Safety breaches are probable cause of recent SARS outbreak, WHO says (2004)

The World Health Organization has confirmed that breaches of safety procedures on at least two occasions at one of Beijing's top virology laboratories were the probable cause of the outbreak of severe acute respiratory syndrome (SARS) there last month, which infected nine people, one of whom died.

However, initial fears that the outbreak would spread as a result of the surge in travel during the “golden week” holiday at the beginning of May seem to have been unfounded.

“Obviously golden week was a big concern, as millions of people were on the move,” said Dr Julie Hall, WHO's coordinator in China of communicable disease surveillance and response. “But once the alarm was raised about the cases, over 1000 of their close contacts were isolated very quickly, temperature monitoring was introduced in key locations, information was released to the public, and the authorities attempted extensive contact tracing. These measures appear to have ensured that people were able to travel.”

How the outbreak happened and why the index patient was allowed to travel between Beijing and her home province of Anhui, to the west of Shanghai, while sick are still cause for concern, she added. WHO has been assisting the Chinese Ministry of Health in identifying the source of the outbreak and assessing how well it was controlled and how it differed from previous outbreaks.

Dr Hall said, “Clearly there was a link to the Institute of Virology, and our investigations are still ongoing, but we haven't found a single incident that links the two cases of laboratory workers at the institute, so it appears to be two separate breaches of bio-safety, and we can't find any single incident or accident that explains either case. It has raised real concerns about bio-safety in general, how bio-safety guidelines are implemented, and how that is supervised and monitored.”

This is the third outbreak of SARS to have been traced to a laboratory: small outbreaks occurred in Taiwan and Singapore last year. “The WHO may call for a containment policy for SARS to reduce the number of samples of the virus and the number of laboratories handling it,” said Dr Hall.

Although the authorities reacted swiftly once the alarm was raised, there was a delay of almost a month from the date of first infection to when the index case of infection was announced. By that time all the other cases of infection had already occurred.

The index patient received medical care in both Beijing and Anhui but was still allowed to travel while sick, despite her high risk occupation and the fact that her mother also had a fever. The mother subsequently died.

“This case has lessons for us all, in terms of how healthcare workers take patient histories and ask about infection among other family members,” said Dr Hall. “We are lucky that she travelled on a train and not on an international flight. Had she landed in another country I am not sure her occupation and the fact that her mother was also sick would have been noted or rung any alarm bells.

“We don't know when the next global pandemic will happen, and this incident with SARS in China has raised the issue of how we look at the potential threat of respiratory disease.”

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