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.
|
