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Enron Mail |
Greetings: Welcome to this Friday Letter Special Edition. With all of the
talk about anthrax and other bio-terrorist weapons, Gilder Biotech Report editor Scott Gottlieb filed the following comments we thought you'd find of interest. =-=-=-=-=-=-=-=-=-=-==-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Dear Friday Letter Reader: Over the last week I've been asked a lot of questions about how to protect against smallpox -- a threat which seems to have a growing number of people concerned. A friend who works with the CDC says some there believe it may the bioterrorists' weapon du jour. Given the lack of technical sophistication of this crowd, any smallpox attack would likely consist of a dozen bioterrorists self-infecting and then walking around the New York City subways. The simplicity of such an action provides some opportunities to protect ourselves, including making available some powerful antivirals, many of which came about during the AIDS crisis. First a little background on smallpox. The virus spreads from person to person, primarily by tiny droplets expelled from the throats of infected persons and by direct contact. Contaminated clothing or bed linens can also spread the virus. Patients spread smallpox primarily to household members and friends; large outbreaks in schools, for example, were uncommon. This finding was accounted for in part by the fact that transmission of smallpox virus did not occur until onset of a rash. By then, many patients had been confined to bed because of the high fever and lethargy caused by the early stages of the illness. Secondary cases were usually restricted to those who came into contact with patients, usually in the household or in the hospital. The patient was most infectious from onset of rash through the first 7 to 10 days of rash. As scabs formed, infectivity waned rapidly. Although the scabs contained large amounts of viable virus, laboratory studies showed that they were not especially infectious, presumably because the virus particles were bound tightly in the rash. Infection starts after virus particles are implanted in the throat, nose, or lungs. The infectious dose is unknown but is believed to be only a few virus particles. After about two weeks, patients experience high fever, malaise, headaches and backaches. Severe abdominal pain and delirium are sometimes present. A rash that resembles chicken pox then appears in the mouth and throat, face, and forearms, and spreads to the trunk and legs As patients recover, the scabs break and turn into pitted scars. Back as late as the 1970s, when the last cases of smallpox were reported in the Western world, there were few treatments -- other than vaccination. That has changed. There are at least half-dozen antivirals that are believed to have efficacy against smallpox. Many of these can probably be used as post-exposure prophylaxis. Most of the studies with these drugs have been conducted in animals and test tubes. There are a few human trials to draw on. I will focus on two drugs: one because it's believed to be excellent, and could be available in the time of a crisis. The second, while not as effective, is widely available today. The first is Cidofovir, an antiviral agent aimed at DNA viruses, developed by Gilead Sciences (GILD). Cidofovir was tried against HIV, but didn't work that well. First of all, it had to be delivered intravenously to be effective. Also, it was toxic to the kidneys. So it was largely abandoned. The drug, however, is still on the market for limited use in some complications of AIDS, and there is laboratory and clinical data that it would be very effective against smallpox. The other drug is Rifampin, a mainstay in the treatment of tuberculosis. While Rifampin lacks the potency of Cidofovir, it's widely available and could provide some measure of post-exposure prophylaxis. It works by blocking assembly of the smallpox virus. It's easy to get, and certainly better than nothing. All this is not to say anyone expects an imminent attack. But even a few cases of smallpox would be catastrophic. For all the fear over anthrax, it's still a one-time agent. It doesn't spread from person to person. To catch it you need to come directly in contact with the spores. And the first thing we do in the hospital is wash down the suspected victims. The real test for our nation will come when a communicable disease like smallpox crops up. Even doctors are petrified of the possibility. There have been a lot of stories about the risk of a looming attack. Let's hope it's just media hype. --Scott Gottlieb, M.D. Click here, https://www.gilder.com/biotech/biotechnewsSub.asp, if you'd like to subscribe to the Gilder Biotech Report by Scott Gottlieb, MD =-=-=-=-=-=-=-=-=-=-==-=-=-=-=-=-=-=-=-=-=-=-=-=-=- The Friday Letter is published weekly for subscribers and friends of Gilder Publishing. If someone you know would enjoy it, please feel free to forward a copy. To SUBSCRIBE please visit http://www.gilder.com/ =-=-=-=-=-=-=-=-=-=-==-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Copyright 2001 Gilder Publishing LLC --- You are currently subscribed to gilder-technology-report as: alewis@ect.enron.com To unsubscribe send a blank email to leave-gilder-technology-report-661837S@earth.lyris.net
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