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1. Timeline

2. Virology

3. Transmission

4. Epidemiology

5. Prevention

6. Case Definition

7. Diagnostic Tests

8. Clinical Presentation and Diagnosis

9. SARS Treatment

10. Pediatric SARS




First recognized in mid-March 2003, Severe Acute Respiratory Syndrome (SARS) was successfully contained in less than four months. On 5 July 2003, WHO reported that the last human chain of transmission of SARS had been broken.

Much has been learned about SARS, including its causation by a new coronavirus (SARS-CoV); however, our knowledge about the ecology of SARS coronavirus infection remains limited. In the post-outbreak period, all countries must remain vigilant for the recurrence of SARS and maintain their capacity to detect and respond to the re-emergence of SARS should it occur. Resurgence of SARS remains a distinct possibility and we need to be prepared.

For the third edition, most chapters have remained unchanged, with two exceptions: the Virology section has been updated and the chapter entitled SARS Treatment has been completely rewritten by Loletta So, Arthur Lau, and Loretta Yam from the Division of Respiratory and Critical Care Medicine, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, PR China. In the event of a new SARS outbreak, we shall have to rely on existing treatment modalities. These have now been brilliantly overviewed by our new colleagues.

Bernd Sebastian Kamps + Christian Hoffmann


October 17, 2003

Preface to the Second Edition

Just over five months ago, SARS started to spread around the world. It is the first major new infectious disease of this century, unusual in its high morbidity and mortality rates, and it is taking full advantage of the opportunities provided by a world of international travel. At the time of this writing, more than 8,000 persons with probable SARS have been diagnosed; 812 patients have died. Fortunately, one by one, the outbreaks in the initial waves of infection have been brought under control.

SARS demonstrates dramatically the global havoc that can be wreaked by a newly emerging infectious disease. SARS was capable of bringing the healthcare system of entire areas to a standstill, striking nurses, doctors and other medical personnel: human resources vital for disease control. Surgery and vital treatments for patients with serious conditions had to be postponed; care in emergency rooms was disrupted. A significant proportion of patients required intensive care, thus adding to the considerable strain on hospital and healthcare systems. Hospitals, schools, and borders were closed. The economic impact on individuals was profound, affecting tourism, education and employment.

The disease has several features that make it a special threat to international public health. There is no vaccine or treatment, and health authorities have to resort to control tools dating back to the earliest days of empirical microbiology: isolation, infection control and contact tracing.

The response of the scientific community to the new health threat was immediate and breath-taking. The etiologic relationship between a previously unknown coronavirus and SARS was established one month after the WHO issued a global alert and called upon 11 leading laboratories in 9 countries to join a network for multicenter research into the etiology of SARS and to simultaneously develop a diagnostic test. The early recognition of the etiologic agent has made the virus available for investigation of antiviral compounds and vaccines.

Experience with SARS has shown that, with strong global leadership by the WHO, scientific expertise from around the world can work in a very effective, collaborative manner to identify novel pathogens. SARS has demonstrated how the world can come together in scientific collaboration, and what the power of the Internet is. This outstanding effort limited the potentially explosive spread of the outbreak.

Some hope exists that the disease might be contained, but much about SARS remains unknown. How important are animals in its transmission? Will SARS return with a stronger force next year? What are the host or virus factors responsible for the "superspreader" phenomenon, in which a single patient may infect many people through brief casual contact or possibly environmental contamination?

At this moment, a global epidemic of the magnitude of the 1918-19 influenza pandemic appears unlikely. However, development of effective drugs and vaccines for SARS is likely to take a long time. If SARS is not contained, the world will face a situation in which every case of atypical pneumonia, and every hospital-based cluster of febrile patients with respiratory systems will have the potential to rouse suspicions of SARS and spark widespread panic. The world will therefore anxiously watch if new outbreaks occur.

Bernd Sebastian Kamps + Christian Hoffmann

July 10, 2003




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