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... up to 55 percent in people 60 and older, and up to 13.2 percent in younger people..
纽约时报：
Study in Hong Kong Suggests a Higher Rate of SARS Death
By LAWRENCE K. ALTMAN
he death rate from SARS may be significantly higher than health officials had thought, up to 55 percent in people 60 and older, and up to 13.2 percent in younger people, the first major epidemiological study of the disease suggests.
Mortality rates are bound to change somewhat as an epidemic continues. But unless the numbers fall drastically, SARS would be among infectious diseases with the highest death rates. Until now, fatality rates reported by the World Health Organization had ranged from 2 percent, when the epidemic was first detected in March, to 7.2 percent.
The new findings come from a statistical analysis of 1,425 patients suspected of having SARS who were admitted to Hong Kong hospitals from Feb. 20 to April 15. Over all, their mortality rate was estimated to be as high as 19.9 percent. By contrast, the influenza pandemic of 1918, which killed tens of millions of people worldwide, had an estimated mortality rate, over all, of 1 percent or less.
But calculating mortality rates for newly emerging diseases is a notoriously difficult challenge for epidemiologists, especially if there is no definitive diagnostic test, as is the case with severe acute respiratory syndrome.
It is possible, for example, that some people infected with the virus believed to cause the disease never fall ill, or develop symptoms so mild that they do not seek medical assistance. If that is the case, mortality rates could be much lower.
The research, led by Dr. Roy M. Anderson and Dr. Christl A. Donnelly, both of Imperial College in London, is to be reported in Saturday's issue of The Lancet, the British-based medical journal. Its editors posted the report on the journal's Web site, 该网址不再展示, yesterday, citing its public health importance.
The principal authors of the study ?from Imperial College, the University of Hong Kong, the Chinese University of Hong Kong and the Hong Kong health department ?said their findings underscored that SARS was a serious threat to the public and that health officials and workers must act to contain it.
The authors credited Hong Kong's efforts to reduce the time from the onset of symptoms to the isolating of patients in hospitals as an important step in controlling the disease.
Reducing the time did not affect the course of the illness in individual patients, they said, but expediting the isolation process reduced the period when patients could transmit the virus to others.
Yesterday, the W.H.O. said the number of new SARS cases in Hong Kong had steadily declined, which they said suggested that the outbreak there had reached a peak. So far, Hong Kong has reported 1,646 probable cases and 193 deaths, which would mean that the death rate is 11.7 percent.
But death rates calculated from this kind of data ?what epidemiologists call case-fatality rates ?can underestimate actual mortality rates, in part because they do not take into account patients who remain ill, some of whom may die.
By contrast, the authors of the new study arrived at their figures by studying people admitted to Hong Kong hospitals each week. They began their analysis with patients admitted in the week after Feb. 26; until then there were too few to make statistically significant calculations, they said. Their analysis ends with patients admitted in the week ended April 15. For those admitted later, they said, "too little time has elapsed" after the onset to allow analysis of mortality rates.
In an interview, Dr. Michael T. Osterholm, an expert on infectious disease now at the University of Minnesota, said that the Lancet study "looks solid and provides an important source of information about the evolving epidemic."
"Anyone who tries to make a point of precision right now about case-fatality rates does not understand them," he said.
Dr. Klaus St鰄r, the scientific director of the SARS investigation for the W.H.O., said in an interview that the agency was reviewing the new data and the statistical models used to obtain it.
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从2003/7/30- 大家聚在一起做邻居不容易，好好珍惜。 |
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2003-05-07 12:18:02
