Use of quarantine in the control of SARS in Singapore

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Abstract

Background

A total of 238 cases of the severe acute respiratory syndrome (SARS) occurred in Singapore between February 25 and May 11, 2003. Control relied on empirical methods to detect early and isolate all cases and quarantine those who were exposed to prevent spread in the community.

Methods

On April 28, 2003, the Infectious Diseases Act was amended in Parliament to strengthen the legal provisions for serving the Home Quarantine Order (HQO). In mounting large-scale quarantine operations, a framework for contact tracing, serving quarantine orders, surveillance, enforcement, health education, transport, and financial support was developed and urgently put in place.

Results

A total of 7863 contacts of SARS cases were served with an HQO, giving a ratio of 38 contacts per case. Most of those served complied well with quarantine; 26 (0.03%) who broke quarantine were penalized.

Conclusion

Singapore's experience underscored the importance of being prepared to respond to challenges with extraordinary measures. With emerging diseases, health authorities need to rethink the value of quarantine to reduce opportunities for spread from potential reservoirs of infection.

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Most cited references 6

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Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts

Li-Yang Hsu, Cheng-Chuan Lee, Justin Green … (2003)

Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. One of the largest outbreaks of SARS to date began in Singapore in March 2003. We describe the clinical, laboratory, and radiologic features of the index patient and the patient’s initial contacts affected with probable SARS.

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SARS Transmission and Hospital Containment

Gowri Gopalakrishna, Philip Choo, Yee Leo … (2004)

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute care hospitals in Singapore. The critical factor in containing this outbreak was early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

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Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.

L Gostin, K Tonat, C DeAtley … (2001)

Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.

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Author and article information

Contributors

Peng Lim Ooi

Journal

Journal ID (nlm-ta): Am J Infect Control

Journal ID (iso-abbrev): Am J Infect Control

Title: American Journal of Infection Control

Publisher: Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc.

ISSN (Print): 0196-6553

ISSN (Electronic): 1527-3296

Publication date PMC-release: 9 June 2005

Publication date (Print): June 2005

Publication date (Electronic): 9 June 2005

Volume: 33

Issue: 5

Pages: 252-257

Affiliations

[a ]From the Disease Control Branch

[b ]Epidemiology and Disease Control Division Ministry of Health, Singapore

Author notes

[∗ ]Reprint requests: P. L. Ooi, MBBS, MSc(PH), Ministry of Health, 16 College Road, Singapore 169854 ooi_peng_lim@ 123456moh.gov.sg

Article

Publisher ID: S0196-6553(04)00603-0

DOI: 10.1016/j.ajic.2004.08.007

PMC ID: 7119078

PubMed ID: 15947741

SO-VID: df705d1e-1f73-40b5-9596-3178d9891c4a

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Use of quarantine in the control of SARS in Singapore

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Abstract

Background

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Conclusion

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Coronaviruses, COVID-19 and SARS-CoV-2

Most cited references 6

Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts

SARS Transmission and Hospital Containment

Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.

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