Severe acute respiratory syndrome

Abstract

Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress that has been made towards understanding the virus-SARS coronavirus (SARS-CoV)-and the disease. We will also highlight the progress that has been made towards developing vaccines and therapies The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats.

Figure 1. The global spread of SARS.

The number of probable cases of SARS and the date of onset of the first case in each country (or group of countries) is denoted. The countries denoted in red are those where substantial local transmission occurred. The data are based on World Health Organization, http://www.who.int/csr/sars/country/ table2004_04_21/en_21/en/print.html and the figure is adapted from ref. .

Figure 2. Wet markets in Guangdong: 'Wet markets' selling live poultry, fish, reptiles and other mammals are commonplace across southeast Asia and southern China to service the cultural demand for freshly killed meat and fish produce.

In some regions (e.g., Guangdong province, China), increasing affluence has led to the proliferation of markets housing a range of live 'wild' animal species, such as civet cats, pictured, linked to the restaurant trade servicing the demand for these exotic foods. (AP Photo/Xinhua, Liu Dawei)

Figure 3. Schematic diagram of the SARS coronavirus structure (reproduced from ref. 20).

The viral surface proteins (spike, envelope and membrane) are embedded in a lipid bilayer envelope derived from the host cell. Unlike group 2 coronaviruses, SARS-CoV does not possess a hemagglutinin esterase glycoprotein. The single-stranded positive-sense viral RNA is associated with the nucleocapsid protein.