Tags: CDC: | SARS | May | Become | Worse | Fall

CDC: SARS May Become Worse in Fall

Wednesday, 18 June 2003 12:00 AM

"It's too early to predict if SARS is over," said Dr. Julie Gerberding, director of the federal agency in Atlanta that monitors U.S. health problems. "There could be a greater outbreak of the disease this summer and fall."

Gerberding, addressing the annual meeting of the American Medical Association's House of Delegates, and in a news briefing later, suggested severe acute respiratory syndrome could be repeating a type of outbreak in which the disease makes a small impact when it initially appears and then erupts as a widespread pandemic the following year. She noted such a scenario occurred in the 1918-1920 influenza that killed more than 10 million people worldwide.

"This ... pattern is common to many diseases," said Dr. Leonard Morse, commissioner of public health for Worcester, Mass. "This is really a cause for great concern and is especially important to think of that illness in association with influenza season and the possibilities of the health care system having to deal with two viral illnesses at the same time."

Gerberding noted the number of SARS cases in the United States has steadily declined, but at the news briefing she declined to say the country was out of the woods as far as the pneumonia-like disease was concerned.

"We have learned lessons from SARS that we could employ in another outbreak," she said, "especially the rigorous application of isolation measures when people are diagnosed with the disease."

SARS has been identified as being from the family of coronaviruses, which causes the common cold. The first case arose in Guangdong Province in China in late 2002 and has traveled from person to person around the world. Nearly 300 cases have occurred in the United States. About one in 10 people who becomes infected with SARS dies. Isolating people with the disease until they are no longer capable of spreading the virus appears to control the outbreaks.

"We have to be very vigilant," Gerberding said, noting community physicians might find themselves on the front-line of combating a greater outbreak of the disease. "It may not be over," she said.

Morse said the threat of SARS and the yearly spike in influenza cases makes it even more important that health care policymakers stress influenza vaccinations this year for the at-risk population.

"People over 65 years of age," he told United Press International, "and people under 65 who have chronic health conditions should be vaccinated against influenza this year."

Morse, current chairman of the AMA's Council on Ethical and Judicial Affairs, said control of a SARS outbreak will depend on the local primary care physician or local clinician who is likely to see the first cases of the disease.

"All disease outbreaks are won or lost at the local, individual doctor level," he said. "Doctors and patients have to be aware that if a patient has a cough and a fever there has to be good access to health care and facile access to health care. A patient with those symptoms has to be seen today, not next week."

He also said doctors must be aware these patients need to be seen promptly, X-rays have to be taken to determine lung exposure and development of adult respiratory distress syndrome, a deadly consequence of infection with SARS and other viral infections that attack the lungs.

Morse suggested cutbacks in budgets could be hindering public health officials' attempts to reach out to people and community-based doctors to give the tools and information needed to handle SARS outbreaks.

Gerberding said the message about SARS has been effective so far. Most patients with suspected SARS symptoms volunteer to their doctor they have been traveling in areas where the disease has been diagnosed.

SARS, however, is not the only new disease Gerberding must address. The West Nile virus season is approaching and wet conditions in much of the country have health officials on alert against the mosquito-borne disease. She said in states hard-hit by West Nile last year there could be a lull in infections -- again following a disease course seen before: Widespread disease followed by lessening disease because a large population has gained immunity through exposure to the virus.

Gerberding said the monkeypox outbreak, so far confined to those people and contacts with exotic pet rodents, could give CDC researchers a chance to see how long smallpox vaccinations are effective. The smallpox vaccine is thought to be protective against monkeypox, a virus similar to smallpox.

She noted the CDC was investigating whether any people who had received smallpox vaccinations 20-or-more years ago had contracted monkeypox, or whether other people in contact with the rodents did not get infections because they had residual immunization from "remote" vaccinations.

Until recent concerns about terrorist activities, smallpox vaccinations had not been given to individuals since the 1970s. Worldwide, no case of the disease has occurred in the wild since 1979.

Copyright 2003 by United Press International.

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"It's too early to predict if SARS is over," said Dr. Julie Gerberding, director of the federal agency in Atlanta that monitors U.S. health problems. "There could be a greater outbreak of the disease this summer and fall." Gerberding, addressing the annual meeting of...
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