ZKEA

Biological Warfare : Biological Terrorism : Emerging Diseases

Panic was spreading this August through this tidy village of 2,000 as one person after another fell ill with weeks of high fever, exhaustion and excruciating bone pain, just as most of Italy was enjoying Ferragosto, its most important summer holiday.

Officials set out insect traps and were surprised by what they caught: tiger mosquitoes.

“At one point, I simply couldn’t stand up to get out of the car,” said Antonio Ciano, 62, an elegant retiree in a pashmina scarf and trendy blue glasses. “I fell. I thought, O.K., my time is up. I’m going to die. It was really that dramatic.”

By midmonth, more than 100 people had come down with the same malady. Although the worst symptoms dissipated after a couple of weeks, no doctor could figure out what was wrong.

People blamed pollution in the river. They denounced the government. But most of all they blamed recent immigrants from tropical Africa for bringing the pestilence to their sleepy settlement of pastel stucco homes.

“Why immigrants?” asked Rina Ventura, who owns a shop selling shoes and purses. “I kept thinking of these terrible diseases that you see on TV, like malaria. We were terrified. There was no name and no treatment.”

Oddly, the villagers were both right and wrong. After a month of investigation, Italian public health officials discovered that the people of Castiglione di Cervia were, in fact, suffering from a tropical disease, chikungunya, a relative of dengue fever normally found in the Indian Ocean region. But the immigrants spreading the disease were not humans but insects: tiger mosquitoes, who can thrive in a warming Europe.

Aided by global warming and globalization, Castiglione di Cervia has the dubious distinction of playing host to the first outbreak in modern Europe of a disease that had previously been seen only in the tropics.

“By the time we got back the name and surname of the virus, our outbreak was over,” said Dr. Rafaella Angelini, director of the regional public health department in Ravenna. “When they told us it was chikungunya, it was not a problem for Ravenna any more. But I thought: this is a big problem for Europe.”

The epidemic proved that tropical viruses are now able to spread in new areas, far north of their previous range. The tiger mosquito, which first arrived in Ravenna three years ago, is thriving across southern Europe and even in France and Switzerland.

And if chikungunya can spread to Castiglione — “a place not special in any way,” Dr. Angelini said — there is no reason why it cannot go to other Italian villages. There is no reason why dengue, an even more debilitating tropical disease, cannot as well.

“This is the first case of an epidemic of a tropical disease in a developed, European country,” said Dr. Roberto Bertollini, director of the World Health Organization’s Health and Environment program. “Climate change creates conditions that make it easier for this mosquito to survive and it opens the door to diseases that didn’t exist here previously. This is a real issue. Now, today. It is not something a crazy environmentalist is warning about.” ...

When any of the 5,300 inmates at Pleasant Valley State Prison begin coughing and running a fever, doctors do not think flu, bronchitis or even the common cold.

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Plans to ease overcrowding at Pleasant Valley Prison are delayed out of concern that construction might stir up valley fever spores.

They think valley fever; and, more often than they would like, they are right.

In the past three years, more than 900 inmates at the prison have contracted the fever, a fungal infection that has been both widespread and lethal.

At least a dozen inmates here in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths.

Endemic to parts of the Southwest, valley fever has been reported in recent years in a widening belt from South Texas to Northern California. The disease has infected archaeologists digging at the Dinosaur National Monument in Utah and dogs that have inhaled the spores while sniffing for illegal drugs along the Mexican border.

In most cases, the infection starts in the lungs and is usually handled by the body without permanent damage. But serious complications can arise, including meningitis; and, at Pleasant Valley, the scope of the outbreak has left some inmates permanently disabled, confined to wheelchairs and interned in expensive long-term hospital stays.

About 80 prison employees have also contracted the fever, Pleasant Valley officials say, including a corrections officer who died of the disease in 2005.

What makes the disease all the more troubling is that its cause is literally underfoot: the spores that cause the infection reside in the region’s soil. When that soil is disturbed, something that happens regularly where houses are being built, crops are being sown and a steady wind churns, those spores are inhaled. The spores can also be kicked up by Mother Nature including earthquakes and dust storms.

“It doesn’t matter whether you’re custody staff, it doesn’t matter if you’re a plumber or an electrician,” said James A. Yates, the warden at Pleasant Valley. “You breathe the same air as you walk around out there.”

The epidemic at the prison has led to a clash of priorities for a correctional system that is dealing with below average medical care and chronic overcrowding.

Last fall, heeding advice from local health officials and a federal receiver charged with improving the state’s prison medical care, the Department of Corrections and Rehabilitation delayed plans to add 600 new beds out of concern that the construction might stir up more spores.

Officials at the prison blame the construction of a state hospital nearby for causing a spike in valley fever. The construction was under way from 2001 to 2005, and valley fever hit its peak here in 2006, when the disease was diagnosed in 514 inmates....

Missy Baker recalls the moment when she realized that her football-playing son, Boone, didn't just have the flu.

``He told me he was paralyzed,'' Baker said. ``I said, `What do you mean? I just saw you walk to the bathroom two hours ago.' And he said, `Mom, I can't move my arms or legs.'''

Sixteen-year-old Boone, a wide receiver for Texas's Austin High School, was suffering from a recurrence of methicillin- resistant staphylococcus aureus, or MRSA, which his doctor said he got through an abrasion from playing on artificial turf, Baker said.

Texas has artificial turf at 18 percent of its high school football stadiums, according to Web site Texasbob.com. It also has an MRSA infection rate among players that is 16 times higher than the estimated national average, according to three studies by the Texas Department of State Health Services.

``This is a disease that can kill you,'' said Carolina Espinoza, a graduate epidemiology student at the University of Texas in Houston, who helped conduct one of the studies. ``If I were a football player, I would be alarmed.''

MRSA is a virulent strain of drug-resistant staph bacteria that plagued hospitals for decades and migrated into the general population in recent years, said Edward Septimus, an infectious disease specialist at Methodist Hospital System in Houston. Without proper treatment, it can spread to internal organs and bones after reaching the bloodstream, causing organ failure, he said.

In October, the deaths of a Brooklyn boy and a Virginia youth were blamed on MRSA infections.

At least 276 football players were infected with MRSA from 2003 through 2005, a rate of 517 for each 100,000, according to the Texas studies. The U.S. Centers for Disease Control and Prevention in Atlanta reports a rate for the general population of 32 in 100,000.

Football players often become infected at the site of a turf burn and are misdiagnosed, said David Smith, co-author of a study showing that MRSA-related hospitalizations in the U.S. more than doubled from 1999 to 2005.

``The turf burns themselves are just the kind of minor skin injury that MRSA can exploit,'' said Elliot Pellman, medical liaison for the National Football League, which also has had infections among its players.

Football dominates high school sports in Texas, which has more participants than any other state. Seventy-four schools have stadiums seating more than 10,000. The sport provides 22,041 full-time jobs and generates $2.88 billion in annual spending, said Ray Perryman, president of Perryman Group, a Waco economic and financial analysis firm.

Football also produces more MRSA infections than any other sport, said Marilyn...

The United States remains unprepared for disasters ranging from biological attacks to a flu pandemic, and funding for preparedness is falling, according to a report released on Tuesday.

Many states still lack a stockpile of drugs, masks, gloves and other equipment needed to battle a pandemic of diseases, despite five years of constant and detailed warning, the Trust for America's Health said in its report.

"Overall, federal funding for state and local preparedness will have declined by 25 percent in 3 years if the president's FY (fiscal year) 2008 request is approved," the report reads.

"Until all states measure up, the United States is not safe."

The nonprofit Trust has been issuing reports every year for five years, and said the 2001 anthrax attacks, in which five people died when anthrax spores were mailed to several offices, should have been a wake-up call.

The disasters caused by hurricanes Katrina and Rita that wrecked the U.S. Gulf Coast in 2005 should have galvanized more action and highlighted a variety of problems with U.S. disaster preparedness, the group said.

But the report released on Tuesday still finds preparedness is spotty.

"Thirteen states do not have adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile," the report reads.

"Twenty-one states do not have statutes that allow for adequate liability protection for healthcare volunteers during emergencies. Twelve states do not have a disease surveillance system compatible with the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System," it added.

"Seven states have not purchased any portion of their federally subsidized or unsubsidized antivirals to use during a pandemic flu. Seven states and (Washington) D.C. lack sufficient capabilities to test for biological threats."

Health experts agree that a pandemic of some sort of disease is overdue and believe the H5N1 avian influenza circulating in Europe, Asia and Africa is the most immediate threat....

Infectious-disease expert David N. Gilbert was making rounds at the Providence Portland Medical Center in Oregon in April when he realized that an unusual number of patients, including young, vigorous adults, were being hit by a frightening pneumonia.

"What was so striking was to see patients who were otherwise healthy be just devastated," Gilbert said. Within a day or two of developing a cough and high fever, some were so sick they would arrive at the emergency room gasping for air.

"They couldn't breathe," Gilbert said. "They were going to die if we didn't get more oxygen into them."

Gilbert alerted state health officials, a decision that led investigators to realize that a new, apparently more virulent form of a virus that usually causes nothing worse than a nasty cold was circulating around the United States. At least 1,035 Americans in four states have been infected so far this year by the virus, known as an adenovirus. Dozens have been hospitalized, many requiring intensive care, and at least 10 have died.

Health officials say the virus does not seem to be causing life-threatening illness on a wide scale, and most people who develop colds or flulike symptoms are at little or no risk. Likewise, most people infected by the suspect adenovirus do not appear to become seriously ill. But the germ appears to be spreading, and investigators are unsure how much of a threat it poses.

"This virus has the capability of causing severe respiratory illness in people of all ages, regardless of their medical condition," said John Su, a disease investigator for the Centers for Disease Control and Prevention based in Texas, where the largest outbreak is tapering off at an Air Force base after 10 months. Other outbreaks have been reported in Washington state and South Carolina, along with a single case in an infant in New York City.

"What people need to understand is that there is a virus out there that can make you very, very sick," Su said. "If you have a bad cold and your symptoms keep getting worse, go see your doctor. This is nothing to be necessarily alarmed about. But it is important to be aware that this bug is out there."

The emergence of the virus is the latest example of how new, potentially dangerous pathogens can suddenly appear.

"Infectious agents have the capacity to mutate and change form, and from time to time, either genuinely new agents appear or old agents appear in new guises," said William Schaffner, an infectious-disease expert at Vanderbilt University. "This appears to be another one of those emerging infections that has taken on genetic material or mutated so that it is now more virulent than it used to be."...