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ALERT OVER SPREAD OF HEPATITIS В




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The Government has grossly underestimated the spread of hepatitis В in Britain and should launch a drive to vaccinate those most at risk, one of the country's leading experts said.


Professor Aris Zuckerman said there were probably 20000 cases of the potentially fatal disease, 10 times more than the government figures of annual cases.

But the Government was lagging several years behind most European countries and the United States in defining which sections of the population should receive the vaccine against the acute infection of the liver.

Professor Zuckerman, director of medical microbiology at the London School of Hygiene and Tropical Medicine, said homosexuals, drug addicts and prostitutes were high risk groups who should be offered vaccination.

He told an international conference in London organized by the Hospital Infection Society that progress with the development of hepatitis В vaccines has been encouraging.

One of the latest vaccines was given government approval and is estimated to be about half as expensive as previous versions.

Worldwide hepatitis В kills 9000 children every day and more than 284 million are estimated to be carriers of the infection which is transmitted in the same way as AIDS, through contaminated blood and sexual intercourse.

Because of its costs — a course of immunization costs about $70 — vaccination is restricted in Britain to health care workers who are perceived as most at risk through contact with infected blood.

But the World Health Organization recommends that in addition, drug addicts, homosexuals, prostitutes, members of rescue services and patients and staff in institutions should also be protected.

IS "THUCYDIDES SYNDROME" BACK?

For centuries, historians and scientists have puzzled over the calamitous plague of Athens, which decimated the ancient city-state between 430 and 427 B.C. As vividly described by the historian Thucydides, himself a survivor of the illness, the plague attacked suddenly, causing "violent heats" in the head, inflammation of the eyes and throat, "reddish, livid" skin, extreme diarrhea and high fever. Historians agree that the epidemic, which killed the great statesman Pericles, contributed to the fall of Athens in the Peloponnesian War. But there is no agreement on its cause. Was it smallpox? Scarlet fever? Typhus? Measles?

A more exotic explanation was posed in the "New England Journal of Medicines in 1985 by Dr. Alexander Langmuir, formerly chief epidemiologist at the Centres for Disease Control in Atlanta. Thucydides' description, Langmuir theorized., fit the criteria for influenza complicated by toxic shock syndrome. And although this


peculiar combination of ailments had never been observed by modern physicians, Langmuir predicted that "Thucydides syndrome", as he called it, "may reappear", perhaps as part of some future epidemic of influenza.



The Delphian oracle could not have been more clairvoyant. In a recent issue of the "Journal of the American Medical Association", doctors at the Minnesota Department of Health, and the University of Virginia reported a total of ten cases of suspected Thucydides syndrome — flu complicated by TSS. Nine of the cases .occurred during a major influenza outbreak in Minnesota in the winter of 1985 —1986. One occurred in Roanoke, Va., and an eleventh case, in Oregon, has since been reported to the CDC. Like the Athenian scourge, the two-part illness was tethal: six of the patients died. Langmuir says the apparent fulfillment of his prophecy had him "blown over like a feather".

Though most U.S. cases of toxic shock occur in menstruating women, often in conjunction with the use of tampons, this was not true of the flu victims. Four of the eleven were males, and only two of the females were menstruating at the time they fell ill (both said they were not using tampons). The patients ranged in age from five to 56, but most of the deaths were among children. Says Dr. Kristine MacDonald of the Minnesota Department of Health: "There is some suggestion that younger people are more susceptible to TSS. As people get older, more of them have antibodies to protect them". Indeed most adults are immune to the syndrome.

TSS is caused by a toxin-producing strain of the common bacterium, Staphylococcus aureus, carried benignly in the respiratory and genital tracts of perhaps one out of three people. Under certain conditions — a wound, some infections, the presence of a tampon or contraceptive sponge — the bacteria multiply. If the toxin-producing strain is present, such proliferation can lead to TSS. The symptoms are dramatic and develop quickly: high fever, a sunburn-like rash, severe vomiting and diarrhea, culminating in shock, in which blood pressure plummets and circulation deteriorates. Doctors usually try to head off this life-threatening conditions by administering intravenous -fluids with electrolytes, and sometimes drugs to restore blood pressure.

MacDonald speculates that the influenza virus can injure the throat or lungs in a way that favors the growth of S. aureus. Though the complication appears to be rare, it is urgent that doctors be aware of it, says TSS Expert Bruce Dan, in an editorial that accompanied MacDonald's paper. Early recognition and treatment of the syndrome "is the most important factor in being able to prevent fatalities", says Dan. "It behooves all physicians to be on


the lookout for any influenza patient whose condition suddenly worsens".


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