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From the Centers for Disease Control and Prevention
July 9, 2003

Update: Severe Acute Respiratory Syndrome— United States, June 18, 2003

JAMA. 2003;290(2):186. doi:10.1001/jama.290.2.186-a
Update: Severe Acute Respiratory Syndrome— United States, June 18, 2003

MMWR. 2003;52:570

CDC continues to work with state and local health departments, the World Health Organization (WHO), and other partners to investigate cases of severe acute respiratory syndrome (SARS). This report updates reported SARS cases worldwide and in the United States and summarizes changes in travel recommendations for provinces in China with the exclusion of Beijing, where a travel advisory remains.

During November 1, 2002–June 18, 2003, a total of 8,465 probable SARS cases were reported to WHO from 29 countries, including 75 from the United States; 801 deaths (case-fatality proportion: 9.5%) have been reported, with no SARS-related deaths reported from the United States.1 In the United States, a total of 409 SARS cases have been reported from 42 states and Puerto Rico, with 334 (82%) cases classified as suspect SARS and 75 (18%) classified as probable SARS (i.e., more severe illnesses characterized by the presence of pneumonia or acute respiratory distress syndrome).2 Serologic testing for antibody to SARS-associated coronavirus (SARS-CoV) infection has been completed for 136 suspect and 45 probable cases. None of the suspect cases and eight (18%) of the probable cases have demonstrated antibodies to SARS-CoV, all of which have been described previously.3,4 Of the eight laboratory-confirmed SARS patients in the United States, seven had traveled to areas with documented or suspected community transmission of SARS within the 10 days before illness onset. Of these, four reported travel to Hong Kong Special Administrative Region, China; two to Toronto, Canada; and one to both Singapore and Taiwan. The remaining laboratory-confirmed SARS patient is the spouse of a laboratory-confirmed SARS patient that had traveled to Hong Kong.

On June 17, CDC downgraded its travel advisory for Mainland China to alert status for all provinces except Beijing, where the travel advisory remains in effect.5 These changes reflect data reported to the World Health Organization by the Chinese Ministry of Health which indicate that SARS transmission in Mainland China (other than in Beijing) is limited to a small number of specific settings through direct person-to-person spread; no evidence exists of ongoing community transmission, and monitoring by the Ministry of Health indicates that no new outbreaks of illness in these provinces.

Reported by:

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

World Health Organization.  Cumulative number of reported cases of severe acute respiratory syndrome (SARS). Available at
CDC.  Updated interim U.S. case definition of severe acute respiratory syndrome (SARS). Available at
CDC.  Update: Severe acute respiratory syndrome—United States, 2003.  MMWR.2003;52:525-6.
CDC.  Update: Severe acute respiratory syndrome—United States, 2003.  MMWR.2003;52:550-1.
CDC.  Interim travel alert: Mainland China (excluding Beijing). Available at