Faculty Bibliography

When the meeting began, several transplant surgeons and workers argued vehemently against any changes, saying greater scrutiny of donated organs and tissues might scare away potential donors and might cost far too much money for any potential benefit. They noted that standard tests could reliably detect evidence of HIV in the overwhelming majority of donors. By the close of the meeting such criticism seemed muted, in part because Dr. Richard L. Hurwitz, the head of the Virginia transplant service that distributed the infected tissue in 1985, said he had heard of at least one other case of HIV infection after transplant surgery. HIV infections detected after transplant surgery would have to be reported immediately to state or local health officials. At present, doctors in all states must report AIDS cases but generally not HIV infection

Walking a fine line between a serious shortage of donated organs and tissues and a desire to prevent transmission of the virus that causes AIDS, federal health officials are developing a national system to track organs and tissues from the time they are donated to the time they are transplanted. When the meeting began, several transplant surgeons and workers argued vehemently against any changes in the system, saying greater scrutiny of donated organs and tissues might scare away potential donors and might cost far too much money for any potential benefit. They noted that standard tests could reliably detect evidence of HIV in the overwhelming majority of donors. By the close of the meeting such criticism seemed muted, in part because Dr. Richard L. Hurwitz, the head of the Virginia transplant service that distributed the infected tissue in 1985, said he had heard of at least one other case of HIV infection after transplant surgery

Federal health officials said on Dec 12, 1991 that they were working with drug manufacturers to find ways to redistribute the influenza vaccine to areas with shortages

In a joint effort to overhaul their systems to control tuberculosis, New York state and New York City health officials are planning to hire more workers to supervise tuberculosis therapy, require hospitals and prisons to build environmentally sound rooms to prevent spread of the bacterial disease and start a hotline for doctors to get information about cases more quickly

An advisory panel established by the CDC says that Americans are not being adequately protected against tuberculosis and that infected patients are not being given optimal treatment. Without specifying the amount, the panel said that more money is needed to bring the disease under control and bring the country to its goal of having the disease eliminated by 2010

Instead, draft guidelines by the CDC suggest, the emphasis should be on identifying infected health workers who do not meet standards of infection control or whose stamina or mental state makes them unfit to practice. In a draft of the new federal guidelines, which have not been publicly announced, the CDC says the factors to be considered by a local panel include a health-care worker's skill and technique in performing a procedure and the worker's physical and mental stamina to perform routine duties. The draft guidelines, like the previous ones, oppose mandatory testing of health workers for HIV. Instead they call for voluntary tests; those people found to be infected are advised to seek counsel from a local committee of experts before performing invasive procedures

The change amounts to agreement that, as critics said, there is no scientific reason to list procedures that should not be performed by infected health workers. Instead, draft guidelines suggest that the emphasis should be on identifying infected health workers who do not meet standards of infection control or whose stamina or mental state makes them unfit to practice. The draft would revise guidelines the federal agency issued in July pending creation of the list. The draft guidelines emphasize that most routine procedures, like physical examinations, are not invasive. Also, they say, many invasive procedures pose no risk that the AIDS virus will be transmitted to the patient through blood. It gave examples such as injections, drawing blood samples and putting tubes through the mouth and into the stomach, and into the urinary bladder. The new guidelines, like the previous ones, oppose mandatory testing of health workers for HIV, the virus that causes AIDS. Instead they call for voluntary tests. Workers found to be infected are advised to seek counsel from a local committee of experts before performing invasive procedures. Invasive procedures are those in which a doctor's hands or instruments enter a body cavity or touch mucous membranes in the mouth or elsewhere. The draft focuses on procedures performed by surgeons, dentists, gynecologists and obstetricians

The Centers for Disease Control does not have direct regulatory powers, but Dr. William L. Roper, the agency's director, has said he expected health workers to comply with the guidelines through the encouragement of professional groups and state licensing authorities. Moreover, other experts said the guidelines could be cited in lawsuits. The draft guidelines, like the previous ones, oppose mandatory testing of health workers for HIV. Instead they call for voluntary tests; those people found to be infected are advised to seek counsel from a local committee of experts before performing invasive procedures. Invasive procedures are those in which a doctor's hands or instruments enter a body cavity or touch mucous membranes in the mouth or elsewhere. The draft focuses on procedures performed by surgeons, dentists, gynecologists and obstetricians

Uncertainty about influenza is never-ending because the virus constantly mutates to evade the protective benefits of the latest vaccine. Any vaccine left over is worthless, and an entirely new influenza vaccine must be made each year. Health officials still smart over the swine flu fiasco of 1976. President Gerald R. Ford, responding to advice from the Centers for Disease Control that a repetition of the 1918-1919 world epidemic of influenza might be coming, urged all Americans to get a flu shot. The fear was real because in 1918-1919 influenza caused one of the worst epidemics in history, killing 20 million people, including half a million Americans. Importing influenza vaccine from abroad is not a likely solution to the shortage because the Food and Drug Administration says unlicensed products cannot be sold in this country. It would take something like the 1918-1919 pandemic to allow importation of an unlicensed flu vaccine, officials of the agency said.