Severe Acute Respiratory Syndrome Leaves its Mark in the Literature

Severe Acute Respiratory Syndrome Leaves its Mark in the Literature

by David W. Sharp

WHAT'S HOT IN MEDICINE
Rank	Paper	Citations This Period (Nov-Dec 03)	Rank Last Period (Sep-Oct 03)
1	J.E. Rossouw, et al. (Women’s Health Initiat. Invest.), "Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled trial," JAMA-J. Amer. Med. Assoc., 288(3): 321-3, 17 July 2002. [8 U.S. institutions] *573AK	128	1
2	R. Collins, et al. (Heart Protection Study Collaborative Group), "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial," Lancet, 360(9326): 7-22, 6 July 2002. [Authors’ affilations: multiple U.K. institutions, based at Radcliffe Infirmary, Oxford] *569JR	73	3
3	K.M. Flegal, et al., "Prevalence and trends in obesity among US adults, 1999-2000," JAMA-J. Amer. Med. Assoc., 288(14): 1723-7, 9 October 2002. [CDC, Hyattsville, MD] *602BJ	59	7
4	W.C. Knowler, et al. (Diabetes Prevention Prog. Res. Group), "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin," New Engl. J. Med., 346(6): 393-403, 7 February 2002. [35 U.S. institutions] *518UN	56	2
5	B. Dahlof, et al., "Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol," Lancet, 359(9311): 995-1003, 23 March 2002. [15 institutions worldwide] *534KP	49	4
6	C.D. Furberg, et al. (ALLHAT officers and coordinators), "Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)," JAMA-J. Amer. Med. Assoc., 288(23): 2981-97, 18 December 2002. [Corresponding authors: Case Western Reserve U., Cleveland, OH; U. Texas Houston Health Center] *626CG	47	6
7	P.M. Ridker, et al., "Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events," New Engl. J. Med., 347(20): 1557-65, 14 November 2002. [Brigham and Women’s Hosp., Boston, MA; Children’s Hosp., Boston: Harvard Med. Sch., Boston] *614KL	41	†
8	T.G. Ksiazek, et al., "A novel coronavirus associated with severe acute respiratory syndrome," New Engl. J. Med., 348(20): 1953-66, 15 May 2003. [7 institutions worldwide] *677TJ	39	†
9	M.W. Fried, et al., "Peginterferon alfa-2a plus ribavarin for chronic hepatitis C virus infection," New Engl. J. Med., 347(13): 975-82, 26 September 2002. [12 institutions worldwide] *596RD	38	†
10	N. Lee, et al., "A major outbreak of severe acute respiratory syndrome in Hong Kong," New Engl. J. Med., 348(20): 1986-1994, 15 May 2003. [Chinese U. Hong Kong, China] *677TJ	38	†
SOURCE: ISI's Hot Papers Database. the full legend.

"How SARS changed the world in less than six months," the title of a 2003 article in the World Health Organization (WHO) Bulletin, explains why Science Watch is continuing to pick up papers on severe acute respiratory syndrome. Last year research papers and related items on SARS were appearing in the journals at a rate of more than 20 a week, yet until late in 2002 nobody had heard of this disease. A coordinated global attack on it began in March 2003, and by July 5 of that year the epidemic was declared by WHO to be at an end. The true number of cases may never be known but the officially recognized toll worldwide was more than 8,000 and the case fatality rate was about 10%. As Science Watch was going to press, all was still quiet on the SARS front—indeed the disease had been replaced in newspaper headlines by "bird flu" and by the influenza virus subtypes H5N1 and H7N7. The People’s Republic of China, from where, in the southern Guangdong Province, the very first cases arose, announced on February 24 that there had only been four cases of SARS so far this year, all from Guangdong, and at this writing the U.S. Centers for Disease Control and Prevention did not see the latest Guangdong cases as an immediate public health threat. However, we can all recall the sense of panic as SARS was first reported and as the disease seemed to spread rapidly from the Far East—most notably, perhaps, to Toronto, Canada.

Early release of so much SARS research on journal websites complicates citation analysis, but the four highly cited ones this time first entered the public domain within a few days of each other, on April 7-10, 2003. Papers #8, #10 and also #15 (J.S.M. Peiris, et al., Lancet, 362:1319-25, 2003) and #16 (C. Drosten, et al., New Engl. J. Med., 348:1967-76, 2003) tell the story of the epidemiology and virology of SARS. The syndrome is caused by a novel coronavirus, the SARS-associated coronavirus. Early on, many victims were health workers, and Dr. Thomas G. Ksiazek and his colleagues (paper #8) propose that their first isolate of the virus be called the Urbani strain, in honor of the late Carlo Urbani, a WHO expert who died from the disease while working with SARS patients.

The symptoms of SARS were not very specific, and the first task was to eliminate a host of possible viral and bacterial causes, microorganisms known to cause respiratory problems in humans. A coronavirus was first identified by electron microscopy, but molecular studies showed that it did not fit neatly into any of the three previously defined groups of coronaviruses, being closest to group II. These viruses had been thought to cause only mild respiratory illness in humans; they also affect animals.

The definition of SARS was changed in mid-2003 as the work of various international collaborations became available. Indeed (and with no disparagement intended of the advances in molecular and virological knowledge in these papers), the speed with which the first epidemic of SARS was brought under control must to a large extent be credited to international cooperation such as the rapid establishment of WHO laboratories in a dozen countries and to the application of what might be called "old-fashioned" public-health methods. The authorship of this quartet of papers illustrates the global teamwork. If SARS does come back, the source is likely to be some animal reservoir, a previously unrecognized human transmission cycle, or a laboratory accident. This is a dangerous virus to work with, requiring containment level-3 facilities.

Mr. David W. Sharp, M.A. (Cambridge), is a contributing editor to The Lancet, London, U.K.

Science Watch^®, May/June 2004, Vol. 15, No. 3
Citing URL: http://www.sciencewatch.com/may-june2004/sw_may-june2004_page5.htm