Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003
N S Zhong, B J Zheng, Y M Li, Poon, Z H Xie, K H Chan, P H Li, S Y Tan, Q Chang, J P Xie, X Q Liu, J Xu, D X Li, K Y Yuen, Peiris, Y Guan, N S Zhong, B J Zheng, Y M Li, Poon, Z H Xie, K H Chan, P H Li, S Y Tan, Q Chang, J P Xie, X Q Liu, J Xu, D X Li, K Y Yuen, Peiris, Y Guan
Abstract
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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References
- Peng GW, He JF, Lin JY. Epidemiological study on severe acute respiratory syndrome in Guangdong province. Chin J Epidemiol. 2003;24:350–352.
- Guangdong Public Health Office. 2003: Document No 2. Summary report of investigating an atypical pneumonia outbreak in Zhongshan (January 21, 2003).
- Tsang KW, Ho PL, Ooi GC. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1977–1985.
- Lee N, Hui D, Wu A. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994.
- Update: outbreak of severe acute respiratory syndrome-Worldwide, 2003. MMWR Morb Mort Wkl Rep. 2003;52:241–248.
- Anon Severe acute respiratory syndrome (SARS) Wkly Epidemiol Rec. 2003;78:81–83.
- WHO. Cumulative number of reported probable cases of severe acute respiratory syndrome (SARS) (accessed July 16, 2003).
- Peiris J, Lai S, Poon L. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319–1325.
- Poutanen SM, Low DE, Henry B. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005.
- Ksiazek TG, Erdman D, Goldsmith C. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–1966.
- WHO. Case definitions for surveillance of severe acute respiratory syndrome (SARS) (accessed May 1, 2003).
- Marra MA, Jones SJ, Astell CR. The Genome sequence of the SARS-associated coronavirus. Science. 2003;300:1399–1404.
- Guan Y, Peiris JM, Lipatov AS. Emergence of multiple genotypes of H5N1 avian influenza viruses in Hong Kong SAR. Proc Natl Acad Sci USA. 2002;99:8950–8955.
- Kumar S, Tarnura K, Jakobsen IB, Nei M. MEGA2: molecular evolutionary genetics analysis software. Bioinformatics. 2001;17:1244–1245.
- Holmes KV. Coronaviruses. In: Knipe DM, Howley PM, editors. Field Virology. 4th edn. Lippincott Williams and Wilkins; Philadelphia: 2001. pp. 1187–1203.
- Holland JJ, de la Torre JC, Clarke DK. Quantitation of relative fitness and great adaptability of clonal populations of RNA viruses. J Virol. 1991;65:1960–2967.
- Domingo E, Holland JJ. RNA virus mutations and fitness for survival. Annu Rev Microbiol. 1997;51:151–178.
- de Jong JC, Claas EC, Osterhaus AD. A pandemic warning? Nature. 1997;389:544.
- Subbarao K, Klimov A, Katz J. Characterisation of an avian influenza A (H5N1) virus isolated from a child with a fatal respiratory illness. Science. 1998;279:393–396.
- Shortridge KF, Stuart-Harris CH. An influenza epicentre? Lancet. 1982;2:812–813.
Source: PubMed