Faculty Bibliography

News of Mr. [Colin Powell]'s cancer surprised all but his closest associates. Adam Ereli, another State Department spokesman, said the surgery had been scheduled for some time, but neither Mr. Powell nor his aides chose to disclose it publicly until the day it was performed

For all the public concern over the rapid spread of the new Fujian strain of influenza, health officials and doctors say there is still no way to know whether this year's flu season is particularly severe or just off to an early start. And for all the clamor for dwindling supplies of vaccine, no one knows how effective the current vaccine will be against the Fujian strain. No one knows why influenza has hit the western United States in particular, or why it happened so early this season. No evidence exists to suggest that the Fujian strain is more virulent than other strains that have caused past epidemics or that this season's influenza is worse than those of the past. Although the Fujian strain also struck early in Europe, the World Health Organization said it was not aware of unusually severe influenza this season outside the United States. The Fujian strain was detected too late to be included in this season's vaccine. Officials have said that the vaccine should still afford ''some protection'' against the Fujian strain but do not know how much

Influenza is arguably the most unpredictable of viruses, and protecting the public is a tricky balancing act. It involves a number of factors: inadequate scientific knowledge of the virus; educated guesswork in choosing what strains of influenza to include in each year's vaccine; time-consuming, old-fashioned manufacturing techniques; and skills in communicating with a skeptical public. Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, says the majority of influenza cases are an annoyance, causing only a mild respiratory illness. But Gerberding also noted that influenza is lethal for 36,000 Americans on average each year. The time when the three strains are chosen is critical to vaccine production. One reason is that it takes tens of millions of chicken eggs to produce each season's vaccine, and they must be bought months in advance. Once production is complete, additional doses cannot be made without reducing the amount that could be produced for the next influenza season, Gerberding said

No treatment now exists for Ebola, and tests of a vaccine have just begun in humans. Though scientists have had earlier successes in treating Ebola in mice and guinea pigs with antivirals, these drugs did not work in nonhuman primates. In an interview this week in Dallas, Terry Fredeking, a co- author and an expeditionary biologist, said he supplied the raw material that was used to re-create a protein for the new drug. I won't say how long it took me to persuade Peter Jahrling that spit from hookworms might be able to treat monkeys with Ebola, said Fredeking, founder and president of Antibody Systems, a research company in Hurst, Texas. Fredeking said that the World Health Organization in Geneva had asked team members whether rNAPc2 might be used on an experimental basis to treat people in a current outbreak of Ebola in the Congo Republic north of that country's capital, Brazzaville. That outbreak, which is thought to be waning, has caused 28 deaths as of Dec. 2, according to the UN health agency

She also mentioned a new type of vaccine -- given by nasal spray -- that is still readily available. As of Tuesday, nearly four million doses of the vaccine, FluMist, made from live but weakened influenza viruses, were available, Dr. [Julie L. Gerberding] said. Made by Wyeth Pharmaceuticals in Collegeville, Pa., the vaccine was licensed for the first time earlier this year, and is recommended only for healthy individuals ages 5 to 49. FluMist should not be taken by pregnant women and individuals with heart, lung, diabetes, kidney failure and other chronic conditions, health officials say. Individuals with weakened immune systems, like those infected with the AIDS virus, or who take anti-cancer and other medications that can weaken the immune system are also advised not to take FluMist. FluMist is not recommended for health workers who care for individuals with suppressed immune systems. Influenza can be treated with four licensed influenza drugs: amantadine, rimantadine, oseltamivir and zanamivir. Studies have shown that they can reduce the duration of influenza illness by about a day among healthy adults if taken within 48 hours on onset of symptoms

Ebola usually starts with a fever and flulike symptoms of malaise, muscle aches, headache, followed by vomiting, diarrhea and a rash. The virus disrupts the blood clotting system in monkeys and humans, leading to abnormal blood clotting and then to severe bleeding and death. Mr. [Terry M. Fredeking] said the World Health Organization in Geneva had asked team members whether rNAPC2 might be used on an experimental basis to treat people in a current outbreak of Ebola in Congo. That outbreak, which is thought to be waning, has caused 28 deaths as of Dec. 2, according to the W.H.O. Dr. C. J. Peters, an infectious-disease expert at the University of Texas Medical Branch at Galveston who has worked on Ebola, called the new results ''very impressive.'' Dr. Peters said a treatment for the Ebola virus would be even more important than a vaccine

[Julie L. Gerberding] added that government rationing of the remaining stocks was not an option, because most vaccine is in the hands of practicing physicians, who dispense it according to patient need and demand. 'For the last five years, we have thrown a lot of flu vaccine away,' Gerberding said. Even if the government can import vaccine from Europe, the amount is likely to be relatively small. Gerberding said the government was exploring the possibility of securing a half-million doses of vaccine from the British unit of Chiron. That vaccine is licensed but not approved for use in the United States, Gerberding said, and her agency is working with the Food and Drug Administration to determine whether it can be used in time

Even if the government can import vaccine from Europe, the amount is likely to be relatively small. Dr. [Julie L. Gerberding] said the government was exploring the possibility of securing a half-million doses of vaccine from the British unit of Chiron. That vaccine is licensed but not approved for use in the United States, Dr. Gerberding said, and her agency is working with the Food and Drug Administration to determine whether it can be used in time. Health officials here and in Europe had earlier reported that a new Fujian strain of flu virus was causing a vast majority of cases of the respiratory illness. Also, Dr. Gerberding has said early laboratory tests show that the current vaccine offers some protection against Fujian flu. Dr. Gerberding said it would take several weeks before officials learned from studies how well this season's vaccine was protecting against the Fujian strain

Nigeria has reported the largest number this year, 251, compared with 145 for the comparable period last year. Epidemiologists have traced the spread of polio from Nigeria to four countries that were previously thought to be polio-free, Burkina Faso, Chad, Ghana and Togo. Niger, the fifth country, has had a succession of imported cases. Four polio cases have also occurred since late June in Lagos in southern Nigeria, which had been polio free since April 2001. Nigeria is the last major challenge to the goal of eradication, Dr. [David L. Heymann] said. There, the W.H.O. has run into an unexpected hurdle from accusations by some Islamic leaders that the polio vaccine leaves young girls infertile

Some experts criticized countries that used thermal scanners, which detect elevated body temperatures and are costly, at airports, saying there is no evidence they are cost effective in detecting sick passengers. But Dr. Heymann said that the criticism overlooked the psychological advantage scanners offered by raising confidence among travelers and their role as deterrents in keeping sick passengers off planes. Scanners remain in use at many airports partly because no one knows whether SARS will return this year or next. According to the World Health Organization, SARS was rarely transmitted aboard flights. The United Nations agency, which is headquartered in Geneva, received verified reports of 40 international flights that carried 37 passengers (some of whom were on two flights) with SARS before March 27. The disease was transmitted to at least one other passenger on five of the flights. But no transmission occurred after March 27, when W.H.O. advised airports to screen passengers leaving SARS-affected areas, said Dr. David L. Heymann, a W.H.O. epidemiologist who oversaw the agency's SARS investigation