Severe acute respiratory syndrome: review and lessons of the 2003 outbreak

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Abstract
On 11 February 2003, the Chinese Ministry of Health notified the World Health Organization (WHO) of an outbreak of atypical pneumonia that likely emerged in Guandong Province, China, in November 2002.1 During late February to early March 2003, clusters of atypical pneumonia were recognized in Vietnam, Hong Kong, Canada, and Singapore.2 –6 Epidemiological investigations revealed that the index patients for each of these clusters had stayed on the ninth floor of a hotel in Hong Kong on 21–22 February (Figure 1). Further investigation indicated that the likely source of the outbreak was a physician from Guandong Province (Case A) who stayed on the same hotel floor on 21 February. This physician had cared for patients affected by the respiratory disease outbreak and he had been symptomatic with a febrile, respiratory illness since 15 February. This dramatic chain of transmission brought to the world's attention this new respiratory disease, called severe acute respiratory syndrome (SARS), and clearly illustrated the potential for SARS to spread extensively from a single infected person and to rapidly disseminate globally through air travel. The WHO issued an historic global alert7 and, together with its international partners, initiated a rapid and intense response to this global public health emergency. The response led within 2 weeks to the identification of the aetiological agent, SARS-associated coronavirus (SARS-CoV),8 –11 and to a series of decisive and effective containment efforts that interrupted the last chain of human transmission in less than 4 months.12 In this article, we review what has been learned about the aetiological agent and its pathogenesis and pathology, clinical manifestations, epidemiology, and diagnosis plus strategies for control of SARS.