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RAPID AWARENESS AND TRANSMISSION OF SEVERE ACUTE RESPIRATORY SYNDROME IN HANOI FRENCH HOSPITAL, VIETNAM

HIROSHI NISHIURAThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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TADATOSHI KURATSUJIThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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TRAN QUYThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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NGUYEN CHI PHIThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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VO VAN BANThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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LE DANG HAThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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HOANG THUY LONGThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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HIDEKI YANAIThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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NAOTO KEICHOThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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TERUO KIRIKAEThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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TAKEHIKO SASAZUKIThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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ROY M. ANDERSONThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, United Kingdom; Research Institute, International Medical Center of Japan, Tokyo, Japan; Bach Mai Hospital, Hanoi, Vietnam; Hanoi-French Hospital, Hanoi, Vietnam; National Institute for Clinical Research in Tropical Medicine, Hanoi, Vietnam; National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

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A case-control study was conducted to examine the relationship between severe acute respiratory syndrome (SARS) and the time-dependent precautionary behaviors taken during an outbreak of SARS in Hanoi French Hospital (HFH), Vietnam. Masks (odds ratio [OR] = 0.3; 95% confidence interval [CI]: 0.1, 0.7) and gowns (OR = 0.2; 95% CI: 0.0, 0.8) appeared to prevent SARS transmission. The proportion of doctors and nurses who undertook each measure significantly improved (χ2 = 9.8551, P = 0.043) after the onset of secondary cases. The impact of individual behaviors on an outbreak was investigated through mathematical approaches. The reproduction number decreased from 4.1 to 0.7 after notification. The basic reproduction number was estimated, and the use of masks alone was shown to be insufficient in containing an epidemic. Intuitive results obtained by means of stochastic individual-based simulations showed that rapid improvements in behavior and isolation would increase the probability of extinction.

Author Notes

Reprint requests: Tadatoshi Kuratsuji, Research Institute, International Medical Center of Japan, 1-21-1, Toyama Shinjuku-ku, Tokyo, 162-8655, Japan, Telephone: 81-3-3202-7181, Fax: 81-3-5273-4526, E-mail: kuratsuji@ri.imcj.go.jp.
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