Duration and distance of exposure are important predictors of transmission among community contacts of Ontario SARS cases

We report attack rates and contact-related predictors among community contacts of severe acute respiratory syndrome (SARS) cases from the 2003 Toronto-area outbreak. Community contact data was extracted from public health records for single, well-defined exposures to a SARS case. In total, 8662 community-acquired exposures resulted in 61 probable cases; a crude attack rate of 0·70% [95% confidence interval (CI) 0·54–0·90]. Persons aged 55–69 years were at higher risk of acquiring SARS (1·14%) than those either younger (0·60%) or older (0·70%). In multivariable analysis exposures for at least 30 min at a distance of ⩽1 m increased the likelihood of becoming a SARS case 20·4-fold (95% CI 11·8–35·1). Risk related to duration of illness in the source case at time of exposure was greatest for illness duration of 7–10 days (rate ratio 3·4, 95% CI 1·9–6·1). Longer and closer proximity exposures incurred the highest rate of disease. Separate measures of time and distance from source cases should be added to minimum datasets for the assessment of interventions for SARS and other emerging diseases.