Highlights & Basics
- Severe acute respiratory syndrome (SARS) is an emerging infectious disease responsible for the first pandemic of the 21st century; there have been no reported cases since 2004.
- Infection control precautions are of paramount importance; transmission is usually caused by direct contact with infected individuals through respiratory droplets.
- Reverse-transcription polymerase chain reaction (RT-PCR) is the test of choice for confirming diagnosis.
- Treatment is mainly supportive; neither specific therapy nor a vaccine is available.
- Fatality rate is about 11% and death usually occurs due to severe respiratory failure.
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Citations
Christian MD, Poutanen SM, Loutfy MR, et al. Severe acute respiratory syndrome. Clin Infect Dis. 2004;38:1420-1427.[Abstract][Full Text]
Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772.[Abstract]
Mahony JB, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art. J Mol Diagn. 2005;7:551-559.[Abstract]
Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431-2441.[Abstract]
Fowler RA, Lapinsky SE, Hallet D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-373.[Abstract][Full Text]
1. Christian MD, Poutanen SM, Loutfy MR, et al. Severe acute respiratory syndrome. Clin Infect Dis. 2004;38:1420-1427.[Abstract][Full Text]
2. World Health Organization: global alert and response (GAR). Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. December 2003 [internet publication].[Full Text]
3. Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319-1325.[Abstract]
4. Hui DS, Chan MC, Wu AK, et al. Severe acute respiratory syndrome (SARS): epidemiology and clinical features. Postgrad Med J. 2004 Jul;80(945):373-81.[Abstract][Full Text]
5. Liang WN, Zhao T, Liu ZJ, et al. Severe acute respiratory syndrome--retrospect and lessons of 2004 outbreak in China. Biomed Environ Sci. 2006 Dec;19(6):445-51.[Abstract]
6. Kuiken T, Fouchier RA, Schutten M, et al. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. Lancet. 2003;362:263-270.[Abstract]
7. Guan Y, Zheng BJ, He YQ, et al. Isolation and characterization of viruses related to SARS coronavirus from animals in southern China. Science. 2003;302:276-278.[Abstract]
8. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019 Mar;17(3):181-92.[Abstract][Full Text]
9. Cheng VC, Lau SK, Woo PC, et al. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev. 2007;20:660-694.[Abstract][Full Text]
10. Anderson LJ, Tong S. Update on SARS research and other possibly zoonotic coronaviruses. Int J Antimicrob Agents. 2010;36(suppl 1):S21-S25.[Abstract]
11. Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450-454.[Abstract]
12. World Health Organization. Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). May 2003 [internet publication].[Full Text]
13. Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772.[Abstract]
14. Parashar UD, Anderson LJ. Severe acute respiratory syndrome: review and lessons of the 2003 outbreak. Int J Epidemiol. 2004;33:628-634.[Abstract][Full Text]
15. Lipsitch M, Cohen T, Cooper B, et al. Transmission dynamics and control of severe acute respiratory syndrome. Science. 2003;300:1966-1970.[Abstract][Full Text]
16. Shen Z, Ning F, Zhou W, et al. Superspreading SARS events, Beijing, 2003. Emerg Infect Dis. 2004;10:256-260.[Abstract]
17. Varia M, Wilson S, Sarwal S, et al. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285-292.[Abstract][Full Text]
18. Tsang KW, Ooi GC, Ho PL. Diagnosis and pharmacotherapy of severe acute respiratory syndrome: what have we learnt? Eur Respir J. 2004;24:1025-1032.[Abstract]
19. Nicholls JM, Poon LL, Lee KC, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361:1773-1778.[Abstract]
20. Gu J, Korteweg C. Pathology and pathogenesis of severe acute respiratory syndrome. Am J Pathol. 2007;170:1136-1147.[Abstract][Full Text]
21. Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1977-1985.[Abstract][Full Text]
22. Lin M, Tseng HK, Trejaut JA, et al. Association of HLA class I with severe acute respiratory syndrome coronavirus infection. BMC Med Genet. 2003;4:9.[Abstract][Full Text]
23. Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS) version 2. Supplement B: SARS surveillance. Appendix B1: revised CSTE SARS surveillance case definition. May 2005 [internet publication].[Full Text]
24. Scales DC, Green K, Chan AK, et al. Illness in intensive care staff after brief exposure to severe acute respiratory syndrome. Emerg Infect Dis. 2003;9:1205-1210.[Abstract]
25. Lau JT, Lau M, Kim JH, et al. Probable secondary infections in households of SARS patients in Hong Kong. Emerg Infect Dis. 2004;10:235-243.[Abstract]
26. Eurosurveillance editorial team. Case of SARS reported in a laboratory research worker in Taiwan. Euro Surveill. 2003 Dec 18;7(51):pii=2347.
27. Orellana C. Laboratory-acquired SARS raises worries on biosafety. Lancet Infect Dis. 2004 Feb;4(2):64.[Full Text]
28. Dowell SF, Simmerman JM, Erdman DD, et al. Severe acute respiratory syndrome coronavirus on hospital surfaces. Clin Infect Dis. 2004 Sep 1;39(5):652-7.[Abstract][Full Text]
29. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986-1994.[Abstract][Full Text]
30. Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:2801-2809.[Abstract]
31. Wong KT, Antonio GE, Hui DS, et al. Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology. 2003;228:401-406.[Abstract]
32. Chu CM, Leung YY, Hui JY, et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. Eur Respir J. 2004;23:802-804.[Abstract][Full Text]
33. Grinblat L, Shulman H, Glickman A, et al. Severe acute respiratory syndrome: radiographic review of 40 probable cases in Toronto, Canada. Radiology. 2003;228:802-809.[Abstract]
34. World Health Organization: global alert and response (GAR). Alert, verification and public health management of SARS in the post-outbreak period. August 2003 [internet publication].[Full Text]
35. Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS) version 2/3. Supplement F: Laboratory Guidance. May 2004 [internet publication].[Full Text]
36. Mahony JB, Petrich A, Louie L, et al. Performance and cost evaluation of one commercial and six in-house conventional and real-time reverse-transcription-PCR assays for detection of severe acute respiratory syndrome coronavirus. J Clin Microbiol. 2004;42:1471-1476.[Abstract][Full Text]
37. Mahony JB, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art. J Mol Diagn. 2005;7:551-559.[Abstract]
38. Grant PR, Garson JA, Teddar RS, et al. Detection of SARS coronavirus in plasma by real-time RT-PCR. N Engl J Med. 2003;349:2468-2469.[Abstract]
39. Richardson SE, Tellier R, Mahony J. The laboratory diagnosis of severe acute respiratory syndrome: emerging laboratory tests for an emerging pathogen. Clin Biochem Rev. 2004;25:133-42.[Abstract]
40. Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431-2441.[Abstract]
41. Hon KL, Leung CW, Cheng WT, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet. 2003;361:1701-1703.[Abstract]
42. Lau KK, Yu WC, Chu CM, et al. Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis. 2004;10:342-344.[Abstract]
43. Fisher DA, Lim TK, Lim YT, et al. Atypical presentations of SARS. Lancet. 2003;361:1740.[Abstract]
44. Centers for Disease Control and Prevention. In the absence of SARS-CoV transmission worldwide: guidance for surveillance, clinical and laboratory evaluation, and reporting, version 2. Jan 2004 [internet publication].[Full Text]
45. Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med. 2014;20:233-241.[Abstract]
46. United Nations Office for Disaster Risk Reduction. Severe Acute Respiratory Syndrome (SARS). 2025 [internet publication].[Full Text]
47. World Health Organization: global alert and response (GAR). Severe acute respiratory syndrome (SARS): WHO guidelines/recommendations/descriptions. 2020 [internet publication].[Full Text]
48. Wong SS, Yuen KY. The management of coronavirus infections with particular reference to SARS. J Antimicrob Chemother. 2008;62:437-441.[Abstract][Full Text]
49. Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS): infection control. May 2005 [internet publication].[Full Text]
50. Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS), version 2/3. Supplement D: community containment measures, including non-hospital isolation and quarantine. Jan 2004 [internet publication].[Full Text]
51. Donnelly CA, Ghani AC, Leung GM, et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361:1761-1766.[Abstract]
52. Wang YH, Lin AS, Chao TY, et al. A cluster of patients with severe acute respiratory syndrome in a chest ward in southern Taiwan. Intensive Care Med. 2004;30:1228-1231.[Abstract]
53. Fowler RA, Lapinsky SE, Hallet D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-373.[Abstract][Full Text]
54. Lew TW, Kwek TK, Tai D, et al. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:374-80.[Abstract]
55. Esquinas AM, Egbert Pravinkumar S, Scala R, et al; International NIV Network. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev. 2014;23:427-438.[Abstract][Full Text]
56. Levy MM, Baylor MS, Bernard GR, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med. 2005;171:518-26.[Abstract]
57. Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004;59:252-256.[Abstract][Full Text]
58. Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest. 2006;129:1441-1452.[Abstract][Full Text]
59. Ho JC, Wu AY, Lam B, et al. Pentaglobin in steroid-resistant severe acute respiratory syndrome. Int J Tuberc Lung Dis. 2004;8:1173-1179.[Abstract]
60. Ströher U, DiCaro A, Li Y, et al. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon- alpha. J Infect Dis. 2004;189:1164-1167.[Abstract][Full Text]
61. Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006;3:e343.[Abstract][Full Text]
62. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al; Convalescent Plasma Study Group. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 2015;211:80-90.[Abstract][Full Text]
63. Maunder RG, Lancee WJ, Balderson KE, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. 2006;12:1924-1932.[Abstract][Full Text]
64. Pollock A, Campbell P, Cheyne J, et al. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review. Cochrane Database Syst Rev. 2020 Nov 5;11:CD013779.[Abstract][Full Text]
65. Maxwell C, McGeer A, Tai KFY, Sermer M. No. 225-management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS). J Obstet Gynaecol Can. 2017;39(8):e130-7.[Full Text]
66. Tsui PT, Kwok ML, Yuen H, et al. Severe acute respiratory syndrome: clinical outcome and prognostic correlates. Emerg Infect Dis. 2003;9:1064-1069.[Abstract]
67. Chan JW, Ng CK, Chan YH, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax. 2003;58;686-689.[Abstract]
68. Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. 2003;326:1358-1362.[Abstract][Full Text]
69. Morgenstern C, Rawson T, Routledge I, et al. Severe acute respiratory syndrome (SARS) mathematical models and disease parameters: a systematic review. Lancet Microbe. 2025 Sep;6(9):101144.[Abstract][Full Text]
70. Chan KS, Zheng JP, Mok YW, et al. SARS: prognosis, outcome and sequelae. Respirology. 2003;8:S36-S40.[Abstract]
71. Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med. 2003;4:279-283.[Abstract]
72. Bitnun A, Allen U, Heurter H, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics. 2003;112:e261.[Abstract][Full Text]
73. Tansey CM, Louie M, Loeb M, et al. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167:1312-1320.[Abstract][Full Text]
74. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37.[Abstract][Full Text]
75. Xie L, Liu Y, Xiao Y, et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127:2119-2124.[Abstract][Full Text]
76. Tsai LK, Hsieh ST, Chang YC. Neurological manifestations in severe acute respiratory syndrome. Acta Neurol Taiwan. 2005;14:113-119.[Abstract]
77. Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191:292-297.[Abstract]
78. Griffith JF, Antonio GE, Kumta SM, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology. 2005;235:168-175.[Abstract]
79. World Health Organization. WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS): updated recommendations. Oct 2004 [internet publication].[Full Text]
80. Lai TS, Yu WC. The lessons of SARS in Hong Kong. Clin Med. 2010;10:50-53.[Abstract]
81. Yen MY, Lin YE, Lee CH, et al. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers. J Hosp Infect. 2011;77:332-337.[Abstract]
82. Naylor CD, Chantler C, Griffiths S. Learning from SARS in Hong Kong and Toronto. JAMA. 2004;291:2483-2487.[Abstract]
83. Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ. 2016;188:567-574.[Abstract][Full Text]
84. Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020 May 15;5(5):CD011621.[Abstract][Full Text]
85. Chen WQ, Ling WH, Lu CY, et al. Which preventive measures might protect health care workers from SARS? BMC Public Health. 2009;9:81.[Abstract][Full Text]
