Faculty Bibliography

Smallpox vaccine can lead to serious and potentially fatal complications, especially in people with impaired immune systems. The virus from which the vaccine is derived, a cousin of the smallpox virus, can spread from recipients to people with whom they come in contact and can cause life-threatening complications among them. More disturbing were the data concerning risks among people with a common skin condition, eczema. People with it, or who have had it, are at higher risk of complications from the smallpox vaccine. The rate was one case of complications per 100,000 vaccinations, a figure that exceeds the risk of paralysis from the oral polio vaccine. The government stopped oral polio vaccinations because it considered the risk too high. ''Unless it's an emergency where we may need to vaccinate everyone within a couple days, we need to go slow in the initial rollout, work out the kinks and get some experience in giving the vaccine,'' Dr. [Marcelle Layton] said. The problems include who will have legal liability for adverse reactions and risks in administering the vaccine, which is considered the most dangerous of all immunizations. Training doctors and health workers how to administer the vaccine properly and recognize a successful smallpox vaccination reaction, known as a ''take,'' could also be a challenge. Last fall, when the C.D.C. vaccinated nearly 200 staff members as part of its smallpox response team, it canceled plans to vaccinate more in part because the doctors who performed the vaccinations became alarmed at the severity of the reactions and the accompanying fever, sore arms and swollen lymph nodes. The doctors prescribed antibiotics in the mistaken belief that some vaccination takes had become infected

More than two months after a national advisory panel recommended vaccinating thousands of health-care and emergency workers against smallpox as a precaution against a bioterrorist attack, state and local health officials are waiting for the government to announce its official policy. No vaccinations have taken place. Because the United States stopped routine smallpox vaccinations in 1972, tens of millions of younger Americans have never been vaccinated against a disease that can kill up to 30 percent of its victims. It is unclear how well protected those people, who received vaccinations decades ago, are

More than two months after a national advisory panel recommended vaccinating thousands of health care and emergency workers against smallpox as a precaution against a bioterrorist attack, state and local health officials are waiting for the government to announce its official policy. No vaccinations have taken place. On June 20, the panel unanimously rejected a proposal to offer vaccine to every American and recommended immunizing only about 15,000 'first responders' -- the health care and law enforcement workers who would be most likely to respond to a biological attack

No patient has entered the trial, which the F.D.A. allowed on Monday, said Dr. James Rahal, the chief of infectious diseases at New York Hospital Queens and a leader of the study. Dr. Rahal was one of the first American physicians to study West Nile virus in 1999, when the illness, which is carried by mosquitoes, was first detected in this hemisphere

The strain of West Nile virus spreading in the United States is identical to one that infected geese and humans in Israel, but no one knows how it came here. Large numbers of bird deaths from West Nile disease have occurred concurrently with human cases only in Israel and the United States, said Dr. Lyle R. Petersen, an epidemiologist who specializes in studying insect-borne infections at the Centers for Disease Control and Prevention

Already, West Nile has provided some useful, and sometimes painful, information. Most disturbing is the virus' changing face. The frequency of human outbreaks in Europe, the Middle East and this country has risen over the last decade. So, apparently, has the severity of human disease. Also, at 55, the median age of West Nile encephalitis cases in this country this year seems to be a decade lower than in earlier outbreaks. The strain of West Nile virus spreading in the United States is identical to one that infected geese and humans in Israel, but no one knows how it came here. Large numbers of bird deaths from West Nile disease have occurred concurrently with human cases only in Israel and the United States, said Dr. Lyle R. Petersen, an epidemiologist who specializes in studying insect-borne infections at the Centers for Disease Control and Prevention. Israeli doctors reported the first epidemics in 1951. A large outbreak of an illness in the region in 1941 may have been West Nile fever, but documentation is lacking because diagnostic tests were not available. Later outbreaks in Israel involved nursing home patients and soldiers, but West Nile was nearly forgotten there by the end of the 20th century

Most people infected by West Nile virus suffer a mild flulike illness or experience no symptoms at all. Data from countries where West Nile has been recognized for decades suggest that even a mild infection confers lifelong immunity. There is no human vaccine for the virus. Scientists do not know why West Nile virus has hit Louisiana harder than neighboring states. Dr. [Lyle R. Petersen] said Louisiana tended to have high numbers of mosquito-borne diseases ''simply because it is an area with a lot of water and a long mosquito season'' and an abundance of ''the kinds of mosquitoes that can potentially spread West Nile virus.'' The main reservoir of West Nile virus is birds that have been bitten by infected mosquitoes. In some areas tests have shown that virtually all dead birds were infected, and health officials no longer test dead birds for the virus. ''It makes no sense to keep testing dead birds when you know all are positive,'' Dr. Petersen said

The strain of West Nile virus spreading in the United States is identical to one that infected geese and humans in Israel, but no one knows how it came here. Large numbers of bird deaths from West Nile disease have occurred concurrently with human cases only in Israel and the United States, said Dr. Lyle R. Petersen, an epidemiologist who specializes in studying insect-borne infections at the Centers for Disease Control and Prevention. West Nile virus is here to stay, health officials say. Until a vaccine is developed for humans and a clearer picture emerges of how to stop the virus's spread in nature, West Nile virus is likely to move throughout the Western Hemisphere to cause anxiety, if not major public health problems. West Nile virus has spread to 36 states and the District of Columbia. Birmingham, Ala., recently sprayed to kill virus-spreading mosquitoes. (Associated Press)(pg. F1); Brenda White of the Florida Department of Health holds a dead pet macaw that the state will test for West Nile virus infection. (Reuters)(pg. F6)

Blood bank screening for hepatitis has brought several previously hidden cases to my office door. Some privacy has been forsaken for the more important goal of keeping our blood supply safe. A doctor must be able to communicate a patient's information to another doctor, provided the patient has authorized this referral. This method has always been used and it must continue. No additional written consent for expert consultation or chart notes passed among physicians is possible without gumming up the works. And a patient should want a consulting doctor to know his history and be able to pass a comprehensive evaluation back to the primary physician. This routine optimizes care

George W. Bush, 56, passed his second annual medical checkup as president with flying colors and a prediction from the eight examining doctors that he would remain in good health for the rest of his term. After Mr. Bush ran on a treadmill and underwent other tests, the doctors said that he had no evidence of heart disease