2 The list of epidemics then under investigation included:
• Several U.S. outbreaks of lethal food poisoning due to a newly emerging strain of E. coli 0157 bacteria, and reports of the same drug-resistant bacteria’s spread in South Africa and Swaziland.
• Cryptosporidiosis parasite contamination of the Milwaukee water supply.
• Outbreaks in several hospitals and child care centers of multidrug-resistant pneumonia-producing bacterial disease.
• Reports of vancomycin-resistant stomach infections in New York City hospitals due to enterococcal bacteria.
• A new strain of influenza A spotted in China (A/Beijing/32/92) that some flu experts feared would reach the United States during the coming fall.
• Cholera spreading steadily northward across Latin America since its first arrival in Peru in 1991.
• Yellow fever, for the first time in history, erupting in western Kenya, in an area rife with ethnic warfare.
• A new deadly mutant strain of cholera, causing an epidemic in India and Bangladesh.
• An epidemic of the mosquito-carried disease Rift Valley fever, claiming thousands of victims in southern Egypt.
• Two new outbreaks of the deadly hemorrhagic viral disease Lassa fever in Nigeria.
• The appearance of a new antibiotic-resistant strain of bacteria causing lethal dysentery among children in Burundi.
• Multidrug-resistant strains of tuberculosis surfacing in New York City, Cambodia, and a few other sites in the United States—and rumors of emergences in Switzerland, Paris, Madrid, and London.
• Bolivian hemorrhagic fever, the Machupo viral disease, breaking out again in eastern Bolivia for the first time in thirty years.
• An epidemic of a newly discovered lethal virus in Venezuela, dubbed Venezuelan hemorrhagic fever.
In all of these cases CDC personnel were actively involved in field investigations or laboratory work. In addition, CDC scientists were advising other international and U.S. state agencies on how best to handle several other disease outbreaks, including an out-of-control epidemic of visceral leishmaniasis that had already claimed some 60,000 lives in war-ravaged southern Sudan.
3 For further accounts of these and other events in the outbreak, see L. K. Altman, “Virus That Caused Deaths in New Mexico Is Isolated,†New York Times, November 21, 1993: A21; L. Garrett, “Medical Gumshoes Confront a Mystery,†Newsday, Discover section, September 28, 1993: 69–72; D. Grady, “Death at the Corners,†Discover, December 1993: 82–92; J. Horgan, “Were Four Corners Victims Biowar Casualties?†Scientific American, November 1993: 16; J. M. Hughes, C. J. Peters, M. L. Cohen, and B. W. J. Mahy, “Hantavirus Pulmonary Syndrome: An Emerging Infectious Disease,†Science 262 (1993): 850–51; B. Le Guenno, “Identifying a Hantavirus Associated with Acute Respiratory Illness: A PCR Victory?†Lancet 342 (1993): 1438–39; M. D. Lemonick, “Closing In on a Mysterious Killer,†Time, December 6, 1993: 66–67; R. Levins, P. R. Epstein, M. E. Wilson, et al., “Hantavirus Disease Emerging,†Lancet 342 (1993): 1292; E. Marshall and R. Stone, “Hantavirus Outbreak Yields to PCR,†Science 262 (1993): 832–836; and W. F. Rahson, “Indians Doubt Rodents Source of ‘Mystery Illness,’†Associated Press, July 1, 1993.
4 The Chinese described an ailment 1,000 years ago that some have interpreted to be a hantaviral disease, and both Russian and Japanese scientists showed during World War II that people suffering hemorrhagic renal failure had an infectious disease. They did so by injecting the filtered urine of disease victims into “volunteers,†who subsequently developed the disease.
5 J. W. LeDuc, T. G. Ksiazek, C. A. Rossi, et al., “A Retrospective Analysis of Sera Collected by the Hemorrhagic Fever Commission During the Korean Conflict,†Journal of Infectious Diseases 162 (1990): 1182–84.
6 H. W. Lee, “Korean Hemorrhagic Fever,†in Ebola Virus Haemorrhagic Fever (New York: Elsevier, 1978), 331–43.
7 M. Linderholm, B. Settergren, C. Ahlm, et al., “A Swedish Case of Fatal Nephropathia Epidemica,†Scandinavian Journal of Infectious Diseases 23 (1991): 501–2; B. Settergren, “Nephropathia Epidemica in Scandinavia,†Reviews of Infectious Diseases 13 (1991): 736–44; and A. Lundkvist, A. Fatouros, and B. Niklasson, “Antigenic Variation of European Haemorrhagic Fever with Renal Syndrome Viral Strains Characterized Using Bank Vole Monoclonal Antibodies,†Journal of General Virology 72 (1991): 2097–2103.
8 Later one of van der Gröen’s graduate students uncovered another hantavirus strain in Ireland, carried by Rattus rattus, the world’s most common black urban rat. See C. F. Stanford, J. H. Connolly, W. A. Ellis, et al., “Zoonotic Infections in Northern Ireland Farmers,†Epidemiology and Infection 105 (1990): 565–70.
9 J. E. Childs, G. E. Glass, T. G. Ksiazek, et al., “Human-Rodent Contact and Infection with Lymphocytic Choriomeningitis and Seoul Viruses in an Inner-city Population,†American Journal of Tropical Medicine and Hygiene 44 (1991): 117–21; and J. E. Childs, G. E. Glass, G. W. Korch, et al., “Evidence of Human Infection with a Rat-Associated Hantavirus in Baltimore, Maryland,†American Journal of Epidemiology 127 (1988): 875–78.
10 G. E. Glass, A. J. Watson, J. W. LeDuc, et al., “Infection with a Ratborne Hantavirus in U.S. Residents Is Consistently Associated with Hypertensive Renal Disease,†Journal of Infectious Diseases 167 (1993): 614–20.
11 L. J. Back, R. Yanagihara, C. J. Gibbs, et al., “Leakey Virus: A New Hantavirus Isolated from Mus musculus in the United States,†Journal of General Virology 69 (1988): 3129–32.
12 R. Weiss, “Rat-Borne Virus May Take Secret Toll,†Science 135 (1993): 292; Glass, Watson, LeDuc, et al. (1993), op. cit.; and J. W. LeDuc, J. E. Childs, and G. E. Glass, “The Hantaviruses, Etiologic Agents of Hemorrhagic Fever with Renal Syndrome: A Possible Cause of Hypertension and Chronic Renal Disease in the United States,†Annual Review of Public Health 13 (1992): 79–98.
13 R. R. Arthur, R. S. Lofts, J. Gomez, et al., “Grouping of Hantaviruses by Small S Genome Segment Polymerase Chain Reaction,†American Journal of Tropical Medicine and Hygiene 47 (1992): 210–24.
14 J. W. Huggins, C. M. Hsiang, T. M. Cosgriff, et al., “Prospective, Double-Blind, Concurrent, Placebo-Controlled Clinical Trials of Intravenous Ribavirin Therapy of Hemorrhagic Fever with Renal Syndrome,†Journal of Infectious Diseases 164 (1991): 1119–27.
15 Centers for Disease Control and Prevention, “Update: Outbreak of Hantavirus Infection—Southwestern United States, 1993,†Morbidity and Mortality Weekly Report 42 (1993): 477–78.
16 S. T. Nichol, C. F. Spiropoulou, S. Morzunov, et al., “Genetic Identification of a Hantavirus Associated with an Outbreak of Acute Respiratory Illness,†Science 262 (1993): 914–18.
17 “Congress Mobilizes Against Hantavirus,†Science 261 (1993): 415.
18 Centers for Disease Control and Prevention, “Update: Hantavirus Pulmonary Syndrome—United States, 1993,†Morbidity and Mortality Weekly Report 42 (1993): 816–20.
19 H. Zinsser, “Much About Rats—A Little About Mice,†Rats, Lice and History (Boston: Little, Brown, 1934), chapter 11.
20 G. Neild, “Mysterious Respiratory Disease in USA†(letter), Lancet 342 (1993): 61.
21 J. Pilaski, C. Ellerich, T. Kreutzer, et al., “Haemorrhagic Fever with Renal Syndrome in Germany†(letter), Lancet 337 (1991): 111; and P. Kulzer and R. M. Schaefer, “Haemorrhagic Fever with Renal Syndrome, 1993: Endemic or Unrecognised Pandemic?†(letter), Lancet 342 (1993): 313.
22 Ibid.; and B. Le Guenno, M. A. Camprasse, J. C. Guilbaut, et al., “Hantavirus Epidemic in Euro
pe, 1993,†Lancet 343 (1994): 114–15.
23 Le Guenno (1993), op. cit.; J. Clement, P. McKenna, P. Colson, et al., “Hantavirus Epidemic in Europe, 1993,†Lancet 343 (1994): 114; P. E. Rollin, D. Coudrier, and P. Sureau, “Hantavirus Epidemic in Europe, 1993,†Lancet 343 (1994): 115–16; and R. A. J. Esselink, M. N. Gerding, P. J. A. M. Brouwers, et al., “Guillain-Barré Syndrome Associated with Hantavirus Infection,†Lancet 343 (1994): 180–81.
24 Not everyone agreed with this analysis. Some scientists adamantly rejected the hantavirus association with the Four Corners outbreak, and insisted well after all PCR analysis was completed that the ailment was caused by toxic chemicals. See, for example, W. F. Denetclaw, Jr., and T. H. Denetclaw, “Is ‘South-West U.S. Mystery Disease’ Caused by Hantavirus?†Lancet 343 (1994): 53–54.
25 E. Marshall and R. Stone. “Race to Grow Hantavirus Ends in Tie,†Science 262 (1993): 1509; P. B. Jahrling, presentation to the annual meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, GA, November 1993; and J. S. Duchin, F. T. Koster, C. J. Peters, et al., “Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease,†New England Journal of Medicine 330 (1994): 949–55.
26 For a discussion of Seoul Hantaan, see: C. S. Schmaljohn, S. E. Hasty, and J. M. Dalrymple, “Preparation of Candidate Vaccine-Vectored Vaccines for Haemorrhagic Fever with Renal Syndrome,†Vaccine 10 (1992): 10–13.
27 Centers for Disease Control and Prevention, “Hantavirus Pulmonary Syndrome—United States, 1993,†Morbidity and Mortality Weekly Report 43 (1994): 45–48.
28 L. Garrett, “Hantavirus Source Is Still a Mystery,†New York Newsday, March 25, 1994: A32; E. Lane, “Hantavirus Rodents: A Hard Catch,†New York Newsday, March 6, 1994: 18; E. Lane, L. Garrett, and A. Smith, “Virus’ Deadly Clues,†Newsday, February 26, 1994: 8; and L. Garrett, E. Lane, J. Mangaliman, et al., “Hantavirus: The Search Is On,†Newsday, February 25, 1994: 4.
16. Nature and Homo sapiens
1 United Nations Population Fund, “The State of the World Population,†United Nations, New York, 1991.
2 For cogent arguments on the relationship between rapid human population growth and environmental destruction and/or human suffering (warfare, economic despair, human rights violations, low quality of life), see P. Kennedy, Preparing for the Twenty-first Century (New York: Vintage, 1993); Population Crisis Committee, “Human Suffering Index,†Washington, D.C., 1987–93, annually; P. Harrison, The Third Revolution (London: I. B. Tauris, 1992); and R. D. Kaplan, “The Coming Anarchy,†Atlantic Monthly, February 1994: 44–76.
3 E. O. Wilson, The Diversity of Life (Cambridge, MA: Harvard University Press, 1992).
4 E. O. Wilson, “Rain Forest Canopy: The High Frontier,†National Geographic, December 1991: 78–107.
5 Food and Agriculture Organization, “The Forest Resources of the Tropical Zone by Main Ecological Regions,†report to the United Nations Conference on Environment and Development by the Forest Resource Assessment 1990 Project, FAO, Rome, 1992.
The FAO results are described in P. Aldous, “Tropical Deforestation: Not Just a Problem in Amazonia,†Science 259 (1993): 1390. When the loss rate was described in terms of percentages of whole forest areas, FAO found:
Region % of Forest Lost Annually
South America 0.6
Southeast Asia 1.6
Central America 1.5
6 A. Gentry, presentation to the Neotropical Montane Forests: Biodiversity and Conservatism meeting, New York Botanical Garden, June 21–25, 1993.
7 For a detailed discussion of the conflicting economic and ecological interests at play in the Amazon, see J. de Onis, The Green Cathedral: Sustainable Development of Amazonia (New York: Oxford University Press, 1992).
8 D. Skole and C. Tucker, “Tropical Deforestation and Habitat Fragmentation in the Amazon: Satellite Data from 1978 to 1988,†Science 260 (1993): 1905–10.
9 Centers for Disease Control, “Lyme Disease Surveillance—United States, 1989–1990,†Morbidity and Mortality Weekly Report 40 (1991): 417–20; and T. F. Tsai, presentation to the Annual Meeting of the American Society of Tropical Medicine and Hygiene, Honolulu, December 10–14, 1989.
10 M. Kirsch, F. L. Ruben, A. C. Steere, et al., “Fatal Adult Respiratory Distress Syndrome in a Patient with Lyme Disease,†Journal of the American Medical Association 259 (1988): 2737–39; and J. F. Bradley, R. C. Johnson, and J. L. Goodman, “The Persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis,†Annals of Internal Medicine 120 (1994): 487–89.
11 A. C. Steere, E. Taylor, G. L. McHugh, and E. L. Logigian, “The Overdiagnosis of Lyme Disease,†Journal of the American Medical Association 269 (1993): 1812–16.
12 A. C. Steere, R. L. Grodzicki, A. N. Kornblatt, et al., “The Spirochetal Etiology of Lyme Disease,†New England Journal of Medicine 308 (1983): 733–40.
13 A. C. Steere, “Lyme Disease,†New England Journal of Medicine 321 (1989): 586–96.
14 A. G. Barbour and D. Fish, “The Biology and Social Phenomenon of Lyme Disease,†Science 260 (1993): 1610–16.
15 H. S. Ginsberg, “Transmission Risk of Lyme Disease and Implications for Tick Management,†American Journal of Epidemiology 138 (1993): 65–73.
16 J. F. Levine, M. L. Wilson, and A. Spielman, “Mice as Reservoirs of the Lyme Disease Spirochete,†American Journal of Tropical Medicine and Hygiene 34 (1985): 355–60; J. G. Donahue, J. Piesman, and A. Spielman, “Reservoir Competence of White-Footed Mice for Lyme Disease Spirochetes,†American Journal of Tropical Medicine and Hygiene 36 (1987): 92–96; J. Piesman, T. N. Mather, G. J. Dammin, et al., “Seasonal Variation of Transmission Risk of Lyme Disease and Human Babeosis,†American Journal of Epidemiology 126 (1987): 1187–89; S. R. Telford, T. N. Mather, S. I. Moore, et al., “Incompetence of Deer as Reservoirs of the Lyme Disease Spirochete,†American Journal of Tropical Medicine and Hygiene 39 (1988): 105–9; and T. N. Mather, M. L. Wilson, S. I. Moore, et al., “Comparing the Relative Potential of Rodents as Reservoirs of the Lyme Disease Spirochete (Borrelia burgdorferia),†American Journal of Epidemiology 130 (1989): 143–50.
17 D. J. White, H. G. Chang, J. L. Benach, et al., “The Geographic Spread and Temporal Increase of the Lyme Disease Epidemic,†Journal of the American Medical Association 266 (1991): 1230–36.
18 Crucial clues to the history of the emergence of Lyme disease were provided by a study of the 1980–81 appearance of the disease in Ipswich, Massachusetts. See C. C. Lastavica, M. L. Wilson, V. P. Berardi, et al., “Rapid Emergence of a Focal Epidemic of Lyme Disease in Coastal Massachusetts,†New England Journal of Medicine 320 (1989): 133–37.
19 A. Spielman, “The Emergence of Lyme Disease and Human Babeosis in a Changing Environment,†presentation to the Workshop on New Diseases, Woods Hole, MA, November 7–10, 1993.
20 O. L. Phillips and A. H. Gentry, “Increasing Turnover Through Time in Tropical Forests,†Science 263 (1994): 954–58; and S. L. Pimm and A. M. Sugden, “Tropical Diversity and Global Change,†Science 263 (1994): 933–34.
21 This has been, and continues to be, a very lively debate that directly affects global treaties still in negotiation. What kind of refrigerants were in American kitchen appliances, the allowable carbon monoxide emissions for Italian cars, incineration policies for Japanese plastics wastes, and forestry plans for Southeast Asia all impinged upon scientific interpretations of available data on ozone depletion and global warming.
As a result, mountains have been written on the topic, and it is well b
eyond the scope of this book to scrutinize the data at the root of the debate. For a flavor of that debate, see A. Gore, Earth in the Balance (New York: Houghton Mifflin, 1992); J. F. Gleason, P. K. Bhartia, J. R. Herman, et al., “Record Low Global Ozone in 1992,†Science 260 (1993): 523–36; J. Oerlemans, “Quantifying Global Warming from the Retreat of Glaciers,†Science (1994): 243–45; A. Tabazadeh and R. P. Turco, “Stratospheric Chlorine Injection by Volcanic Eruptions: HCI Scavenging and Implications for Ozone,†Science 260 (1993): 1082–86; G. Taubes, “The Ozone Backlash,†Science 260 (1993): 1580–83; M. D. Lemonick, “The Ozone Vanishes,†Time, February 17, 1992: 60–68; J. B. Kerr and C. T. McElroy, “Evidence for Large Upward Trends of Ultraviolet-B Radiation Limited to Ozone Depletion,†Science 262 (1993): 1032–34; and E. M. Pokras and A. C. Mix, “Earth’s Precession Cycle and Quaternary Climactic Change in Tropical Africa,†Nature 326 (1987): 486–87.
22 For a detailed discussion of global warming and its expected impact upon potential disease, see T. E. Lovejoy, “Global Change and Epidemiology: Nasty Synergies,†Chapter 25 in S. S. Morse, ed., Emerging Viruses (Oxford, Eng.: Oxford University Press, 1993).
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