Intended for healthcare professionals


Sudden acute respiratory syndrome

BMJ 2003; 326 doi: (Published 29 March 2003) Cite this as: BMJ 2003;326:669

May be a rehearsal for the next influenza pandemic

  1. Maria Zambon, deputy director (,
  2. Karl G Nicholson, professor of infectious disease
  1. Enteric Respiratory and Neurological Virus Laboratory, Public Health laboratory Service, London NW9 5HT
  2. University of Leicester, Leicester LE1 9HN

    News p 677

    Plagues are as certain as death and taxes.1 The optimism of the 1960s and 1970s has given way to a mature realism that the relationship between human beings and microbes is neither completely predictable nor biased in favour of humans. Over the past few decades several important human viruses have emerged. Some, such as HIV, prove to be sustainable modern plagues adding to the toll of human misery. Others, such as hepatitis F, occupy a seemingly silent niche, passengers in a human caravan but contributing little to the joint relationship. Whereas viruses such as Ebola, Hantaan, and Nipah spring from an animal reservoir, destroying life but unable to sustain transmission in a new environment, others such as human metapneumovirus2 are associated with respiratory illness in young children but their contribution to adult disease remains uncertain, suggesting a balance between virus and host immune system achieved after some evolutionary negotiation. Each of these viruses has been identified through the study of human disease processes, each of which exists along a spectrum of possible outcomes between virus and host.

    Emergence of new diseases

    Against this background, the emergence of new human infectious diseases or viruses is unsurprising. Severe acute respiratory syndrome was first recognised at the end of February in Hanoi, Vietnam.3

    The agent is highly infectious, with attack rates of >50% among healthcare workers caring for patients with the syndrome.4 Preliminary data from the first cluster of about 60 probable cases in Hanoi indicate an incubation period of 5–9 days. The …

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