SARS outbreak in Germany 2003: workload of local health departments and their compliance in quarantine measures--implications for outbreak modeling and surge capacity?

OBJECTIVE: Public health management of severe acute respiratory syndrome epidemic must be evaluated to improve contingency planning for epidemics.
METHODS: Standardized questionnaires on case management were sent to local health departments of 15 of 16 states in Germany.
RESULTS: Of the 384 local health departments who received the questionnaire, 280 (72%) completed them. They reported 271 suspect or probable severe acute respiratory syndrome cases under investigation (average 4.7). The average duration of quarantine was 5.4 days. Contacts without professional activity were 2.78 times more likely to stay under 10-day quarantine than those with professional activity (CI: 0.80-9.86). Local health departments with at least one case under investigation had invested an average of 104.5 working hours.
CONCLUSIONS: Our contact-case ratios may serve for planning for modeling in epidemics. We found discrepancies between local and national surveillance figures; home quarantine was frequently not applied as recommended and the burden on urban health departments was disproportionally higher. Flexibility of the national surveillance system and surge capacity for the prevention of future epidemics need improvement, particularly in urban health departments.