The 2003 SARS Outbreaks in Taiwan

  • Yi-Ming Arthur Chen

Severe acute respiratory syndrome (SARS) is caused by SARS-associated coronaviruses (SARS-CoVs) (Drosten et al., 2003; Fouchier et al., 2003; Peiris et al., 2003b; Ksiazek et al., 2003). The first known outbreak of SARS occurred in China’s Guangdong province in November, 2002 (Chinese SARS Molecular Epidemiology Consortium, 2004). By August 7 of the following year, SARS had spread to more than 30 countries, affecting 8,096 people and resulting in 774 deaths worldwide (World Health Organization, 2004). In 2003, Taiwan experienced a series of SARS outbreaks and the Municipal Hoping Hospital (referred to hereafter as HP) in Taipei City suffered the first and the most serious outbreak of SARS-CoV nosocomial infections: 137 probable cases and 26 deaths (Division of Surveillance and Investigation, Center for Disease Control, Taiwan, 2003; Lan et al., 2005b). According to the Center for Disease Control (CDC) in Taiwan, 364 of the 664 probable Taiwanese SARS cases reported to the World Health Organization were confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) and/or neutralizing antibody tests (Center for Disease Control, 2003a). In this chapter, we will discuss the molecular and clinical epidemiology of SARS infection in Taiwan during 2003.


Human Leukocyte Antigen Severe Acute Respiratory Syndrome Human Leukocyte Antigen Class Severe Acute Respiratory Syndrome Human Leukocyte Antigen Allele 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ahmad, R., Sindhu, S. T., Tran, P., Toma, E., Morisset, R., Menezes, J., Ahmad A. (2001). Modulation of expression of the MHC class I-binding natural killer cell receptors, and NK activity in relation to viral load in HIV-infected/AIDS patients. Journal of Medical Virology, 65, 431–440PubMedCrossRefGoogle Scholar
  2. Bauer, S., Groh, V., Wu, J., Steinle, A., Phillips, J. H., Lanier, L. L., Spies, T. (1999). Activation of NK cells and T cells by NKG2D, a receptor for stress-inducible MICA. Science, 285, 727–729PubMedCrossRefGoogle Scholar
  3. Bureau of Animal and Plant Health Inspection an Quarantine. (2007). Council of Agriculture, Executive Yuan, Republic of China. Animal health inspection: Accomplishment. = 296&CtNode = 1701&mp = 2 (accessed January 29, 2007)
  4. Carrington, M., O’Brien, S. J. (2003). The influence of HLA genotype on AIDS. Annual Review of Medicine, 54, 535–551PubMedCrossRefGoogle Scholar
  5. Center for Disease Control and Prevention (CDC). (2003a). Severe acute respiratory syndrome-Taiwan, 2003. Morbidity and Mortality Weekly Report, 52, 461–466Google Scholar
  6. Center for Disease Control and Prevention. (2003b). Update: Outbreak of severe acute respiratory syndrome-Worldwide, 2003. Morbidity and Mortality Weekly Report, 52, 241–248Google Scholar
  7. Chen, Y. M., Liang, S. Y., Chu, D. C., Lee, Y. M., Chang, L., Jung, S. Y., Chen, H. Y., Chjan, Y. J., Ho, M. S., Liang, K. Y., Jang, Y. J., Chu, T. C. (2006). Epidemiological and genetic correlates of SARS coronavirus infection in a hospital with the highest nosocomial infection rate in Taiwan in 2003. Journal of Clinical Microbiology, 44, 359–362PubMedCrossRefGoogle Scholar
  8. Chim, S. S., Tsui, S. K., Chan, K. C., Au, T. C., Hung, E. C., Tong, Y. K., Chiu, R. W., Ng, E. K., Chan, P. K., Chu. C.M., Sung, J. J, Tam, J. S., Fung, K. P., Waye, M. M., Lee, C. Y., Yuen, K. Y., Lo, Y. M., CUHK Molecular SARS Research Group. (2003). Genomic characterization of the severe acute respiratory syndrome coronavirus of Amoy Gardens outbreak in Hong Kong. Lancet; 362, 1807–1808PubMedCrossRefGoogle Scholar
  9. Chinese SARS Molecular Epidemiology Consortium. (2004). Molecular evolution of the SARS coronavirus during the course of the SARS epidemic in China. Science, 303, 1666–1669PubMedCrossRefGoogle Scholar
  10. Chung, W. H., Hung, S. I., Hong, H. S., Hsih, M. S., Yang, L. C., Ho, H. C., Wu, J. Y., Chen, Y. T. (2004). Medical genetics: A marker for Stevens-Johnson syndrome. Nature, 428, 486PubMedCrossRefGoogle Scholar
  11. Doherty, P. C., Zinkernagel, R. M. (1975). Enhanced immunological surveillance in mice heterozygous at the H-2 gene complex. Nature, 256, 50–52PubMedCrossRefGoogle Scholar
  12. Division of Surveillance and Investigation, Center for Disease Control, Taiwan. (2003) SARS probable cases in Taiwan-reclassified on 15 September 2003. In: Su IJ, editor. Memoir of severe acute respiratory syndrome control in Taiwan. Republic of China Center for Disease Control, TaipeiGoogle Scholar
  13. Drosten, C., Gunther, S., Preiser, W., van der Werf, S., Brodt, H. R., Becker, S., Rabenau, H., Panning, M., Kolesnikova, L., Fouchier, R. A., Berger, A., Burguiere, A. M., Cinatl, J., Eickmann, M., Escriou, N., Grywna, K., Kramme, S., Manuguerra, J. C., Muller, S., Rickerts, V., Sturmer, M., Vieth, S., Klenk, H. D., Osterhaus, A. D., Schmitz, H., Doerr, H. W. (2003) Identification of a novel coronavirus in patients with severe acute respiratory syndrome. The New England Journal of Medicine, 348, 1967–1976PubMedCrossRefGoogle Scholar
  14. Fouchier, R. A., Kuiken T., Schutten, M., van Amerongen, G., van Doornum, G. J., van den Hoogen, B. G., Peiris, M., Lim, W., Stohr, K., Osterhaus, A. D. (2003). Aetiology: Koch’s postulates fulfilled for SARS virus. Nature, 423, 240PubMedCrossRefGoogle Scholar
  15. Guan, Y., Peiris, J. S., Zheng, B., Poon, L. L., Chan, K. H., Zeng, F. Y., Chan, C. W., Chan, M. N., Chen, J. D., Chow, K. Y., Hon, C. C., Hui, K. H., Li, J., Li, V. Y., Wang, Y., Leung, S. W., Yuen, K. Y., Leung, F. C. (2004). Molecular epidemiology of the novel coronavirus that causes severe acute respiratory syndrome. Lancet, 363, 99–104PubMedCrossRefGoogle Scholar
  16. Guan, Y., Zheng, B. J., He, Y. Q., Liu, X. L., Zhuang, Z. X, Cheung, C. L., Luo, S. W., Li, P. H., Zhang, L. J., Guan, Y. J., Butt, K. M., Wong, K. L., Chan, K. W., Lim, W., Shortridge, K. F., Yuen, K. Y., Peiris, J. S., Poon, L. L. (2003). Isolation and characterization of viruses related to the SARS coronavirus from animals in southern China. Science, 302, 276–278PubMedCrossRefGoogle Scholar
  17. Hsieh, Y. H., King, C. C., Chen, C. W. S., Ho, M. S., Lee, J. Y., Liu, F. C., Wu, Y. C., Wu, J. S. (2005). Quarantine for SARS, Taiwan. Emerging Infectious Diseases, 11, 278–282PubMedGoogle Scholar
  18. Huang, C. Y., Sun, C. T., Hsieh, J. L., Chen, Y. M., Lin, H. (2005). A novel small-world model: Using social mirror identities for epidemic simulations. Simulation, 81, 671–699CrossRefGoogle Scholar
  19. Jeffery, K. J., Siddiqui A. A., Bunce, M., Lloyd, A. L., Vine, A. M., Witkover, A. Izumo, D. S., Usuku, K., Welsh, K. I., Osame, M., Bangham, C. R. (2000). The influence of HLA class I alleles and heterozygosity on the outcome of human T cell lymphotropic virus type I infection. Journal of Immunology, 165, 7278–7284Google Scholar
  20. Khakoo, S. I., Thio, C. L., Martin, M. P., Brooks, C. R., Gao, X., Astemborski, J., Cheng, J., Goedert, J. J., Vlahov, D., Hilgartner, M., Cox, S., Little, A. M., Alexander, G. J., Cramp, M. E., O’Brien, S. J., Rosenberg, W. M., Thomas, D. L., Carrington, M. (2004). HLA and NK cell inhibitory receptor genes in resolving hepatitis C virus infection. Science, 305, 872–874PubMedCrossRefGoogle Scholar
  21. Ksiazek, T. G., Erdman, D., Goldsmith, C. S., Zaki, S. R., Peret, T., Emery, S., Tong, S., Urbani, C., Comer, J. A., Lim, W., Rollin, P. E., Dowell, S. F., Ling, A. E., Humphrey, C. D., Shieh, W. J., Guarner, J., Paddock, C. D., Rota, P., Fields, B., DeRisi, J., Yang, J. Y., Cox, N., Hughes, J. M., LeDuc, J. W., Bellini, W.J., Anderson, L. J., SARS Working Group. (2003). A novel coronavirus associated with severe acute respiratory syndrome. New England Journal of Medicine, 348, 1953–1966PubMedCrossRefGoogle Scholar
  22. Lan, Y. C., Liu, H. F., Shih, Y. P., Yang, J. Y., Chen, H. Y., Chen, Y. M. (2005a). Phylogenetic analysis and sequence comparison of structural and non-structural SARS coronavirus protein in Taiwan. Infection, Genetics, and Evolution, 5, 261–269CrossRefGoogle Scholar
  23. Lan, Y. C., Liu, T. T., Yang, J. Y., Lee, C. M., Chen, Y. J., Chan, Y. J., Lu, J. J., Liu, H. F., Hsuing, C. A., Ho, M. S., Hsiao, K. J., Chen, H. Y., Chen, Y. M. (2005b). Molecular epidemiology of severe acute respiratory syndrome-associated coronavirus infections in Taiwan. Journal of Infectious Diseases, 191, 1478–1489PubMedCrossRefGoogle Scholar
  24. Leung, G. M., Chung, P. H., Tsang, T., Lim, W., Chan, S. K., Chau, P., Donnelly, C. A., Ghani, A. C., Fraser, C., Riley, S., Ferguson, N. M., Anderson, R. M., Law, Y. L., Mok, T., Ng, T., Fu, A., Leung, P. Y., Peiris, J. S., Lam, T. H., Hedley, A. J. (2004). SARS-CoV antibody prevalence in all Hong Kong patient contacts. Emerging Infectious Diseases, 10, 1653–1656PubMedGoogle Scholar
  25. Li, K. S., Guan, Y., Wang, J., Smith, G. J., Xu, K. M., Duan, L., Rahardjo, A. P., Puthavathana, P., Buranathai, C., Nguyen, T. D., Estoepangestie, A. T., Chaisingh, A., Auewarakul, P., Long, H. T., Hanh, N. T., Webby, R. J., Poon, L. L., Chen, H., Shortridge, K. F., Yuen, K. Y., Webster, R. G., Peiris, J. S. (2004). Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature, 430, 209–213PubMedCrossRefGoogle Scholar
  26. Lin, M., Tseng, H. K., Trejaut, J. A., Lee, H. L., Loo, J. H., Chu, C. C., Chen, P. J., Su, Y. W., Lim, K. H., Tsai, Z. U., Lin, R. Y., Lin, R. S., Huang, C. H. (2003). Association of HLA class I with severe acute respiratory syndrome coronavirus infection. BMC Medical Genetics, 4, 9PubMedCrossRefGoogle Scholar
  27. Machulla, H. K., Stein, J., Gautsch, A., Langner, J., Schaller, H. G., Reichert, S. (2002). HLA-A, B, Cw, DRB1, DRB3/4/5, DQB1 in German patients suffering from rapidly progressive periodontitis (RPP) and adult periodontitis (AP). Journal of Clinical Periodontology, 29, 573–579PubMedCrossRefGoogle Scholar
  28. Marra, M. A., Jones, S. J., Astell, C. R., Holt, R. A., Brooks-Wilson, A., Butterfield, Y. S., Khattra, J., Asano, J. K., Barber, S. A., Chan, S. Y., Cloutier, A., Coughlin, S. M., Freeman, D., Girn, N., Griffith, O. L., Leach, S. R., Mayo, M., McDonald, H., Montgomery, S. B., Pandoh, P. K., Petrescu, A. S., Robertson, A. G., Schein, J. E., Siddiqui, A., Smailus, D. E., Stott, J. M., Yang, G. S., Plummer, F., Andonov, A., Artsob, H., Bastien, N., Bernard, K., Booth, T. F., Bowness, D., Czub, M., Drebot, M., Fernando, L., Flick, R., Garbutt, M., Gray, M., Grolla, A., Jones, S., Feldmann, H., Meyers, A., Kabani, A., Li, Y., Normand, S., Stroher, U., Tipples, G. A., Tyler, S., Vogrig, R., Ward, D., Watson, B., Brunham, R. C., Krajden, M., Petric, M., Skowronski, D. M., Upton, C., Roper, R. L. (2003). The genome sequence of the SARS-associated coronavirus. Science, 300, 1399–1404PubMedCrossRefGoogle Scholar
  29. National Research Project for SARS, Beijing Group. (2004). The involvement of natural killer cells in the pathogenesis of severe acute respiratory syndrome. American Journal of Clinical Pathology, 121, 507–511CrossRefGoogle Scholar
  30. Ng, M. H., Lau, K. M., Li, L., Cheng, S. H., Chan, W. Y., Hui, P. K., Zee, B., Leung, C. B., Sung, J. J. (2004). Association of human-leukocyte-antigen class I (B*0703) and class II (DRB1*0301) genotypes with susceptibility and resistance to the development of severe acute respiratory syndrome. Journal of Infectious Diseases, 190, 515–518PubMedCrossRefGoogle Scholar
  31. Olsen, S. J., Chang, H. L., Cheung, T. Y., Tang, A. F., Fisk, T. L., Ooi, S. P., Kuo, H. W., Jiang, D. D., Chen, K. T., Lando, J., Hsu, K. H., Chen, T. J., Dowell, S. F. (2003). Transmission of the severe acute respiratory syndrome on aircraft. New England Journal of Medicine, 349, 2416–2422PubMedCrossRefGoogle Scholar
  32. Peiris, J. S., Chu, C. M., Cheng, V. C., Chan, K. S., Hung, I. F., Poon, L. L., Law, K. I., Tang, B. S., Hon, T. Y., Chan, C. S., Chan, K. H., Ng, J. S., Zheng, B. J., Ng, W. L., Lai, R. W., Guan, Y., Yuen, K. Y. (2003a). Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet, 361, 1767–1772PubMedCrossRefGoogle Scholar
  33. Peiris, J. S., Lai, S. T., Poon, L. L., Guan, Y., Yam, L. Y., Lim, W., Nicholls, J., Yee, W. K., Yan, W. W., Cheung, M. T., Cheng, V. C., Chan, K. H., Tsang, D. N., Yung, R. W., Ng, T. K., Yuen, K. Y., SARS Study Group. (2003b). Coronavirus as a possible cause of severe cause of severe acute respiratory syndrome. Lancet, 361, 1319–1325PubMedCrossRefGoogle Scholar
  34. Rota, P. A., Oberste, M. S., Monroe, S. S., Nix, W. A., Campagnoli, R., Icenogle, J. P., Penaranda, S., Bankamp, B., Maher, K., Chen, M. H., Tong, S., Tamin, A., Lowe, L., Frace, M., DeRisi, J. L., Chen, Q., Wang, D., Erdman, D. D., Peret T. C., Burns, C., Ksiazek, T. G., Rollin, P. E., Sanchez A., Liffick, S., Holloway, B., Limor, J., McCaustland, K., Olsen-Rasmussen, M., Fouchier, R., Gunther, S., Osterhaus, A. D., Drosten, C., Pallansch, M. A., Anderson, L. J., Bellini, W. J. (2003). Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science, 300, 1394–1399PubMedCrossRefGoogle Scholar
  35. Segal, S., Hill, A. V. (2003). Genetic susceptibility to infectious disease. Trends in Microbiology, 11, 445–448PubMedCrossRefGoogle Scholar
  36. Thio, C. L., Gao, X., Goedert, J. J., Vlahov, D., Nelson, K. E., Hilgartner, M. W., O’Brien, S. Karacki, J. P., Astemborski, J., Carrington, M., Thomas, D. L. (2002). HLA-Cw*04 and hepatitis C virus persistence. Journal of Virology, 76, 4792–4797PubMedCrossRefGoogle Scholar
  37. Twu, S. J., Chen, T. J., Chen, C. J., Olsen, S. J., Lee, L. T., Fisk, T., Hsu, K. H., Chang, S. C., Chen, K. T., Chiang, I. H., Wu, Y. C., Wu, J. S., Dowell, S. F. (2003). Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerging Infectious Diseases, 9, 718–720PubMedGoogle Scholar
  38. Woo, P. C., Lau, S. K., Tsoi, H. W., Chan, K. H., Wong, B. H., Che, X. Y., Tam, V. K., Tam, S. C., Cheng, V. C., Hung, I. F., Wong, S. S., Zheng, B. J., Guan, Y., Yuen. K. Y. (2004). Relative rates of non-pneumonic SARS coronavirus infection and SARS coronavirus pneumonia. Lancet, 363, 841–845PubMedCrossRefGoogle Scholar
  39. World Health Organization, Geneva. (2004). Summary of probable SARS cases with onset of illness 2002 to 31 July 2003. (Accessed April 21, 2004)

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Yi-Ming Arthur Chen
    • 1
  1. 1.Institute of Microbiology and ImmunologyNational Yang-Ming UniversityChina

Personalised recommendations