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P>Objective To find out whether there was over-reporting of SARS patients in mainland China in view of the relatively low case fatality ratio in mainland China, in comparison with other affected countries and areas. Methods We searched PubMed for all SARS antibody detection papers (in English or Chinese language) using the keywords 'SARS' and 'antibody'. Then the resulting articles were further read through to select the SARS detection results using ELISA methods of serum samples collected at least 1 month after disease onset. A multi-level logistic regression was applied to test for possible differences in the proportions positive between locations of the study. Results A total of 48 studies were identified, including 39 from mainland China and nine from elsewhere (Hong Kong, Taiwan, Canada and Vietnam). For mainland China, there was no difference between Guangdong, Beijing and other provinces in the proportions testing positive (83.0%, 85.8% and 85.4% respectively). The grand average of 84.2% seropositive was lower than the 95.1% for the countries and areas outside of mainland China combined. However, this difference was far from significant after correcting for dependency of individual tests within the same study. Conclusions Our study showed no evidence of over-reporting of SARS in mainland China, nor in Guangdong, where the SARS epidemic started. Even if the lower seroprevalence in mainland China, relative to other affected areas, does represent actual over-reporting, then this factor can only explain a modest 10% of the lower case fatality in mainland China.

Summary objectives To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients ina hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factorsassociated with the death of cases; to describe the implementation of preventive interventions during thehospital outbreak.methods Physical and haematological information was obtained from clinical records. White bloodcell counts, and percentages of neutrophilic granulocytes and neutrophilic lymphocytes were measured.The service department of the hospital provided information about daily use of protective materials.Differences in clinical symptoms between probable and suspected SARS cases were tested by Fisher’sexact test. Non-linear mixed modelling was used to test for differences between the haematologicalpatterns for probable and suspected cases. Risk factors for dying among probable SARS cases weretested by logistic regression.results TheSARSoutbreakstartedwithapatientfromBeijingon15April2003,andspreadquicklyamongthehealthcareworkersandin-patientsinthehospital.Intotal90probableand21suspectedcaseswerereported,with17deathsamongthem(casefatalityrate15%).Haematologicalpatternsweresignifi-cantlydifferentbetweenprobableandsuspectedcases,whereasthepercentageswithcertainclinicalsymptomsshowednoapparentdifference.DeathofprobableSARScaseswasonlysignificantlyassociatedwithhighageanduseofarespiratorymachine(mainlyforthemostseverecases),wherease.g.co-morbidityandsteroidtreatmentshowednoimpactinmultivariateanalysis.Stringentcontrolmeasures,includingdistributionofhugenumbersofprotectivematerials,startedon20April,whichsoonleadtoastrongdecreaseintheincidenceofnewcases.AfterthelastSARScaseleftthehospitalon6June,protectivematerialsweredispensedatsubstantiallylowerrates,butnottozero,aswasthecaseduringthefirstdaysoftheoutbreak.conclusion The working definition of probable SARS used during the epidemic appeared to havebeen fairly accurate. Many valuable lessons were learned regarding prevention of hospital spread ofinfection, especially the need to have sufficient protective supplies available and to implement theserigidly and at an early stage of an (threatening) epidemic.keywords severe acute respiratory syndrome, hospital outbreak, haematology, protective materials,ChinaIntroductionOn 12 March 2003, the World Health Organization(WHO) issued a global alert on atypical pneumonia, calledsevere acute respiratory syndrome (SARS), after reportsfrom the Department of Health of Hong Kong of anoutbreak of pneumonia in one of its public hospitals(WHO 2003). At about the same time, WHO receivedreports of these cases from China, Singapore, Vietnam,Thailand, Indonesia, Taiwan and Philippines, as well asfrom countries in other continents including Canada, theUnited States and Germany (WHO 2003). After the diseasespread from Guangdong province to Beijing, Shanxiprovince and other places, Tianjin city was also hit by the