• Vol. 35 No. 5, 301–316
  • 15 May 2006

Epidemiology and Control of SARS in Singapore



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Severe acute respiratory syndrome (SARS) was imported into Singapore in late February 2003 by a local resident who returned from a holiday in Hong Kong and started an outbreak in the hospital where she was admitted on 1 March 2003. The disease subsequently spread to 4 other healthcare institutions and a vegetable wholesale centre. During the period between March and May 2003, 238 probable SARS cases, including 8 imported cases and 33 deaths, were reported. Transmission within the healthcare and household settings accounted for more than 90% of the cases. Factors contributing to the spread of infection included the failure to recognise the high infectivity of this novel infection, resulting in a delay in isolating initial cases and contacts and the implementation of personal protective measures in healthcare institutions; and the super-spreading events by 5 index cases, including 3 with co-morbid conditions presenting with atypical clinical manifestations of SARS. Key public health measures were directed at prevention and control within the community and hospitals, and the prevention of imported and exported cases. An isolated laboratory-acquired case of SARS was reported on 8 September 2003. Based on the lessons learnt, Singapore has further strengthened its operational readiness and laboratory safety to respond to SARS, avian flu and other emerging diseases.

Since the 1990s, a number of infectious diseases have emerged in Singapore, despite its high standard of environmental hygiene, comprehensive childhood immunisation programme and strict control of imported food and livestock. These emerging diseases include Bengal cholera caused by a new cholera biotype, Vibrio cholerae O139, multi-drug-resistant salmonellosis caused by Salmonella enterica subsp. enterica serotype Typhimurium DT 104 L, norovirus gastroenteritis, Nipah virus disease, meningococcal disease caused by an uncommon serogroup of Neisseria meningitidis, W 135 and hand, foot and mouth disease caused by enterovirus 71.

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