Table of contents :

• 17 out of 940 blood samples that had originally been collected in Hong Kong in 2001 for a research project on hepatitis B carried antibodies either to the human SARS coronavirus, to a closely related animal coronavirus, or to both, indicating that the Hong Kong inhabitants were exposed to SARS or to one of its animal cousins 18 months before the disease was known or named. Such infections probably came from a market animal or an environment contaminated by animal viruses^ref. A 2003 study showed that 70% of civet cats were SARS-CoV carriers, but about 40% of people trading in wild animals in the Chinese markets also carried antibodies to SARS
• an epidemic appeared in 7 municipalities of Guangdong province (China) since 16 November 2002. The outbreak wasn't caused by a single species jump : 11 people apparently were independently infected in the Pearl River Delta area of Guangdong Province, where exotic animals are part of the diet, beginning in November 2002. 7 of these cases had documented contact with wild animals. 2 major genotypes predominated, whose sequences were similar to those of coronaviruses found in some captive civets^ref. The first case of SARS was reported in Foshan and HeYuan city, an industrial and fish-farming city, population 3.5 million, 20 km from Guangzhou city. However the medical professor Xie JinKui in RenMin hospital of HeYuan county said that the first case was detected on 17th of Dec 2002 in a 35 year old man, a cook in ShenZhen, working in a restaurant where he has close contact with wild animals, such as snakes : before he visited RenMin hospital in HeYuan, he went to FuTian hospital in ShenZhen on 15th of Dec, 2002. Prof. Xie emphasized that the patient's health was very bad when he was first sent to RenMin hospital (high fever, dyspnea, and shadows in chest X-ray test). On the 2nd day, the patient was sent to the GuangZhou Military hospital, where he infected serveral medical staffs. Furthermore, his wife and 2 sisters were also infected. Prof. Xie said that the first case of HeYuan is from ShenZhen. From the medical record, several original patients have close relationships with wild animals : some of them are cooks and some of them are providers of wild animals to restaurants. Prof. Xie said at last that HeYuan is the first county who reported SARS to Guangdong local medical officials. But he emphasised that this does not mean that SARS is originating from HeYuan. After the talk with Prof. Xie, reporters of Ming Bao also visited the FuTian hospital in Shenzhen. And they did find the record of the patient that Prof. Xie mentioned, but the date was 20th August, 2002, not 15th Dec, 2002. Finally they even found the patient himself: he admitted that he got pneumonia last year, but refused to give more details. In Guangdong, the habit to eat all kinds of wild food is widely spread, and might have indeed an importance in the transfer of animal viruses to humans. Rumors about the disease were rife, causing a run on herbal medicines and price-gouging on white vinegar, heralded as deadly to the infective agent, whatever it was. The evolution of the spike protein from its animal to human attack mode began in mid-November 2002 and was complete by the end of February 2003, a mere 15 weeks later : as the virus perfected its human attack mechanism, its potency soared from being able to infect only 3% of the people who came in contact with a patient to an infectivity rate of 70% a few months later. Then came the outbreak's "middle phase", started with the first "super-spreader event (SSE)", associated with more than 130 primary and secondary infections in January 2003 in the city of Guangzhou. The late phase involved an outbreak in Hong Kong, traced to a physician who worked with patients in Guangzhou who visited Hotel M. During the second phase, the SARS-CoV sequences contained a new 29-nucleotide deletion affecting the S protein (which is responsible for virus-host interactions), that dominated the viral population for the rest of the epidemic : the epidemic started and ended with deletion events together with a progressive slowing of the non-synonymous mutation rates and a common genotype that predominated during the latter part of the epidemic. In one of its earliest reports about cases of atypical pneumonia to WHO, the Chinese Ministry of Health reported 305 cases (105 of them medical workers and 200 household contacts of patients) and 5 deaths, from mid-November to 9 February, in 6 municipalities: Foshan, Guangzhou, Heyuan, Jiangmen, Shenzhen, and Zhongshan. Guangzhou was the home of the 64-year old professor of nephrology Liu Jianlun, at Zhongshan University, who is thought to be the index case who sparked the outbreak in Hong Kong. During late February, he stayed in room 911 on the ninth floor of the Metropole Hotel (nowadays it has been assigned the number 913 and every subsequent odd-numbered room has had its number changed too). 16 guests and visitors from Hong Kong, Toronto and Singapore staying on the hotel’s 9th floor sparked outbreaks in other countries when they returned to their homes. A 48-year-old American businessman, who also stayed on the 9th floor, is believed to have originated the outbreaks in Hanoi and in Hong Kong’s Princess Margaret Hotel, where he was transferred. One local Hong Kong resident, who visited an acquaintance on the ninth floor, subsequently sparked an outbreak in a second Hong Kong hospital. Esther Mok went to Hong Kong to shop but came home carrying a deadly flu-like virus that has since spread to more than 100 people in Singapore and killed both of her parents and her pastor. Miraculously, she has survived. Mok, a 26-year-old former flight attendant, was one of 3 original cases of severe acute respiratory syndrome, or SARS, to emerge in Singapore early last month. Mok was very sick — and very contagious — when admitted to a Singapore hospital on March 1, but doctors had no idea that she was suffering from the strange form of pneumonia that had already killed dozens in China. She had regular visits from her family and members of her church — all oblivious to the fact that they were exposing themselves to SARS. Her father, mother and pastor have since died of SARS. Her uncle is in intensive care battling the illness. Mok's grandmother and brother are also sick but in stable condition. In fact, all but a handful of the 118 reported cases in Singapore have been traced to Mok, and health officials have dubbed her a SARS "super spreader". It remains unknown whether such “super-spreaders” are persons secreting an exceptionally high amount of infectious material or whether some other factor, perhaps in the environment, is working to amplify transmission at some key phase of virus shedding. 2 other Singaporean women also traveled to Hong Kong in February and developed SARS after exposure to a Chinese doctor, Liu Jianjun, while staying at the Metropole Hotel. They have not infected others. 2 other so-called super spreaders, Canadian Kwan Siu-Chiu and American Chinese businessman Johnny Chen, fell ill after a stay at the Metropole hotel and have helped spread the illness around the world. Unlike Mok, both died. Jiang Yanyong of the People's Liberation Army General Hospital (known as Hospital 301) claimed that at one Beijing hospital alone, more than 60 SARS patients had been admitted and at least 7 had died. The statement to Time magazine said that 2 People's Liberation Army hospitals were now treating SARS patients--hospitals 309 and 302--and Hospital 309 is already full to capacity. On 28 February 806 cases and 34 deaths, on 7 August, 5327 cases, 34 deaths (CFR ~ 7 %) and 4949 recovered (93.7%). Chinese mainland's last 2 SARS patients were discharged from hospital on August 16 in Beijing after more than 100 days of medical treatment. Since 16 Dec 2003 there have been 4 other laboratory confirmed cases in Guangdong Province : all 4 patients have recovered from their illness and have been discharged from the hospital (none of their contacts have developed SARS-like illness) :
• on December 27, 2003 a 32-year-old man (a freelance TV station worker who lived in Panyu District of Guangzhou, capital of Guangdong Province) who has been receiving treatment in quarantine in south China's Guangdong Province was confirmed to be a suspected case on the basis of unspecified rise in neutralizing antibody titre in consecutive samples of the patent's blood, usually a specific and unequivocal diagnostic test : however, as yet there is no confirmation that an infectious SARS-coronavirus has been isolated from this patient. This circumstance, in conjunction with the absence of spread to contacts, suggests that  the patient's virus load may have been low, perhaps as a consequence of a low level of pre-existing immunity from previous exposure in the spring of 2003 but, due to internally developing antibodies, may not have shown any symptoms until now. He began to have a fever and headache in the evening of 16 Dec and went to see a doctor at No. 1 Hospital affiliated to Zhongshan University on 20 Dec. He was diagnosed as pneumonia with the right lower lung and was quarantined for treatment. The patient was transferred to the quarantine ward of Guangzhou No. 8 People's Hospital on 24 Dec and was released on Jan 8. Earlier, he had told the Chinese media that he had never eaten civet, and that his only contact with wild game was with a mouse. He apparently threw a mouse out a window at some point before he became ill. One Guangdong newspaper quoted him as saying he had handled the mouse with chopsticks. Laboratory tests have shown that some of the rats caught in his apartment also tested positive for SARS. No further transmission.
• a 20-years old waitress from Henan province who works at a seafood restaurant that apparently serves civet in Guangzhou was indicated as a suspected SARS case. State media said the waitress, a migrant worker from Henan Province, came down with a fever on 25 Dec 2003, went to a hospital on 31 Dec, and was discharged on Jan 2004. WHO found SARS-CoV in cages housing civet cats at a restaurant where one of China's 2 present suspected cases worked. No further transmission.
• a 35-year-old patient from Shenzhen (a Hong Kong-China border city with a large economic free zone) was admitted and isolated on 6 Jan 2004 after developing symptoms (probable case) on 31 Dec 2003 and was discharged from hospital on 21 Jan 2004. No further transmission
• a 40-year-old director of a hospital and practicing physician from Guangzhou, Guangdong Province who developed symptoms of SARS on 7 Jan 2004. He was admitted to a hospital in Guangdong with pneumonia on 16 Jan and placed in respiratory isolation on the suspicion of SARS. He has made a full recovery and was discharged home on 30 Jan. No further transmission
• Song Wei, a 26-year-old female medical student from Hefei, Anhui Province, who travellled on 6 Mar 2004 on the Hefei - Beijing line 1410 train. She studied from Mar 7 to Mar 22 in a viral morphology lab in the Beijing Center for Disease Control and Prevention, China, and became ill on 22 March : on 23 Mar she took the Beijing - Hefei T63 "inferior" train [?second class] to come back home. On 25 Mar she developed fever and on 27 Mar she took the Hefei - Beijing T64 "inferior" train of 17 compartments [?second class] back. What is not clear is whether the laboratory contamination was from a specimen from another as yet unidentified patient with SARS-CoV infection, or from research being conducted on the SARS-CoV during Feb and Mar. The method used for decontamination of the laboratory (1% NP40 + PBS + 1% SDS for 60 mins) had not been monitored. On 29 Mar she underwent a medical examination, was found to have pneumonia and was admitted to hospital at the Jiangong hospital. For reasons that are not clear, she was discharged from Jiangong on 2 Apr and returned with her mother to a hospital in Anhui Huai Nan by Beijing - Huai Nan 1409 train of 13 compartments. There, on 4 Apr she was transferred to the Anhui Medical College for continued treatment of viral pneumonia. She left the university hospital in the Anhui provincial capital of Hefei on May 11, after 15 consecutive days without fever: confirmation of SARS-CoV infection from an independent international reference laboratory is still pending
• beginning 31 Mar, her 53-years old mother, a medical doctor, continuously cared for and accompanied her and provided nursing care. On 8 Apr she developed a fever and was admitted to hospital in the Anjui Medical College Hospital with viral pneumonia. On 19 Apr, her mother worsened and died : this appears to be the 1st indication of classification as suspected case(s) of SARS. Upon receipt of notification of this death by the local medical department, the early warning mechanism was activated. On 21 Apr, the Anhui Province Disease Control center had IgG positive blood tests for SARS-CoV, this was reexamined by the Jiangsu Province Disease Control Center which also had IgM and IgG seropositivity. On the evening of 21 Apr, the Anhui Province Health Department reported the findings to the Medical Department. On the morning of 22 Apr, the Medical Department expert group rushed to Anhui. On 23 Apr the China Center for Disease Control senate compared the laboratory tests (IgG and IgM findings). The medical department expert group reviewed the 2 patients clinical courses/presentations, the laboratory examinations and the epidemiologic investigation and confirmed the diagnosis of atypical pneumonia in the index case from Anhui the graduate student and referred autopsy specimens for confirmation on the index case's mother. Analysis of a chest fluid sample identified a SARS-CoV (HT-SCoV-2) with a gene sequence consistent with that studied in the laboratory
• another 353  people in Anhui are under medical observation : 3 of them had been isolated with fever symptoms but none have developed signs of pneumonia, and 89 individuals have been released from observation
• a 20 year old nurse who cared for the index case from Anhui during the period 29 Mar to 2 Apr when the patient was in the Healthy Palace Hospital in Beijing has also fallen ill with SARS-like symptoms (fever, cough and shivering) in Beijing on 5 Apr and was admitted to Jiangong Hospital on 7 Apr. As her condition did not improve, she was transferred on 14 Apr to ICU of the Ditan Renmin Hospital attached to the Beijing University. A medical examination at the hospital showed that the patient was IgG positive on Wed 21 Apr. In the morning of Thu 22 Apr, an examination by the Beijing Center for Disease Prevention and Control (CDC) showed the patient was IgG and IgM positive. She is stable, now with 18 consecutive days without fever
• among 640 contacts placed under observation, 5 have developed symptoms of SARS and been isolated at Ditan Hospital : 3 are close relatives of the Beijing case and 2 are from the hospital contacts at the Earth Temple Hospital (one a patient and one a visitor caring for a patient). 99 individuals have been released from observation
• both the nurse's 44 year old mother (fever and no signs of pneumonia) and her 36 year old aunt (still in critical condition but appears to be improving) have been confirmed to have been infected with SARS-CoV based on IgM and IgG serologic findings :
• the nurse's 45-years father has a fever without signs of pneumonia
• 2 patients hospitalized on the same ward as either the nurse or the index patient have a fever and no signs of pneumonia
• one of them was reported by Beijing on Apr 27, a 49 year old woman, a retired doctor from Beijing Xuanwu district admitted to hospital because of another illness. On 9 Apr, she had a chest infection with fluid in the chest cavity and was admitted to the Xuanwu Hospital emergency medical treatment ward. 3 days later she was transferred to another hospital in Beijing when information became available that she had shared a hospital ward with the nurse who had cared for the index case. On 22 Apr bilateral pulmonary infiltrates were noted and she was transferred to Ditan Hospital for isolation. On 27 Apr she was diagnosed as a suspected case of SARS based on clinical and epidemiologic findings. At present the patient is in a serious condition with bilateral infiltrates and respiratory failure. Onset of symptoms for all 4 occurred between 16 and 19 Apr
• the retired doctor's 23 year old daughter-in-law, who accompanied her at the time of hospital admission, is the 5th case
• 2 doctors who treated the postgraduate student during her hospitalization in Hefai, Anhui, have developed fever. A person in close contact with one of the doctors has also developed fever
• a 31 year old male post-doctoral student in Beijing who worked alongside the 26 year old patient from Anhui in the lab was also suspected of having the disease : he fell ill on 17 Apr (the dates of symptom onset in the 2 cases were separated by 23 days, suggesting that more than one opportunity for exposure may have occurred in the laboratory from mid-March through early April), on 22 Apr he was admitted in isolation to the Ditan Earth Temple Hospital and on 23 Apr he was diagnosed as a suspected case of SARS. On 30 Apr, the Beijing Disease Control Center reported positive IgG and IgM serology on specimens from this patient and accordingly has reclassified this case as confirmed based on clinical, epidemiologic, and laboratory examinations.

Close contacts of this case have not demonstrated any signs of illness.
• that lab was closed on 23 Apr and the 200 staff were put in isolation in a hotel near another lab in Cham Ping, about 20 km North of Bei
• 2 laboratory workers in Beijing had suffered SARS-like illnesses in Feb 2004, recovered and went back to work : they weren't detected until they tested positive for SARS IgG when hundreds of lab workers were screened following the April outbreak traced to the same facility 2 months later killed one person. ne of the ill workers oversaw the inactivation of the virus, which should have made her a prime suspect for SARS
Hence, it appears that in the period 25 Mar through 19 Apr, the index case and her mother were clinically ill with probable SARS CoV infection, and were potentially infectious to others in their contact environment, including during 2 travels on trains between Beijing and Anhui province, and during hospitalization in general clinical care wards without isolation. No cases were further reported. This is now the 3rd incident of SARS transmission within a laboratory working on SARS research. The first 2 occurred in Singapore in September 2003 and Taiwan, China in December 2003. In addition, 4 cases (3 confirmed and 1 probable) were reported in Guangdong Province in December 2003 and January 2004, presumably acquired from an environmental source. Unlike the present outbreak, these cases were associated with mild illness only and did not result in secondary transmission to others. Since the 2003 outbreak, it seems as though laboratory exposure is a higher risk factor than the possible zoonotic exposure. During and after the SARS outbreak of 2003, a large number of specimens were collected from possible human cases, animals and the environment. These specimens, which may contain live SARS coronavirus, are still kept in various laboratories around the world. Some of them are stored in laboratories at an inappropriate containment level. SARS coronavirus has also been propagated in reference and research laboratories, and distributed to other laboratories for research purposes. Research using live and inactivated SARS coronavirus -­ and other pathogens capable of causing serious illness -- is being conducted in many laboratories. WHO strongly recommends BSL 3 as the minimum containment level to work with live SARS coronavirus. WHO also urges member states to maintain a thorough inventory of laboratories working with and/or storing live SARS coronavirus and to ensure that necessary biosafety standards are in place. The Chinese doctor who exposed China SARS cover-up last year has disappeared in what is believed to be part of a government crackdown on potential dissidents before the 15th anniversary of the Tiananmen Square massacre : Jiang Yanyong, who is also a leading democracy campaigner, was reported missing along with his wife by their daughter on June 4 2004. He is likely to be among dozens of people -- including elderly mothers, young dissidents and ailing reformers -- put under house arrest or taken out of Beijing by security agents.
Web resources :
• WHO biosafety guidelines for handling of SARS specimens (25 Apr 2003)
• Summary of the discussion and recommendations of the SARS laboratory workshop of 22 Oct 2003
• WHO post-outbreak biosafety guidelines for handling of SARS coronavirus specimens and cultures (18 Dec 2003)
The decision to kill up to 10,000 civet cats and other speciality-food creatures (including raccoon dogs, ferret badgers, hog badgers and Eurasian badgers) in the wildlife markets of the southern province of Guangdong came on 5 Jan 2004 : Guangdong’s wildlife markets were ordered closed, and the provincial Forestry Department put 2,030 presumably doomed civet cats in quarantine.
• Hong Kong Special Administrative Region (SAR) of China^{Ref1, Ref2} : 1755 cases, 300 deaths (CFR ~ 17 %) and 1448 recovered (81.4%). The Prince of Wales Hospital was the initial epicentre of the outbreak : hospitals are becoming overwhelmed and a decision to suspend all primary, secondary, special schools and kindergartens until 6 April has been extended up to 21 April. In Hong Kong, a large and sudden cluster of almost simultaneous cases (321) seen in residents of the Amoy Gardens housing estate has raised the possibility of transmission from an environmental source. The epidemic curve and spatial distribution of the cases are consistent with virus-laden aerosols spread from a single source^ref. The vast majority of Amoy Gardens cases have been traced to vertically linked apartments in a single building, Block E. In addition, reports from Hong Kong health authorities indicate that patients in this cluster depart in some ways from the previously established clinical picture. The disease appears to be more severe both in Amoy residents and in related cases among hospital staff. Around 20% of Amoy-related cases require intensive care, compared with 10% seen in non-Amoy cases. Some deaths are now occurring in younger, previously healthy persons as well as in the elderly and persons with underlying disease. Around 66% of Amoy Gardens patients present with diarrhea as a symptom, compared with 2% to 7% of cases in other outbreaks. Speculation centres on whether these cases represent infection with high virus loads, as might occur following exposure to a concentrated environmental source, or whether the virus may have mutated into a more virulent form (viruses in the Coronavirus family are known to mutate frequently) : alterations in the SARS coronavirus genome are unlikely to have caused the distinctive clinical features of the Amoy Gardens patients^ref
• Macao SAR of China : 1 case who recovered
• Taiwan : 665 cases, 180 deaths (CFR ~ 27%), 475 recovered
• a single case of infection with SARS coronavirus in a 44 year old Taiwanese senior male SARS research scientist at a Taipei military hospital (National Defence University, the only level P4 lab in Taiwan) was reported on December 17, 2003. 6 Dec 2003 was the last day he worked in the laboratory. He recalled an incident during the final cleaning after an experiment on SARS before his exit from the laboratory. In the negative-pressure transporting chamber -- a part of the biosafety containment facility for transporting experimental reagents in the laboratory -- he noted some spillage of waste medium in an area he could not reach with the attached chamber gloves. Before opening a Class III biological Safety Cabinet (a special transport cabinet), the principal investigator "inactivated" a spill using 70% ethanol instead of the time-consuming procedure recommended (H₂O₂) : he disinfected the area with alcohol spray and opened the chamber door to clean up the spilled medium -- an unusual process for him to carry out. In this case, the principal investigator was working alone at BSL-4. He worked excessive hours, and methods were not approved. There is also a major problem with a lack of understanding of chemical disinfection. Many scientific staff think that 70% ethanol is a good disinfectant (its use is not recommended except for bench decontamination in a relatively clean laboratory, and, certainly, not in a biological safety cabinet). The researcher had earlier travelled to Singapore from 7 to 10, but started to run a fever only hours after returning to taiwan : anyway Singapore ordered 70 people into quarantine. He began to feel unwell late on December 10 and placed himself in home quarantine. On December 16, he called an ambulance and was admitted to the hospital with a fever.
• Vietnam outbreak began on 26/2 when an American businessman was admitted to hospital shortly after arriving in Hanoi from China. 63 cases, 5 deaths (CFR ~ 8 %) and 58 recovered. It was declared SARS-free by WHO on 28/4, 20 consecutive days (the duration of two incubation periods) since the last new case was detected.
• Mongolia : 9 cases who recovered
• Russian Federation : 1 case who recovered
• India : 3 cases who recovered
• Singapore : 238 cases, 33 deaths (CFR ~ 14 %) and 205 recovered
• a doctor believed to be infected was taken off a New York-to-Singapore flight in Frankfurt, Germany on 15/3 and quarantined at Wolfgang Goethe University Clinic as well as 2 accompanying family members (his wife and another doctor) when they developed fever and respiratory symptoms several days later. As a result of this prompt action, Germany experienced no further spread linked to the 3 imported cases. Another 155 passengers who deplaned in Frankfurt were quarantined at the airport : German nationals were released while passengers in transit to other cities in Europe were awaiting travel permission from those countries. 85 people bound for Singapore and the plane's 20-member crew continued their journey but were to be quarantined upon arrival
• a super-spreader Chinese man in his 60s was treated at Singapore General Hospital from 5 to 20 March for chronic kidney disease and diabetes
• a 27-years old National University of Singapore virologist caught SARS at one of 2 Singapore BSL-3 laboratories where he worked and where SARS research is done due to inappropriate laboratory procedures and a cross-contamination of West Nile virus samples with SARS coronavirus : he tested positive on September 9 (the world's first reported case since the WHO declared a global outbreak of the disease over on July 5) and left hospital on September 16, diagnosed as healthy after a week without fever, sent home by ambulance to begin a 14-day quarantine. The Singapore incident is clearly documented on the Singapore Ministry of Health web-site. The main causes were, firstly, that the laboratory did not handle West Nile virus in the same way as SARS-CoV in the same BSL-3 laboratory. Secondly, there was little training of staff, and, finally, the laboratory procedures were not consistent with BSL-3 procedures, and significant breaches occurred when the accident took place. A major problem in all of these incidents has been the poor training of staff, and, improper operating procedures, rather than with accidents associated with containment. There would appear to be no justification for moving SARS-CoV to BSL-4, but, rather, a need for laboratory accreditation and proper training of staff. In virtually all of the laboratories there was little understanding of infection control and how to handle laboratory spills. This becomes of greater concern as molecular biologists move into these laboratories with little microbiology training.
• Malaysia : 5 cases, 2 deaths and 3 recovered
• Republic of Korea : 3 cases who recovered
• Indonesia : 2 cases who recovered
• Australia : 6 cases who recovered
• New Zealand : 1 case who recovered
• Canada^Ref : 251 cases, 43 deaths (CFR ~ 18 % !) and 200 recovered
• United States of America (USA) : 33 cases (CFR ~ 0 % !), 26 recovered
• Colombia : 1 case who recovered
• Brazil : 3 cases, 2 recovered
• Thailand : 9 cases, 2 deaths (including the WHO physician and infectious disease specialist Dr Carlo Urbani) and 7 recovered
• Philippines : 14 cases, 2 deaths, and 12 recovered
• Spain : 1 case who recovered
• United Kingdom : 4 cases who recovered
• Republic of Ireland : 1 case who recovered
• Sweden : 3 cases who recovered
• Finland : 1 case who recovered
• France : 7 cases, 1 death, and 6 recovered
• Germany : 9 cases who recovered
• Switzerland : 1 case who recovered
• Italy : 4 cases who recovered
• Romania : 1 case who recovered
• Kuwait : 1 case who recovered
• South Africa : 1 case who died

• SARS coronavirus AS
• SARS coronavirus BJ01 (Beijing)
• SARS coronavirus BJ02 (Beijing)
• SARS coronavirus BJ03 (Beijing)
• SARS coronavirus BJ04 (Beijing)
• SARS coronavirus BJ2232
• SARS coronavirus BJ302
• SARS Coronavirus CDC#200301157
• SARS coronavirus CUHK-AG01
• SARS coronavirus CUHK-AG02
• SARS coronavirus CUHK-AG03
• SARS coronavirus CUHK-L2
• SARS coronavirus CUHK-Su10 (Hong Kong)
• SARS coronavirus CUHK-WI (Hong Kong)
• SARS coronavirus cw037
• SARS coronavirus cw049
• SARS coronavirus FRA
• SARS coronavirus Frankfurt 1
• SARS coronavirus GD01
• SARS coronavirus GD03T0013
• SARS coronavirus GD322
• SARS coronavirus GD69
• SARS coronavirus GZ-A
• SARS coronavirus GZ-B
• SARS coronavirus GZ-C
• SARS coronavirus GZ-D
• SARS coronavirus GZ02 (from Guangzhou)
• SARS coronavirus GZ43 (from a 36-year-old female health-care worker from Guangzhou)
• SARS coronavirus GZ50 (from a 49-year-old female clerk from Guangzhou)
• SARS coronavirus GZ60 (from a 39-year-old male health-care worker from Guangzhou)
• SARS coronavirus HB
• SARS coronavirus HC/SZ/61/03
• SARS coronavirus HGZ8L1-A
• SARS coronavirus HGZ8L1-B
• SARS coronavirus HGZ8L2
• SARS coronavirus HHS-2004
• SARS coronavirus HKU-36871
• SARS coronavirus HKU-39849 (Hong Kong)
• SARS coronavirus HKU-65806
• SARS coronavirus HKU-66078
• SARS coronavirus Hong Kong/03/2003
• SARS coronavirus HPZ-2003
• SARS coronavirus HSR 1
• SARS coronavirus HSZ-A
• SARS coronavirus HSZ-Bb
• SARS coronavirus HSZ-Bc
• SARS coronavirus HSZ-Cb
• SARS coronavirus HSZ-Cc
• SARS coronavirus HSZ2-A
• SARS coronavirus HZS2-Bb
• SARS coronavirus HZS2-C
• SARS coronavirus HZS2-D
• SARS coronavirus HZS2-E
• SARS coronavirus HZS2-Fb
• SARS coronavirus HZS2-Fc
• SARS coronavirus JMD
• SARS coronavirus KYK (Singapore)
• SARS coronavirus LC1
• SARS coronavirus LC2
• SARS coronavirus LC3
• SARS coronavirus LC4
• SARS coronavirus LC5
• SARS coronavirus LLJ-2004
• SARS coronavirus NS-1
• SARS coronavirus PUMC01
• SARS coronavirus PUMC02
• SARS coronavirus PUMC03
• SARS coronavirus sf098
• SARS coronavirus sf099
• SARS coronavirus ShanghaiQXC1
• SARS coronavirus ShanghaiQXC2
• SARS coronavirus Shanhgai LY
• SARS coronavirus Sin0409
• SARS coronavirus Sin2500
• SARS coronavirus Sin2677
• SARS coronavirus Sin2679
• SARS coronavirus Sin2748
• SARS coronavirus Sin2774
• SARS coronavirus Sin3408
• SARS coronavirus Sin3408L
• SARS coronavirus Sin3725V
• SARS coronavirus Sin3765V
• SARS coronavirus Sin842
• SARS coronavirus Sin845
• SARS coronavirus Sin846
• SARS coronavirus Sin847
• SARS coronavirus Sin848
• SARS coronavirus Sin849
• SARS coronavirus Sin850
• SARS coronavirus Sin852
• SARS coronavirus Sin_WNV
• SARS coronavirus Sino1-11
• SARS coronavirus Sino3-11
• SARS coronavirus SinP1
• SARS coronavirus SinP2
• SARS coronavirus SinP3
• SARS coronavirus SinP4
• SARS coronavirus SinP5
• SARS coronavirus SoD
• SARS coronavirus SZ1
• SARS coronavirus SZ3
• SARS coronavirus SZ13
• SARS coronavirus SZ16
• SARS coronavirus Taiwan
• SARS coronavirus Taiwan JC-2003
• SARS coronavirus Taiwan TC1
• SARS coronavirus Taiwan TC2
• SARS coronavirus Taiwan TC3
• SARS coronavirus TJF
• SARS coronavirus Tor2 (Toronto)
• SARS coronavirus TW
• SARS coronavirus TW-GD1
• SARS coronavirus TW-GD2
• SARS coronavirus TW-GD3
• SARS coronavirus TW-GD4
• SARS coronavirus TW-GD5
• SARS coronavirus TW-HP1
• SARS coronavirus TW-HP2
• SARS coronavirus TW-HP3
• SARS coronavirus TW-HP4
• SARS coronavirus TW-JC2
• SARS coronavirus TW-KC1
• SARS coronavirus TW-KC3
• SARS coronavirus TW-PH1
• SARS coronavirus TW-PH2
• SARS coronavirus TW-YM1
• SARS coronavirus TW-YM2
• SARS coronavirus TW-YM3
• SARS coronavirus TW-YM4
• SARS coronavirus TW1
• SARS coronavirus TW2
• SARS coronavirus TW3
• SARS coronavirus TW4
• SARS coronavirus TW5
• SARS coronavirus TW6
• SARS coronavirus TW7
• SARS coronavirus TW8
• SARS coronavirus TW9
• SARS coronavirus TW10
• SARS coronavirus TW11
• SARS coronavirus TWC
• SARS coronavirus TWC2
• SARS coronavirus TWC3
• SARS coronavirus TWH
• SARS coronavirus TWJ
• SARS coronavirus TWK
• SARS coronavirus TWS
• SARS coronavirus TWY
• SARS coronavirus Urbani (Hanoi/Bangkok)
• SARS coronavirus Vietnam
• SARS coronavirus WHU
• SARS coronavirus xw002
• SARS coronavirus ZJ-HZ01
• SARS coronavirus ZJ01
• SARS coronavirus ZMY 1
• SARS coronavirus ZS-A
• SARS coronavirus ZS-B
• SARS coronavirus ZS-C

• orf1ab [putative polymerase gene]:
• 3047 V to A [Val to Ala] in BJ01, BJ02, BJ03, CUHK-W1
• 3072 V to A [Val to Ala] in CUHK-W1
• 3196 A to V [Ala to Val} in BJ01, BJ02, BJ03
• 5768 D to E [Asp to Glu] in BJ01, BJ02, BJ03, BJ04, GZ01, CUHK-W1
• E2 [putative glycoprotein gene]:
• 77 G to D [Gly to Asp] in BJ03, CUHK-W1
• 244 T to I [Thr to Ile] in BJ01, BJ02, BJ03, BJ04, GZ01, CUHK-W1
• 577 A to S [Ala to Ser] in KYK, BJ01, GZ01
• N [putative nucleoprotein gene] : 387 N to P [Asn to Pro] in GZ01, BJ02

• mammalian orthoreovirus (63% of patients; 0.03% of controls) : preliminary animal experiments showed that inoculation of the orthoreovirus into mice caused death with
• atypical pneumonia
• HMPV has been identified in 12% of SARS patients^Ref, but, on the contrary of the coronavirus, it doesn't satisfy first Koch's postulate
• unclassified paramyxovirus
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae

• structural proteins :
• nucleocapsid
• small envelope proteins
• SARS E2-spike protein has a superantigen (SAg) in the region of 690 to about 1050 residues. Using carbohydrate microarrays, the carbohydrate binding activity of SARS-CoV neutralizing antibodies elicited by an inactivated SARS-CoV vaccine has been characterized. In these antibodies, undesired autoantibody reactivity specific for the carbohydrate moieties of an abundant human serum glycoprotein asialo-orosomucoid (ASOR) has been detected. This observation provides important clues for the selection of specific immunologic probes to examine whether SARS-CoV expresses antigenic structures that mimic the host glycan. Lectin PHA-L (Phaseolus vulgaris L.), which is specific for a defined complex carbohydrate of ASOR, stained the SARS-CoV-infected cells specifically and intensively. A carbohydrate structure of SARS-CoV shares antigenic similarity with host glycan complex carbohydrates^ref
• membrane (M) protein is predicted to contain a triple-spanning transmembrane (TM) region, a single N-glycosylation site near its N-terminus that is in the exterior of the virion, and a long C-terminal region in the interior. The M protein harbors a higher substitution rate (0.6% correlated to its size) among viral open reading frames (ORFs) from published data. The 4 substitutions detected in the M protein, which cause non-synonymous changes, can be classified into 3 types
• changes of pI (isoelectric point) and charge, affecting antigenicity
• changes hydrophobicity of the TM region
• relates to hydrophilicity of the interior structure.
Phylogenetic tree building based on the variations of the M protein appears to support the non-human origin of SARS-CoV. To investigate its immunogenicity, 8 oligopeptides covering 69.2% of the entire ORF were synthesized and screened by using ELISA with sera from SARS patients : the results confirmed predictions on antigenic sites^ref.
• hypothetical proteins :
• SARS3a
• SARS3b
• SARS6
• SARS7a
• SARS9b

• CD13 / aminopeptidase N
• angiotensin-converting enzyme 2 (ACE2) binds the S1 domain of S protein.
• a section of '3C-like protease', the protein that causes SARS virus to multiply in humans, must be 'switched on' before replication can occur. A possible mechanism for the extensive damage seen in the major target organs for this disease involves cell entry mechanisms :
• endosomal pathway
• proteases such as trypsin and thermolysin enabled SARS-CoV adsorbed onto the cell surface to enter cells directly from that site. The protease-mediated entry facilitated a 100- to 1,000-fold higher efficient infection than did the endosomal pathway used in the absence of proteases. These results suggest that the proteases produced in the lungs by inflammatory cells are responsible for high multiplication of SARS-CoV, which results in severe lung tissue damage. Likewise, elastase, a major protease produced in the lungs during inflammation, also enhanced SARS-CoV infection in cultured cells^ref.

• Chinese horseshoe bats (Rhinolophus sinicus) a CoV closely related to SARS-CoV (bat-SARS-CoV) was isolated from 23 (39%) of 59 anal swabs by using RT-PCR. Sequencing and analysis of three bat-SARS-CoV genomes from samples collected at different dates showed that bat-SARS-CoV is closely related to SARS-CoV from humans and civets. Phylogenetic analysis showed that bat-SARS-CoV formed a distinct cluster with SARS-CoV as group 2b CoV, distantly related to known group 2 CoV. Most differences between the bat-SARS-CoV and SARS-CoV genomes were observed in the spike genes, ORF 3 and ORF 8, which are the regions where most variations also were observed between human and civet SARS-CoV genomes. In addition, the presence of a 29-bp insertion in ORF 8 of bat-SARS-CoV genome, not in most human SARS-CoV genomes, suggests that it has a common ancestor with civet SARS-CoV. Antibody against recombinant bat-SARS-CoV nucleocapsid protein was detected in 84% of Chinese horseshoe bats by using an enzyme immunoassay. Neutralizing antibody to human SARS-CoV also was detected in bats with lower viral loads. Precautions should be exercised in the handling of these animals^ref. The researchers could not determine how the bats were originally infected or whether bats were responsible for transmitting the SARS coronavirus to other mammals including the civets. But because bat feces are used in Chinese traditional medicine, and bat meat is considered a delicacy in parts of Asia, the researchers suggest caution in handling them. 3 species of horseshoe bat of the genus Rhinolophus are a natural host of coronaviruses closely related (92% similarity) to those responsible for the SARS outbreak. These viruses, termed SARS-like coronaviruses (SL-CoV), display greater genetic variation than SARS-CoV isolated from humans or civets. The human and civet isolates of SARS-CoV nestle phylogenetically within the spectrum of SL-CoVs, indicating that the virus responsible for the SARS outbreak was a member of this coronavirus group^ref. This virus cannot infect humans : one of the big questions is, then, how the virus jumped from bats to humans -- and whether in the body of an intermediary, such as the civet, it can adapt in such a way that it can then infect a human
• caged masked palm civets or civet cats (Paguma larvata) : the civet may have served only as an amplification host for SARS-CoV and provided the environment for major genetic variations permitting efficient animal-to human and human-to-human transmissions
• raccoon dogs (Nyctereutes procyonoides)
• Chinese ferret badger (Melogale moschata) ?
• foxes (Vulpes spp.)
• rats (Rattus rattus) : however, this does not necessarily mean that the rats are the definitive source. The result may have been caused by some other strain of coronavirus carried by the rats, since there is a slight difference from the kind that caused the SARS outbreak in human beings in the spring of 2003. In fact, other strains have been found in rats, as well as in other animals long before the new case emerged
• ferrets (Mustela putorius furo) and cats (Felis catus) are susceptible to infection by SARS coronavirus and they can efficiently transmit the virus to previously uninfected animals that are housed with them^ref : anyway both are unlikely to be the reservoir (ferrets densities are likely too low to support an enzootic cycle of SCV transmission and the ferret species examined does not naturally occur in China; cats would have caused human cases of SARS over a broad geographic area long before had it been the host). In April 2004 a Chinese team tested thousands of people for SARS antibodies in 16 cities in Guangdong and found that among 994 people working in animal markets, 10.6% carried positive antibodies, and among 123 civet cat husbandry staff, only 3.25% tested positive.
• all the 6 index cases in 4 cities in Guandong had either eaten wildlife, or had dealt with wildlife, particularly snakes, 10 days before they fell ill
• 17 of the 18 complete sequences of isolates of the human SARS coronavirus exhibit the same 29-nucleotide deletion (5'-CCTACTGGTTACCAACCTGAATGGAATAT -3', residue 27869 to 27897, at 246 nucleotides upstream of the start codon of the N gene) relative to the genome sequences of at least 2 Prionailurus viverrinus (a.k.a. Felis viverrinus, fishing cat) coronavirus -- and 1 of the 18 human isolates (the GZ01 sequence). The additional 29 nucleotides in the GZ01 and the civet cat sequences bring ORF10 (coding for N-protein, which is attached to the interior of the virus envelope) in frame with ORF 11 and may generate a protein with 122 amino acids and a transmembrane domain. A deletion of sequence in the same region occurred during a few passages of the Frankfurt 1 strain of SARS coronavirus in cultured cells. In addition to that, there were 43 to 57 nucleotide differences observed over the rest of the genome. Most of these differences were found in the S gene coding region. The analyses support a mammalian-like origin for the replicase protein, an avian-like origin for the matrix and nucleocapsid proteins, and a mammalian-avian mosaic origin for the host-determining spike protein. A bootscan recombination analysis of the S gene reveals high nucleotide identity between the SARS virus and a feline infectious peritonitis virus (FIPV) throughout the gene, except for a 200- base-pair region of high identity to an avian sequence. These data support the phylogenetic analyses and suggest a possible past recombination event between mammalian-like and avian-like parent viruses. This event occurred near a region that has been implicated to be the human receptor binding site and may have been directly responsible for the switch of host of the SARS coronavirus from animals to humans^ref. It seems that this first mutation has been followed by 2 mutations (A19838G and C27243T) in CUHK-W1 and then by 2 mutations (C9404T and A21721G) in BJ04

• SARS-CoV has been found in ...
• lung, trachea/bronchus => exposure to large respiratory droplets reaching the mucous membranes of nose and lungs during close face-to-face contact, such as among hospital health care workers and striking family members; additional protective measures should be taken, such as requiring patients to wear gloves and gowns. But healthcare workers are currently advised to wear masks and carry out frequent handwashing.
• as droplets are generated when patients cough and, to a lesser extent, when they talk during the early stages of disease, some believe that the efficiency of transmission of SARS by talking might be affected by the language spoken. As of mid June, 2003, the number of probable cases of SARS in Japan remained 0, whereas there were > 70 cases diagnosed in the USA.1 There were about 3.1 million Japanese travellers to mainland China, Hong Kong, and Taiwan in 2000, and about 2.3 million US citizens visited these areas in 2001. The Chinese language has an aspiration/non-aspiration pronunciation system: the consonants p, t, k, q, ch, and c, when placed in front of vowels, are pronounced with a strong breath, by contrast with b, d, g, j, zh, and z. In English, but not in Japanese, p, t, and k are pronounced with a similar accompanying exhalation of breath. Furthermore, the p sound is not used as frequently in Japanese as in English. Aspiration could produce droplets. A Chinese attendant in a souvenir shop probably speaks to American tourists in English, and to Japanese tourists in Japanese. If the shop assistant is in the early stages of SARS and has no cough, American tourists would, hence, be exposed to the infectious droplets to a greater extent than would Japanese tourists
• stomach, pancreas, liver and small intestine => excreted in faeces : Amoy Gardens, where feces and urine from SARS patients with diarrhea were aerosolized through inadequate plumbing and a faulty sewage system and emerged into apartments, shows that you can aerosolize other sorts of infectious materials, like feces or urine that can be inhaled and have contact with mucous membranes, but this is not what is normally understood as the "oral–fecal" transmission route. At RT the virus survives in faeces for > 2 dd (in diarrhoic faeces, with a higher pH, for > 4 days)
• distal convoluted renal tubule => excreted in urine. At RT the virus survives in urine for > 24 hrs
• sweat gland
• parathyroid
• pituitary and cerebrum
• adrenal gland
• => excreted in tears^{ref1, ref2}
... from 4 patients who died of SARS
• brain tissue specimen obtained from a patient with SARS with significant central nervous symptoms : pathologic examination of the brain tissue revealed necrosis of neuron cells and broad hyperplasia of gliocytes. Immunostaining demonstrated that CXCL9 / MIG was expressed in gliocytes with the infiltration of CD68⁺ monocytes/macrophages and CD3⁺ T lymphocytes in the brain mesenchyme. Cytokine/chemokine assay revealed that levels of IP10 and Mig in the blood were highly elevated, although the levels of other cytokines and chemokines were close to normal^ref

diarrhea

• direct (early) diagnosis (at 3 to 5 days after onset of clinical signs, when they come to the hospital) requires viral isolation from patients : patients don't produce sputum because it's a nonproductive cough and, although you can get virus by doing a BAL, you'd be exposing yourself to high amounts of infectious agent. The URT specimens and swabs are unfortunately not very good in the early stages
• virus neutralization tests (they need live viruses and therefore require high-level containment) : hyperimmune sera against coronaviruses group 1 species ((porcine) transmissible gastroenteritis virus (TGEV), human coronavirus 229E and feline infectious peritonitis virus (FIPV) > group 2 species (murine hepatitis virus (MHV)) inhibit growth of SARS virus in cell-culture.
• nested primers RNA PCR with generic coronavirus primers is useful in the early stages of infection but can analytically find about 500 viruses per mL of respiratory material (sensitivity = 20-25%). Further you are not sure whether what you are seeing is a live virus or is only an immature virus that cannot cause disease
• cytopathogenic effect (CPE) in VERO cells, FRhk-4 cells, or human Caco-2 cells, which can be inhibited with serum from SARS convalescent patients
• IFA with serum from convalescent patients after day 10 of infection detects viral antigens in cells from the nasopharyngeal samples
• genotypying with allelic discrimination assays based on the use of fluorogenic oligonucleotide probes (TaqMan). Genotyping of the SARS-coronavirus isolates obtained from these patients were carried out by the allelic discrimination assays and confirmed by direct sequencing. Genotyping based on the allelic discrimination assays were fully concordant with direct sequencing. All of the 30 SARS-coronavirus genotypes studied were characteristic of genotypes previously documented to be associated with the latter part of the epidemic. 7 of the isolates contained a previously reported major deletion but in patients not epidemiologically related to the previously studied cohort^ref.
• indirect diagnosis
• IFA with serum from convalescent patients after day 10 of infection detects cells infected with the virus in cell-culture. Reactivity with SARS-virus could not be detected in serum from several hundreds of non-SARS individuals in the U.S.A., Canada and Hong Kong !
• ELISA (15' test sold at < $10 each only to hospitals and maybe family doctors) detects antibodies in convalescent sera reliably (99% accurate) but only from about day 16-20 after the onset of clinical symptoms
• immunochromatography (ICT) detects antibodies in 16% of those who had disease for 7-8 days and in 50-60% of those who had disease for 14 days
• antibodies against the hypothetical (SARS 3a, 3b, 6, 7a and 9b) and structural proteins (envelope, membrane, nucleocapsid and spike) of the coronavirus were generated from predicted antigenic epitopes of each protein. The presence of these proteins were first verified in coronavirus-infected Vero E6 tissue culture model. IHC studies on different human tissues, including a cohort of 9 autopsies, 2 liver biopsies and intestinal biopsies of SARS patients, further confirmed the existence of coronaviral hypothetical and structural proteins in the cytoplasm of pneumocytes and small intestinal surface enterocytes in SARS patients. With this vast array of antibodies, no signal was observed in other cell types including those organs in which RT-PCRs were reported to be positive. Structural proteins and the functionally undefined hypothetical proteins were expressed in coronavirus-infected cells with distinct expression pattern in different organs in SARS patients. These antipeptide antibodies can be useful for the diagnosis of SARS at the tissue level^ref
• a peptide chip platform was created and the profiles of antibodies to these epitopes were investigated in 59 different SARS patients' sera that were obtained at 6-103 days after the onset of the illness. Serial sera of 5 additional patients were also studied. Epitopes at the N-terminus of the membrane protein and the C-terminus of nucleocapsid protein elicited strong antibody responses. Epitopes on the Spike protein were only moderately immunogenic but the effects were persistent. Antibodies were also detected for some putative proteins, noticeably, the C-termini of SARS3a and SARS6^ref
• chest radiographs may be normal during the febrile prodrome and throughout the course of illness. However, in a substantial proportion of patients, the respiratory phase is characterized by early focal infiltrates progressing to more generalized, patchy, interstitial infiltrates. Some chest radiographs from patients in the late stages of SARS have also shown areas of consolidation.
• leukopenia
• thrombocytopenia or low-normal platelet counts (50,000 – 150,000 / mL).
• CPK levels up to 3000 IU / L
• hepatic transaminases 2- to 6-times the upper limits of normal
• diffuse alveolar damage (DAD) : haemophagocytosis, epithelial cell proliferation, rise in number of macrophages, bronchial epithelial denudation

• glycyrrhizin / glycyrrhizic acid > IFN-b > PEG-IFN-a (macaques given 3 doses and then infected have their throats almost free of viral particles 2 days later, meaning they exhaled fewer infectious particles. Treated monkeys also have 10,000 times fewer infectious viral particles in their type 1 pneumocytes than non-treated animals. And macaques on interferon had fewer fluid-filled cells in their lungs' lining, allowing them to breathe more easily. When IFN-a is given after infection with the virus, the effects were similar but less pronounced^ref) > ribavirin^ref
• ribavirin and GR agonists (osteonecrosis has been found in 10% at follow-up)
• short interfering RNA (siRNA) inhibitors exemplifies a powerful new means to combat emerging infectious diseases. Potent siRNA inhibitors of SARS-CoV in vitro were further evaluated for efficacy and safety in a rhesus macaque (Macaca mulatta) SARS model using clinically viable delivery while comparing 3 dosing regimens. Observations of SARS-like symptoms, measurements of SCV RNA presence and lung histopathology and IHC consistently showed siRNA-mediated anti-SARS efficacy by either prophylactic or therapeutic regimens. The siRNAs used provided relief from SCV infection-induced fever, diminished SCV viral levels and reduced acute diffuse alveoli damage. The 10-40 mg/kg accumulated dosages of siRNA did not show any sign of siRNA-induced toxicity. These results suggest that a clinical investigation is warranted and illustrate the prospects for siRNA to enable a massive reduction in development time for new targeted therapeutic agents^ref.
• 10% decline, usually around day 7, and need mechanical assistance to breathe. The care of these people is often complicated by the presence of other diseases. In this group, mortality is high. Age over 40 years also appears to be associated with a more severe form of disease.
• 10 food handlers from Guandong province have been tested for antibodies to the human SARS virus, and 5 had seroconverted : the food-handlers' antibodies could inhibit both the human and the civet cat virus
• convalescent plasma (500 mL) was obtained from each of 3 SARS patients and transfused into 3 infected HCW. Donors were blood type O and seronegative for hepatitis B and C, HIV, syphilis and human T-cell lymphotropic virus types I and II (HTLV-I and -II). Serum antibody (IgG) titre was >640. Apharesis was performed with a CS 3000 plus cell separator followed by the forming of the convalescent phase plasma. As part of the routine check with donated plasma, the convalescent plasma was confirmed free of residual SARS-CoV by RT-PCR. Serial serum samples obtained from the recipients of the convalescent plasma were collected to undertake real-time quantitative RT-PCR for SARS-CoV for direct measurement of viral concentration. Specific immunoglobulin IgM and IgG concentrations were titrated using an antigen microarray developed in-house. Viral load dropped from 495 x 10³, 76 x 10³ or 650 x 10³ copies/mL to zero or 1 copy/mL 1 day after transfusion. Anti-SARS-CoV IgM and IgG also increased in a time-dependent manner following transfusion. All three patients survived. One HCW became pregnant subsequently, delivering 13 months after discharge. Positive anti-SARS-CoV IgG was detected in the newborn. Passive transfer of anti-SARS-CoV antibody from the mother was considered as a possibility. All infected HCW whose condition had progressed severely and who had failed to respond to the available treatment, survived after transfusion with convalescent plasma^ref

• clinical symptoms/findings:
• afebrile for 48 hours
• no cough
• laboratory tests: if previously abnormal
• white cell (lymphocyte) count returning to normal
• platelet count returning to normal
• creatinine phosphokinase returning to normal
• liver function tests returning to normal
• radiological findings:
• improving chest x-ray changes
• follow-up for convalescent cases:

• it is killed at 10,000 U / 15' with heat at 56° C
• subunit vaccine : epitopes at the N-terminus of the membrane protein and the C-terminus of nucleocapsid protein elicited strong antibody responses. Epitopes on the spike protein were only moderately immunogenic but the effects were persistent. Antibodies were also detected for some putative proteins, noticeably the C-termini of SARS3a and SARS6^ref
• monoclonal antibodies

• Cumulative number of reported suspect and probable cases, WHO
• Epidemic curves, WHO
• Affected areas, WHO
• SARS, CDC
• SARS, New Scientist
• SARS at Center for the Study of Emerging Infections (CSEI)
• SARS Bioinformatics Suite
• SARS Coronavirus Resource at NCBI
• SARS Headlines.org
• SARS Reference by Bernd Sebastian Kamps and Christian Hoffmann

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