Faculty Bibliography

Tamiflu, a powerful antiviral drug that might slow the early stages of an outbreak, is in extremely short supply, according to the World Health Organization. And a vaccine the only thing that could stop the global spread of the disease will not be available for months. Chiron, one of two manufacturers trying to develop a human bird-flu vaccine, last week had its license to make conventional flu vaccine temporarily suspended by the British government. The suspension created a severe shortage of the flu vaccine in the United States. Whether it will affect the testing of the company's experimental human avian-influenza vaccine remains to be seen. Until 1997, scientists had not believed it was even possible for an avian influenza virus to pass directly from birds to people without first combining with a mammalian influenza virus. Pigs can harbor avian and mammalian influenza viruses while showing no ill effects, and have been blamed for periodically allowing new avian influenza viruses into human populations that have little if any immunity to them. The United Nations Food and Agriculture Organization declared in late September that the virus had become so widespread in domesticated and wild birds alike that it would take years to wipe out, though health officials are not even sure it is possible to do so. The U.S. National Institute of Allergy and Infectious Diseases plans to begin clinical safety trials of human avian-flu vaccines developed by Chiron, based in Emeryville, California, and Aventis Pasteur, in Swiftwater, Pennsylvania, after receiving the pilot batches, expected in December. But there will be no findings until spring. Chiron's human avian-flu vaccine is being made in a different facility from the one that made the conventional vaccine this year

In small Thai chicken farms, Vietnamese communes and the jungles of northern Malaysia, health officials, scientists and farm workers are fighting an increasingly menacing yet little-understood foe the A(H5N1) strain that causes avian influenza, or more popularly, bird flu. Until 1997, scientists had not believed it was even possible for an avian influenza virus to pass directly from birds to people without first combining with a mammalian influenza virus. Pigs, which can harbour avian and mammalian influenza viruses while showing no ill effects, have been blamed for periodically allowing new avian influenza viruses into human populations that have little if any immunity to them

The first successful organ transplant recipient was a 23-year- old man from Northboro, Massachusetts named Richard Herrick, who had just been discharged from the Coast Guard. On Dec. 23, 1954, he received a kidney from his healthy identical twin brother, Ronald, in an operation performed at what is now Brigham and Women's Hospital in Boston. Richard survived for eight years until the original kidney disease destroyed his new organ. Over the years, the biggest obstacle facing patients and surgeons has been the rejection of transplanted organs. Several years after Herrick's surgery, doctors began using anti-rejection drugs like azathioprine and, later, cyclosporine. In the early 1990s, [Thomas Starzl] and other transplant surgeons noticed that some patients who did not take their drugs regularly or at all were able to keep their donated organs. Perhaps the most disputed frontier in transplantation science is the face transplant, a procedure that surgeons say is now within their capabilities and that raises complex ethical questions extending even beyond identity and appearance. Ethics committees in England and France have rejected proposals to perform face transplants because of the unknown risks of long-term use of large doses of immunosuppressive drugs for a procedure that does not save lives. But in October, an institutional review board that oversees the safety of human experiments at the Cleveland Clinic became the first such group to approve a face transplant

Immediate health threats include wounds from stepping on nails and broken glass; dehydration and heat stroke from exposure in hot, muggy weather; the possibility of electrocution from downed wires; and diarrhea and respiratory diseases caused by various bacteria and viruses that can spread rapidly because of poor sanitation and a lack of clean water. Doctors Without Borders had to delay until Wednesday a shipment of 32 tons of relief materials to Sumatra from Ostende, Belgium, because of the lack of an available airplane. The cargo includes generators, water bladders and tanks; plastic sheeting; mosquito nets; chlorination kits; a hospital tent; and various medical supplies

Doctors regard transplants performed between identical twins very differently from those between people who do not have identical genes. Transplanting an organ between identical twins can be likened to taking tissue from one area of a person's body and putting it in another area of the body. The transplant recipient does not need antirejection drugs. They include Ms. [Edith Helm] and another of Dr. [Joseph E. Murray]'s patients; a patient whose surgery was performed with Dr. Murray's assistance at the [Thomas E. Starzl] Oregon Health & Sciences University in Portland in 1959; and a patient of Dr. Starzl's who received a kidney at the Veterans Administration Hospital in Denver in 1962. Dr. Murray recalled that when Ms. Helm was having her first child, she was in the same hospital in Boston where Dr. Murray's wife, Bobby, was delivering her fifth child, Tom. Since then, Dr. Murray has often stopped to visit Ms. Helm on the way to see Tom in Denton, Tex

Immediate health threats include wounds from stepping on nails and broken glass; dehydration and heat stroke from exposure in hot muggy weather; the possibility of electrocution from downed wires; and diarrheal and respiratory diseases caused by various bacteria and viruses that can spread rapidly because of poor sanitation and a lack of clean water. Doctors Without Borders said it had to delay until Wednesday a shipment of 32 tons of relief materials to Sumatra from Ostende, Belgium, because of the lack of an available airplane. The cargo includes generators, water bladders and tanks, plastic sheeting, mosquito nets, chlorination kits, a hospital tent and various medical supplies. Dangers also loom from eating spoiled food. Infectious diseases like dysentery, cholera, hepatitis A and leptospirosis that are present in an area can spread through sewage, said Dr. Maria Connelly, a W.H.O. expert on emergencies. The threat depends in part on which diseases are prevalent in an area, and it can increase when sewage spills into streets

Bird flu is highly lethal, having killed 32 of the 44 people previously confirmed to have caught it this year, all in Thailand and Vietnam. But the tests from Japan confirm reports that the virus can also cause infection that produces mild symptoms or none. Such findings have come from tests of farmers and health workers exposed to the A(H5N1) virus in an outbreak in Hong Kong in 1997, and a different type of avian influenza in the Netherlands in 2003. Scientists at the National Institute of Infectious Diseases in Tokyo had to adapt laboratory tests developed elsewhere to detect antibodies to A(H5N1) virus in humans. The more sophisticated tests were needed because the level of antibodies of the virus that humans form is much lower than the level formed in response to the regular human influenza, [Klaus Stohr] said. Because the tests involve live viruses, they must be conducted in a laboratory with tight biological security, he said. Scientists also must confirm the findings by using tests validated by other laboratories

The tests from Japan confirm reports that the virus can also cause infection that produces mild symptoms or none. Such findings have come from tests of farmers and health workers exposed to the A(H5N1) virus in an outbreak in Hong Kong in 1997, and a different type of avian influenza in the Netherlands in 2003. Scientists at the National Institute of Infectious Diseases in Tokyo had to adapt laboratory tests developed elsewhere to detect antibodies to A(H5N1) virus in humans. The more sophisticated tests are needed because the level of antibodies of the virus that humans form is much lower than the level formed in response to the regular human influenza, Dr. [Klaus Stohr] said. because the 58 people whose blood was tested were a tiny fraction of workers exposed to the A(H5N1) virus, they did not represent a scientifically valid random sample, Dr. Stohr said, and firm conclusions about the frequency of symptomless infections cannot be drawn. More information may come from tests to be done on 1,200 blood samples obtained in Korea and hundreds more in China, Thailand and Vietnam

In October, the nation's expected supply of influenza vaccine was suddenly cut in half when the British government suspended the manufacturing license of the Chiron Corporation, an American biotechnology company, because of contamination at its factory in Liverpool, England. Chiron, one of two major manufacturers of the vaccine for Americans, had been expected to supply nearly 50 million doses. The C.D.C. responded by limiting use of the vaccine to the vulnerable groups. Health officials still consider those groups a priority for influenza vaccine. But midseason estimates of vaccination rates are below those of last season for adults in the priority groups, said Dr. Julie L. Gerberding, the director of the centers

Thursday, Dec. 23, will be the 50th anniversary of the first successful organ transplant, a kidney transplant from a living donor performed in Boston in 1954. Mr. [Robert Phillips] and a small number of other long-term survivors attest to how well organ transplants can work in the best cases. A face transplant could also raise unrealistic hopes, experts say. No guarantee exists that the transplant recipient will look normal. The new face could worsen the appearance and reduce facial expression. A face transplant could be technically successful but leave the recipient and the family dissatisfied. At the same time, a successful transplant may send a message that disfigured people who do not choose to have transplants cannot have a high quality of life. Robert Phillips has lived almost 42 years since a kidney transplant. (Photo by Steve Ruark for The New York Times); [Richard Herrick], front left, recipient, and Ronald Herrick, donor, with the surgical team after the 1954 kidney transplant. (Photo by Courtesy of Brigham and Women's Hospital); The first successful organ transplant took place on Dec. 23, 1954, when Richard Herrick received a kidney from his healthy identical twin brother, Ronald. Richard survived for eight years until the original kidney disease struck again. (Photo by Courtesy of Brigham and Women's Hospital)(pg. F7); (Illustrations by Al Granberg, Alain Delaqueriere/The New York Times)(pg. F1)