Faculty Bibliography

It is the second World Health Organization team since early February to be denied access to Guangdong Province, just north of Hong Kong. The group arrived on Sunday in Beijing, where its members are reviewing epidemiologic information about the illness known as SARS, for severe acute respiratory syndrome, and have met with officials from Guangdong and Beijing. Dr. [David L. Heymann] said the organization was also ''very concerned'' about the rising number of cases in Hong Kong, because ''we have less information and we are less sure that containment activities are being successful'' there than in other countries. Hong Kong has reported 286 SARS cases, including 10 deaths. Hong Kong officials played down the seriousness of SARS earlier this month. Dr. Yeoh Eng-kiong, Hong Kong's secretary of health, welfare and food, who has managed the SARS outbreak with Dr. William Ho, the chief executive of the Hong Kong Hospital Authority, accused the World Health Organization of being too quick to sound an international alarm

Since Sept. 11 the agency has also offered doctors training materials to sharpen their ability to recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems now used in many communities to flag odd patterns of illness or medicine use. In addition, hospitals have retooled their disaster plans. The United States now has enough smallpox vaccine to inoculate the entire population, and, Dr. [Tara O'Toole] said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs. The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less. The drills that have been conducted may not have been realistic enough. James D. Bentley, senior vice president of the American Hospital Association, said: ''The problem is, we tend to organize these drills in a way I'll call nondisruptive drills, on Saturday morning, with off-shift nurses and firemen. We haven't done many in this country where at 2 o'clock in the afternoon Mayor Bloomberg goes out there and stages something that will really disrupt the Bronx or Brooklyn. If there is a real terrorist incident, we'll have to do that. It's those kind of drills that I think the preparedness community wishes we could do more of.''

''This virus could be, if not the entire cause of SARS, at least contributing to SARS,'' said Dr. Julie L. Gerberding, director of the centers. But she cautioned at a news conference that it is ''very premature to assign a cause.'' The time in the course of a patient's illness when a specimen was collected can be critical to the interpretation of laboratory findings. For example, if a specimen was obtained from an autopsy, a virus that caused an illness may no longer be present because the immune system may have cleared it so that what is left is tissue damaged by the virus. So the inability to identify a virus in an autopsy specimen may be meaningless. For that and other reasons, the network is seeking as many specimens as possible obtained in the early course of a patient's illness. The important message, Dr. Gerberding said, is that scientists at the centers have cultured coronavirus from two of the four patients from whom it has specimens. The scientists also saw the virus in electron microphotographs from one of the patients from whom the coronavirus was detected and have found evidence of the virus in affected tissues like lungs and kidneys

The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less

Dr. Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies, said: 'We have done some useful things, as a nation and in states and some cities, to prepare for a bioterror attack. But I think people don't appreciate the kind of scale of effort that is needed and has not been achieved. I think there is also an understandable reluctance to talk truthfully about how vulnerable we are, lest we encourage would-be terrorists and undermine our own defense. I don't think we're a lot less vulnerable now than we were in 2001.' Since Sept. 11, the agency has offered doctors training materials to sharpen their ability to recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems now used in many communities to flag odd patterns of illness or medicine use. In addition, many hospitals have retooled their disaster plans. The United States now has enough smallpox vaccine to inoculate the entire population, and, O'Toole said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs. The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less

Since 9-11 the agency has also offered doctors training materials to help recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems used to flag odd patterns of illness or medicine use. In addition, hospitals have retooled their disaster plans. The United States has enough smallpox vaccine to inoculate the population, and, [Tara O'Toole] said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs

Chinese health officials have given the World Health Organization the first sketchy details about a mysterious respiratory ailment that is believed to have first broken out in Guangdong Province in November and that Chinese officials say has tapered off in recent weeks. It was the first official communication from China about the illness, and it provided a longer-term view to the health organization of how the illness has behaved since the first cases were detected. Although the new information hinted that the outbreak may be tapering off for unknown reasons in Guangdong, World Health Organization officials said they needed more information to be certain. 'If it has burned out, it certainly will give us optimism over its control' elsewhere, said Dr. David Heymann, a health agency official. 'That is why we need more information to know what the natural history of the illness has been since November.' The World Health Organization, an agency of the United Nations, on Saturday declared the ailment 'a worldwide health threat.' The agency calls the ailment severe acute respiratory syndrome, or SARS, and says it has caused at least nine deaths in six countries in recent weeks. The spread of the ailment, a form of atypical pneumonia, has been aided by international travel. New cases, including those of many hospital workers, are being reported daily in affected countries, a World Health Organization official. Laboratories in at least five countries have failed to detect any known infectious agent as a cause of the illness. The illness generally starts with the sudden onset of a fever of 101.4 degrees Fahrenheit (38.6 centigrade) or higher, muscle aches, headache, sore throat, dry cough and shortness of breath. X-rays show pneumonia or respiratory distress syndrome. Laboratory tests show low numbers of white blood cells and platelets, which help blood clot. A 32-year-old doctor from Singapore and his 62-year-old mother-in-law were being treated for pneumonia in isolation in a German hospital after having attended a medical conference in New York. Officials believe the doctor may have contracted the illness in treating the first two cases in Singapore, where 20 cases now have been reported. The doctor had a fever and a slight cough, and the mother-in-law had a high fever, doctors at the Johann Wolfgang Goethe-University Hospital in Frankfurt said. They said the doctor's 30-year-old wife, who is pregnant, has shown no symptoms of the ailment

No cases have been reported in the United States, Dr. [Julie L. Gerberding] said. Doctors have reported 14 suspicious cases, but 10 have been judged not to be SARS, and it is unlikely that the four others will turn out to be, Dr. Gerberding said. So microbiologists at major laboratories often use molecular biology methods known as DNA probes to identify an agent. If SARS is a co-infection, say by a bacteria and a virus, ''we should be able to figure it out,'' Dr. Gerberding said. But, she added, even the most sensitive DNA technology can fail to detect a microbe if it is present in tiny amounts. The second feature was the rapidity and severity with which pneumonia developed in some patients. Even among patients who suffer a system illness with influenza, ''it is quite unusual to develop pneumonia,'' Dr. Gerberding said. ''Here we had a very high proportion of individuals developing pneumonia, and that signaled something unusual,'' requiring a closer look

As a mysterious respiratory illness spread to more countries, the World Health Organization took the rare step of issuing a health alert, declaring the ailment 'a worldwide health threat' and urging all countries to help in seeking its cause and control. The agency said that in the past week it had received reports of more than 150 new suspected cases of the illness, now known as severe acute respiratory syndrome, or SARS. The syndrome has caused at least nine deaths, the last victim a nurse in Hanoi. Some victims have recovered, but no one has done so in the past two weeks. The ailment apparently does not respond to anti-viral and antibiotic drugs. Reported cases have come from Canada and six countries in Asia Hong Kong and elsewhere in China, Indonesia, the Philippines, Singapore, Thailand and Vietnam, the health organization said. There have been no reports of the illness in the United States, but Saturday a sick passenger and two companions who traveled from New York City were removed from a flight after it arrived in Frankfurt and put in isolation in a German hospital. The ill passenger was a doctor from Singapore who treated one of the earliest cases there and who flew to a medical meeting in New York City, said Dick Thompson, a spokesman for WHO. The doctor may have gone to a hospital in New York the agency is not certain which one before flying back to Singapore via Frankfurt with his wife and another doctor. Before boarding the flight, the doctor called a colleague in Singapore to describe his symptoms, and the colleague notified the World Health Organization. The cause of the ailment has not been identified. Scientists do not know whether it is a virus or even an infectious agent

In recent weeks scientists at laboratories in at least five countries have failed to detect the avian flu strain in any SARS case. Dr. David L. Heymann, executive director in charge of communicable diseases for the W.H.O., said, ''We have not ruled out influenza definitively.'' But many experts are wondering whether they are confronting a previously unknown infectious agent, possibly one of animals that has jumped species to humans. For reasons not fully understood, SARS has exerted its heaviest toll so far on health care workers in third world countries like Vietnam where there are relatively few trained personnel. The ninth victim of SARS was a nurse who died in Hanoi late last week. The incubation period of SARS seems to range from two to seven days, most commonly four to five days. That is shorter than the period for influenza, which can spread in less than a day. In controlling outbreaks of known diseases, health officials use that kind of information to detect healthy carriers of an infectious agent or people who have mild cases that do not normally require medical attention. But without any tests for SARS there is no way to find such carriers, if any exist. So far chest X-rays have been the only way to detect mild cases