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SARS - H5N1 Avian bird flu

Severe acute respiratory syndrome is a new human respiratory disease, first recognised in late February, 2003, in Hanoi, Vietnam. The disease quickly spread to over 30 countries, most prominently in mainland China, Hong Kong, and Taiwan. The epidemic in Hong Kong has been characterised by two large clusters, initiated by two separate "super-spread" events (SSEs), and ongoing community transmission. Epidemiological data from Singapore and the epidemic curves from other settings suggest that in general, a single infectious case of SARS will infect about 3 secondary cases in a population that has not yet instituted control measures.

Severity of the disease, combined with its rapid spread along international air-travel routes, prompted WHO to set up a network of scientists from 11 laboratories around the world to try to identify the causal agent. In March 2003, a novel coronavirus (SARS-CoV) was discovered in association with cases of severe acute respiratory syndrome (SARS). The genome of SARS-CoV consists of 29,727 nucleotides in length and has 11 open reading frames, and its genome organisation is similar to that of other coronaviruses. Phylogenetic analyses and sequence comparisons showed that SARS-CoV is not closely related to any of the previously characterised coronaviruses. It is also known that this virus has a high propensity to mutate and one common variant seems to be associated with a non-conservative amino acid change in the S1 region of the spike protein suggesting that immunological pressures might already be starting to influence the evolution of the SARS virus in human populations.

Clinically, SARS is associated with epithelial-cell proliferation and an increase in macrophages in the lung. The presence of haemophagocytosis supports the contention that cytokine dysregulation may account, at least partially, for the severity of the clinical disease. The standard clinical treatment protocol using antibacterial and a combination of ribavarin and methylprednisolone has met with increasing criticism. This is in large part due to the fact that ribavarin is ineffective as an anti-SAR-CoV agent and that use of steroids can lead to additional complications.

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