n engl j med
established in 1812
A Novel Coronavirus Associated
with Severe Acute Respiratory Syndrome
Thomas G. Ksiazek, D.V.M., Ph.D., Dean Erdman, Dr.P.H., Cynthia S. Goldsmith, M.S., Sherif R. Zaki, M.D., Ph.D.,
Teresa Peret, Ph.D., Shannon Emery, B.S., Suxiang Tong, Ph.D., Carlo Urbani, M.D.,* James A. Comer, Ph.D., M.P.H.,
Wilina Lim, M.D., Pierre E. Rollin, M.D., Scott F. Dowell, M.D., M.P.H., Ai-Ee Ling, M.D., Charles D. Humphrey, Ph.D.,
Wun-Ju Shieh, M.D., Ph.D., Jeannette Guarner, M.D., Christopher D. Paddock, M.D., M.P.H.T.M., Paul Rota, Ph.D.,
Barry Fields, Ph.D., Joseph DeRisi, Ph.D., Jyh-Yuan Yang, Ph.D., Nancy Cox, Ph.D., James M. Hughes, M.D.,
James W. LeDuc, Ph.D., William J. Bellini, Ph.D., Larry J. Anderson, M.D., and the SARS Working Group†
From the Special Pathogens Branch (T.G.K.,
J.A.C., P.E.R.), Respiratory and Enteric Virus
Branch (D.E., T.P., S.E., S.T., P.R., W.J.B.,
L.J.A.), Infectious Disease Pathology Ac-
tivity (C.S.G., S.R.Z., C.D.H., W.-J.S., J.G.,
C.D.P.), Influenza Branch (N.C.), Division
of Bacterial and Mycotic Diseases (B.F.),
and Office of the Director, Division of Viral
and Rickettsial Diseases (J.W.L.), and Office
of the Director, National Center for Infec-
tious Diseases (J.M.H.), National Center for
Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta; the World
Health Organization, Hanoi, Vietnam
(C.U.); the Government Virus Unit, Queen
Mary Hospital, Hong Kong, China (W.L.);
the International Emerging Infectious Dis-
eases Program, Bangkok, Thailand (S.F.D.);
the Department of Pathology, Singapore
General Hospital (A.-E.L.); the University
of California, San Francisco (J.D.); and the
Center for Disease Control, Department of
Health, Taipei, Taiwan (J.-Y. Y.).
†Members of the SARS (Severe Acute Res-
piratory Syndrome) Working Group are
listed in the Appendix.
This article was published at www.nejm.org
on April 10, 2003.
N Engl J Med 2003;348:1953-66.
Copyright © 2003 Massachusetts Medical Society.
A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated
with exposures originating from a single ill health care worker from Guangdong Prov-
ince, China. We conducted studies to identify the etiologic agent of this outbreak.
We received clinical specimens from patients in seven countries and tested them, using
virus-isolation techniques, electron-microscopical and histologic studies, and molecular
and serologic assays, in an attempt to identify a wide range of potential pathogens.
None of the previously described respiratory pathogens were consistently identified.
However, a novel coronavirus was isolated from patients who met the case definition of