai-Ming Ho1, Thomas Tsang4, Chiu-Wen Chang3, Christl A Donnelly5 and Gabriel M Leung1

Author Affiliations

1 School of Public Health, The University of Hong Kong, Pokfulam Road, Hong Kong

2 Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan

3 Second Division of Centers for Disease Control, No 6, Linshen South Road., Taipei, Taiwan

4 Centre for Health Protection, Department of Health, Government of the Hong Kong Special Administrative Region, 147C Argyle Street, Kowloon, Hong Kong

5 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College, St Mary's Campus, Norfolk Place, London W2 1PG, UK

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BMC Infectious Diseases 2010, 10:50  doi:10.1186/1471-2334-10-50

Published: 6 March 2010



The 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak infected 8,422 individuals leading to 916 deaths around the world. However, there have been few epidemiological studies of SARS comparing epidemiologic features across regions. The aim of this study is to identify similarities and differences in SARS epidemiology in three populations with similar host and viral genotype.


We present a comparative epidemiologic analysis of SARS, based on an integrated dataset with 3,336 SARS patients from Hong Kong, Beijing and Taiwan, epidemiological and clinical characteristics such as incubation, onset-to-admission, onset-to-discharge and onset-to-death periods, case fatality ratios (CFRs) and presenting symptoms are described and compared between regions. We further explored the influence of demographic and clinical variables on the apparently large differences in CFRs between the three regions.


All three regions showed similar incubation periods and progressive shortening of the onset-to-admission interval through the epidemic. Adjusted for sex, health care worker status and nosocomial setting, older age was associated with a higher fatality, with adjusted odds ratio (AOR): 2.10 (95% confidence interval: 1.45, 3.04) for those aged 51-60; AOR: 4.57 (95% confidence interval: 3.32, 7.30) for those aged above 60 compared to those aged 41-50 years. Presence of pre-existing comorbid conditions was also associated with greater mortality (AOR: 1.74; 95% confidence interval: 1.36, 2.21).


The large discrepancy in crude fatality ratios across the three regions can only be partly explained by epidemiological and clinical heterogeneities. Our findings underline the importance of a common data collection platform, especially in an emerging epidemic, in order to identify and explain consistencies and differences in the eventual clinical and public health outcomes of infectious disease outbreaks, which is becoming increasingly important in our highly interconnected world.