The SARS epidemic in mainland China: bringing together all epidemiological data

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Summary

Objective To document and verify the number of cases of severe acute respiratory syndrome (SARS) during the 2002–2003 epidemic in mainland China.

Method All existing Chinese SARS data sources were integrated in one final database. This involved removing non‐probable and duplicate cases, adding cases at the final stage of the outbreak, and collecting missing information.

Results The resulting database contains a total of 5327 probable SARS cases, of whom 343 died, giving a case fatality ratio (CFR) of 6.4%. While the total number of cases happens to be equal to the original official reports, there are 5 cases overall which did not result in death. When compared with Hong Kong Special Administrative Region of China, China Taiwan, and Singapore, the SARS epidemic in mainland China resulted in a considerably lower CFR, involved relatively younger cases and included fewer health care workers.

Conclusions To optimise future data collection during large‐scale outbreaks of emerging or re‐emerging infectious disease, China must further improve the infectious diseases reporting system, enhance collaboration between all levels of disease control, health departments, hospitals and institutes nationally and globally, and train specialized staff working at county centres of disease control.

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Most cited references 55

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Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome

Christian Drosten, Stephan Günther, Wolfgang Preiser … (2003)

The severe acute respiratory syndrome (SARS) has recently been identified as a new clinical entity. SARS is thought to be caused by an unknown infectious agent. Clinical specimens from patients with SARS were searched for unknown viruses with the use of cell cultures and molecular techniques. A novel coronavirus was identified in patients with SARS. The virus was isolated in cell culture, and a sequence 300 nucleotides in length was obtained by a polymerase-chain-reaction (PCR)-based random-amplification procedure. Genetic characterization indicated that the virus is only distantly related to known coronaviruses (identical in 50 to 60 percent of the nucleotide sequence). On the basis of the obtained sequence, conventional and real-time PCR assays for specific and sensitive detection of the novel virus were established. Virus was detected in a variety of clinical specimens from patients with SARS but not in controls. High concentrations of viral RNA of up to 100 million molecules per milliliter were found in sputum. Viral RNA was also detected at extremely low concentrations in plasma during the acute phase and in feces during the late convalescent phase. Infected patients showed seroconversion on the Vero cells in which the virus was isolated. The novel coronavirus might have a role in causing SARS. Copyright 2003 Massachusetts Medical Society

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A novel coronavirus associated with severe acute respiratory syndrome.

Thomas G Ksiazek, Dean Erdman, Cynthia Goldsmith … (2003)

A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. We conducted studies to identify the etiologic agent of this outbreak. We received clinical specimens from patients in seven countries and tested them, using virus-isolation techniques, electron-microscopical and histologic studies, and molecular and serologic assays, in an attempt to identify a wide range of potential pathogens. None of the previously described respiratory pathogens were consistently identified. However, a novel coronavirus was isolated from patients who met the case definition of SARS. Cytopathological features were noted in Vero E6 cells inoculated with a throat-swab specimen. Electron-microscopical examination revealed ultrastructural features characteristic of coronaviruses. Immunohistochemical and immunofluorescence staining revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coronavirus primers designed to amplify a fragment of the polymerase gene by reverse transcription-polymerase chain reaction (RT-PCR) were used to obtain a sequence that clearly identified the isolate as a unique coronavirus only distantly related to previously sequenced coronaviruses. With specific diagnostic RT-PCR primers we identified several identical nucleotide sequences in 12 patients from several locations, a finding consistent with a point-source outbreak. Indirect fluorescence antibody tests and enzyme-linked immunosorbent assays made with the new isolate have been used to demonstrate a virus-specific serologic response. This virus may never before have circulated in the U.S. population. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Because of the death of Dr. Carlo Urbani, we propose that our first isolate be named the Urbani strain of SARS-associated coronavirus. Copyright 2003 Massachusetts Medical Society

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Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003

NS Zhong, BJ Zheng, YM Li … (2003)

Summary Background An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province. Methods We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent. Findings SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world. Interpretation SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.

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Author and article information

Journal

Journal ID (nlm-ta): Trop Med Int Health

Journal ID (iso-abbrev): Trop. Med. Int. Health

Journal ID (doi): 10.1111/(ISSN)1365-3156

Journal ID (publisher-id): TMI

Title: Tropical Medicine & International Health

Publisher: Blackwell Publishing Ltd (Oxford, UK )

ISSN (Print): 1360-2276

ISSN (Electronic): 1365-3156

Publication date (Electronic): 05 June 2009

Publication date (Print): November 2009

Volume: 14

Issue: Suppl 1 , SARS in China ( doiID: 10.1111/tmi.2009.14.issue-s1 )

Pages: 4-13

Affiliations

[ ¹ ] Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P.R. China

[ ² ] Chinese PLA General Hospital, Beijing, P.R. China

[ ³ ] Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Author notes

[*] Corresponding Author Wu‐Chun Cao, Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, 20 Dong‐Da street, Feng Tai District, 100071, Beijing, P.R. China. E‐mail: caowc@ 123456nic.bmi.ac.cn

Article

Publisher ID: TMI2145

DOI: 10.1111/j.1365-3156.2008.02145.x

PMC ID: 7169858

PubMed ID: 19508441

SO-VID: 561fc612-bf25-4724-a0ab-3c689b0eaaa5

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This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

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cover-date November 2009

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ScienceOpen disciplines: Medicine

Keywords: severe acute respiratory syndrome,epidemiology,data collection,data analysis,mainland china

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ScienceOpen disciplines: Medicine

Keywords: severe acute respiratory syndrome, epidemiology, data collection, data analysis, mainland china

The SARS epidemic in mainland China: bringing together all epidemiological data

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Microbiology Society: Coronaviruses

Most cited references 55

Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome

A novel coronavirus associated with severe acute respiratory syndrome.

Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003

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