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Coronavirus Biology and Pathogenesis
On the Front Lines
Clinical Spectrum of SARS Infection
Clinical Experience in Toronto
SARS: An Update from China
Panel 2 Discussion
Approaches to Vaccines and Drug Development
Future Perspectives on Emerging Infections
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SARS in the Context of Emerging Infectious Threats SARS in the Context of Emerging Infectious Threats
On the Front Lines
Clinical Spectrum of SARS Infection

Larry Anderson, Centers for Disease Control and Prevention, Atlanta
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Highlights

Early SARS Transmission
• Index Case was a visitor to Hong Kong from China; ten people were exposed and transmitted SARS to other countries.
• SARS is predominantly transmitted in hospital settings.
• Close contact is the predominant mode of transmission in droplets, fomites, direct contact, and autoinoculation. Some airborne transmission may have occurred.
• Infection control practices limit transmission, even from super-spreaders.
• Transmission was controlled or stopped in Canada, Singapore, Thailand, and the United States.
• Because of success with control, patients likely transmit only when sick.

Symptoms and Illness
• Symptoms begin with fever, then cough, shortness of breath, interstitial pneumonia on X-ray, and lymphopenia.
• Illness is generally more severe with older patients.
• There is a high rate of severe illness with SARS.
• Case fatality rate is going up, mostly likely due to ways of accounting for cases.

Diagnosis and Detection Issues
• We do not yet know what the best specimen is at certain times of illness for detecting infection.
• Diagnosis to date has used electronmicroscopy, isolation of virus, detection of antigens in tissue, and detection of viral RNA by PCR.
• Virus has been detected in respiratory secretions, stool specimens, urine specimens, bronchial lavage specimens, and in lung and kidney tissue.
• Antibody has not been detected in non-SARS patients.
• SARS in immune-suppressed patients could be a problem in the future.

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