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From the Centers for Disease Control and Prevention
May 28, 2003

Update: Severe Acute Respiratory Syndrome—United States, 2003

JAMA. 2003;289(20):2637. doi:10.1001/jama.289.20.2637-a

MMWR. 2003;52:411-413

2 figures, 1 table omitted

CDC, in collaboration with state and local health departments, the World Health Organization (WHO), and other partners, continues to investigate cases of severe acute respiratory syndrome (SARS). During November 1, 2002–May 7, 2003, a total of 6,903 SARS cases were reported to WHO from 29 countries, including the United States; 495 deaths (case-fatality proportion: 7.2%) have been reported.1 This report updates information on reported U.S. SARS cases.

As of May 7, a total of 328 SARS cases in the United States have been reported from 38 states, of which 265 (81%) were classified as suspect SARS, and 63 (19%) were classified as probable SARS (more severe illnesses characterized by the presence of pneumonia or acute respiratory distress syndrome).2 Of the 63 probable SARS patients, 42 (67%) were hospitalized, and three (5%) required mechanical ventilation. No SARS-related deaths have been reported in the United States.

Laboratory testing to evaluate infection with the SARS-associated coronavirus (SARS-CoV) has been completed for 69 cases. Six cases of laboratory-confirmed infection with SARS-CoV have been identified; all were probable cases, as described previously.3,4 No new SARS-CoV confirmed cases have been identified since the last update. Negative findings (i.e., the absence of antibody to SARS-CoV in convalescent serum obtained >21 days after symptom onset) have been documented for 63 cases (49 suspect and 14 probable).

Of the 63 probable SARS patients, one (2%) was a health-care worker who provided care to a SARS patient, and one (2%) was a household contact of a SARS patient.5 The remaining 61 (97%) probable SARS patients had traveled to areas with documented or suspected community transmission of SARS during the 10 days before illness onset.2 Among the probable SARS patients with travel exposure, 36 (59%) had traveled to mainland China; 19 (31%) to Hong Kong Special Administrative Region, China; five (8%) to Singapore; three (5%) to Hanoi, Vietnam; and seven (12%) to Toronto, Canada. Eight (13%) probable patients had visited two or more areas with SARS during the 10 days before illness onset. Of the six probable SARS patients with positive SARS-CoV laboratory results, two had traveled to Hong Kong; one to Hong Kong and Thailand; one to Hong Kong and Guangdong, China; one to Singapore; and one to Toronto.

Since the last update,6 the epidemiology of SARS in the United States has not changed markedly; the majority of cases continue to be associated with travel and secondary spread to contacts (e.g., family members and health-care workers) is limited. However, the collection and testing of convalescent serum is an ongoing priority to precisely characterize the epidemiology of SARS in the United States and worldwide.

Reported by:

State and local health departments. SARS Investigative Team, CDC.

References
1.
World Health Organization.  Cumulative number of reported cases of severe acute respiratory syndrome (SARS). Available at http://www.who.int/csr/sarscountry/2003_04_30/en.
2.
CDC.  Updated interim U.S. case definition of severe acute respiratory syndrome (SARS). Available at http://www.cdc.gov/ncidod/sars/casedefinition.htm.
3.
CDC.  Severe acute respiratory syndrome (SARS) and coronavirus testing—United States, 2003.  MMWR.2003;52:297-302.
4.
CDC.  Update: severe acute respiratory syndrome—United States, 2003.  MMWR.2003;52:357-60.
5.
CDC.  Update: severe acute respiratory syndrome—United States, 2003.  MMWR.2003;52:332-6.
6.
CDC.  Update: severe acute respiratory syndrome—United States, 2003.  MMWR.2003;52:388-91.
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