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Abstract
Recent investigations into the March 2003 outbreak of SARS in Hong Kong have concluded that environmental factors played an important role in the transmission of the disease. These studies have focused on a particular outbreak event, the rapid spread of SARS throughout Amoy Gardens, a large, private apartment complex. They have demonstrated that, unlike a typical viral outbreak that is spread through person-to-person contact, the SARS virus in this case was spread primarily through the air. High concentrations of viral aerosols in building plumbing were drawn into apartment bathrooms through floor drains. The initial exposures occurred in these bathrooms. The virus-laden air was then transported by prevailing winds to adjacent buildings at Amoy Gardens, where additional exposures occurred. This article reviews the results of the investigations and provides recommendations for maintenance and other measures that building owners can take to help prevent environmental transmission of SARS and other flulike viruses in their buildings.
Background
Severe acute respiratory syndrome, or SARS, is a highly contagious respiratory illness that can cause severe illness and death. Symptoms of SARS include fever, headache, fatigue, dry cough, and muscle aches. Gastrointestinal symptoms, such as nausea and diarrhea, are also common. Most SARS patients develop pneumonia, and up to 20 percent of patients require mechanical ventilation (Lee et al, 2003). SARS is caused by a coronavirus (CoV) similar to one of the coronavirus types that cause the common cold (Tsang et al, 2003). The SARS CoV is not an influenza virus, but like influenza viruses, it originally occurred in animals and spread to humans. Both kinds of virus are present in the mucus and feces of infected people, and they share the ability to persist in the environment (de Jong et al., 2005). The influenza virus can persist for hours in dried mucus (Community and Hospital Infection Control Association-Canada, 2004), while the SARS CoV can persist on surfaces for a day or longer and in feces from infected people for as long as four days (World Health Organization [WHO], 2003). Some studies indicate that other types of virus (such as adenoviruses and noroviruses) persist longer in an infectious state (International Association of Plumbing and Mechanical Officials, 2003).
Between November 2002 and July 2003, a SARS epidemic caused 8,098 infections...