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CLINICAL MICROBIOLOGY REVIEWS Oct. 2007, p. 60-694 0893-8512/07/$08.00+0 doi:10.112 CMR.00023 7 Copyright 2007, American Society or Microb logy. All Rights Reserved. Severe Acute Respiratory Syndrome Coronavirus as an Emerging and Reemerging Infection Vincent C. C. Cheng, Susanna K. P. Lau, Patrick C. Y. Woo, and Kwok Yu State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Research Centre Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, ( SARS-CoV AS AN AGENT OF EMERGING/REEMERGING INFECTION 683 or immunization (Table 10). The Koch's pos- 5-CoV as a causative agent of SARS were primate model using cynomolgus macaques iris), which demonstrated clinical and patho- vith some similarities to those found in hu- SHOULD WE BE READY FOR THE REEMERGENCE OF SARS? The medical and scientific community demonstrated mar- velous efforts in the understanding and control of SARS within a short time, as evident by over 4,000 publications available online. Despite these achievements, gaps still exist in terms of the molecular basis of the physical stability and transmissibility of this virus, the molecular and immunological basis of disease pathogenesis in humans, screening tests for early or cryptic SARS cases, foolproof infection control procedures for patient care, effective antivirals or antiviral combinations, the useful- the contrary, African green monkeys (Cerco- ) did not develop significant lung pathology with the SARS-CoV. The lack of consistency I models of rhesus, cynomolgus, and African or experimental SARS was noted in another cover, these large mammals are expensive and 2. BALB/c mice demonstrated asymptomatic s in lungs and nasal turbinates by intranasal h was not significantly different from the find- ition of immunological Th1-biased C57BL/6 B/c mice that were 12 to 14 months old de- natie pneumonia, which correlated with the ptibility to acute SARS in humans (287). As 1 knockout-immunodeficient mice had fatal I disease (143). Transgenic mice expressing eptors also developed fatal disease, with ex- ssemination to many organs including the It is interesting that mouse-adapted SARS- ness of immunomodulatory agents for late presenters, an ef- fective vaccine with no immune enhancement, and the imme- diate animal host that transmitted the virus to caged civets in the market at the beginning of the epidemic. Coronaviruses are well known to undergo genetic recombination (375), which may lead to new genotypes and outbreaks. The presence of a large reser- voir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.

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CLINICAL MICROBIOLOGY REVIEWS Oct. 2007, p. 60-694 0893-8512/07/$08.00+0 doi:10.112 CMR.00023 7 Copyright 2007, American Society or Microb logy. All Rights Reserved. Severe Acute Respiratory Syndrome Coronavirus as an Emerging and Reemerging Infection Vincent C. C. Cheng, Susanna K. P. Lau, Patrick C. Y. Woo, and Kwok Yu State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, Research Centre Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, ( SARS-CoV AS AN AGENT OF EMERGING/REEMERGING INFECTION 683 or immunization (Table 10). The Koch's pos- 5-CoV as a causative agent of SARS were primate model using cynomolgus macaques iris), which demonstrated clinical and patho- vith some similarities to those found in hu- SHOULD WE BE READY FOR THE REEMERGENCE OF SARS? The medical and scientific community demonstrated mar- velous efforts in the understanding and control of SARS within a short time, as evident by over 4,000 publications available online. Despite these achievements, gaps still exist in terms of the molecular basis of the physical stability and transmissibility of this virus, the molecular and immunological basis of disease pathogenesis in humans, screening tests for early or cryptic SARS cases, foolproof infection control procedures for patient care, effective antivirals or antiviral combinations, the useful- the contrary, African green monkeys (Cerco- ) did not develop significant lung pathology with the SARS-CoV. The lack of consistency I models of rhesus, cynomolgus, and African or experimental SARS was noted in another cover, these large mammals are expensive and 2. BALB/c mice demonstrated asymptomatic s in lungs and nasal turbinates by intranasal h was not significantly different from the find- ition of immunological Th1-biased C57BL/6 B/c mice that were 12 to 14 months old de- natie pneumonia, which correlated with the ptibility to acute SARS in humans (287). As 1 knockout-immunodeficient mice had fatal I disease (143). Transgenic mice expressing eptors also developed fatal disease, with ex- ssemination to many organs including the It is interesting that mouse-adapted SARS- ness of immunomodulatory agents for late presenters, an ef- fective vaccine with no immune enhancement, and the imme- diate animal host that transmitted the virus to caged civets in the market at the beginning of the epidemic. Coronaviruses are well known to undergo genetic recombination (375), which may lead to new genotypes and outbreaks. The presence of a large reser- voir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.

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