Role of fomites in SARS transmission during the largest hospital outbreak in Hong Kong

PLoS One. 2017 Jul 20;12(7):e0181558. doi: 10.1371/journal.pone.0181558. eCollection 2017.


The epidemic of severe acute respiratory syndrome (SARS) had a significant effect on global society in the early 2000s and the potential of its resurgence exists. Studies on the modes of transmission of SARS are limited though a number of outbreak studies have revealed the possible airborne route. To develop more specific and effective control strategies, we conducted a detailed mechanism-based investigation that explored the role of fomite transmission in the well-known Ward 8A outbreak. We considered three hypothetical transmission routes, i.e., the long-range airborne, fomite and combined routes, in 1,744 scenarios with combinations of some important parameters. A multi-agent model was used to predict the infection risk distributions of the three hypothetical routes. Model selection was carried out for different scenarios to compare the distributions of infection risk with that of the reported attack rates and select the hypotheses with the best fitness. Our results reveal that under the assumed conditions, the SARS coronavirus was most possible to have spread via the combined long-range airborne and fomite routes, and that the fomite route played a non-negligible role in the transmission.

MeSH terms

  • Adult
  • Air
  • Cross Infection / epidemiology*
  • Cross Infection / transmission*
  • Disease Outbreaks*
  • Fomites / virology*
  • Hong Kong / epidemiology
  • Hospitals
  • Humans
  • Male
  • Models, Biological
  • Mucous Membrane / virology
  • Nurses
  • Physicians
  • Respiratory System / virology
  • Risk
  • SARS Virus*
  • Severe Acute Respiratory Syndrome / epidemiology*
  • Severe Acute Respiratory Syndrome / transmission*
  • Touch

Grant support

The study was supported by an Research Grants Council (RGC) General Research Fund (GRF) grant (No. 17205014) and an Research Grants Council (RGC) Theme-based Research Scheme (TRS) grant (No. T11-705/14-N) of the Hong Kong SAR Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.