Faculty Bibliography

The flu vaccine includes three strains of influenza virus, but was not designed to protect against a new one that has appeared in a number of countries over the last year. It is known as the Fujian strain, a variant of the Panama strain that is included in the current vaccine. Both are categorized as H3N2 strains that have been linked to higher rates of serious illness requiring admission to a hospital and to death, Dr. [Julie L. Gerberding] said. The influenza virus mutates frequently. Health officials change the strains of virus put in the flu vaccine each year as they try to keep up with mutations. But matching strains in the vaccine with those circulating among humans during a flu season is a notoriously unpredictable exercise. The World Health Organization committee that makes the recommendations for the flu vaccine knew about the Fujian strain in February, said Dr. Klaus Stohr, an influenza expert at the organization. But Dr. Stohr said in a recent interview that the committee decided not to include the Fujian strain because scientists could not make it pure enough in time for a human vaccine

Such may be the case with the new Cypher heart stent, which in April became the first licensed drug-coated stent in the United States. The F.D.A. gave Cordis, a subsidiary of Johnson & Johnson, approval to sell Cypher after clinical tests gave the device glowing reports. The incidence of complications has steadily declined to 0.05 events per unit shipped since a peak of 0.12 in July, the month that Cordis introduced the largest-size Cypher, Dr. [Dennis Donohoe] said. Still, a puzzling element is why the F.D.A. does not have the information it needs to determine whether more complications occur with Cypher than with bare stents. As a condition of licensing and to gain a more accurate picture of Cypher problems in everyday medical practice, the F.D.A. required Cordis to conduct a detailed postmarketing study of 2,000 patients in this country. The study seeks to answer questions like: How did the doctors select patients for Cypher? Precisely how did the doctors implant the stent? How did the doctors prescribe the drugs used in the procedure? How did patients take the drugs?

Infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are being increasingly observed in patients who lack traditional risk factors. We described 8 postpartum women who developed skin and soft-tissue infections caused by MRSA at a mean time of 23 days (range, 4-73 days) after delivery. Infections included 4 cases of mastitis (3 of which progressed to breast abscess), a postoperative wound infection, cellulitis, and pustulosis. The outbreak strains were compared with the prototype CA-MRSA strain MW2 and found to be indistinguishable by pulsed-field gel electrophoresis. All were spa type 131, all contained the staphylococcal chromosomal cassette mec type IV, and all expressed Panton-Valentine leukocidin and staphylococcal enterotoxins C and H. The route of transmission was not discovered: the results of surveillance cultures of samples obtained from employees of the hospital, the hospital environment, and newborns were negative for the outbreak strain. We report that MW2, which was previously limited to the midwestern United States, has spread to the northeastern United States and has become a health care-associated pathogen

Doctors have trained many police, fire, airline and other workers to use defibrillators as the devices have become standard equipment in many airports, shopping malls, convention centers and health clubs. Still, in the United States alone, more than 1,200 people die from cardiac arrest each day before they can be admitted to a hospital. The survival rates vary widely depending on the geographic area, in part because of the time it takes for emergency medical technicians to reach victims. The vast majority die before reaching a hospital

The stent is coated with taxol, a drug long and widely used in treating breast cancer. But use of taxol in the heart stent, which Boston Scientific of Natick, Massachusetts, manufactures as Taxus, is experimental. There is no indication yet that it is safer or more effective than another type of drug-coated stent, already in use, that the government has linked to blood clots and deaths in about 60 patients since its approval last spring

A different one-year study of 76 health clubs in Great Britain with defibrillators found that using them along with CPR saved the lives of six of eight people who suffered sudden cardiac arrest, reported a team headed by Dr. Kyle McInnis. Fifty cardiac arrest cases were shocked with defibrillators before emergency medical technicians arrived. Half were later discharged from the hospital with survival rates similar to those who were treated only by emergency workers. Addressing concerns about brain damage among cardiac arrest survivors, a Dutch study of 57 such patients found that most did not experience cognitive impairment as of six months after the event. Of these, 58 percent scored ''unimpaired'' on all eight cognitive tests. However, one in four survivors did suffer severe cognitive impairment

The Geneva-based UN agency expressed optimism last week after convening a panel of 50 experts from 15 countries to review reports on a number of candidate SARS vaccines. Scientists in Canada, China, the United States and possibly other countries began developing them after the SARS epidemic this year. [Marie-Paule Kieny] said by telephone that for many reasons it was too difficult to predict which research team would inject the first human with a SARS vaccine, and when, if ever, a vaccine might be available. If SARS does not return, and an experimental vaccine is found safe and able to produce antibodies in humans, ethics would preclude deliberately trying to infect a vaccine recipient with the SARS virus as a scientific challenge. The reason is the high death rate from SARS, about 11 percent

The stent is coated with taxol, a drug long and widely used in treating breast cancer. But use of taxol in the heart stent, which Boston Scientific of Natick, Mass., manufactures as Taxus, is experimental. There is no indication yet that it is safer or more effective than another type of drug-coated stent, already in use, that the government has linked to blood clots and deaths in about 60 patients since its approval last spring. Last month the agency issued its second health warning to doctors about the Cypher device, saying that it had received more than 290 reports of blood clots among Cypher recipients and that in more than 60 of the cases the device was linked to patient deaths. The clots occurred up to 30 days after the stent had been implanted. The new update on the taxol-coated stent involved 1,326 patients at 73 American hospitals who had never received a stent. Repeat angiographic tests of 559 of the participants, or 76 percent, showed that the stents were effective at varying lengths, as determined by the degree of blockage, and in arteries of varying diameters, Dr. [Gregg W. Stone] and Dr. [Stephen G. Ellis] said

The longstanding threat of bioterrorism turned real with the deliberate release of anthrax spores in 2001. When SARS suddenly appeared, there was speculation that it was bioterrorism. Experts dismissed that. No one was ''smart enough to invent a SARS from scratch,'' said Dr. Joshua Lederberg, a Nobel Prize-winning microbiologist. Now, he said, ''SARS may end up being a biological weapon.'' If SARS does not return in the next few years, will companies have a continuing incentive to develop a vaccine that might never be needed? If industry lacks incentive, yet SARS returns, the consequences could be devastating. Plagues past and present, from 14th-century Florence to the Hong Kong airport during the SARS scare to the AIDS Quilt in Washington in 1996 and the AIDS virus. (Photo by Corbis-Bettmann, plague; Agence France-Presse, SARS screening; Associated Press, AIDS quilt)