|
By STACEY ZOLT Scripps Howard News Service
Rare
diseases that have long been off the American radar screen
still pose a considerable threat, experts said, in large
part because the nation's medical community is ill-prepared
to diagnose, treat and contain sudden outbreaks.
"One
of our biggest fears is that many of the diseases which
have fortunately been wiped out by immunization would be
very difficult to diagnose," said Dr. Bradley Connor
of the New York Center for Travel and Tropical Medicine.
"The
world is becoming a smaller place. You don't have to leave
the United States to get traveler's diarrhea. It comes to
you," Connor said.
While
the global economy increases the risk of diseases traveling
via international tourists or imported foods, doctors also
fear bioterrorism could threaten Americans' health.
Smallpox,
the plague and anthrax are now foreign to the United States
because of medical advances, but they could come back through
an act of terrorism.
Dr.
Sam Katz of Duke University said the threat of a smallpox
outbreak from bioterrorism is "very real."
Katz
said Iraq and Russia are widely thought to have reservoirs
of smallpox, which could be disseminated through aerosol
spray. Where exactly the supply is and who possesses it
is uncertain, he said.
"We
live, unfortunately, in a world where bioterrorism is increasingly
a concern," Katz said.
The
last known case of smallpox was in Somalia in October 1971.
Therefore, few doctors practicing today would be able to
recognize the disease's symptoms, Katz said.
"Most
of us who may have seen a case of smallpox are in our 70s.
The people who are in emergency rooms and elsewhere may
have some difficulty; they might mistake it as chicken pox
or something," he said.
Katz
said the government should contract with a pharmaceutical
firm to manufacture a smallpox vaccine for public use. For
the last 15 to 20 years, only laboratory workers who could
come into contact with the virus have received the vaccine,
he said.
Specialists
are keeping an eye on several diseases that could potentially
arrive on U.S. shores through bioterrorism or travel.
One
example is Dengue Fever, a viral illness transmitted by
mosquitoes that causes so-called "breakbone fever."
Connor said it "literally feels like your bones are
breaking."
The
disease is currently found in the Caribbean and across Asia,
but doctors worry that increased development will lead to
infected mosquitoes showing up in semi-urban areas. Consequently,
Americans who travel to these areas could bring the disease
home.
GeoSentinel,
an information network operated by the International Society
of Travel Medicine, attempts to prevent isolated outbreaks
of rare diseases in distant lands from turning into epidemics
by disseminating disease reports from the federal Centers
for Disease Control and Prevention in Atlanta worldwide.
For
example, a few months ago Connor saw a patient with leptospirosis,
a disease not common in the United States. The patient had
recently been at the Eco-challenge sports competition in
Borneo.
Connor
contacted GeoSentinel and found there were patients in England
and Canada who had returned from the Eco-challenge with
similar symptoms. GeoSentinel then put out an alert to all
attendees of the event so they could seek treatment.
"If
we didn't have this network, isolated doctors in isolated
countries would be seeing isolated cases," Connor said.
Doctors
suggest that travelers seek medical advice before traveling
abroad, and be sure to tell their health-care provider where
they've been the past few months if they get ill, since
diseases such as malaria can have an incubation period of
up to several months.
"People
die of malaria because physicians don't think to make the
diagnosis," Connor said. "Travel history is a
very important part of medical history."
Doctors
also are pressing the government to maintain funding and
public education for diseases that were once threatening
and have now declined.
Dr.
Henry Blumberg of the Emory University School of Medicine
said the sudden boom of tuberculosis in the mid-1980s to
early 1990s should serve as a lesson to the medical community
not to let its guard down.
Just
when doctors assumed tuberculosis was completely wiped out,
it reappeared in a multidrug-resistant form in many HIV-positive
patients.
"The
rates were going down, so people didn't think (tuberculosis)
would be a problem. The federal funding for (it) was cut
and essentially wiped out," Blumberg said.
But
outbreaks began when doctors misdiagnosed symptoms in HIV
patients, and reversing the damage was ultimately a costly
public health problem.
"It
took $1 billion in New York City alone over a number of
years to rebuild the public health infrastructure,"
Blumberg said.
|
