Faculty Bibliography

Mycobacterium tuberculosis Beijing genotype strains are highly prevalent in Asian countries and in the territory of the former Soviet Union. They are increasingly reported in other areas of the world and are frequently associated with tuberculosis outbreaks and drug resistance. Beijing genotype strains, including W strains, have been characterized by their highly similar multicopy IS6110 restriction fragment length polymorphism (RFLP) patterns, deletion of spacers 1 to 34 in the direct repeat region (Beijing spoligotype), and insertion of IS6110 in the genomic dnaA-dnaN locus. In this study the suitability and comparability of these three genetic markers to identify members of the Beijing lineage were evaluated. In a well-characterized collection of 1,020 M. tuberculosis isolates representative of the IS6110 RFLP genotypes found in The Netherlands, strains of two clades had spoligotypes characteristic of the Beijing lineage. A set of 19 Beijing reference RFLP patterns was selected to retrieve all Beijing strains from the Dutch database. These reference patterns gave a sensitivity of 98.1% and a specificity of 99.7% for identifying Beijing strains (defined by spoligotyping) in an international database of 1,084 strains. The usefulness of the reference patterns was also assessed with large DNA fingerprint databases in two other European countries and for identification strains from the W lineage found in the United States. A standardized definition for the identification of M. tuberculosis strains belonging to the Beijing/W lineage, as described in this work, will facilitate further studies on the spread and characterization of this widespread genotype family of M. tuberculosis strains

OBJECTIVES: To genetically characterize and compare Mycobacterium tuberculosis isolates among culture-confirmed TB cases in two regions in the Czech Republic in 1998. METHODS: Consecutive M. tuberculosis isolates from 111 TB patients in Prague and 120 patients in the South Moravia region were genotyped using the standardized IS6110 Southern blot hybridization method and by spoligotyping. RESULTS: Eighty of the Prague patients (72.1%) had isolates with unique RFLP patterns, while 31 (27.9%) had isolates which belonged to 10 clusters. Seventy-eight (64.7%) of the South Moravia strains displayed unique RFLP pattern and 42 (35.3%) were assigned into 15 clusters. The spoligotype profiles previously identified in the U.S. were found in 69 (33%) samples and newly identified Czech spoligotypes in 24 (11.4%) of the total number of examined strains. CONCLUSIONS: The present population-based molecular epidemiological study performed in two regions of the Czech Republic in 1998 demonstrated the distribution of individual genotypes as well as clustered strains of M. tuberculosis isolated from TB patients, and confirmed the similarity between the Czech strain collection and the European Community TB Database, that includes countries with low TB rate. The sporadic import of TB cases from foreign countries and recent transmission events probably do not play significant roles in the epidemiological situation in the Czech Republic

BACKGROUND AND OBJECTIVE: For individuals with hypertension, diabetes, or hypercholesterolemia, the relative magnitude of cardiovascular risk factors and the effect of multiple risk factors remains controversial and both treatment practices and health care usage vary. We sought to determine the effect of hypertension, diabetes, hypercholesterolemia, and their combinations on health care utilization and health status through analysis of data from a large national survey. METHODS: We applied the Anderson model to a cross-sectional representative sample (n=15,107) of the U.S. civilian, noninstitutionalized population (the 1996 Medical Expenditure Panel Survey). RESULTS: For diabetes, additional risk factors did not increase the likelihood of emergency room (ER) visits or hospitalizations but were associated with increased outpatient visits and poorer health status. For hypertension, additional risk factors increased the likelihood of hospitalization (but not ER visits), the number of outpatient visits, and poorer health status. For hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and poorer health status but not more outpatient visits. Diabetes had the largest effect on health care utilization and health status. CONCLUSION: These findings re-emphasize the magnitude of diabetes as a major risk factor associated with increased ER visits, hospitalizations, outpatients visits, and lower health status

The vaccine problems raise concern because Chiron, the world's fifth-largest vaccine manufacturer, is under contract with the United States government to produce pilot supplies of human vaccines against two strains of avian influenza, which has spread widely in Asia. The pilot vaccines are needed because health officials around the world have expressed fears that in a worst-case scenario, the avian strains could mutate to cause a human pandemic. The rates of adverse reactions were significantly higher among the children receiving the Chiron vaccine, which is made in Italy, than among children who received a vaccine made by another company, the Brazilian representative of the Pan American Health Organization said. The organization, part of the World Health Organization, supplies the vaccine. Chiron's vaccine against the three childhood diseases is sold in Italy, Asia and South America, but not in the United States, said Ms. [Alison Marquiss]. She said the episode in Brazil was the first time any problems had been reported from Chiron's MMR vaccine

Tens of millions of doses of standard influenza vaccines are produced on a seasonal basis, and the industry does not have the capacity to produce a pandemic vaccine at the same time. So, the government is taking steps to help manufacturers produce vaccine at any time of the year, [Anthony Fauci] said. 'Vaccination with a pandemic strain-specific vaccine is likely to be the most important strategy for preventing morbidity and mortality from pandemic influenza,' the plan said. But the initial supply will be limited. Because the influenza virus mutates quickly and unpredictably, the A(H5N1) strain may change significantly in an epidemic. Or some other strain may cause the next pandemic. So mass production of the A(H5N1) vaccine would come only if the virus started spreading from human to human, which it has not done so far. **

Chiron makes about half the 100-million-dose supply that federal health officials expected to be used this flu season. Its chief executive, Howard Pien, said in a telephone interview that it informed the Food and Drug Administration and the Centers for Disease Control and Prevention about the problem on Wednesday. Other than a relatively small amount sent to distributors in July, Mr. Pien said, the company will probably not begin issuing the vaccine until mid-October, about a month later than expected. Chiron (pronounced KY-rohn), based in Emeryville, Calif., outside Oakland, manufactures the vaccine in Liverpool, England. Its quality controls cover a wide range of tests, said Mr. Pien, who declined to specify which of those the eight contaminated Fluvirin batches had failed. He said the contamination was biological in nature and possibly due to human error, but again would not be more specific. The four million doses in the eight batches will be destroyed, Mr. Pien said. He said that though Chiron shipped the first one million doses of Fluvirin to distributors in July, they had not been distributed to doctors and clinics

The spread of polio to Guinea and Mali brings to 12 the number of previously polio-free African countries that have experienced an outbreak of the disease since January 2003. Guinea and Mali are outside a ring of countries that conducted synchronized polio vaccination programs last winter in an attempt to create an immunologic firewall to limit the spread of the disease from Nigeria and Niger. In addition to Guinea and Mali, the countries to which polio has spread from Nigeria are: Benin, Botswana, Burkina Faso, Cameroon, Central African Republic, Chad, Ghana, Ivory Coast, Sudan and Togo

As of Aug. 24, there were 602 polio cases worldwide, of which 476, or 79 percent, are in Nigeria. Ninety percent of the world's cases are in Africa, where all but two countries Nigeria and Niger had been freed of polio by the end of 2002. In addition to Guinea and Mali, the countries to which polio has spread from Nigeria are Benin, Botswana, Burkina Faso, Cameroon, Central African Republic, Chad, Ghana, Ivory Coast, Sudan and Togo

Guinea and Mali are outside a ring of countries that had conducted synchronized polio vaccination programs last winter in an attempt to limit the spread of the disease from Nigeria and Niger. Polio was last reported from Guinea in October, 1999, and from Mali in January, 1999. As of Aug. 24, there were 602 polio cases worldwide, of which 476, or 79%, are in Nigeria. Ninety per cent of the world's cases are in Africa, where all but two countries -- Nigeria and Niger -- had been freed of polio by the end of 2002. Black & White Photo: Georges Gobet, Agence France-Presse / A medical assistant administers drops of polio vaccine to a child...; Black & White Photo: Georges Gobet, Agence France-Presse / ...earlier this year in Ivory Coast. The World Health Organization fears an outbreak of polio in northern Nigeria could lead to an epidemic of the disease, which it had hoped to eradicate by the end of the year, across sub-Saharan Africa

The administration released the plan at this time in part because of the recent experience with severe acute respiratory syndrome, or SARS, and the anthrax attacks. Also, health officials are deeply concerned about the wide spread of the A(H5N1) strain of avian influenza that has devastated poultry and bird flocks in Southeast Asia. Experts fear that the genes of A(H5N1) could combine with the genes of a human influenza strain to create an entirely new virus that could ignite a worldwide epidemic. Because the influenza virus mutates quickly and unpredictably, the A(H5N1) strain might change significantly as it causes an epidemic. Or some other strain may cause the next pandemic. Meanwhile, the government has stockpiled enough of the antiviral drug, Tamiflu, to prevent or treat influenza in one million people. A full course involves taking 10 Tamiflu pills -- two a day for five days. But that would be woefully inadequate to treat enough people in a pandemic