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Issue Cover for Volume 10, Number 2—February 2004

Volume 10, Number 2—February 2004

[PDF - 57.12 MB - 227 pages]

THEME ISSUE
2004 SARS Edition
SARS Origins

SARS-related Virus Predating SARS Outbreak, Hong Kong [PDF - 92 KB - 3 pages]
B. J. Zheng et al.

Using immunofluorescence and neutralization assays, we detected antibodies to human severe acute respiratory syndrome–associated coronavirus (SARS-CoV) and/or animal SARS-CoV–like virus in 17 (1.8%) of 938 adults recruited in 2001. This finding suggests that a small proportion of healthy persons in Hong Kong had been exposed to SARS-related viruses at least 2 years before the recent SARS outbreak.

EID Zheng BJ, Guan Y, Wong KH, Zhou J, Wong KL, Young BW, et al. SARS-related Virus Predating SARS Outbreak, Hong Kong. Emerg Infect Dis. 2004;10(2):176-178. https://dx.doi.org/10.3201/eid1002.030533
AMA Zheng BJ, Guan Y, Wong KH, et al. SARS-related Virus Predating SARS Outbreak, Hong Kong. Emerging Infectious Diseases. 2004;10(2):176-178. doi:10.3201/eid1002.030533.
APA Zheng, B. J., Guan, Y., Wong, K. H., Zhou, J., Wong, K. L., Young, B. W....Lee, S. S. (2004). SARS-related Virus Predating SARS Outbreak, Hong Kong. Emerging Infectious Diseases, 10(2), 176-178. https://dx.doi.org/10.3201/eid1002.030533.

Susceptibility of Pigs and Chickens to SARS Coronavirus [PDF - 212 KB - 6 pages]
H. M. Weingartl et al.

An outbreak of severe acute respiratory syndrome (SARS) in humans, associated with a new coronavirus, was reported in Southeast Asia, Europe, and North America in early 2003. To address speculations that the virus originated in domesticated animals, or that domestic species were susceptible to the virus, we inoculated 6-week-old pigs and chickens intravenously, intranasally, ocularly, and orally with 106 PFU of SARS-associated coronavirus (SARS-CoV). Clinical signs did not develop in any animal, nor were gross pathologic changes evident on postmortem examinations. Attempts at virus isolation were unsuccessful; however, viral RNA was detected by reverse transcriptase-polymerase chain reaction in blood of both species during the first week after inoculation, and in chicken organs at 2 weeks after inoculation. Virus-neutralizing antibodies developed in the pigs. Our results indicate that these animals do not play a role as amplifying hosts for SARS-CoV.

EID Weingartl HM, Copps J, Drebot MA, Marszal P, Smith G, Gren J, et al. Susceptibility of Pigs and Chickens to SARS Coronavirus. Emerg Infect Dis. 2004;10(2):179-184. https://dx.doi.org/10.3201/eid1002.030677
AMA Weingartl HM, Copps J, Drebot MA, et al. Susceptibility of Pigs and Chickens to SARS Coronavirus. Emerging Infectious Diseases. 2004;10(2):179-184. doi:10.3201/eid1002.030677.
APA Weingartl, H. M., Copps, J., Drebot, M. A., Marszal, P., Smith, G., Gren, J....Czub, M. (2004). Susceptibility of Pigs and Chickens to SARS Coronavirus. Emerging Infectious Diseases, 10(2), 179-184. https://dx.doi.org/10.3201/eid1002.030677.
SARS Epidemiology

SARS Surveillance during Emergency Public Health Response, United States, March–July 2003 [PDF - 195 KB - 10 pages]
S. J. Schrag et al.

In response to the emergence of severe acute respiratory syndrome (SARS), the United States established national surveillance using a sensitive case definition incorporating clinical, epidemiologic, and laboratory criteria. Of 1,460 unexplained respiratory illnesses reported by state and local health departments to the Centers for Disease Control and Prevention from March 17 to July 30, 2003, a total of 398 (27%) met clinical and epidemiologic SARS case criteria. Of these, 72 (18%) were probable cases with radiographic evidence of pneumonia. Eight (2%) were laboratory-confirmed SARS-coronavirus (SARS-CoV) infections, 206 (52%) were SARS-CoV negative, and 184 (46%) had undetermined SARS-CoV status because of missing convalescent-phase serum specimens. Thirty-one percent (124/398) of case-patients were hospitalized; none died. Travel was the most common epidemiologic link (329/398, 83%), and mainland China was the affected area most commonly visited. One case of possible household transmission was reported, and no laboratory-confirmed infections occurred among healthcare workers. Successes and limitations of this emergency surveillance can guide preparations for future outbreaks of SARS or respiratory diseases of unknown etiology.

EID Schrag SJ, Brooks JT, Van Beneden C, Parashar UD, Griffin PM, Anderson LJ, et al. SARS Surveillance during Emergency Public Health Response, United States, March–July 2003. Emerg Infect Dis. 2004;10(2):185-194. https://dx.doi.org/10.3201/eid1002.030752
AMA Schrag SJ, Brooks JT, Van Beneden C, et al. SARS Surveillance during Emergency Public Health Response, United States, March–July 2003. Emerging Infectious Diseases. 2004;10(2):185-194. doi:10.3201/eid1002.030752.
APA Schrag, S. J., Brooks, J. T., Van Beneden, C., Parashar, U. D., Griffin, P. M., Anderson, L. J....Chamberland, M. E. (2004). SARS Surveillance during Emergency Public Health Response, United States, March–July 2003. Emerging Infectious Diseases, 10(2), 185-194. https://dx.doi.org/10.3201/eid1002.030752.

Introduction of SARS in France, March–April, 2003 [PDF - 178 KB - 6 pages]
J. Desenclos et al.

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.

EID Desenclos J, van der Werf S, Bonmarin I, Levy-Bruhl D, Yazdanpanah Y, Hoen B, et al. Introduction of SARS in France, March–April, 2003. Emerg Infect Dis. 2004;10(2):195-200. https://dx.doi.org/10.3201/eid1002.030351
AMA Desenclos J, van der Werf S, Bonmarin I, et al. Introduction of SARS in France, March–April, 2003. Emerging Infectious Diseases. 2004;10(2):195-200. doi:10.3201/eid1002.030351.
APA Desenclos, J., van der Werf, S., Bonmarin, I., Levy-Bruhl, D., Yazdanpanah, Y., Hoen, B....Scheidegger, S. (2004). Introduction of SARS in France, March–April, 2003. Emerging Infectious Diseases, 10(2), 195-200. https://dx.doi.org/10.3201/eid1002.030351.

SARS Outbreak, Taiwan, 2003 [PDF - 81 KB - 6 pages]
Y. Hsieh et al.

We studied the severe acute respiratory syndrome (SARS) outbreak in Taiwan, using the daily case-reporting data from May 5 to June 4 to learn how it had spread so rapidly. Our results indicate that most SARS-infected persons had symptoms and were admitted before their infections were reclassified as probable cases. This finding could indicate efficient admission, slow reclassification process, or both. The high percentage of nosocomial infections in Taiwan suggests that infection from hospitalized patients with suspected, but not yet classified, cases is a major factor in the spread of disease. Delays in reclassification also contributed to the problem. Because accurate diagnostic testing for SARS is currently lacking, intervention measures aimed at more efficient diagnosis, isolation of suspected SARS patients, and reclassification procedures could greatly reduce the number of infections in future outbreaks.

EID Hsieh Y, Chen C, Hsu S. SARS Outbreak, Taiwan, 2003. Emerg Infect Dis. 2004;10(2):201-206. https://dx.doi.org/10.3201/eid1002.030515
AMA Hsieh Y, Chen C, Hsu S. SARS Outbreak, Taiwan, 2003. Emerging Infectious Diseases. 2004;10(2):201-206. doi:10.3201/eid1002.030515.
APA Hsieh, Y., Chen, C., & Hsu, S. (2004). SARS Outbreak, Taiwan, 2003. Emerging Infectious Diseases, 10(2), 201-206. https://dx.doi.org/10.3201/eid1002.030515.

Multiple Contact Dates and SARS Incubation Periods [PDF - 94 KB - 3 pages]
M. I. Meltzer

Many severe acute respiratory syndrome (SARS) patients have multiple possible incubation periods due to multiple contact dates. Multiple contact dates cannot be used in standard statistical analytic techniques, however. I present a simple spreadsheet-based method that uses multiple contact dates to calculate the possible incubation periods of SARS.

EID Meltzer MI. Multiple Contact Dates and SARS Incubation Periods. Emerg Infect Dis. 2004;10(2):207-209. https://dx.doi.org/10.3201/eid1002.030426
AMA Meltzer MI. Multiple Contact Dates and SARS Incubation Periods. Emerging Infectious Diseases. 2004;10(2):207-209. doi:10.3201/eid1002.030426.
APA Meltzer, M. I. (2004). Multiple Contact Dates and SARS Incubation Periods. Emerging Infectious Diseases, 10(2), 207-209. https://dx.doi.org/10.3201/eid1002.030426.
SARS Transmission

Risk Factors for SARS among Persons without Known Contact with SARS Patients, Beijing, China [PDF - 203 KB - 7 pages]
J. Wu et al.

Most cases of severe acute respiratory syndrome (SARS) have occurred in close contacts of SARS patients. However, in Beijing, a large proportion of SARS cases occurred in persons without such contact. We conducted a case-control study in Beijing that compared exposures of 94 unlinked, probable SARS patients with those of 281 community-based controls matched for age group and sex. Case-patients were more likely than controls to have chronic medical conditions or to have visited fever clinics (clinics at which possible SARS patients were separated from other patients), eaten outside the home, or taken taxis frequently. The use of masks was strongly protective. Among 31 case-patients for whom convalescent-phase (>21 days) sera were available, 26% had immunoglobulin G to SARS-associated coronavirus. Our finding that clinical SARS was associated with visits to fever clinics supports Beijing’s strategy of closing clinics with poor infection-control measures. Our finding that mask use lowered the risk for disease supports the community’s use of this strategy.

EID Wu J, Xu F, Zhou W, Feikin DR, Lin C, He X, et al. Risk Factors for SARS among Persons without Known Contact with SARS Patients, Beijing, China. Emerg Infect Dis. 2004;10(2):210-216. https://dx.doi.org/10.3201/eid1002.030730
AMA Wu J, Xu F, Zhou W, et al. Risk Factors for SARS among Persons without Known Contact with SARS Patients, Beijing, China. Emerging Infectious Diseases. 2004;10(2):210-216. doi:10.3201/eid1002.030730.
APA Wu, J., Xu, F., Zhou, W., Feikin, D. R., Lin, C., He, X....Schuchat, A. (2004). Risk Factors for SARS among Persons without Known Contact with SARS Patients, Beijing, China. Emerging Infectious Diseases, 10(2), 210-216. https://dx.doi.org/10.3201/eid1002.030730.

Lack of SARS Transmission and U.S. SARS Case-Patient
A. J. Peck et al.

In early April 2003, severe acute respiratory syndrome (SARS) was diagnosed in a Pennsylvania resident after his exposure to persons with SARS in Toronto, Canada. To identify contacts of the case-patient and evaluate the risk for SARS transmission, a detailed epidemiologic investigation was performed. On the basis of this investigation, 26 persons (17 healthcare workers, 4 household contacts, and 5 others) were identified as having had close contact with this case-patient before infection-control practices were implemented. Laboratory evaluation of clinical specimens showed no evidence of transmission of SARS-associated coronavirus (SARS-CoV) infection to any close contact of this patient. This investigation documents that, under certain circumstances, SARS-CoV is not readily transmitted to close contacts, despite ample unprotected exposures. Improving the understanding of risk factors for transmission will help focus public health control measures.

EID Peck AJ, Newbern EC, Feikin DR, Isakbaeva ET, Park BJ, Fehr JT, et al. Lack of SARS Transmission and U.S. SARS Case-Patient. Emerg Infect Dis. 2004;10(2):217-224. https://dx.doi.org/10.3201/eid1002.030746
AMA Peck AJ, Newbern EC, Feikin DR, et al. Lack of SARS Transmission and U.S. SARS Case-Patient. Emerging Infectious Diseases. 2004;10(2):217-224. doi:10.3201/eid1002.030746.
APA Peck, A. J., Newbern, E. C., Feikin, D. R., Isakbaeva, E. T., Park, B. J., Fehr, J. T....Lingappa, J. R. (2004). Lack of SARS Transmission and U.S. SARS Case-Patient. Emerging Infectious Diseases, 10(2), 217-224. https://dx.doi.org/10.3201/eid1002.030746.

SARS-associated Coronavirus Transmission, United States [PDF - 90 KB - 7 pages]
E. T. Isakbaeva et al.

To better assess the risk for transmission of the severe acute respiratory syndrome–associated coronavirus (SARS-CoV), we obtained serial specimens and clinical and exposure data from seven confirmed U.S. SARS patients and their 10 household contacts. SARS-CoV was detected in a day-14 sputum specimen from one case-patient and in five stool specimens from two case-patients. In one case-patient, SARS-CoV persisted in stool for at least 26 days after symptom onset. The highest amounts of virus were in the day-14 sputum sample and a day-14 stool sample. Residual respiratory symptoms were still present in recovered SARS case-patients 2 months after illness onset. Possible transmission of SARS-CoV occurred in one household contact, but this person had also traveled to a SARS-affected area. The data suggest that SARS-CoV is not always transmitted efficiently. Laboratory diagnosis of SARS-CoV infection is difficult; thus, sputum and stool specimens should be included in the diagnostic work-up for SARS-CoV infection.

EID Isakbaeva ET, Khetsuriani N, Beard RS, Peck A, Erdman DD, Monroe SS, et al. SARS-associated Coronavirus Transmission, United States. Emerg Infect Dis. 2004;10(2):225-231. https://dx.doi.org/10.3201/eid1002.030734
AMA Isakbaeva ET, Khetsuriani N, Beard RS, et al. SARS-associated Coronavirus Transmission, United States. Emerging Infectious Diseases. 2004;10(2):225-231. doi:10.3201/eid1002.030734.
APA Isakbaeva, E. T., Khetsuriani, N., Beard, R. S., Peck, A., Erdman, D. D., Monroe, S. S....Widdowson, M. (2004). SARS-associated Coronavirus Transmission, United States. Emerging Infectious Diseases, 10(2), 225-231. https://dx.doi.org/10.3201/eid1002.030734.

Secondary Household Transmission of SARS, Singapore [PDF - 42 KB - 3 pages]
D. L. Goh et al.

Secondary household transmission of severe acute respiratory syndrome (SARS) was studied in 114 households involving 417 contacts. The attack rate was low (6.2%). Occupation of the index case was the factor that most influenced household transmission (adjusted hazard ratio for healthcare workers 0.157; 95% confidence interval 0.042 to 0.588).

EID Goh DL, Lee BW, Chia KS, Heng BH, Chen M, Ma S, et al. Secondary Household Transmission of SARS, Singapore. Emerg Infect Dis. 2004;10(2):232-234. https://dx.doi.org/10.3201/eid1002.030676
AMA Goh DL, Lee BW, Chia KS, et al. Secondary Household Transmission of SARS, Singapore. Emerging Infectious Diseases. 2004;10(2):232-234. doi:10.3201/eid1002.030676.
APA Goh, D. L., Lee, B. W., Chia, K. S., Heng, B. H., Chen, M., Ma, S....Tan, C. C. (2004). Secondary Household Transmission of SARS, Singapore. Emerging Infectious Diseases, 10(2), 232-234. https://dx.doi.org/10.3201/eid1002.030676.

Probable Secondary Infections in Households of SARS Patients in Hong Kong [PDF - 235 KB - 8 pages]
J. Lau et al.

Although severe acute respiratory syndrome (SARS) is highly infectious in clinical settings, SARS has not been well examined in household settings. The household and household member attack rates were calculated for 1,214 SARS case-patients and their household members, stratified by two phases of the epidemic. A case-control analysis identified risk factors for secondary infection. Secondary infection occurred in 14.9% (22.1% versus 11% in earlier and later phases) of all households and 8% (11.7% versus 5.9% in the earlier and later phases) of all household members. Healthcare workers’ households were less likely to be affected. Risk factors from the multivariate analysis included at-home duration before hospitalization, hospital visitation to the SARS patient (and mask use during the visit), and frequency of close contact. SARS transmission at the household level was not negligible in Hong Kong. Transmission rates may be greatly reduced with precautionary measures taken by household members of SARS patients.

EID Lau J, Lau M, Kim JH, Wong E, Tsui H, Tsang T, et al. Probable Secondary Infections in Households of SARS Patients in Hong Kong. Emerg Infect Dis. 2004;10(2):236-243. https://dx.doi.org/10.3201/eid1002.030626
AMA Lau J, Lau M, Kim JH, et al. Probable Secondary Infections in Households of SARS Patients in Hong Kong. Emerging Infectious Diseases. 2004;10(2):236-243. doi:10.3201/eid1002.030626.
APA Lau, J., Lau, M., Kim, J. H., Wong, E., Tsui, H., Tsang, T....Wong, T. W. (2004). Probable Secondary Infections in Households of SARS Patients in Hong Kong. Emerging Infectious Diseases, 10(2), 236-243. https://dx.doi.org/10.3201/eid1002.030626.

Lack of SARS Transmission among Healthcare Workers, United States [PDF - 167 KB - 8 pages]
B. J. Park et al.

Healthcare workers accounted for a large proportion of persons with severe acute respiratory syndrome (SARS) during the worldwide epidemic of early 2003. We conducted an investigation of healthcare workers exposed to laboratory-confirmed SARS patients in the United States to evaluate infection-control practices and possible SARS-associated coronavirus (SARS-CoV) transmission. We identified 110 healthcare workers with exposure within droplet range (i.e., 3 feet) to six SARS-CoV–positive patients. Forty-five healthcare workers had exposure without any mask use, 72 had exposure without eye protection, and 40 reported direct skin-to-skin contact. Potential droplet- and aerosol-generating procedures were infrequent: 5% of healthcare workers manipulated a patient’s airway, and 4% administered aerosolized medication. Despite numerous unprotected exposures, there was no serologic evidence of healthcare-related SARS-CoV transmission. Lack of transmission in the United States may be related to the relative absence of high-risk procedures or patients, factors that may place healthcare workers at higher risk for infection.

EID Park BJ, Peck AJ, Kuehnert MJ, Newbern C, Smelser C, Comer JA, et al. Lack of SARS Transmission among Healthcare Workers, United States. Emerg Infect Dis. 2004;10(2):244-248. https://dx.doi.org/10.3201/eid1002.030793
AMA Park BJ, Peck AJ, Kuehnert MJ, et al. Lack of SARS Transmission among Healthcare Workers, United States. Emerging Infectious Diseases. 2004;10(2):244-248. doi:10.3201/eid1002.030793.
APA Park, B. J., Peck, A. J., Kuehnert, M. J., Newbern, C., Smelser, C., Comer, J. A....McDonald, L. C. (2004). Lack of SARS Transmission among Healthcare Workers, United States. Emerging Infectious Diseases, 10(2), 244-248. https://dx.doi.org/10.3201/eid1002.030793.

Healthcare Worker Seroconversion in SARS Outbreak [PDF - 23 KB - 2 pages]
P. K. Chow et al.

Serum samples were obtained from healthcare workers 5 weeks after exposure to an outbreak of severe acute respiratory syndrome (SARS). A sensitive dot blot enzyme-linked immunosorbent assay, complemented by a specific neutralization test, shows that only persons in whom probable SARS was diagnosed had specific antibodies and suggests that subclinical SARS is not an important feature of the disease.

EID Chow PK, Ooi E, Tan H, Ong K, Sil BK, Teo M, et al. Healthcare Worker Seroconversion in SARS Outbreak. Emerg Infect Dis. 2004;10(2):249-250. https://dx.doi.org/10.3201/eid1002.030397
AMA Chow PK, Ooi E, Tan H, et al. Healthcare Worker Seroconversion in SARS Outbreak. Emerging Infectious Diseases. 2004;10(2):249-250. doi:10.3201/eid1002.030397.
APA Chow, P. K., Ooi, E., Tan, H., Ong, K., Sil, B. K., Teo, M....Soo, K. (2004). Healthcare Worker Seroconversion in SARS Outbreak. Emerging Infectious Diseases, 10(2), 249-250. https://dx.doi.org/10.3201/eid1002.030397.

SARS among Critical Care Nurses, Toronto [PDF - 80 KB - 5 pages]
M. B. Loeb et al.

To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), we conducted a retrospective cohort study among 43 nurses who worked in two Toronto critical care units with SARS patients. Eight of 32 nurses who entered a SARS patient’s room were infected. The probability of SARS infection was 6% per shift worked. Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently wearing a mask (either surgical or particulate respirator type N95) while caring for a SARS patient was protective for the nurses, and consistent use of the N95 mask was more protective than not wearing a mask. Risk was reduced by consistent use of a surgical mask, but not significantly. Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. We conclude that activities related to intubation increase SARS risk and use of a mask (particularly a N95 mask) is protective.

EID Loeb MB, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among Critical Care Nurses, Toronto. Emerg Infect Dis. 2004;10(2):251-255. https://dx.doi.org/10.3201/eid1002.030838
AMA Loeb MB, McGeer A, Henry B, et al. SARS among Critical Care Nurses, Toronto. Emerging Infectious Diseases. 2004;10(2):251-255. doi:10.3201/eid1002.030838.
APA Loeb, M. B., McGeer, A., Henry, B., Ofner, M., Rose, D., Hlywka, T....Walter, S. D. (2004). SARS among Critical Care Nurses, Toronto. Emerging Infectious Diseases, 10(2), 251-255. https://dx.doi.org/10.3201/eid1002.030838.

Superspreading SARS Events, Beijing, 2003 [PDF - 67 KB - 5 pages]
Z. Shen et al.

Superspreading events were pivotal in the global spread of severe acute respiratory syndrome (SARS). We investigated superspreading in one transmission chain early in Beijing’s epidemic. Superspreading was defined as transmission of SARS to at least eight contacts. An index patient with onset of SARS 2 months after hospital admission was the source of four generations of transmission to 76 case-patients, including 12 healthcare workers and several hospital visitors. Four (5%) case circumstances met the superspreading definition. Superspreading appeared to be associated with older age (mean 56 vs. 44 years), case fatality (75% vs. 16%, p = 0.02, Fisher exact test), number of close contacts (36 vs. 0.37) and attack rate among close contacts (43% vs. 18.5%, p < 0.025). Delayed recognition of SARS in a hospitalized patient permitted transmission to patients, visitors, and healthcare workers. Older age and number of contacts merit investigation in future studies of superspreading.

EID Shen Z, Ning F, Zhou W, He X, Lin C, Chin DP, et al. Superspreading SARS Events, Beijing, 2003. Emerg Infect Dis. 2004;10(2):256-260. https://dx.doi.org/10.3201/eid1002.030732
AMA Shen Z, Ning F, Zhou W, et al. Superspreading SARS Events, Beijing, 2003. Emerging Infectious Diseases. 2004;10(2):256-260. doi:10.3201/eid1002.030732.
APA Shen, Z., Ning, F., Zhou, W., He, X., Lin, C., Chin, D. P....Schuchat, A. (2004). Superspreading SARS Events, Beijing, 2003. Emerging Infectious Diseases, 10(2), 256-260. https://dx.doi.org/10.3201/eid1002.030732.

Atypical SARS in Geriatric Patient [PDF - 189 KB - 4 pages]
A. K. Tee et al.

We describe an atypical presentation of severe acute respiratory syndrome (SARS) in a geriatric patient with multiple coexisting conditions. Interpretation of radiographic changes was confounded by cardiac failure, with resolution of fever causing delayed diagnosis and a cluster of cases. SARS should be considered even if a contact history is unavailable, during an ongoing outbreak.

EID Tee AK, Oh HM, Hui K, Lien CT, Narendran K, Heng B, et al. Atypical SARS in Geriatric Patient. Emerg Infect Dis. 2004;10(2):261-264. https://dx.doi.org/10.3201/eid1002.030322
AMA Tee AK, Oh HM, Hui K, et al. Atypical SARS in Geriatric Patient. Emerging Infectious Diseases. 2004;10(2):261-264. doi:10.3201/eid1002.030322.
APA Tee, A. K., Oh, H. M., Hui, K., Lien, C. T., Narendran, K., Heng, B....Ling, A. (2004). Atypical SARS in Geriatric Patient. Emerging Infectious Diseases, 10(2), 261-264. https://dx.doi.org/10.3201/eid1002.030322.

Lack of SARS Transmission among Public Hospital Workers, Vietnam [PDF - 72 KB - 4 pages]
L. D. Ha et al.

The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment.

EID Ha LD, Bloom SA, Hien NQ, Maloney SA, Mai LQ, Leitmeyer KC, et al. Lack of SARS Transmission among Public Hospital Workers, Vietnam. Emerg Infect Dis. 2004;10(2):265-268. https://dx.doi.org/10.3201/eid1002.030707
AMA Ha LD, Bloom SA, Hien NQ, et al. Lack of SARS Transmission among Public Hospital Workers, Vietnam. Emerging Infectious Diseases. 2004;10(2):265-268. doi:10.3201/eid1002.030707.
APA Ha, L. D., Bloom, S. A., Hien, N. Q., Maloney, S. A., Mai, L. Q., Leitmeyer, K. C....Plant, A. J. (2004). Lack of SARS Transmission among Public Hospital Workers, Vietnam. Emerging Infectious Diseases, 10(2), 265-268. https://dx.doi.org/10.3201/eid1002.030707.

Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong [PDF - 251 KB - 8 pages]
T. Wong et al.

We studied transmission patterns of severe acute respiratory syndrome (SARS) among medical students exposed exclusively to the first SARS patient in the Prince of Wales Hospital in Hong Kong, before his illness was recognized. We conducted a retrospective cohort study of 66 medical students who visited the index patient’s ward, including 16 students with SARS and 50 healthy students. The risk of contracting SARS was sevenfold greater among students who definitely visited the index case’s cubicle than in those who did not (10/27 [41%] versus 1/20 [5%], relative risk [RR] 7.4; 95% confidence interval [CI] 1.0 to 53.3). Illness rates increased directly with proximity of exposure to the index case. However, four of eight students who were in the same cubicle, but were not within 1 m of the index case-patient, contracted SARS. Proximity to the index case-patient was associated with transmission, which is consistent with droplet spread. Transmission through fomites or small aerosols cannot be ruled out.

EID Wong T, Lee C, Tam W, Lau JT, Yu T, Lui S, et al. Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong. Emerg Infect Dis. 2004;10(2):269-276. https://dx.doi.org/10.3201/eid1002.030452
AMA Wong T, Lee C, Tam W, et al. Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong. Emerging Infectious Diseases. 2004;10(2):269-276. doi:10.3201/eid1002.030452.
APA Wong, T., Lee, C., Tam, W., Lau, J. T., Yu, T., Lui, S....Parashar, U. D. (2004). Cluster of SARS among Medical Students Exposed to Single Patient, Hong Kong. Emerging Infectious Diseases, 10(2), 269-276. https://dx.doi.org/10.3201/eid1002.030452.
Infection Control

Surgical Helmets and SARS Infection [PDF - 296 KB - 3 pages]
J. L. Derrick and C. D. Gomersall

Performance testing of two brands of surgical helmets indicated that their efficiency at in vivo filtration of sub–micrometer-sized particles is inadequate for their use as respirators. These helmets are not marketed for respiratory protection and should not be used alone for protection against severe acute respiratory syndrome when performing aerosol-generating procedures.

EID Derrick JL, Gomersall CD. Surgical Helmets and SARS Infection. Emerg Infect Dis. 2004;10(2):277-279. https://dx.doi.org/10.3201/eid1002.030764
AMA Derrick JL, Gomersall CD. Surgical Helmets and SARS Infection. Emerging Infectious Diseases. 2004;10(2):277-279. doi:10.3201/eid1002.030764.
APA Derrick, J. L., & Gomersall, C. D. (2004). Surgical Helmets and SARS Infection. Emerging Infectious Diseases, 10(2), 277-279. https://dx.doi.org/10.3201/eid1002.030764.

SARS Transmission among Hospital Workers in Hong Kong [PDF - 317 KB - 7 pages]
J. Lau et al.

Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having <2 hours of infection control training, and not understanding infection control procedures. No significant differences existed between the case and control groups in the proportion of workers who performed high-risk procedures, reported minor protection equipment problems, or had social contact with SARS-infected persons. Perceived inadequacy of personal protection equipment supply, infection control training <2 hours, and inconsistent use of personal protection equipment when in contact with SARS patients were significant independent risk factors for SARS infection.

EID Lau J, Fung KS, Wong TW, Kim JH, Wong E, Chung S, et al. SARS Transmission among Hospital Workers in Hong Kong. Emerg Infect Dis. 2004;10(2):280-286. https://dx.doi.org/10.3201/eid1002.030534
AMA Lau J, Fung KS, Wong TW, et al. SARS Transmission among Hospital Workers in Hong Kong. Emerging Infectious Diseases. 2004;10(2):280-286. doi:10.3201/eid1002.030534.
APA Lau, J., Fung, K. S., Wong, T. W., Kim, J. H., Wong, E., Chung, S....Cheng, A. (2004). SARS Transmission among Hospital Workers in Hong Kong. Emerging Infectious Diseases, 10(2), 280-286. https://dx.doi.org/10.3201/eid1002.030534.

Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation [PDF - 6.86 MB - 7 pages]
M. D. Christian et al.

Infection of healthcare workers with the severe acute respiratory syndrome–associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.

EID Christian MD, Loutfy M, McDonald LC, Martinez KF, Ofner M, Wong T, et al. Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation. Emerg Infect Dis. 2004;10(2):287-293. https://dx.doi.org/10.3201/eid1002.030700
AMA Christian MD, Loutfy M, McDonald LC, et al. Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation. Emerging Infectious Diseases. 2004;10(2):287-293. doi:10.3201/eid1002.030700.
APA Christian, M. D., Loutfy, M., McDonald, L. C., Martinez, K. F., Ofner, M., Wong, T....Low, D. E. (2004). Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation. Emerging Infectious Diseases, 10(2), 287-293. https://dx.doi.org/10.3201/eid1002.030700.
Laboratory Studies

Detection of SARS Coronavirus in Patients with Suspected SARS [PDF - 340 KB - 6 pages]
K. H. Chan et al.

Cases of severe acute respiratory syndrome (SARS) were investigated for SARS coronavirus (SARS-CoV) through RNA tests, serologic response, and viral culture. Of 537 specimens from patients in whom SARS was clinically diagnosed, 332 (60%) had SARS-CoV RNA in one or more clinical specimens, compared with 1 (0.3%) of 332 samples from controls. Of 417 patients with clinical SARS from whom paired serum samples were available, 92% had an antibody response. Rates of viral RNA positivity increased progressively and peaked at day 11 after onset of illness. Although viral RNA remained detectable in respiratory secretions and stool and urine specimens for >30 days in some patients, virus could not be cultured after week 3 of illness. Nasopharyngeal aspirates, throat swabs, or sputum samples were the most useful clinical specimens in the first 5 days of illness, but later in the illness viral RNA could be detected more readily in stool specimens.

EID Chan KH, Poon LL, Cheng V, Guan Y, Hung I, Peiris JS, et al. Detection of SARS Coronavirus in Patients with Suspected SARS. Emerg Infect Dis. 2004;10(2):294-299. https://dx.doi.org/10.3201/eid1002.030610
AMA Chan KH, Poon LL, Cheng V, et al. Detection of SARS Coronavirus in Patients with Suspected SARS. Emerging Infectious Diseases. 2004;10(2):294-299. doi:10.3201/eid1002.030610.
APA Chan, K. H., Poon, L. L., Cheng, V., Guan, Y., Hung, I., Peiris, J. S....Peiris, J. S. (2004). Detection of SARS Coronavirus in Patients with Suspected SARS. Emerging Infectious Diseases, 10(2), 294-299. https://dx.doi.org/10.3201/eid1002.030610.

Real-Time Polymerase Chain Reaction for Detecting SARS Coronavirus, Beijing, 2003 [PDF - 902 KB - 4 pages]
J. Zhai et al.

During the 2003 severe acute respiratory syndrome (SARS) outbreak, a real-time quantitative polymerase chain reaction, which targets the nucleocapsid gene at the 3′-end of the viral genome, was established to detect and identify the SARS-associated coronavirus. We describe the use of this assay to screen >700 clinical samples.

EID Zhai J, Briese T, Dai E, Wang X, Pang X, Du Z, et al. Real-Time Polymerase Chain Reaction for Detecting SARS Coronavirus, Beijing, 2003. Emerg Infect Dis. 2004;10(2):300-303. https://dx.doi.org/10.3201/eid1002.030799
AMA Zhai J, Briese T, Dai E, et al. Real-Time Polymerase Chain Reaction for Detecting SARS Coronavirus, Beijing, 2003. Emerging Infectious Diseases. 2004;10(2):300-303. doi:10.3201/eid1002.030799.
APA Zhai, J., Briese, T., Dai, E., Wang, X., Pang, X., Du, Z....Yang, R. (2004). Real-Time Polymerase Chain Reaction for Detecting SARS Coronavirus, Beijing, 2003. Emerging Infectious Diseases, 10(2), 300-303. https://dx.doi.org/10.3201/eid1002.030799.

Serologic and Molecular Biologic Methods for SARS-associated Coronavirus Infection, Taiwan [PDF - 384 KB - 7 pages]
H. Wu et al.

Severe acute respiratory syndrome (SARS) has raised a global alert since March 2003. After its causative agent, SARS-associated coronavirus (SARS-CoV), was confirmed, laboratory methods, including virus isolation, reverse transcriptase–polymerase chain reaction (RT-PCR), and serologic methods, have been quickly developed. In this study, we evaluated four serologic tests ( neutralization test, enzyme-linked immunosorbent assay [ELISA], immunofluorescent assay [IFA], and immunochromatographic test [ICT]) for detecting antibodies to SARS-CoV in sera of 537 probable SARS case-patients with correlation to the RT-PCR . With the neutralization test as a reference method, the sensitivity, specificity, positive predictive value, and negative predictive value were 98.2%, 98.7%, 98.7%, and 98.4% for ELISA; 99.1%, 87.8%, 88.1% and 99.1% for IFA; 33.6%, 98.2%, 95.7%, and 56.1% for ICT, respectively. We also compared the recombinant-based western blot with the whole virus–based IFA and ELISA; the data showed a high correlation between these methods, with an overall agreement of >90%. Our results provide a systematic analysis of serologic and molecular methods for evaluating SARS-CoV infection.

EID Wu H, Chiu S, Tseng T, Lin S, Lin J, Hsu Y, et al. Serologic and Molecular Biologic Methods for SARS-associated Coronavirus Infection, Taiwan. Emerg Infect Dis. 2004;10(2):304-310. https://dx.doi.org/10.3201/eid1002.030731
AMA Wu H, Chiu S, Tseng T, et al. Serologic and Molecular Biologic Methods for SARS-associated Coronavirus Infection, Taiwan. Emerging Infectious Diseases. 2004;10(2):304-310. doi:10.3201/eid1002.030731.
APA Wu, H., Chiu, S., Tseng, T., Lin, S., Lin, J., Hsu, Y....Su, I. (2004). Serologic and Molecular Biologic Methods for SARS-associated Coronavirus Infection, Taiwan. Emerging Infectious Diseases, 10(2), 304-310. https://dx.doi.org/10.3201/eid1002.030731.

Real-Time Reverse Transcription–Polymerase Chain Reaction Assay for SARS-associated Coronavirus [PDF - 429 KB - 6 pages]
S. L. Emery et al.

A real-time reverse transcription–polymerase chain reaction (RT-PCR) assay was developed to rapidly detect the severe acute respiratory syndrome–associated coronavirus (SARS-CoV). The assay, based on multiple primer and probe sets located in different regions of the SARS-CoV genome, could discriminate SARS-CoV from other human and animal coronaviruses with a potential detection limit of <10 genomic copies per reaction. The real-time RT-PCR assay was more sensitive than a conventional RT-PCR assay or culture isolation and proved suitable to detect SARS-CoV in clinical specimens. Application of this assay will aid in diagnosing SARS-CoV infection.

EID Emery SL, Erdman DD, Bowen MD, Newton BR, Winchell JM, Meyer RF, et al. Real-Time Reverse Transcription–Polymerase Chain Reaction Assay for SARS-associated Coronavirus. Emerg Infect Dis. 2004;10(2):311-316. https://dx.doi.org/10.3201/eid1002.030759
AMA Emery SL, Erdman DD, Bowen MD, et al. Real-Time Reverse Transcription–Polymerase Chain Reaction Assay for SARS-associated Coronavirus. Emerging Infectious Diseases. 2004;10(2):311-316. doi:10.3201/eid1002.030759.
APA Emery, S. L., Erdman, D. D., Bowen, M. D., Newton, B. R., Winchell, J. M., Meyer, R. F....Anderson, L. J. (2004). Real-Time Reverse Transcription–Polymerase Chain Reaction Assay for SARS-associated Coronavirus. Emerging Infectious Diseases, 10(2), 311-316. https://dx.doi.org/10.3201/eid1002.030759.

Interferon-β 1a and SARS Coronavirus Replication [PDF - 1.64 MB - 3 pages]
L. E. Hensley et al.

A global outbreak of severe acute respiratory syndrome (SARS) caused by a novel coronavirus began in March 2003. The rapid emergence of SARS and the substantial illness and death it caused have made it a critical public health issue. Because no effective treatments are available, an intensive effort is under way to identify and test promising antiviral drugs. Here, we report that recombinant human interferon (IFN)-β 1a potently inhibits SARS coronavirus replication in vitro.

EID Hensley LE, Fritz EA, Jahrling PB, Karp C, Huggins JW, Geisbert TW. Interferon-β 1a and SARS Coronavirus Replication. Emerg Infect Dis. 2004;10(2):317-319. https://dx.doi.org/10.3201/eid1002.030482
AMA Hensley LE, Fritz EA, Jahrling PB, et al. Interferon-β 1a and SARS Coronavirus Replication. Emerging Infectious Diseases. 2004;10(2):317-319. doi:10.3201/eid1002.030482.
APA Hensley, L. E., Fritz, E. A., Jahrling, P. B., Karp, C., Huggins, J. W., & Geisbert, T. W. (2004). Interferon-β 1a and SARS Coronavirus Replication. Emerging Infectious Diseases, 10(2), 317-319. https://dx.doi.org/10.3201/eid1002.030482.

Ultrastructural Characterization of SARS Coronavirus [PDF - 808 KB - 7 pages]
C. S. Goldsmith et al.

Severe acute respiratory syndrome (SARS) was first described during a 2002–2003 global outbreak of severe pneumonia associated with human deaths and person-to-person disease transmission. The etiologic agent was initially identified as a coronavirus by thin-section electron microscopic examination of a virus isolate. Virions were spherical, 78 nm in mean diameter, and composed of a helical nucleocapsid within an envelope with surface projections. Herein, we show that infection with the SARS-associated coronavirus resulted in distinct ultrastructural features: double-membrane vesicles, nucleocapsid inclusions, and large granular areas of cytoplasm. These three structures and the coronavirus particles were shown to be positive for viral proteins and RNA by using ultrastructural immunogold and in situ hybridization assays. In addition, ultrastructural examination of a bronchiolar lavage specimen from a SARS patient showed numerous coronavirus-infected cells with features similar to those in infected culture cells. Electron microscopic studies were critical in identifying the etiologic agent of the SARS outbreak and in guiding subsequent laboratory and epidemiologic investigations.

EID Goldsmith CS, Tatti KM, Ksiazek TG, Rollin PE, Comer JA, Lee WW, et al. Ultrastructural Characterization of SARS Coronavirus. Emerg Infect Dis. 2004;10(2):320-326. https://dx.doi.org/10.3201/eid1002.030913
AMA Goldsmith CS, Tatti KM, Ksiazek TG, et al. Ultrastructural Characterization of SARS Coronavirus. Emerging Infectious Diseases. 2004;10(2):320-326. doi:10.3201/eid1002.030913.
APA Goldsmith, C. S., Tatti, K. M., Ksiazek, T. G., Rollin, P. E., Comer, J. A., Lee, W. W....Zaki, S. R. (2004). Ultrastructural Characterization of SARS Coronavirus. Emerging Infectious Diseases, 10(2), 320-326. https://dx.doi.org/10.3201/eid1002.030913.
Clinical Studies

Combining Clinical and Epidemiologic Features for Early Recognition of SARS [PDF - 87 KB - 7 pages]
J. A. Jernigan et al.

Early recognition and rapid initiation of infection control precautions are currently the most important strategies for controlling severe acute respiratory syndrome (SARS). No rapid diagnostic tests currently exist that can rule out SARS among patients with febrile respiratory illnesses. Clinical features alone cannot with certainty distinguish SARS from other respiratory illnesses rapidly enough to inform early management decisions. A balanced approach to screening that allows early recognition of SARS without unnecessary isolation of patients with other respiratory illnesses will require clinicians not only to look for suggestive clinical features but also to routinely seek epidemiologic clues suggestive of SARS coronavirus exposure. Key epidemiologic risk factors include 1) exposure to settings where SARS activity is suspected or documented, or 2) in the absence of such exposure, epidemiologic linkage to other persons with pneumonia (i.e., pneumonia clusters), or 3) exposure to healthcare settings. When combined with clinical findings, these epidemiologic features provide a possible strategic framework for early recognition of SARS.

EID Jernigan JA, Low DE, Helfand RF. Combining Clinical and Epidemiologic Features for Early Recognition of SARS. Emerg Infect Dis. 2004;10(2):327-333. https://dx.doi.org/10.3201/eid1002.030741
AMA Jernigan JA, Low DE, Helfand RF. Combining Clinical and Epidemiologic Features for Early Recognition of SARS. Emerging Infectious Diseases. 2004;10(2):327-333. doi:10.3201/eid1002.030741.
APA Jernigan, J. A., Low, D. E., & Helfand, R. F. (2004). Combining Clinical and Epidemiologic Features for Early Recognition of SARS. Emerging Infectious Diseases, 10(2), 327-333. https://dx.doi.org/10.3201/eid1002.030741.

Clinical Description of a Completed Outbreak of SARS in Vietnam, February–May, 2003 [PDF - 79 KB - 5 pages]
H. T. Vu et al.

We investigated the clinical manifestations and course of all probable severe acute respiratory syndrome (SARS) patients in the Vietnam outbreak. Probable SARS cases were defined by using the revised World Health Organization criteria. We systematically reviewed medical records and undertook descriptive statistical analyses. All 62 patients were hospitalized. On admission, the most prominent symptoms were malaise (82.3%) and fever (79.0%). Cough, chest pain, and shortness of breath were present in approximately one quarter of the patients; 79.0% had lymphopenia; 40.3% had thrombocytopenia; 19.4% had leukopenia; and 75.8% showed changes on chest radiograph. Fever developed on the first day of illness onset, and both respiratory symptoms and radiographic changes occurred on day 4. On average, maximal radiographic changes were observed on day 10, and fevers subsided by day 13. Symptoms on admission were nonspecific, although fever, malaise, and lymphopenia were common. The complications of SARS included invasive intubation and ventilation (11.3%) and death (9.7%).

EID Vu HT, Leitmeyer KC, Le DH, Miller MJ, Nguyen QH, Uyeki TM, et al. Clinical Description of a Completed Outbreak of SARS in Vietnam, February–May, 2003. Emerg Infect Dis. 2004;10(2):334-338. https://dx.doi.org/10.3201/eid1002.030761
AMA Vu HT, Leitmeyer KC, Le DH, et al. Clinical Description of a Completed Outbreak of SARS in Vietnam, February–May, 2003. Emerging Infectious Diseases. 2004;10(2):334-338. doi:10.3201/eid1002.030761.
APA Vu, H. T., Leitmeyer, K. C., Le, D. H., Miller, M. J., Nguyen, Q. H., Uyeki, T. M....Plant, A. J. (2004). Clinical Description of a Completed Outbreak of SARS in Vietnam, February–May, 2003. Emerging Infectious Diseases, 10(2), 334-338. https://dx.doi.org/10.3201/eid1002.030761.

Index Patient and SARS Outbreak in Hong Kong [PDF - 95 KB - 3 pages]
R. S. Wong and D. S. Hui

During the global outbreak of severe acute respiratory syndrome (SARS) in 2003, treatment was empiric. We report the case history of the index patient in a hospital outbreak of SARS in Hong Kong. The patient recovered after conventional antimicrobial therapy. Further studies are needed to address treatment of SARS, which has high attack and death rates.

EID Wong RS, Hui DS. Index Patient and SARS Outbreak in Hong Kong. Emerg Infect Dis. 2004;10(2):339-341. https://dx.doi.org/10.3201/eid1002.030645
AMA Wong RS, Hui DS. Index Patient and SARS Outbreak in Hong Kong. Emerging Infectious Diseases. 2004;10(2):339-341. doi:10.3201/eid1002.030645.
APA Wong, R. S., & Hui, D. S. (2004). Index Patient and SARS Outbreak in Hong Kong. Emerging Infectious Diseases, 10(2), 339-341. https://dx.doi.org/10.3201/eid1002.030645.

Possible Central Nervous System Infection by SARS Coronavirus [PDF - 182 KB - 3 pages]
K. Lau et al.

On day 22 of illness, generalized tonic-clonic convulsion developed in a 32-year-old woman with severe acute respiratory syndrome (SARS). Cerebrospinal fluid tested positive for SARS coronavirus (SARS-CoV) by reverse transcriptase–polymerase chain reaction. SARS-CoV may have caused an infection in the central nervous system in this patient.

EID Lau K, Yu W, Chu C, Lau S, Sheng B, Yuen K. Possible Central Nervous System Infection by SARS Coronavirus. Emerg Infect Dis. 2004;10(2):342-344. https://dx.doi.org/10.3201/eid1002.030638
AMA Lau K, Yu W, Chu C, et al. Possible Central Nervous System Infection by SARS Coronavirus. Emerging Infectious Diseases. 2004;10(2):342-344. doi:10.3201/eid1002.030638.
APA Lau, K., Yu, W., Chu, C., Lau, S., Sheng, B., & Yuen, K. (2004). Possible Central Nervous System Infection by SARS Coronavirus. Emerging Infectious Diseases, 10(2), 342-344. https://dx.doi.org/10.3201/eid1002.030638.

SARS and Pregnancy: A Case Report [PDF - 197 KB - 4 pages]
C. A. Robertson et al.

We report a laboratory-confirmed case of severe acute respiratory syndrome (SARS) in a pregnant woman. Although the patient had respiratory failure, a healthy infant was subsequently delivered, and the mother is now well. There was no evidence of viral shedding at delivery. Antibodies to SARS virus were detected in cord blood and breast milk.

EID Robertson CA, Lowther SA, Birch T, Tan C, Sorhage F, Stockman L, et al. SARS and Pregnancy: A Case Report. Emerg Infect Dis. 2004;10(2):345-348. https://dx.doi.org/10.3201/eid1002.030736
AMA Robertson CA, Lowther SA, Birch T, et al. SARS and Pregnancy: A Case Report. Emerging Infectious Diseases. 2004;10(2):345-348. doi:10.3201/eid1002.030736.
APA Robertson, C. A., Lowther, S. A., Birch, T., Tan, C., Sorhage, F., Stockman, L....Bresnitz, E. (2004). SARS and Pregnancy: A Case Report. Emerging Infectious Diseases, 10(2), 345-348. https://dx.doi.org/10.3201/eid1002.030736.

Atypical SARS and Escherichia coli Bacteremia [PDF - 110 KB - 4 pages]
T. T. Tan et al.

We describe a patient with severe acute respiratory syndrome (SARS) whose clinical symptoms were masked by Escherichia coli bacteremia. SARS developed in a cluster of healthcare workers who had contact with this patient. SARS was diagnosed when a chest infiltrate developed and when the patient’s brother was hospitalized with acute respiratory failure. We highlight problems in atypical cases and offer infection control suggestions.

EID Tan TT, Tan BH, Kurup A, Oon LL, Heng D, Thoe SY, et al. Atypical SARS and Escherichia coli Bacteremia. Emerg Infect Dis. 2004;10(2):349-352. https://dx.doi.org/10.3201/eid1002.030501
AMA Tan TT, Tan BH, Kurup A, et al. Atypical SARS and Escherichia coli Bacteremia. Emerging Infectious Diseases. 2004;10(2):349-352. doi:10.3201/eid1002.030501.
APA Tan, T. T., Tan, B. H., Kurup, A., Oon, L. L., Heng, D., Thoe, S. Y....Ling, A. E. (2004). Atypical SARS and Escherichia coli Bacteremia. Emerging Infectious Diseases, 10(2), 349-352. https://dx.doi.org/10.3201/eid1002.030501.
Preparedness and Response

HHS/CDC Legal Response to SARS Outbreak [PDF - 43 KB - 3 pages]
J. J. Misrahi et al.

Before the severe acute respiratory syndrome (SARS) outbreak, the Centers for Disease Control and Prevention’s (CDC) legal authority to apprehend, detain, or conditionally release persons was limited to seven listed diseases, not including SARS, and could only be changed using a two-step process: 1) executive order of the President of the United States on recommendation by the Secretary, U.S. Department of Health and Human Services (HHS), and 2) amendment to CDC quarantine regulations (42 CFR Parts 70 and 71). In April 2003, in response to the SARS outbreak, the federal executive branch acted rapidly to add SARS to the list of quarantinable communicable diseases. At the same time, HHS amended the regulations to streamline the process of adding future emerging infectious diseases. Since the emergence of SARS, CDC has increased legal preparedness for future public health emergencies by establishing a multistate teleconference program for public health lawyers and a Web-based clearinghouse of legal documents.

EID Misrahi JJ, Foster JA, Shaw FE, Cetron MS. HHS/CDC Legal Response to SARS Outbreak. Emerg Infect Dis. 2004;10(2):353-355. https://dx.doi.org/10.3201/eid1002.030721
AMA Misrahi JJ, Foster JA, Shaw FE, et al. HHS/CDC Legal Response to SARS Outbreak. Emerging Infectious Diseases. 2004;10(2):353-355. doi:10.3201/eid1002.030721.
APA Misrahi, J. J., Foster, J. A., Shaw, F. E., & Cetron, M. S. (2004). HHS/CDC Legal Response to SARS Outbreak. Emerging Infectious Diseases, 10(2), 353-355. https://dx.doi.org/10.3201/eid1002.030721.

Making State Public Health Laws Work for SARS Outbreaks [PDF - 51 KB - 2 pages]
E. P. Richards and K. C. Rathbun
EID Richards EP, Rathbun KC. Making State Public Health Laws Work for SARS Outbreaks. Emerg Infect Dis. 2004;10(2):356-357. https://dx.doi.org/10.3201/eid1002.030836
AMA Richards EP, Rathbun KC. Making State Public Health Laws Work for SARS Outbreaks. Emerging Infectious Diseases. 2004;10(2):356-357. doi:10.3201/eid1002.030836.
APA Richards, E. P., & Rathbun, K. C. (2004). Making State Public Health Laws Work for SARS Outbreaks. Emerging Infectious Diseases, 10(2), 356-357. https://dx.doi.org/10.3201/eid1002.030836.

Fear and Stigma: The Epidemic within the SARS Outbreak [PDF - 88 KB - 6 pages]
B. Person et al.

Because of their evolving nature and inherent scientific uncertainties, outbreaks of emerging infectious diseases can be associated with considerable fear in the general public or in specific communities, especially when illness and deaths are substantial. Mitigating fear and discrimination directed toward persons infected with, and affected by, infectious disease can be important in controlling transmission. Persons who are feared and stigmatized may delay seeking care and remain in the community undetected. This article outlines efforts to rapidly assess, monitor, and address fears associated with the 2003 severe acute respiratory syndrome (SARS) epidemic in the United States. Although fear, stigmatization, and discrimination were not widespread in the general public, Asian-American communities were particularly affected.

EID Person B, Sy F, Holton K, Govert B, Liang A, Garza B, et al. Fear and Stigma: The Epidemic within the SARS Outbreak. Emerg Infect Dis. 2004;10(2):358-363. https://dx.doi.org/10.3201/eid1002.030750
AMA Person B, Sy F, Holton K, et al. Fear and Stigma: The Epidemic within the SARS Outbreak. Emerging Infectious Diseases. 2004;10(2):358-363. doi:10.3201/eid1002.030750.
APA Person, B., Sy, F., Holton, K., Govert, B., Liang, A., Garza, B....Zauderer, L. (2004). Fear and Stigma: The Epidemic within the SARS Outbreak. Emerging Infectious Diseases, 10(2), 358-363. https://dx.doi.org/10.3201/eid1002.030750.

Crisis Prevention and Management during SARS Outbreak, Singapore [PDF - 47 KB - 5 pages]
S. R. Quah and L. Hin-Peng

We discuss crisis prevention and management during the first 3 months of the severe acute respiratory syndrome (SARS) outbreak in Singapore. Four public health issues were considered: prevention measures, self-health evaluation, SARS knowledge, and appraisal of crisis management. We conducted telephone interviews with a representative sample of 1,201 adults, ≥21 years of age. We found that sex, age, and attitude (anxiety and perception of open communication with authorities) were associated with practicing preventive measures. Analysis of Singapore’s outbreak improves our understanding of the social dimensions of infectious disease outbreaks.

EID Quah SR, Hin-Peng L. Crisis Prevention and Management during SARS Outbreak, Singapore. Emerg Infect Dis. 2004;10(2):364-368. https://dx.doi.org/10.3201/eid1002.030418
AMA Quah SR, Hin-Peng L. Crisis Prevention and Management during SARS Outbreak, Singapore. Emerging Infectious Diseases. 2004;10(2):364-368. doi:10.3201/eid1002.030418.
APA Quah, S. R., & Hin-Peng, L. (2004). Crisis Prevention and Management during SARS Outbreak, Singapore. Emerging Infectious Diseases, 10(2), 364-368. https://dx.doi.org/10.3201/eid1002.030418.

SARS Preparedness Checklist for State and Local Health Officials [PDF - 35 KB - 4 pages]
R. S. Hopkins et al.

A planning checklist for widespread severe acute respiratory syndrome, modeled on an Association of State and Territorial Health Officials (ASTHO) pandemic influenza planning checklist, was developed jointly by ASTHO, the National Association of County and City Health Officials, and the Centers for Disease Control and Prevention. This checklist, distributed May, 2003, has been widely used.

EID Hopkins RS, Misegades L, Ransom J, Lipson L, Brink EW. SARS Preparedness Checklist for State and Local Health Officials. Emerg Infect Dis. 2004;10(2):369-372. https://dx.doi.org/10.3201/eid1002.030729
AMA Hopkins RS, Misegades L, Ransom J, et al. SARS Preparedness Checklist for State and Local Health Officials. Emerging Infectious Diseases. 2004;10(2):369-372. doi:10.3201/eid1002.030729.
APA Hopkins, R. S., Misegades, L., Ransom, J., Lipson, L., & Brink, E. W. (2004). SARS Preparedness Checklist for State and Local Health Officials. Emerging Infectious Diseases, 10(2), 369-372. https://dx.doi.org/10.3201/eid1002.030729.

Body Temperature Monitoring and SARS Fever Hotline, Taiwan [PDF - 68 KB - 4 pages]
S. C. Kaydos-Daniels et al.

In Taiwan, a temperature-monitoring campaign and hotline for severe acute respiratory syndrome (SARS) fever were implemented in June 2003. Among 1,966 calls, fever was recorded in 19% (n = 378); 18 persons at high risk for SARS were identified. In a cross-sectional telephone survey, 95% (n = 1,060) of households knew about the campaign and 7 households reported fever.

EID Kaydos-Daniels SC, Olowokure B, Chang H, Barwick RS, Deng J, Lee M, et al. Body Temperature Monitoring and SARS Fever Hotline, Taiwan. Emerg Infect Dis. 2004;10(2):373-376. https://dx.doi.org/10.3201/eid1002.030748
AMA Kaydos-Daniels SC, Olowokure B, Chang H, et al. Body Temperature Monitoring and SARS Fever Hotline, Taiwan. Emerging Infectious Diseases. 2004;10(2):373-376. doi:10.3201/eid1002.030748.
APA Kaydos-Daniels, S. C., Olowokure, B., Chang, H., Barwick, R. S., Deng, J., Lee, M....Maloney, S. A. (2004). Body Temperature Monitoring and SARS Fever Hotline, Taiwan. Emerging Infectious Diseases, 10(2), 373-376. https://dx.doi.org/10.3201/eid1002.030748.

Health Communication during SARS [PDF - 68 KB - 4 pages]
P. M. Arguin et al.

During the severe acute respiratory syndrome (SARS) outbreak, electronic media made it possible to disseminate prevention messages rapidly. The Centers for Disease Control and Prevention’s Travelers’ Health Web site was frequently visited in the first half of 2003; more than 2.6 million visits were made to travel alerts, advisories, and other SARS-related documents.

EID Arguin PM, Navin AW, Steele SF, Weld LH, Kozarsky PE. Health Communication during SARS. Emerg Infect Dis. 2004;10(2):377-380. https://dx.doi.org/10.3201/eid1002.030812
AMA Arguin PM, Navin AW, Steele SF, et al. Health Communication during SARS. Emerging Infectious Diseases. 2004;10(2):377-380. doi:10.3201/eid1002.030812.
APA Arguin, P. M., Navin, A. W., Steele, S. F., Weld, L. H., & Kozarsky, P. E. (2004). Health Communication during SARS. Emerging Infectious Diseases, 10(2), 377-380. https://dx.doi.org/10.3201/eid1002.030812.
Volume 10, Number 2—February 2004 - Continued

Commentaries

Wresting SARS from Uncertainty [PDF - 94 KB - 4 pages]
J. R. Lingappa et al.
EID Lingappa JR, McDonald LC, Simone P, Parashar UD. Wresting SARS from Uncertainty. Emerg Infect Dis. 2004;10(2):167-170. https://dx.doi.org/10.3201/eid1002.031032
AMA Lingappa JR, McDonald LC, Simone P, et al. Wresting SARS from Uncertainty. Emerging Infectious Diseases. 2004;10(2):167-170. doi:10.3201/eid1002.031032.
APA Lingappa, J. R., McDonald, L. C., Simone, P., & Parashar, U. D. (2004). Wresting SARS from Uncertainty. Emerging Infectious Diseases, 10(2), 167-170. https://dx.doi.org/10.3201/eid1002.031032.

The Impressive and Rapidly Expanding Knowledge Base on SARS [PDF - 156 KB - 2 pages]
J. M. Hughes
EID Hughes JM. The Impressive and Rapidly Expanding Knowledge Base on SARS. Emerg Infect Dis. 2004;10(2):171-172. https://dx.doi.org/10.3201/eid1002.031043
AMA Hughes JM. The Impressive and Rapidly Expanding Knowledge Base on SARS. Emerging Infectious Diseases. 2004;10(2):171-172. doi:10.3201/eid1002.031043.
APA Hughes, J. M. (2004). The Impressive and Rapidly Expanding Knowledge Base on SARS. Emerging Infectious Diseases, 10(2), 171-172. https://dx.doi.org/10.3201/eid1002.031043.

Global Surveillance, National Surveillance, and SARS [PDF - 49 KB - 3 pages]
D. L. Heymann and G. Rodier
EID Heymann DL, Rodier G. Global Surveillance, National Surveillance, and SARS. Emerg Infect Dis. 2004;10(2):173-175. https://dx.doi.org/10.3201/eid1002.031038
AMA Heymann DL, Rodier G. Global Surveillance, National Surveillance, and SARS. Emerging Infectious Diseases. 2004;10(2):173-175. doi:10.3201/eid1002.031038.
APA Heymann, D. L., & Rodier, G. (2004). Global Surveillance, National Surveillance, and SARS. Emerging Infectious Diseases, 10(2), 173-175. https://dx.doi.org/10.3201/eid1002.031038.
Letters

SARS Epidemic in the Press [PDF - 284 KB - 2 pages]
I. Superiore di Sanità et al.
EID Superiore di Sanità I, Rezza G, Marino R, Farchi F, Taranto M. SARS Epidemic in the Press. Emerg Infect Dis. 2004;10(2):381-382. https://dx.doi.org/10.3201/eid1002.030743
AMA Superiore di Sanità I, Rezza G, Marino R, et al. SARS Epidemic in the Press. Emerging Infectious Diseases. 2004;10(2):381-382. doi:10.3201/eid1002.030743.
APA Superiore di Sanità, I., Rezza, G., Marino, R., Farchi, F., & Taranto, M. (2004). SARS Epidemic in the Press. Emerging Infectious Diseases, 10(2), 381-382. https://dx.doi.org/10.3201/eid1002.030743.

SARS-associated Coronavirus Infection in Teenagers [PDF - 286 KB - 2 pages]
G. Yang et al.
EID Yang G, Lin S, Liao K, Lee J, Wang L. SARS-associated Coronavirus Infection in Teenagers. Emerg Infect Dis. 2004;10(2):382-383. https://dx.doi.org/10.3201/eid1002.030485
AMA Yang G, Lin S, Liao K, et al. SARS-associated Coronavirus Infection in Teenagers. Emerging Infectious Diseases. 2004;10(2):382-383. doi:10.3201/eid1002.030485.
APA Yang, G., Lin, S., Liao, K., Lee, J., & Wang, L. (2004). SARS-associated Coronavirus Infection in Teenagers. Emerging Infectious Diseases, 10(2), 382-383. https://dx.doi.org/10.3201/eid1002.030485.
About the Cover

Liu Sung-nien (1174–1224), Sung Dynasty. Lohan (1207) [PDF - 1.36 MB - 1 page]
P. Potter
EID Potter P. Liu Sung-nien (1174–1224), Sung Dynasty. Lohan (1207). Emerg Infect Dis. 2004;10(2):387. https://dx.doi.org/10.3201/eid1002.ac1002
AMA Potter P. Liu Sung-nien (1174–1224), Sung Dynasty. Lohan (1207). Emerging Infectious Diseases. 2004;10(2):387. doi:10.3201/eid1002.ac1002.
APA Potter, P. (2004). Liu Sung-nien (1174–1224), Sung Dynasty. Lohan (1207). Emerging Infectious Diseases, 10(2), 387. https://dx.doi.org/10.3201/eid1002.ac1002.
Conference Summaries

SARS Preparedness and Response Planning [PDF - 578 KB - 2 pages]
U. D. Parashar and L. J. Anderson
EID Parashar UD, Anderson LJ. SARS Preparedness and Response Planning. Emerg Infect Dis. 2004;10(2):384-385. https://dx.doi.org/10.3201/eid1002.030803
AMA Parashar UD, Anderson LJ. SARS Preparedness and Response Planning. Emerging Infectious Diseases. 2004;10(2):384-385. doi:10.3201/eid1002.030803.
APA Parashar, U. D., & Anderson, L. J. (2004). SARS Preparedness and Response Planning. Emerging Infectious Diseases, 10(2), 384-385. https://dx.doi.org/10.3201/eid1002.030803.
Corrections

Correction, Vol. 10, No. 1 [PDF - 254 KB - 1 page]
EID Correction, Vol. 10, No. 1. Emerg Infect Dis. 2004;10(2):385. https://dx.doi.org/10.3201/eid1002.c11002
AMA Correction, Vol. 10, No. 1. Emerging Infectious Diseases. 2004;10(2):385. doi:10.3201/eid1002.c11002.
APA (2004). Correction, Vol. 10, No. 1. Emerging Infectious Diseases, 10(2), 385. https://dx.doi.org/10.3201/eid1002.c11002.
Page created: July 10, 2012
Page updated: July 10, 2012
Page reviewed: July 10, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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