epidemic but also the lessons that were learned and the preparations being made to handle any future challenges that may arise from SARS or other emerging diseases.

The chapter continues with a broad overview of what is known and hypothesized about the emergence of SCoV, the natural history of the epidemic, the evolution of the virus, and the clinical profile of SARS. The authors suggest studies to answer some of the many remaining questions about this new disease.

Given the likelihood of an animal reservoir for the virus in China that could reinfect the human population, continued vigilance for SARS is warranted. This chapter explores the value of modern quarantine in curtailing the spread of infectious disease in general and SARS in particular. Risks for the reintroduction of SARS include the possibility of initial low-level transmission that eludes surveillance and a laboratory-acquired infection, as occurred in Singapore in September 2003 and in Taiwan in December 2003.

During the epidemic, hospitals in Hong Kong, Singapore, Vietnam, and Canada struggled to contain SARS within their walls. For example, in the first phase of the Toronto epidemic, which began on February 23, unrecognized SARS patients infected scores of other patients, family members, and hospital workers. Even after increased infection control measures were undertaken, this scenario was replayed in several area hospitals, as well as others around the globe. A sobering analysis of mistakes made in the communication and practice of hospital and community hygiene during the epidemic concludes the chapter.


J.S. Mackenzie, P. Drury, A. Ellis,1T. Grein, K.C. Leitmeyer, S. Mardel, A. Merianos, B. Olowokure, C. Roth, R. Slattery, G. Thomson, D. Werker, and M. Ryan

Global Alert and Response, Department of Communicable Disease Surveillance and Response

Severe acute respiratory syndrome (SARS) is the first severe and readily transmissible new disease to emerge in the 21st century. Initially recognized as a global threat in mid-March 2003, SARS was successfully contained in less than 4 months, largely because of an unprecedented level of international collaboration and cooperation. The international response to SARS was coordinated by the World Health Organization (WHO) with the assistance of the Global Outbreak


Strategy for Development and Monitoring Zoonoses, Foodborne Diseases and Kinetoplastidae, Department of Communicable Diseases Control, Prevention and Eradication, World Health Organization, Geneva, Switzerland.

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