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Update: Severe Acute Respiratory Syndrome --- United States, 2003

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 Beijing and Taiwan, where travel advisories have been downgraded to travel alerts.

During November 1, 2002--July 2, 2003, a total of 8,442 probable SARS cases were reported to WHO from 29 countries, including 73 cases from the United States; 812 deaths (case-fatality proportion: 9.6%) have been reported, with no SARS-related deaths reported from the United States (1). In the United States, a total of 419 SARS cases have been reported from 42 states and Puerto Rico, with 346 (83%) cases classified for investigation purposes as suspect SARS and 73 (17%) as probable SARS (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 162 suspect and 47 probable cases; no suspect and eight probable cases have demonstrated antibodies to SARS-CoV, all of which have been previously described (3,4). Of the 39 probable cases in which no demonstrated antibody to SARS-CoV was identified in a convalescent blood specimen, 25 (64%) patients had specimens that were negative for >28 days after onset of symptoms (range: 29--61 days), and 14 (36%) had specimens that were negative for 22--28 days after onset of symptoms. Of the remaining 26 probable cases, convalescent serum specimens for 25 persons have not been submitted to CDC, and one person, who has recovered, has refused further testing. Obtaining convalescent serum samples is critical to making a final determination about infection with SARS-CoV.

Median age of the eight laboratory-confirmed SARS patients is 43 years (range: 22--53 years); four are female. Seven were hospitalized, and one required mechanical ventilation. All have recovered.

On June 25, CDC downgraded the travel alert status for both Beijing and Taiwan from advisory to alert (5,6). Reasons for this change include information that SARS transmission in China, including Beijing, and Taiwan, is limited to a small number of specific settings through direct person-to-person spread with no evidence of ongoing community transmission. In addition, monitoring by the health ministries in China and Taiwan indicates that no new outbreaks of illness are occurring.

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_06_18/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. Update: severe acute respiratory syndrome---United States, 2003. MMWR 2003;52:525--6.
  4. CDC. Update: severe acute respiratory syndrome---United States, 2003. MMWR 2003;52:550--1.
  5. CDC. Interim travel alert: mainland China, including Beijing. Available at http://www.cdc.gov/travel/other/sarschina2.htm.
  6. CDC. Interim travel alert: Taiwan. Available at http://www.cdc.gov/travel/other/sarstaiwan.htm.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.


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