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Update: Severe Acute Respiratory Syndrome --- United States, June 11, 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 SARS cases reported worldwide and in the United States, and describes the eighth probable U.S. SARS case with laboratory evidence of SARS-associated coronavirus (SARS-CoV) infection.

During November 1, 2002--June 11, 2003, a total of 8,435 probable SARS cases were reported to WHO from 29 countries, including 70 from the United States; 789 deaths (case-fatality proportion: 9.4%) have been reported, with no SARS-related deaths reported from the United States (1). In the United States, a total of 393 SARS cases have been reported from 42 states and Puerto Rico, with 323 (82%) cases classified as suspect SARS and 70 (18%) classified as probable SARS (i.e., more severe illnesses characterized by the presence of pneumonia or acute respiratory distress syndrome) (2). Of the 70 probable patients, 68 (97%) had traveled to areas with documented or suspected community transmission of SARS within the 10 days before illness onset; the remaining two (3%) patients were a health-care worker who provided care to a SARS patient and a household contact of a SARS patient (3). Of the 68 probable SARS cases attributed to travel, 35 (51%) patients reported travel to mainland China; 17 (25%) to Hong Kong Special Administrative Region, China; five (7%) to Singapore; one (1%) to Hanoi, Vietnam; 14 (21%) to Toronto, Canada; and five (7%) to Taiwan; of these, seven (10%) reported travel to more than one of these areas.

Serologic testing for antibody to SARS-CoV has been completed for 134 suspect and 41 probable cases. None of the suspect cases and eight (20%) of the probable cases have demonstrated antibodies to SARS-CoV, seven of which have been described previously (3). The eighth serologically confirmed probable SARS case occurred in a North Carolina resident who traveled to Toronto, Canada, on May 15 and visited a relative in a health-care facility on May 16 and 17. The relative's hospital roommate and another visitor in the room during these visits both subsequently had SARS diagnosed. The patient returned to the United States on May 18, and had a fever on May 24, followed by respiratory symptoms. He was treated as an outpatient for these symptoms beginning on May 27, and a chest radiograph on June 3 documented pneumonia. The patient has remained in isolation at home. All of the exposed health-care workers and family contacts are under active surveillance for SARS.

Serologic testing on this patient was negative for antibody to SARS-CoV at day 10 of illness and positive at day 11. SARS-CoV RNA was not detected by RT-PCR in nasopharyngeal and oropharyngeal swabs collected from the patients 11 days after onset of symptoms.

Reported by: State and local health departments. SARS Investigative Team, CDC.


  1. World Health Organization. Cumulative number of reported cases of severe acute respiratory syndrome (SARS). Available at
  2. CDC. Updated interim U.S. case definition of severe acute respiratory syndrome (SARS). Available at
  3. CDC. Update: Severe acute respiratory syndrome---United States, 2003. MMWR 2003;52:525--6.

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