SrasV1, Istex, Corpus, bibRecord, 000481

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Clinical Infectious Diseases [ 1058-4838 ] ; 2005.

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DOI: 10.1086/512345

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<sec id="sec1">

<title>Bird Flu Far More Deadly than SARS, WHO Says</title>

<p>29 November (Reuters Health [Tan Ee Lyn])—The bird flu virus is far more lethal than the severe acute respiratory syndrome (SARS) virus that struck Asia last year and could unleash a pandemic that could kill as many as 50 million people, a World Health Organization (WHO) official said.</p>

<p>A WHO estimate last week that H5N1 could infect up to 30% of the world's population and kill between 2 and 7 million people was a conservative estimate, said Shigeru Omi, regional director of WHO's Western Pacific Regional Office.</p>

<p>“The maximum range is more…maybe 20 to 50 million people,” Omi said in a speech in Hong Kong.</p>

<p>“It will be incomparable to SARS,” he said, referring to the severe acute respiratory syndrome epidemic that killed 800 people around the world in 2003.</p>

<p>While SARS had a mortality rate of around 15%, the deadly H5N1 strain of bird flu kills up to a third of the people it infects. H5N1 has proven to be versatile and is now able to latch itself onto more hosts, Omi said.</p>

<p>“It has gone through huge genetic changes and become more pathogenic. It has affected not only birds, but cats, pigs, and tigers…ducks are now playing a more important role,” Omi said.</p>

<p>The virus has killed 32 people in Thailand and Vietnam this year and millions of chickens, ducks, and other birds have been culled across Asia.</p>

<p>Almost all the human bird flu victims in Hong Kong, Thailand, and Vietnam fell ill after direct contact with sick chickens.</p>

<p>With the illness now endemic in poultry farms, experts fear it will only be a matter of time before the disease mutates into a form that can leap between humans and sweep through populations with no immunity. Pigs are seen as a likely next step.</p>

<p>Infected ducks now display no symptoms of the disease but shed huge amounts of the virus in their feces, a source of concern because ducks and chickens are often kept together in Asia, and this could give rise to cross infection.</p>

<p>Two US companies and a Japanese firm are working on a vaccine against H5N1, and clinical trials on its efficacy and safety have begun, Omi said. But he cautioned people against thinking that vaccines were a cure-all.</p>

<p>Due to commercial reasons, mass production of vaccines would only start after a pandemic begins, which means it would only reach the public after a time-lag of at least 5-6 months.</p>

<p><italic>Editor's comment</italic>
. There have been numerous estimates about the potential death toll from an influenza pandemic associated with the H5N1 avian influenza A virus. Such estimates have been provided by the WHO, the Centers for Disease Control and Prevention, and numerous authorities at universities. All agree that if such a pandemic occurs, it will be an international disaster. The above article lists the current mortality rate as up to one-third of infected individuals. In fact, according to information on the WHO Web site, the mortality rate has been >70% among persons with recognized cases this year (<ext-link ext-link-type="uri" xlink:href="http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_10_04/en/">http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_10_04/en/</ext-link>
).</p>

<p>However, if a pandemic were to occur, the additional genes needed in the virus to allow person-to-person spread might make the disease much less lethal. There has been only 1 truly catastrophic influenza virus outbreak documented (that of 1918–1919), and the reason for the severity of that outbreak is still obscure. In that pandemic, mortality rates were 0.5% of the US population and 1% of the world population; these rates were disastrous but less than mortality rates observed in Thailand and Vietnam this year. Later pandemics were not associated with exceptionally high mortality rates. It may be an overreaction to predict even a 30% mortality rate for a hypothetical outbreak of avian influenza in the human population. Very few people have contracted avian influenza in eastern Asia. Although there was a very high mortality rate for this small group, there is no reason to assume that a virus capable of human-to- human spread would produce similar mortality rates.</p>

</sec>

<sec id="sec2">

<title>Iraq War Is Public Health Disaster, Report Finds</title>

<p>30 November (Reuters Health [Patricia Reaney])—War in Iraq has caused a public health disaster that has left the country's medical system in tatters and increased the risk of disease and death, according to a recent report.</p>

<p>Medact, a British-based charity that examines the impact of war on health, said cases of vaccine-preventable diseases were rising and relief and reconstruction work had been mismanaged.</p>

<p>“The health of the Iraqi people has deteriorated since the 2003 invasion,” Gill Reeve, the deputy director of Medact, told a news conference to launch the report. “Immediate action is needed to halt this health disaster.”</p>

<p>The report, which is based on interviews in Jordan with Iraqi civilians, relief organizations, and health professionals who worked in Iraq, called for Britain to set up an independent commission to investigate civilian casualties and to provide emergency relief and a better health system.</p>

<p>“The 2003 war exacerbated the threats to health posed by the damage inflicted by previous wars, tyranny, and sanctions. It not only created the conditions for further health decline, but also damaged the ability of Iraqi society to reverse it,” it said.</p>

<p>Mortality in Iraq was high before the 2003 war. The report details a recurrence of previously well-controlled illnesses like diarrhea, acute respiratory infections, and typhoid.</p>

<p>Postwar security worries limit access to health care, particularly in flashpoint areas. The quality of health services is poor because of chronic under-funding, poor physical infrastructure, mismanagement of supplies, and staff shortages.</p>

<p>One in 4 people in Iraq still depend on food aid, and more children are underweight or chronically malnourished than in 2000, the report added.</p>

<p>“Maintaining adequate care is a real problem,” said Mike Rowson, the executive director of Medact.</p>

<p>Iraqis increasingly rely on self-diagnosis and traditional healing and buy prescription medicines in the marketplace. “The U.N., traditionally responsible for coordinating humanitarian crisis responses, has been marginalized while US assistance has been characterized by damaging political in-fighting,” the report added.</p>

<p>Rowson said a lot of money had been pledged for reconstruction but very little had been distributed to rebuild the Iraqi health system. “The political situation is key to making health improvements in Iraq,” he added.</p>

</sec>

<sec id="sec3">

<title>Improved Screening Prompts Jump in Chlamydia Cases</title>

<p>30 November (Reuters Health [Paul Simao])— The number of sexually transmitted chlamydia infections reported in the United States rose more than 5% last year, the Centers for Disease Control and Prevention (CDC) said.</p>

<p>The increase is due largely to better screening and diagnosing of the sexually transmitted disease (STD), the CDC said.</p>

<p>Total cases of the disease numbered 877,478 in 2003, compared to 834,555 cases in 2002. The agency estimated there were an additional 2 million unreported or undiagnosed cases last year, many among young women.</p>

<p>CDC officials, however, said they doubt the jump in reported chlamydia cases indicates a resurgence of the disease.</p>

<p>The CDC recommends sexually active women under the age of 26 and older women with new or multiple sex partners be screened annually.</p>

<p>In addition to warning about chlamydia, the agency noted that syphilis cases rose last year, the third consecutive annual increase. In 2003, there were 7177 primary and secondary syphilis infections compared to 6862 in 2002.</p>

<p>Researchers estimate that >60% of the 2003 syphilis caseload occurred among gay and bisexual men. The growth of the disease in that high-risk group is of particular concern because of its links to transmission of HIV.</p>

<p>Up to 70% of gay and bisexual men infected in recent syphilis outbreaks in the United States were HIV positive.</p>

<p>In contrast to the rise in chlamydia and syphilis, the incidence of gonorrhea fell 4.8% to 116.2 cases per 100,000 in 2003 from 122 cases per 100,000 in the previous year.</p>

<p>There were 335,104 gonorrhea infections reported in 2003, compared to 351,852 in 2002.</p>

<p>STDs cost the nation as much as $15.5 billion in direct medical costs each year. Almost half of these infections occur in teenagers and young adults between the ages of 15 and 24.</p>

</sec>

<sec id="sec4">

<title>Barr Says FDA Approves Generic Version of Anti-HIV Drug</title>

<p>3 December (Reuters Health)—Barr Pharmaceuticals Inc. on Friday said the Food and Drug Administration (FDA) approved the company's generic version of Videx EC, an antiretroviral drug developed by Bristol-Myers Squibb.</p>

<p>The FDA granted an expedited review of Barr's application to make a generic version of the drug, didanosine (ddI), under the president's emergency plan for AIDS relief, said the Woodcliff Lake, New Jersey-based company.</p>

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