Apr 3, 2003 TERRORWARS

America has been told that there are sufficient doses (300 million) of an effective vaccine to render all of the U.S. population protected from a smallpox attack.by Saul B. Wilen, M.D.

San Antonio - Mar 28, 2003

One would think, after the many months of debate and evaluation by the experts, that all of the major concerns about the United States smallpox protection plan presently being implemented, would have been resolved. However, at last count seven weeks into stage one (of three stages), only about 17,000 individuals (3.7 percent of the goal) have been vaccinated.

Stage one was expected to complete the vaccination goal of 450,000 hospital healthcare workers in four weeks. However, there has been widespread refusal by hospitals and individuals to participate. Do the remaining 433,000 healthcare workers who have chosen not to participate know something that the experts do not know? At this rate of 5000 vaccinated per week it could take up to 86 weeks, or 1.7 years, just to complete stage one.

America has been told that there are sufficient doses (300 million) of an effective vaccine to render all of the U.S. population protected from a smallpox attack. With this stockpile of available vaccine in place and stage one of the protection program floundering, it has been suggested that moving on to stage two, the vaccination of first responders (police, firefighters and emergency management personnel) might in some way compensate for the shortfall. Participation estimates for this target group is also expected to be disappointingly low.

Additionally, stage two vaccinations will not produce the smallpox-protected teams of healthcare workers necessary for vaccinating the general public as planned for in stage three. The remaining 289 million Americans are slated for vaccination within four days of a confirmed smallpox outbreak.

Is this possible, and at what price? Such a feat has never been previously attempted. Will mass panic be the result? Can such an approach allow for the proper, methodical screening of the general population for potential contraindications (reasons why the vaccine should not be given) so that life-threatening complications are reduced, not increased?

Smallpox is one of the most dangerous biological weapons of mass-destruction available to terrorists. It is a contagious viral disease with no known treatment once an individual is infected. Thirty percent of those who become infected with smallpox (3 out of every 10) will die. The United States population is unprotected.

Smallpox killed hundreds of millions of people around the world before being declared eradicated in 1980. Early smallpox symptoms are flu-like in nature. Those who are not protected against smallpox and become infected during a bio-terror attack using smallpox, pose a clear and present danger to their families, their communities, and the nation. The commitment must be prevention as the key to survival for the welfare of the American people and in support of winning the war on terrorism.

However, there are life-threatening complications and deaths related to the vaccine, which includes a live virus that can infect the body. This represents a risk that equates to approximately 300 to 600 deaths (l in 500,000) included in up to 10,500 complications possible for the total population of 300 million.

The universal vaccination of the U.S. population would be a prevention strategy, rendering the use of smallpox as a bio-terrorism weapon essentially meaningless. Vaccination properly performed will protect individuals from infection. Protection can result from a systematic, methodical, and progressive program of universal (everyone who can be vaccinated safely) smallpox vaccination of Americans. This is one of the very few opportunities available to remove a bio-terror agent from being used by America's enemies.

Universal vaccination has been resisted based on concerns relating to potential complications of the vaccine. A major stumbling block has also been doubts about the certainty as to whether the threat of a bio-terrorism attack using smallpox as the agent, justifies the risk. Many hospitals have rejected participation due to concerns about vaccinated workers accidentally spreading the live virus in the vaccine to patients susceptible to complications.

Compensation for those injured by vaccination has been an issue raised by medical and healthcare workers when they refused participation in the vaccination program.

A compensation proposal of $262,100 for each person who dies or is permanently and totally disabled by the vaccine has been proposed. Another factor has been virtually non-existent education programs for the public in general, ineffective education programs for medical professionals, healthcare workers, and first responders, and contradictory information that has been released by government officials on all levels.

Many opponents, especially physicians and other healthcare professionals, of a universal program for smallpox vaccination starting as soon as possible for all Americans without contraindications, are now rethinking this position.

In the editorial by Dr. John Clough in the February 2003 issue of the Cleveland Clinic Journal of Medicine he agonizes through the alternatives and comes to the conclusion, "The choices are not pretty or easy. And perhaps it comes down to the nasty conclusion that we really don't have any choice. We may have to provide whatever protection we can for the population."

A recently related concern has been the outbreak of a respiratory illness with associated pneumonia now having resulted in deaths, which seems to have begun in China as early as January 2003. As it spreads it is becoming a serious world public health problem. It is not considered to be terrorist related.

The illness called SARS (severe acute respiratory syndrome) begins with flu-like symptoms. For the first three weeks of March 2003 the World Health Organization (WHO) working with the other major public health organizations and laboratories has been trying to identify the cause.

This demonstrates that even in the hands of the best available public health organizations and laboratories identification has at best been difficult and delays can and do occur. Such a delay in responding to a bio-terror agent changes the response assumptions and the preparedness to react.

In applying this scenario, flaws in expert thinking process used in the design of the smallpox vaccine protection program become apparent, especially in relation to stage three.

The use of smallpox virus by terrorists is a consideration since the virus is contagious, has no treatment, has a high death rate, is easily transported, and can be readily disseminated to an unprotected population.

Just as in the anthrax experience in 2001 where finely milled spores with a high potential for causing death were used, the smallpox virus could be genetically altered. Changes are possible in the incubation period for the disease (the length of time before the disease symptoms appear) and changes in the duration of the early flu-like symptoms therefore, making it more difficult to diagnose infection.

Elements that make identification more difficult cause the assumed time frames such as a four day window in which to vaccinate the American population to be unrealistic.

America is not presently prepared for a bio-terrorism attack, especially not for the use of smallpox as the bio-terror agent. There is a better way than the program presently in place.

A universal smallpox vaccination program instituted now and progressively implemented with enough time to adequately screen out those with contraindications will protect the vast majority of the American population and simultaneously minimize the complications and deaths due to the vaccine. Using a universal protection program, prevention is established against a terrorism attack using smallpox as the bio-terror agent.

Dr. Saul B. Wilen is President and CEO of International Horizons Unlimited (IHU), a national consulting and resources consortium based in San Antonio, Texas that applies "educational foundations and processes that support prevention strategies to solve problems." Dr. Wilen is a recognized authority in prevention strategies and problem solving, systems dynamics, and informatics. He directs IHU terrorism prevention and strategies development initiatives. Dr. Wilen serves on the U.S. Secret Service Task Force on Electronic Crimes and Terrorism, the U.S. Department of Commerce Critical Infrastructure Working Group on Community Structure for Crisis Management and Preparedness, and as a consultant to the Best Practices Institute of the National Governors' Association.

TERRORWARS Bio Threat Needs Aggressive Action Plan Warn Researchers Stanford - Mar 19, 2003 A reasonable defense against an airborne anthrax attack requires more aggressive action by the U.S. government than now planned, says a study published the week of March 17 in the Proceedings of the National Academy of Sciences (PNAS).

Jewish World Review March 10, 2003 / 6 Adar II, 5763 By Robert A. Wascher, M.D., F.A.C.S. jewishworldreview.com www.NewsAndOpinion.com |

SARS (Severe Acute Respiratory Syndrome) is a viral infection that has recently become a source of concern among public health officials. First identified in Vietnam, cases of SARS have now appeared in China (in Hong Kong and Guangdong province, in particular), Singapore, Indonesia, Canada, Thailand, the Phillipines, and the United States. Approximately another dozen countries have reported possible cases of SARS within the past several days. At the present time, nearly 1600 cases SARS, including 54 deaths, have been reported throughout the world by the WHO and CDC. Although the causative agent of SARS is not fully understood at this time, it appears to be a previously unknown member of the coronavirus family of viruses. Sadly, the Italian physician who first identified SARS in a German businessman under his care in Vietnam has, himself, now died of the disease.

According to the US Centers for Disease Control (CDC) and the World Health Organization (WHO), the symptoms of SARS include high fever, sore throat, dry cough, shortness of breath, and decreased white blood cell and platelet counts. Other typical symptoms of viral infection may occur with SARS, including headache, muscular pain and stiffness, loss of appetite, malaise, confusion, rashes and diarrhea. The incubation period for SARS appears to be relatively short, ranging from 2 to 7 days following initial exposure. Based upon the rather high prevalence of infections among healthcare personnel, the WHO has indicated that close and sustained contact with infected persons may be necessary to spread SARS. In particular, contact with respiratory droplets from coughs and sneezes, as well as direct contact with bodily secretions, are thought to be important infection vectors. However, recent reports of SARS spread among tenants within apartment buildings in China, and at least one case involving a flight attendant on a Hong Kong-based airline, suggest that the SARS virus may be passed with more casual contact.

The treatment of patients infected with the SARS virus is similar to that recommended for other serious viral respiratory infections, as there are no antibiotics that have any activity against such diseases. The current recommendation is that patients with SARS should be kept in respiratory isolation wards. Supplemental oxygen, inhaled medications to keep the airways clear of secretions and to prevent collapse of small airways, control of excessive fever, intravenous fluids to support blood pressure and vital organs, and, in some cases, mechanical ventilation, are mainstays of supportive treatment.

At the present time, public health officials are not advising prospective travelers to cancel their trips overseas. However, some officials are now suggesting that travel to endemic areas be deferred if possible. Some flight attendants and travelers have taken to wearing surgical face masks in an effort to reduce the risk of inhaling respiratory aerosols from potentially infected persons, although the efficacy of this strategy is uncertain at this time. If you-or anyone you know-has recently developed a severe upper respiratory infection, particularly following travel to one of the countries mentioned above, then medical care should be urgently sought. While there are hundreds of other viruses that can cause the same symptoms as SARS, the virulence of the virus causing SARS seems to approach, at least in some cases, that of strains of influenza that have caused pandemics of severe illness and death in the past.

UPDATE ON SMALLPOX VACCINE

The CDC announced, on March 25th, an advisory regarding the administration of the smallpox vaccine to people with a history of heart disease. More than 30,000 healthcare workers have recently received the smallpox vaccine as part of recent Homeland Defense initiatives. Among these volunteers, seven have developed cardiac-related complications, although it is presently unknown if these complications are directly related to the vaccine. Among these seven stricken healthcare workers, three have experienced heart attacks (one of which was fatal), two cases of angina (chest pain due to blocked coronary arteries) occurred, and two cases of myopericarditis (inflammation of the heart muscle or the fibrous sac that surrounds the heart) occurred. The CDC is currently studying the medical histories of each of these seven patients, and is carefully evaluating their cardiac disease risk profiles (at least one of these patients was reported to have had an extensive history of preexisting heart disease). While cases of heart inflammation were reported during the period when smallpox vaccine was most extensively administered (in the 1960s and 1970s), no epidemiologic studies were carried out at the time in order to ascertain any causative effect by the vaccine.

As it is currently unclear whether or not the smallpox vaccine, which consists of a live virus that is related to the smallpox virus, is linked to these few cases of cardiac complications, the CDC is being somewhat circumspect in its advisory. The CDC is now recommending that persons with a history of cardiomyopathy, heart attack or angina, or any other evidence of heart disease be temporarily deferred from receiving the smallpox vaccine.

INFLAMMATORY MARKERS & RISK OF HEART FAILURE

There is growing evidence that the progression of coronary artery disease is influenced by mediators of inflammation. Most recently, C-reactive protein has taken center stage as a key inflammatory protein that appears to play a critical role in the development of coronary atherosclerosis. While coronary artery disease has been linked with inflammation and, in turn, directly with the risk of developing a heart attack, another equally life-threatening cardiac ailment has not previously been associated with inflammation. Congestive heart failure (CHF), which most commonly occurs after a heart attack permanently damages heart muscle, is a common cause of disability and death among older Americans. As its name implies, CHF results when the heart becomes sufficiently damaged so that its ability to pump blood to the body becomes seriously impaired. Patients with CHF may have difficulty breathing due to fluid build-up in their lungs, and often experience debilitating weakness and fatigue as a result of inadequate oxygen delivery throughout their bodies. Swelling of the lower extremities may also cause difficulties for patients with CHF.

A new study in the journal Circulation looks at the potential role of inflammation in patients with CHF who have never had a heart attack before. This study was conducted within the framework of the highly respected Framingham Heart Study, one of the longest running and largest heart study research programs ever undertaken. In this new study, a total of 732 elderly patients who entered the Framingham Heart Study without any prior evidence of CHF or heart attack were followed for an average of 5.2 years. All study volunteers underwent extensive blood tests upon entry into the study, which included assays for known mediators of inflammation, including C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. Among the 732 volunteers, 56 of them subsequently developed CHF-without experiencing any heart attacks-during the course of this study. The study determined that initially elevated levels of any of these inflammatory mediators were significantly correlated with the subsequent development of CHF among the study volunteers. Among patients who had elevations in the blood levels of all three of these markers upon entering the study, the risk of subsequently developing CHF was more than four time higher when compared to other study volunteers without elevated levels of these inflammatory markers. The study's authors concluded that a single measurement of inflammatory markers in the blood was highly predictive of the risk for subsequently developing CHF, even in the absence of heart attacks.

BREAST FIBROADENOMAS & THE RISK OF BREAST CANCER

The presence of benign fibrous nodules in the breast, called fibroadenomas, has been linked, in some studies, to a slightly increased risk of developing breast cancer. Other benign breast conditions, including ductal hyperplasia, and even a history of prior breast biopsies for benign lesions, have been statistically associated with small increases in breast cancer risk as well.

A new study in the Archives of Surgery looked at 32 patients with fibroadenomas occurring in the breast at the same time as breast cancer. These patients were compared with 26 control patients who had breast fibroadenomas without the concomitant presence of breast cancer in the same breast. The researchers used several highly sensitive tests to assess both the fibroadenoma tumors and the breast cancer tumors for characteristic genetic mutations associated the development of cancer. The study determined that fibroadenomas of the breast, whether or not they co-existed with breast cancers in the same patient, did not contain any of the genetic mutations commonly identified in the breast cancer tumors. From these results, the authors infer that fibroadenomas are not directly associated with the development of breast cancers. This small study should be repeated with larger numbers of patients to validate its findings. However, these results should provide considerable reassurance to women with benign fibroadenomas of the breast.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.

03/10/03: More Data on Hormone Replacement Therapy & the Risk of Breast Cancer; Oral Health & the Risk of Cardiovascular Disease; More Bad News about C-reactive Protein; Update: Daily Multivitamin & Minerals Supplements; Baby Aspirin & the Risk of Colorectal Adenomas; Aspirin & the Risk of Colorectal Polyps

03/03/03: Management of enlarging thyroid nodules; Long-term anticoagulation reduces the risk of recurrent blood clots in the veins; colon polyp recurrence after colonoscopic polyp removal; Vitamins C & E and Atherosclerotic Disease: The Debate Continues

02/24/03: Tamoxifen & Benign Breast Disease; New Recommendation on Digitalis Dosing; Creutzfeldt-Jakob Disease & the Nose; Radiologist Experience & Accuracy of Mammogram Interpretation; More Data on the Incidence of GI Side Effects with Selective COX-2 NSAIDs; Regular Rest Breaks & the Risk of Industrial Accidents

02/18/03: Update on Alzheimer's Disease; Very Low Birth-weight Babies & Cognitive Development; The Great Blood Pressure Medication Debate

02/03/03: Update on C-reactive Protein; COX-2 Inhibitors & Arterial Function; COX-2 Inhibitors and Gastrointestinal Complications; Telomere Shortening & Risk of Death

01/24/03: Bo-tox that BO Away!; The Super-sizing of America; Marijuana: A Gateway Drug?

01/21/03: Dietary Soy & Prostate Cancer Risks; Retention of Surgical Foreign Bodies after Surgery; Diet & hormone levels in adolescent girls

01/10/03: Can Aspirin Prevent Esophageal Cancer?; A Drink to Your Health!; Hormones & Breast Cancer; The Impact of Obesity on Lifespan

01/06/03:"The Pill" for Males?; Obesity & Diabetes Trends in the United States; Binge Drinking in the United States; One Less Reason to be Depressed; Liver Failure: Trends

12/20/02: Citrus Pectin & Cancer; Echinacea & the Common Cold; Update on High Blood Pressure Treatment

12/06/02: Calcium Intake & Prostate Cancer Risk; Alcohol Consumption & Risk of Breast Cancer; Reducing Blood Transfusions in Critically Ill Patients

12/06/02: Alcohol, Tamoxifen & Carotid Artery Wall Thickness; Coffee & Gallstones?; Irritable Bowel Syndrome Update; Statins: More Good News

11/22/02:Alcohol, HRT & the risk of breast cancer; hormone replacement therapy: more bad news; new vaccines may eliminate cervical cancer; more

11/15/02: The Effects of Diet & Exercise on Blood Pressure & Health; Growth Hormone & Sex Steroid Supplements & the Elderly; C-Reactive Protein & Cardiovascular Disease Risk

11/08/02: More Good News About Statin Drugs; Hormone replacement Therapy (HRT) & Alzheimer's Disease; A Role for Antibiotics in the Treatment of Vascular Disease?; more

11/01/02: Digoxin & gender; driving & degenerative disc disease; Coenzyme Q10 & Parkinson's Disease; Ginseng & erections; Viagra & stroke

10/25/02: Aspirin & coronary artery bypass surgery; glucosamine sulfate & progression of knee arthritis; hospital nurse staffing & patient mortality

10/18/02: Motor Vehicle Exhaust Pollution & Mortality; CT Scans, C-Reactive Protein & Heart Disease; Antiperspirant Use & the Risk of Breast Cancer; Atomic Bomb Radiation Exposure Update; more

10/04/02: Antioxidants & the Risk of Stomach Cancer; Best Way to Diagnose Appendicitis?; Coronary Artery Disease: Stent or Surgery?

09/27/02: Breast Feeding & the Risk of Asthma; HMOs & Quality of Care Scores; Red Wine & Vascular Disease

09/20/02: Dietary Folate & the Risk of Colorectal Cancer; Risks Associated with Smoking after Heart Attacks; BRCA1 Gene Mutation & the Risk of Breast & Non-breast Cancers; Breast Tissue Density & Inheritance

09/13/02: Dairy Products, Calcium, Vitamin D & the Risk of Breast Cancer; Efficacy of Nonprescription Smoking Cessation Aids; A Nutty Approach to Heart Disease Prevention; Update on Prostate Cancer

09/06/02: C-Reactive Protein & Estrogen Replacement Therapy; Walking Women & Cardiovascular Disease; Physical Activity Among Teenaged Girls

08/30/02: Babbling babies & brain function; homocysteine levels, vitamins & coronary artery disease; St. John's Wort & chemotherapy

08/16/02: A New Weapon Against Anthrax?; cataracts & motor vehicle accidents; gingko biloba takes a hit; air pollution & heart function during exercise; breast cancer genes & the estimated risk of breast cancer

08/09/02: Botulinum Toxin & Post-Stroke Spasticity; Intestinal Hormone Kills Appetite; Bone Marrow Cells Improve Blood Flow in Vascular Disease; Effectiveness of Restraining Orders on Domestic Violence

08/02/02: Mammography Saves Lives!; Obesity & the Risk of Heart Failure; High Sugar Diets & the Risk of Colon Cancer; Abuse During Childhood & Possible Effects of Genes on Antisocial Behaviors

07/26/02: Cancer: Nature vs. Nurture; Cardiorespiratory Fitness & Inflammation; Kidney Transplants from Cadaver Donors; Aircraft Cabin Air Recirculation & the Common Cold

07/19/02: PCBs & the Gender of Babies; Breastfeeding & the Risk of Breast Cancer; More Bad News About Hormone replacement Therapy

07/12/02: A cancer surgeon's perspective on hormone replacement therapy

07/08/02: Hormone replacement therapy & the risk of disease; more good news about statins; antioxidant vitamins & disease prevention; more

06/28/02: Antioxidants & the Risk of Alzheimer's Disease; Effects of Exercise on the Hearts of Patients with Mild Hypertension; Statins reduce cardiac events following angioplasty; more

06/21/02: Sex & violence and Advertising: Do Advertisers Get What they Pay For?; Don't Drink the Water (or the Salsa Either!); Vasectomy & Prostate Cancer Risk; Update on Smoking & Disease

06/14/02: Young Men, Obesity & Heart Disease; Breastfeeding & Obesity; Irritable Bowel Syndrome & rectal pain threshold; more data on cox-2 inhibitors & cancer; more

06/07/02: New coronary artery stent reduces risk of restenosis; possible cause of Parkinson's Disease identified; more

05/31/02: New biological insights into obesity & weight loss; broccoli kills cancer-causing stomach bug; anti-inflammatory drugs and the risk of heart attack

05/24/02: Molecular detection of tumor cells in the blood & prognosis; Cox-2 & breast/lung cancers; BRCA2 gene mutations & the risk of breast cancer; breast density & the risk of breast cancer

05/19/02: Moderate alcohol intake and blood sugar levels; more good news for tea drinkers; blood potassium levels & the risk of cardiovascular disease; ethnic differences in diabetic complications

05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage 04/26/02: Angry young men & risk of premature cardiovascular disease; stay-at-home dads & risk of cardiovascular disease; more on the effects of statins; dairy consumption and the risk of pre-diabetes; smallpox vaccine: good to the last drop? 04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts 04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs 04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function 04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ... 03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more 03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings 03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate 03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection? 02/26/02: The continuing controversy regarding screening mammography 02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived? 02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt 02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited 02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment 01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons 01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health 01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders 01/09/02: Cancer & aging: Two sides of the same coin? 01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives 12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts 12/21/01: Vaccination of children controls hepatitis a in the community; a possible cure for sickle cell disease; leptin and the risk of heart attacks 12/14/01: Chernobyl and the Risk of Thyroid Cancer in hildren; children & obesity; gastroesophageal reflux disease update 12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies 11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart 11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome 11/16/01: Cholesterol-lowering drugs reduce risk of heart attack; supplemental radiation therapy reduces risk of breast cancer recurrence; brains of women may answer age-old questions 11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease? 11/02/01: Making sense of bio-warfare 10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease 10/19/01: New insights into autism; the wiley appendix 10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys? 10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant? 09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water 09/17/01: In perspective 09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer 09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes 08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher

BBC News

The World Health Organisation (WHO) has advised against travel to Hong Kong or parts of China due to the outbreak of a deadly, pneumonia-like virus.

The warning came after Chinese authorities said nine more people died from Severe Acute Respiratory Syndrome (Sars) in the Guangdong province last month, bringing the worldwide death toll to 75.

The virus has killed 16 people and infected over 680 in Hong Kong alone.

More than 1,800 people have been infected worldwide, causing widespread fear and the imposition of emergency measures.

Has the Sars outbreak affected you? Have you changed travel plans because of the spreading virus? Will you heed the WHO warning? E-mail us with your experiences.

The following comments reflect the balance of views we have received: Click here

Monday, March 31, 2003 Back The Halifax Herald Limited Vincent Yu / The Associated Press By Chris Morris / <a href=www.herald.ns.ca Canadian Press SARS OUTBREAK

Rugby fans wear masks in an attempt to protect themselves from SARS during a tournament in Hong Kong, where officials said Sunday that 60 more people had fallen ill with the disease.

The principal of a middle school in Miramichi, N.B., has become the first suspect case of the potentially-deadly syndrome in Atlantic Canada.

Dr. Wayne MacDonald, New Brunswick's chief medical health officer, told a hastily called news conference Sunday that the individual has voluntarily quarantined herself in her home where she will stay until she's free of symptoms of the respiratory syndrome which, so far, has killed more than 50 people worldwide.

At least 60 people who have been in contact with the principal since her return last week from a trip to China are also being monitored for signs of SARS.

MacDonald said there are no other suspected cases and no one else is being quarantined. He said the Losier Middle School where the woman works will be cleaned.

"We feel the risk is low," MacDonald said.

Steve Benteau, a spokesman for the New Brunswick Education Department, said the school will be closed until April 8 since officials are having problems contacting about 380 families and staff members from the school.

MacDonald said the woman returned from a week-long trip to China last Monday.

She had been ill during the trip and by the time she came home to the Miramichi, she was starting to feel better.

However, like all people arriving in Canada from places considered high-risk for the mystery illness, including China, she was given a card when she landed and told to watch for symptoms.

She went to the Miramichi hospital Friday, concerned that the symptoms she had experienced during her trip and was still feeling to a lesser extent, might becaused by SARS, notably fever and respiratory difficulties.

"The individual is at home where she's recovering," MacDonald said.

He said he was pleased with the measures taken by the hospital when she arrived to be examined.

He said he is confident proper containment procedures were followed and there should be little or no risk to staff or patients.

As well, MacDonald said Health Canada has been advised of the case. He said it's up to Health Canada to follow up with investigations of the flights she was on and warn her fellow passengers.

More than 100 people across Canada are being watched as suspected or probable cases of SARS, a pneumonia-like illness that causes high fever, coughing and breathing troubles.

Most are in the Toronto area, however suspected cases have been reported in British Columbia, Ottawa, Alberta, Saskatchewan and now New Brunswick.

MacDonald said the incubation period for the illness, believed to be caused by a virus, ranges from two to 10 days with most cases showing up four or five days after exposure.

A fourth Toronto-area resident died of SARS on the weekend, and a 21-month-old child joined the growing list of probable and suspected Canadian cases of the rapidly spreading disease.

Swamped public health officials estimated Ontario has roughly 100 cases of severe acute respiratory syndrome, but admitted they had only been able to analyse data for 81 - 42 probable and 39 suspect cases.

"There are very many more individuals provincewide who are cases that are under investigation," said Dr. Colin D'Cunha, Ontario's chief medical officer of health.

Dr. Jim Young, the province's commissioner of public safety, urged hospitals and health-care workers around the province to be vigilant for potential SARS cases, saying they fear that as time goes on the ripples from the Toronto cases will move further afield.

Vancouver has two probable SARS cases and a number of people under surveillance for the disease. But health officials in Manitoba said Sunday a patient who had been listed as a probable SARS case in Winnipeg does not have the disease.

Health Canada also lists five suspect cases in Alberta and one in Saskatchewan. However, an Alberta health official said Sunday evening the five suspected cases in that province have since been diagnosed as something else.

"There's nothing new in Alberta to report," said Howard May, Alberta Health spokesman.

The Ontario officials confirmed the latest person to die had become infected while receiving treatment in the intensive care unit of Scarborough Grace Hospital - the nexus of Toronto's growing cluster of SARS cases.

One of the original Canadian SARS patients was treated at Scarborough Grace in early March before health-care workers realized they were facing a highly contagious and potentially deadly new disease that required high level infection containment measures: gowns, gloves, goggles and masks at all times. Waves of cases have emanated from that first patient.

The latest person to succumb to SARS was transferred to York Central Hospital on March 16 - long before he began showing signs of SARS. As a result, staff there did not impose the stringent infection control measures needed to contain the disease. The patient died Saturday night.

At least two nurses from York Central have come down with SARS. Both York Central and Scarborough Grace are now closed to new patients. Staff from the two facilities are barred from working elsewhere for the time being.

Anyone who worked at, visited or was a patient of either hospital from March 16 onwards has been asked to go into quarantine for a period of 10 days from the last exposure to the hospitals.

While no one has a good handle on how many people are holed up in their homes, officials have estimated the numbers would reach into the thousands.

March 31, 2003, 12:01AM Experts fear faster spread of SARS By MARGARET WONG Associated Press

HONG KONG -- Dozens more people at a Hong Kong apartment complex contracted a flu-like disease to bring the number there to 213, health officials said Monday, as the mystery illness with no known treatment continued its spread.

Hong Kong's health secretary, Dr. Yeoh Eng-kiong, announced the big rise in severe acute respiratory syndrome, or SARS, cases just hours after authorities imposed a tight quarantine on one section of apartments at the Amoy Gardens complex.

He said 88 new cases were diagnosed at the building complex to add to 125 other cases, bringing the total to 213.

The report came as the World Health Organization said SARS has killed at least 54 people worldwide, with the majority of cases in Hong Kong and China. That figure does not include three more deaths reported Sunday, one each in Hong Kong, Toronto and Singapore. More than 1,600 have been infected worldwide.

Singapore's health minister, Lim Hng Kiang, said the disease may spread more easily than first believed, with some people found to be more infectious than others. Labeled as "super infectors," they can infect as many as 40 others, he said.

"We run the risk of a huge new cluster of infected people, which could start a chain reaction," Lim said.

Singapore said it will station nurses at its airport to examine all travelers arriving from infected areas, while Canada planned to screen those traveling abroad from Toronto.

Yeoh said 107 of the sick people were from one section. He said officials believe the virus was brought to Amoy Gardens by a man infected at the Prince of Wales Hospital, where many of Hong Kong's victims have fallen ill.

Yeoh appeared emotional and initially had trouble speaking as he made a statement on the isolation of the section.

"It's a very exceptional circumstance," Yeoh said. "We haven't done it before, and we hope we won't do it again."

In Canada, meanwhile, another death was reported Sunday to bring the toll there to four. Officials earlier declared a health emergency in Toronto, located 50 miles from the U.S. border. U.S. health officials have reported 62 cases in the United States but no deaths.

About 100 probable or suspect cases have been reported in Canada. Officials have closed two hospitals to new patients, and hundreds of people have been quarantined in their homes.

Another possible case turned up in New Brunswick on Canada's east coast, officials said Sunday, meaning the illness that originated in Asia may now reach across Canada. The New Brunswick case involves a school principal who traveled to China.

Other suspected cases are in Ottawa; Winnipeg, Manitoba; and on the west coast in Vancouver, British Columbia.

The United States and Canada have advised people to avoid travel to afflicted areas in Asia, and the World Health Organization recommended that international travelers from Toronto and several Asian cities get screened for symptoms.

Most of the Toronto-area cases are health care workers at Scarborough Grace Hospital and York Central Hospital who became infected while treating initial victims, all of whom had traveled in Asia or had close contact with other victims.

The disease has caused a run on surgical masks in the city and slowed business by as much as 70 percent at Pacific Mall, a Chinese shopping mall in Toronto's northern suburbs.

Some merchants also were taking precautions, wearing protective masks even though no cases have been linked to the mall.

The International Ice Hockey Federation canceled the women's world championships Thursday in Beijing. The federation said the spread of the illness to Beijing from southern China put the players at risk.

Players for Canada, the defending champion, were disappointed but understood.

"You could lose your life going there and just being in contact with somebody," forward Danielle Goyette said. "Life is more important than hockey right now."