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National Geographic : 2002 Feb
Contents
linchpin in the battle ERADICATION EFFORTS Blinded by smallpox half a lifetime ago, a man in Niger is checked for trachoma (right). A global vaccination campaign against smallpox, launched in 1967, eliminated the disease by 1980. Spread by water, the disease caused by guinea worms will likely disappear soon, after a decade-long drive encouraging the use of water filters in endemic areas. A farmer getting treatment in Niger may be among the last cases. the linchpin in the battle against emerging diseases. It need not be complicated or high tech. When the cryptosporidiosis outbreak hit Milwaukee in 1993, it took officials many days to recognize they had a problem on their hands. The causative organism was not one they tested for routinely. And the foremost symptom of infection-severe diarrhea-was not the kind of thing people typically called their doctors about, at least not at first. After the epidemic was brought under con trol, health officials conducted a retrospective study to see how they might have picked up on it sooner. The very best and earliest indication of trouble, they found, had been a vast increase in sales of over-the-counter antidiarrheal medicines-a simple sales spike that went unnoticed because no one was looking for it. Milwaukee and other cities caught on. Now, for example, the New York City department of health has an arrangement with the Rite-Aid drugstore chain to receive weekly antidiarrheal sales data. In New Mexico, public health offi cials are starting to tally symptoms of people in emergency rooms and are using computers to look for groups of symptoms that might indi cate the spread of a disease through the com munity several days before microbial culture results begin to yield clues. But there's a place for high-tech surveillance as well. In perhaps the best example, scientists at 110 centers around the world collect samples of the influenza virus from patients each winter and conduct sophisticated genetic tests on those viruses, which mutate continually from year to year. The scientists pool this infor mation to predict which strain will dominate in the upcoming year, and vaccine companies rush to make new batches of exactly the right vaccine just in time for the next flu season. "It's an amazing and heroic effort that en ables the pharmaceutical companies to make very effective vaccines," says Barry Bloom, dean of the Harvard School of Public Health. "Our best protection is to know what's coming. With flu we're doing an astonishingly good job." While vaccines are by far the most effective and cost-efficient weapons in the war against infectious diseases, precious little money is being spent on the development of new ones today, and vaccines for HIV, TB, and malaria remain elusive. Again, cooperation is required. For inspiration one need look no further than the current campaign against polio. Thanks to an enormous international effort, polio may be eradicated as early as 2005. To accomplish that goal, countless dedicated health workers have been trekking into every village in the developing world and squeezing lifesaving drops of vaccine into the mouth of every child they can find. The scale of the effort is almost beyond WAR ON DISEASE
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