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Closing in on the cause of SARS


James Hughes, of the Centers for evidence of infection with the virus in electron-microscopic studies on
Disease Control and Prevention 45 of 50 Hong Kong patients with infected material “suggest that
(CDC; Atlanta, GA, USA), doesn’t SARS but no controls (Lancet online coronavirus is highly correlated with
think SARS (severe acute respiratory April 8, http://www.thelancet.com/ SARS infection” but who found
syndrome) has the ability to become a journal/vol361/iss9364/full/llan.361.93 human metapneumovirus in some
pandemic. But he said on April 4 that 64.early_online_publication.25242.1). specimens, adds that “we have limited
“we haven’t heard the end of this. We information about the nature of
have to stay tuned and treat it as the coronavirus, so it is hard to speculate
public-health threat that it is”. about its infectivity”. WHO says that
The number of cases worldwide is three types of diagnostic test
still relatively small—2722, with 106 available—ELISA, an immunofluor-
deaths at April 9. But since Feb 15, escence assay, and a PCR molecular
when the first patient in Hong Kong test—“all have limitations as tools for
fell fatally ill with non-typical bringing the SARS outbreak quickly
pneumonia that was later identified as under control”. Nevertheless, David
a previously unrecognised infection, Heymann, executive director of
SARS has been spread by air travellers communicable diseases at WHO,
to 16 other countries, including concedes that a definitive test is
Vietnam, Singapore, Thailand, the “weeks, rather than months” away.
USA, Canada, and the UK, leading the Hong Kong appeared to be the
WHO, for the first time in its history, main focus of SARS infection until the
to recommend that travellers avoid end of February, when China admitted
specific geographical areas (Hong to having had 300 cases and five deaths
Kong and Guangdong Province, from non-typical pneumonia since
China) except for essential business. Thin-section electron micrograph of of human November in Guangdong Province—
pneumonia-associated coronavirus infected
The USA has introduced compulsory the home of Hong Kong’s index
cells. Reproduced from Peiris et al. Lancet.
quarantine for SARS patients, ranking Published online April 8, 2003 patient. China now accounts for about
the infection alongside smallpox and half of all cases (1280 of the 2722 as at
cholera. Human metapneumovirus (a para- April 9). If Guangdong is where SARS
SARS carries a 4% mortality, and it myxovirus) has been isolated in some started, could the common practice
can kill otherwise healthy adults, outbreaks, including the Canadian there of keeping fowl and other
including a 46-year-old WHO one, where it was seen in four of domestic animals in the house be the
physician who identified Vietnam’s five coronavirus-positive specimens key? Virologist John Oxford (Queen
first case of SARS. Several cases in the (N Engl J Med online March 31, Mary College, University of London,
early days of the Hong Kong outbreak http://content.nejm.org/cgi/reprint/N UK) says, “There is a good chance that
were in health-care workers and family EJMoa030634v2.pdf). Chlamydia has the SARS virus, like H5N1 influenza,
contacts. At present there is no specific also been reported in some SARS crossed species from chickens or
treatment. The agent seems to be patients in China, but its significance is animals to man”.
transmitted by droplets or by direct or unclear. Peiris et al, who found no If anything good has come out of
indirect contact, but airborne and evidence of human metapneumovirus the arrival of SARS it is the
faecal-oral transmission have not been infection, conclude: “It is highly likely demonstration that WHO and its
ruled out. According to WHO the that this coronavirus is either the cause partners in the Global Outbreak Alert
incubation period is 3–10 days. of SARS or a necessary prerequisite for and Response Network are capable of
The primary agent of SARS seems disease progression”. They suggest that rapid response and international
to be a new coronavirus, not closely other viruses may act as “opportunistic collaboration on an unprecedented
related to coronavirus types 229E secondary invaders to increase the scale. “Other new diseases will emerge
and OC43 that cause the common disease progression”. in the future”, says Guenael Rodier,
cold. CDC scientists were the first to As we go to press SARS must still director of WHO’s Communicable
link the novel virus to SARS be diagnosed clinically, but virologist Disease Surveillance and Response.
(http://www.cdc.gov/mmwr/ Maria Zambon at the Public Health “We will respond just as we have with
preview/mmwrhtml/mm5212a1.htm), Laboratory Service (London, UK), one SARS—with maximum efforts to
and other laboratories soon confirmed of WHO’s network of 11 laboratories contain its spread.” Hughes, at CDC,
this finding. Malik Peiris’ team at the that have been racing since March 17 sees the SARS experience as “a fire drill
University of Hong Kong (see page to identify the cause of SARS, claims to for a number of things”, be it the next
309), using serological and a reverse- be on the verge of having a reliable influenza pandemic or a bioterrorist
transcriptase PCR assays specific for “first-generation” diagnostic test for attack.
the novel coronavirus, have found SARS. Zambon, whose PCR and Dorothy Bonn

268 THE LANCET Infectious Diseases Vol 3 May 2003 http://infection.thelancet.com

For personal use. Only reproduce with permission from The Lancet Publishing Group.

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