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SARS outbreaks after the epidemic. The 2003 Severe Acute Respiratory Syndrome outbreak spread to 29 countries, causing more than 8,000 infections and at least 774 deaths. Because 21 percent of cases involved hospital workers, it had the potential to shut down health care services wherever it struck. It is particularly dangerous to handle in the laboratory because there is no vaccine, and it can be transmitted via aerosols.

Moreover, about 5 percent of SARS patients are “super-spreaders” who infect eight or more secondary cases. For instance, one patient spread SARS directly to 33 others (reflecting an infection rate of 45 percent) during a hospitalization, ultimately leading to the infection of 77 people, including three secondary super-spreaders. A super-spreader could turn even a single laboratory infection into a potential pandemic.

SARS has not re-emerged naturally, but there have been six escapes from virology labs: one each in Singapore and Taiwan, and four separate escapes at the same laboratory in Beijing.

The first was in Singapore in August 2003, in a virology graduate student at the National University of Singapore. He had not worked directly with SARS, but it was present in the laboratory where he worked. He recovered and produced no secondary cases. The World Health Organization formed an expert committee to revise SARS biosafety guidelines.

In April 2004, China reported a case of SARS in a nurse who had cared for a researcher at the Chinese National Institute of Virology. While ill, the researcher had traveled twice by train from Beijing to Anhui province, where she was nursed by her mother, a physician, who fell ill and died. The nurse in turn infected five third-generation cases, causing no deaths.

Subsequent investigation uncovered three unrelated laboratory infections in different researchers at the NIV. At least of two primary patients had never worked with live SARS virus. Many shortcomings in biosecurity were found at the NIV, and the specific cause of the outbreak was traced to an inadequately inactivated preparation of SARS virus that was used in general (that is, not biosecure) laboratory areas, including one where the primary cases worked. It had not been tested to confirm its safety after inactivation, as it should have been.

Foot-and-mouth disease in the U.K. in 2007. Foot-and-mouth disease infects cloven-hoofed animals such as pigs, sheep, and cattle. It has been eradicated in North America and most of Europe. It is highly transmissible, capable of spreading through direct contact on the boots of farm workers and by natural aerosol that can spread up to 250 kilometers. Outbreaks in FMD-free areas cause economic disaster because meat exports cease and animals are massively culled. A 2001 U.K. outbreak resulted in 10 million animals killed and $16 billion in economic losses.

In 2007, FMD appeared again in Britain, 4 kilometers from a biosafety level 4 laboratory—a designation indicating the highest level of lab security—located at Pirbright. The strain had caused a 1967 outbreak in the United Kingdom but was not then circulating in animals anywhere. It was, however, used in vaccine manufacture at the Pirbright facility. Investigations concluded that construction vehicles had carriedmud contaminated with FMD from a defective wastewater line at Pirbright to the first farm. That outbreak identified 278 infected animals and required 1,578 animals to be culled. It disrupted U.K. agricultural production and exports and cost an estimated 200 million pounds.