Faculty Bibliography

The epidemic could come back, doctors say, perhaps with the return of colder weather. But for now, health officials and infectious disease experts are racing to learn what they can from the sudden rise and retreat of severe acute respiratory syndrome: What caused it to spread, what strategies worked to contain it, and what might work the next time a new disease jumps from animals, as SARS seems to have done, and begins spreading rapidly among people. Reassuringly, SARS appears to have been controlled mainly through one of the oldest of medical tools: isolation. That possibility has not been entirely extinguished by the decline of the SARS epidemic, experts say. They worry that the disease is really still present, slowly being transmitted among people who do not become very sick, and will burst loose again next autumn and winter, perhaps with even greater virulence. * Researchers believe that SARS is caused by a virus from the corona family, which also causes a third of all common colds. Colds tend to be seasonal, raising the worry that SARS will prove seasonal as well. There's obviously a seasonality with this thing; otherwise we wouldn't see it disappearing like this quite so effectively, said Dr. Robert Webster, a virologist at St. Jude Children's Research Hospital in Memphis, Tennessee. It's not just the quarantine that's been so effective. Nature has been giving a helping hand. It would be foolish to not have that kind of plan available for us, [Julie Gerberding] said. Simply identifying SARS next winter may prove difficult because it is easily confused with influenza and other respiratory illnesses. That is why health officials say developing a reliable diagnostic test for SARS is a top priority. When winter comes, there are going to be many, many background diseases which fit the case definition, [David Heymann] said, adding that these diseases will have to be treated carefully just in case they are SARS. It's a massive undertaking

When Dr. Scribner first became interested in dialysis in 1950, some patients recovered from acute kidney failure after painful short-term dialysis treatments. But chronic dialysis was an insurmountable problem, medical leaders said -- in part because every time a patient was hooked up to a dialysis machine, arteries and veins were damaged, and soon doctors had no way to connect the machine. Even if they could, critics said, no machine could match the kidney's ability to clear the blood of body wastes and perform other functions. From a raft attached to his houseboat, Dr. Scribner flew model airplanes. For many years, he commuted by canoe from the houseboat to the medical school across Portage Bay on Lake Union. But after Dr. Scribner was shown paddling on television, his canoes were stolen. People gave him new canoes, but they disappeared. ''Finally, I had to give up and switch to a motorboat because they just kept stealing the canoes,'' Dr. Scribner said. Dr. Scribner's door was always open for consultation from younger colleagues. A doctor who had just begun his training to be a specialist in internal medicine in the mid-1960's recalled how he meekly knocked on Dr. Scribner's door to ask whether dialysis might be used to remove an overdose of a toxic drug that a critically ill patient had taken. Dr. Scribner greeted him warmly, said he too did not know, and searched textbooks for the pertinent information before determining that dialysis therapy would not work for that patient

Where some people see a cute and cuddly ball of fur, scientists like [Michael T. Osterholm] see a vector: a ball of disease-causing viruses, bacteria, parasites and who knows what other germs. Osterholm, who is director of the Center for Infectious Disease Research and Policy and a professor of public health at the University of Minnesota, said that until recently, his main objection to prairie dogs was that they and their fleas sometimes carried bubonic plague. He had not even thought about monkeypox, the disease brought to the Americas for the first time last month, presumably by a 3-pound African rat, which infected its fellow inmates in a pet shop, prairie dogs, which may then have spread the disease to as many as 82 people in five states. Though Osterholm had not predicted monkeypox, its arrival did not entirely surprise him. The worldwide trade in so-called exotic pets has done two things that are practically a recipe for spreading exotic diseases. First, the trade has transported animals like giant Gambian rats across oceans and brought them together with species that they would never encounter naturally, like prairie dogs. Second, the trade has brought people close to animals -- and to diseases -- they had little or no contact with before. The viruses that cause smallpox, monkeypox and cowpox, because they infect people, are among the best-known members of the pox virus family. But the family has several dozen other members that infect a broad range of animals, causing diseases not found in people, like camelpox, skunkpox, raccoonpox, rabbitpox, mousepox and bird poxes specific to canaries or juncos. Suipoxvirus infects pigs, taterapox infects naked-soled African gerbils, and still another pox virus, thought to have an unknown main host, causes a sickness called Uasin Gishu disease in horses in Africa. Chickenpox, despite its name, is not caused by a pox virus; the microbe that causes it belongs to the herpes family

For now, health officials and infectious disease experts are racing to learn what they can from the sudden rise and retreat of SARS, or severe acute respiratory syndrome: What caused it to spread, what strategies worked to contain it and what might work the next time a new disease jumps from animals, as SARS seems to have done, and begins spreading rapidly among people. Reassuringly, SARS appears to have been controlled mainly through one of the oldest of medical tools: isolation. This was done through better infection controls in hospitals and by early quarantining of people who had close personal contact with infected individuals. Researchers believe SARS is caused by a virus from the corona family, which also causes a third of all common colds. Colds tend to be seasonal, raising the worry that SARS will prove seasonal as well

Simply identifying SARS next winter may prove difficult because it is easily confused with influenza and other respiratory illnesses. That is why health officials say developing a reliable diagnostic test for SARS is a top priority. ''When winter comes, there are going to be many, many background diseases which fit the case definition,'' Dr. [David L. Heymann] said, adding that they will have to be treated carefully just in case they are SARS. ''It's a massive undertaking,'' he said. Typical of the efforts against SARS has been the work at the Guangdong Respiratory Diseases Control and Prevention Research Institute, which occupies a weathered hospital facing the murky waters of the Pearl River in Guangzhou, China, 80 miles upstream of Hong Kong. Dated on the outside but surprisingly modern within, the hospital holds what officials insist are the Chinese province's last three SARS patients, all in serious condition and in isolation on the sixth floor. Hong Kong has managed to control the disease, though only after 1,755 cases and 295 deaths. Its containment program began to succeed when officials started going to unusual lengths to track down the personal contacts of SARS patients. Hong Kong sent police detectives to hunt down the family members and close friends of SARS patients and confine them in their homes

The epidemic could come back, doctors say, perhaps with the return of cold weather. But for now, health officials and infectious disease experts are racing to learn what they can from the sudden rise and retreat of SARS, or severe acute respiratory syndrome: what caused it to spread, what strategies worked to contain it, and what might work the next time a new disease jumps from animals, as SARS seems to have done, and begins spreading rapidly among people. Health officials say SARS has taught them several other lessons: the need to develop a reliable test to detect it in its early stages and distinguish it from other flulike or pneumonialike diseases; the potential volatility of the virus that causes it; and the growing importance of international travel in spreading communicable diseases. Several worries remain. Among the concerns is that researchers in Hong Kong and Guangdong say they have found viruses nearly identical to the SARS virus in several species of wild animals sold for meat in local marketplaces. Nobody knows whether those animals long harbored the disease or happened to catch it in a market stall from some other animal. All of these factors will affect the likelihood of recurrent outbreaks

The outbreak, the first in the Americas, is believed to have resulted from a Gambian giant rat imported from West Africa, where the disease is endemic. The rat then infected prairie dogs that were sold or traded at various pet shops and other sites in this country. Pets that have monkeypox may appear to be tired and not eating or drinking, the centers said. Infected animals in the outbreak have had fever, cough, discharge from the eyes, a cloudy or crusty appearance of the eyes, swelling in the limbs from swollen lymph nodes and a blisterlike rash

Where some people see a cute and cuddly ball of fur, scientists like Dr. [Michael T. Osterholm] see a vector: a ball of disease-causing viruses, bacteria, parasites and who knows what other germs. Dr. Osterholm, who is director of the Center for Infectious Disease Research and Policy and a professor of public health at the University of Minnesota, said that until recently, his main objection to prairie dogs was that they and their fleas sometimes carried bubonic plague. He had not even thought about monkeypox, the disease brought to the Americas for the first time last month, presumably by a three-pound African rat, which infected its fellow inmates in a pet shop, prairie dogs, which may then have spread the disease to as many as 82 people in five states. The viruses that cause smallpox, monkeypox and cowpox, because they infect people, are among the best-known members of the pox virus family. But the family has several dozen other members that infect a broad range of animals, causing diseases not found in people, like camelpox, skunkpox, raccoonpox, rabbitpox, mousepox and bird poxes specific to canaries or juncos. Suipoxvirus infects pigs, taterapox infects naked-soled African gerbils, and still another pox virus, thought to have an unknown main host, causes a sickness called Uasin Gishu disease in horses in Africa. Chickenpox, despite its name, is not caused by a pox virus; the microbe that causes it belongs to the herpes family. The most familiar member of the pox virus family is in some ways the most mysterious. Many people assume that vaccinia, the virus used to make smallpox vaccine, is the same virus that causes cowpox and that was first used by Dr. Edward Jenner in 1796 to vaccinate people against smallpox. In fact, vaccinia is not the cowpox virus. It is a distinct species, and scientists do not know where it came from. But in the early days of vaccination, there was no way to store a vaccine, so people were usually vaccinated with secretions taken from other people or animals. Scientists have speculated that such arm-to-arm passage may have created a hybrid of smallpox and cowpox, or perhaps even brought in a type of horsepox that no longer exists in nature

A health care worker in Wisconsin is suspected of having monkeypox in what would be the first known transmission of the viral disease between humans in the United States, a Wisconsin state health official said. The health worker cared for an adult with monkeypox before doctors and epidemiologists knew that the disease was occurring in the Americas for the first time, said Dr. Jeffrey Davis, Wisconsin state epidemiologist. U.S. officials have advised health workers to use standard infection control measures to prevent the spread of the monkeypox infection

The people affected in 18 cases in Wisconsin -- three confirmed, six probable and nine suspected -- were exposed to the prairie dog as it was moved from place to place, said Dr. Jeffrey P. Davis, the Wisconsin state epidemiologist. ''The prairie dog was a super-transmitter if there ever was one,'' Dr. Davis said in a telephone news conference, referring to the term used when a single human or animal passes a virus to many people. ''The prairie dog was moved quite a bit from a pet store to a household to one veterinary clinic and then to a second veterinary clinic before it died,'' Dr. Davis said. One Wisconsin resident who apparently caught monkeypox from the prairie dog had ''minimal'' contact with the infected animal but slept in the same room as the caged animal, Dr. Davis said. Also, ''a substantial number of individuals in one particular veterinary clinic became ill as a result of'' direct contact, Dr. Davis said. ''We are trying to understand what that all means, precisely what the contact was.''