INFECTIOUS_DISEASES

Hit by a number of liability lawsuits, the pharmaceutical industry is acting defensively. Lederle Laboratories of Wayne, N. J., announced that it is boosting the price pe r shot of its vaccine to $11.40 (it was only 45 cents in 1982), holding back 8_of that amount for what company calls its "liability reserve".

Meanwhile, researchers are scrambling to purge the vaccine of its harmful effects. In its current form, pertussis vaccine is made by killing pertussis bacteria with heat or chemicals and grinding them up, toxins and all. When the resulting mixture is injected, several of the toxins stimulate an immune response that protects the recipient from attacks by live pertussis bacteria. But some of the toxins in the vaccine apparently cause the side effects as well.

Researchers in Japan have brewed what they hope is a safer vaccine by separating out the most dangerous toxins produced by the bacteria, leaving only four to stimulate the immune response. U.S. scientists at the National Institute of Health and the Public Health Service have gone one step further: they announced that they had determined the genetic code of the bacterial gene that orders production of one of the toxins. They hope to alter the gene so that it signals the production of only the part of the toxin that stimulates the immune response, then to use this partial toxin as an essential ingredient of a safe vaccine.

Until a safer vaccine is available in the U.S., the CDC has advised parents to watch carefully for these symptoms in children receiving D.P.T. shots: 1) severe allergic reaction like a rash or troubled breathing; 2) a fever of 105°F or higher within 48 hours of a shot; 3) the onset of shock, which is characterized by clamminess and a rapid pulse; 4) persistent crying that lasts for three hours or more, or unusual high-pitched cries; 5) seizures, fits or convulsions within three days of a ■ shot; 6) dulling of mental function within seven days of a shot. "If any one of these symptoms occurs", says the CDC's Patriarca, "no further doses of the vaccine should be given", and the child should be taken immediately to a doctor, clinic or hospital.

VACCINES FOR ADULT DISEASES

When the flu and pneumonia season arrives, shortly a surprising number of Americans will be caught with their antibodies down, (or no good reason. Around 48 million adults should consider being vaccinated against influenza or pneumonia, medical authorities say. Another 4 million ought to be vaccinated against hepatitis В, а sometimes fatal liver infection that is spreading at an alarming rate: there were 50 percent more new cases in 1986 than in 1981,

according to the Federal Centers for disease control. All told, Health officials estimate, infections for which vaccines already exist kill 70000 Americans a year and s t r i k e hundreds of thousands more — costing tens of billions of dollars in medical care and lost work.

It is curious that while Americans are more fussy about their health than ever before, they're neglecting the most powerful preventive measure in medicine. Shots have saved countless lives since childhood vaccines became widely used. There were 200000 U.S. cases of diphtheria reported in 1921 — none in 1986. Paralytic polio struck around 57000 in 1952 — only two last year. But even in light of such well-known medical triumphs, researchers say, no more than one in five adults whose life would be jeopardized by a vaccine-preventable infection gets immunized against it. "Historically, we've thought of immunization as something for children", says Dr. Alan Hinman, director of the CDC's division of immunization. "But it's an adult thing to do".

Are you unprotected? Whether you should prime your diseasefighting antibodies depends on your age and medical history and the probability of direct infection. For final advice, consult your doctor. So that you can take stock of your bodily defenses, here is a survey of the most threatening diseases for which va ccines are available.

Influenza: In a typical year, influenza kills 10000 to 40000 Americans. In the 1984/85 epidemic, a CDC official estimates, the toll was at least 50000. Influenza costs the nation $3 billion to $5 billion annually in productivity losses and health care, says Dr. David S. Fedson of the University of Virginia, head of the immunization task force of the American College of Physicians. In an epidemic year, he says, the expense is about S12 billion. The CDC now recommends the vaccine for persons over 65, for sufferers of chronic lung and heart disease and for adults living with such high-risk persons, ft is also advised for any adult who wants to lower the odds of getting the flu. The vaccine, which prevents infection in 60 to 70 per cent of recipients and lessens its severity in many others, is reformulated annually and should be taken every fall.

Doctors and patients shun flu shots today partly because of fears stemming from the swine-flu controversy of 1976, in which some 500 of the 45 million people given the vaccine mysteriously developed a neurological disease. Since that episode, says Leonard Kurland, a neurologist and epidemiologist at the Mayo Clinic, flu shots have caused no additional cases of Guillain-Barre syndrome. Today's highly purified flu vaccines, researchers say, "rarely" cause the feverish aches that plagued recipients of the first f l u shots 30 years ago.

Pneumonia: Between 20000 and 40000 Americans die annually of pneumonia caused by pneumococcal bacteria. Like the flu shot, the pneumococcal vaccine is advised for the elderly and the chronically ill and those with whom they live.- The once-in-a-lifetime vaccine is the only preventive measure of any kind that Medicare covers.

A Veterans Administration study published in the "New England Journal of Medicine" last fall has caused some physicians to lose faith in the vaccine. The VA researchers studied 2295 men (mostly over 55) with chronic illness such as diabetes and alcoholism; the 1145 men who received vaccine, the researchers found, had no fewer cases of pneumococcal infection than men who didn't. But the oft-mentioned study is "invalid", some researchers say. For instance, Fedson says, too few subjects were tested for the vaccine's benefits to become apparent, and subjects who received vaccine were by chance more feeble than the controls. Neither the U.S. Public Health Service nor the CDC has changed its vaccine recommendations in the wake of the VA study. Experts still say it prevents infection in two out of three r ecipients who would otherwise become infected.

Hepatitis B: Following the do-as-l-say-and-not-as-l-do medical dictum, most physicians fail to immunize themselves against hepatitis B. Since the virus is transmitted via blood and blood products as well as semen and saliva, health-care workers are urged to get a vaccination: Yet, Hinman says, no more than 30 percent of physicians and 40 percent of dentists have done so. Others at high risk are gay men with multiple partners and i.v. drug abusers who share needles. The CDC also says that heterosexuals with more than one sex partner should consider the vaccine; of the 300000 or so people who became infected last year, says CDC epidemiologist Gary Schatz, about 120000 got it from heterosexual contact.

A major purpose of the vaccine is to stem the tide of virus carriers — now at 500000 to 1 million Americans and rising. About 10 percent of infected persons can't get rid of the hepatitis В virus and become chronic carriers; a fraction of them die of cirrhosis or liver cancer. But the vaccine, which is administered in three doses over six months and is thought to spur lifelong immunity, is not likely to become more popular until it's more convenient and much cheaper.

% Time to bring your immune system up to date? For those who received a tetanus or diphtheria vaccine, researchers recommend a booster every 10 years. And as many as 20 percent of Americans in their 20s and early 30s are susceptible to measles; either they didn't get the disease in childhood, and so have no natural immunity,

or they received a weak measles vaccine. As a result, measles outbreaks have lately occurred on college campuses, prompting some schools to require students t6 prove their immunity or roll up their sleeve. Another immunity gap is rubella, or German measles. About 15 percent of women of childbearing age are susceptible to rubella, which can cause birth defects.

While several once dreaded diseases are disappearing, influenza and pneumonia and hepatitis В are flourishing, relatively unchecked by vaccines. Fear of shots isn't the problem. Repeated surveys show that when physicians advise high -risk patients to get a vaccine, most of them follow doctor's orders.

THREE NEW VACCINES FOR JUNIOR

Two childhood illnesses — chicken pox and meningitis — may soon go the way of measles, diphtheria and polio as new vaccines reach the market in the next year or two. And a third new vaccine, against pertussis (whooping cough), could soon quell fears about adverse reactions associated with the current DPT (diphtheria, pertussis, tetanus) vaccine.

At the annual meeting of the American Academy of Pediatrics in New Orleans, pediatricians will be told that a chicken-pox vaccine at last has tested safe and effective and should be available in two years. The vaccine, against the varicella virus, would protect some 3,5 million young Americans who come down with chicken pox each year.

The illness usually hits between ages 5 and 10 — bringing fever, aches and a rash — and lasts a week . It also strikes adults, in whom the vaccine appears less effective in limited studies so far. A bigger problem: It is not known how long immunity lasts. The vaccine is still protecting kids in Japan after eight years of widespread use—a promising sign, says Dr. Alan Hinman, director of immunization programs at the Centers for Disease Control. If immunity wanes, periodic booster shots may solve the problem. "Parents will certainly be eager for this vaccine", Hinman predicts.

A new vaccine against hemophilus influenza type В — a bacterium that causes 12000 cases of meningitis and 7000 cases of other serious complications in infants each year — is also sure to ease parents' minds. A vaccine exists now that protects children aged 2 and older from the bacteria, but it is ineffective in younger kids, who account for 80 percent of cases. The new vaccine, being tested in Finland and Alaska, has proved effective in kids under 2. It's expected to be available by the end of 1988 — possibly sooner.

The new pertussis vaccine causes fewer minor adverse reactions, such as fever and swelling at the injection site,-than the current

DPT vaccine, studies show. More important: A version of the new vaccine, used in Japan since 1981 and being tested in Sweden and the U.S., appears to cause fewer cases of permanent brain damage and mental retardation. Brain damage occurs in 1 out of every 340000 children who get the current vaccine ~— about 50 per year in the United States. Untreated whooping cough produces 10 times as much brain damage as the vaccine. Mortality is highest among infants.

One defect in the Japanese data is that kids there get the vaccine at .age 2, and the risk of the disease is highest in the first year of life. U.S. officials now eagerly await the outcome of a Swedish study of 3000 6-month-old children who were given the newer vaccine a year ago.

Even if results look good, however, Japanese vaccine makers are fearful about applying for licensing in the United States. The reason: Liability. But Congress went a long way toward solving that problem for all vaccine makers when it authorized an excise tax on the DPT, measles, mumps and polio vaccines for a fund to cover the expenses of children who suffer serious side effects of vaccination.

PART III

КОНТРОЛЬНЫЕ ЗАДАНИЯ

А. Тексты для чтения без словаря и передачи содержания на русском языке.

A Dictionary of Baby and Child Care

BRONCHITIS. Bronchitis may be mild or severe. It simply means that the cold has spread to the air passa ges. There may or may not be fever, but the cough may be severe and it may interfere with feeds and sleep. If there is fever and the child coughs frequently, a doctor should be consulted. Even without fever, if the cough persists you should consult a docto r. Till such time as a doctor is available, the child should be given steam - inhalations to soothe the cough and ease breathing. Aspirin may be given to bring down his fever.

* altitude chamber — барокамера ** salt mines — соляные копи

CHICKENPOX. The illness begins with fever, slight headache and listlessness. Within a day or two spots appear on the chest or back, which soon look like small blisters. Such new "crops" keep appearing for 2—3 days and older ones get scabbed over. There is a lot of itching and the child may scratch some of the blisters. Chlckenpox is usually a mild disease, and there is no particular treatment, except to keep the skin clean and use some soothening lotion (such as Calamine lotion) for itching. The itching can also be relieved by bathing the child with a small quantity of bicarbonate of soda (baking soda) 2—3 times a day. Antihistamine syrup to relieve itching should only be given under medical advice.

As in the case of measles, there is no point keeping the other children in the family away, as they have been exposed to the disease already and it is just as well for them to get it over with.

COMMON COLD. The commonest viral infection is the common cold, and everyone is only too familiar with it. The baby is irritable and restless because he cannot breathe through his mouth. As soon as he tries to suck the breast or bottle, his breathing difficulty increases because his .mouth also gets blocked, and so he stops sucking in order to breathe. The baby not only has the problem of breathing, but also gives up feeding. He finds it difficult to go off to sleep and wakes up again and again. Because of the necessity of breathing through the mouth, many babies who suck their thumb give up this habit, as they have to breathe through their mouths. A cold may also cause pain in the ear and go down the air passages into the lungs.

There is no special medicine for the common cold, except to make the child comfortable by helping to keep his nose open with nose drops, and giving him baby aspirin for fever. Steam inhalations help a great deal. This can be done by the mother sitting with the baby in her lap and covering the head with a towel or a sheet. A steaming kettle is kept nearby and the baby inhales the steam. Be careful not to let the baby touch the hot kettle or to take the baby too near the steam, as it might cause skin burn. Inhalation can be given for about 5 —10 minutes 2—3 times a day. In warm weather it will not be poss ible to give steam inhalation.

CROUP. Croup is the word commonly used for infection of the air passage or larynx. There is a hoarse, barking cough and difficulty in breathing. It comes on suddenly during the evening. The child may have had a cold and some cough, but suddenly wakes up coughing and breathless. His voice is hoarse and he seems to be fighting for breath. It looks frightening, but it is not so serious as it looks. Breathing improves by increasing the humidity

of the room. This can be done by keeping basins of water in the room, hanging wet sheets or towels around the child's bed, by a room cooler or khas-khas chicks. In .winter a steaming kettle can be kept in the room. Breathing improves in a moist room, and the cough also becomes loose and less dry.

Croup with fever. This is a more severe form of croup.There is difficulty in breathing, a feeling of tightness in the chest, and cough. A doctor should be consulted immediately or the child should be taken to the hospital.

DIPHTHERIA. Diphtheria is a highly contagious disease, which mainly effects the throat. The symptoms are sore throat, fever and headache. There is difficulty in swallowing. There is a whitish patch in the throat and if it spreads to the windpipe, there is difficulty in breathing. The child looks ill and toxic. The disease can lead to many complications of nerves, heart and kidneys, and sometimes an emergency operation (tracheostomy) may have to be done if the windpipe gets blocked with the membrane and the child has difficulty in breathing. The child will have to be hospitalized in an infectious disease hospital for 3—4 weeks, and then convalescence proceeds at home for a few weeks more. This disease can be prevented by immunizing the child.

GERMAN MEASLES (Rubella). This is a mild disease with lowgrade fever, some pain behind ears due to enlargement of glands, and a mild pinkish rash, which only lasts for a day or two. The whole illness lasts 2 —3 days and needs no treatment at all. If, however, a pregnant mother gets German measles during the first three months of her pregnancy, there is great danger of the baby being born with some congenital malformation. Under doctor's advice it is permissible to have an abortion induced for such an eventuality. Fortunately, most mothers would have already had the infection in their childhood.

One attack of German measles usually gives a lifelong immunity, although, rarely, a second attack may occur. A vaccine has now been developed to prevent German measles but it is not ye t available in India.

HEPATITIS. This is quite a common disease and every now and then one hears of someone who has jaundice. The,disease is acquired by drinking, or eating anything contaminated by the hepatitis virus, which is passed in the infected person's stool. The presence of hepatitis is a pointer to the inadequqte arrangements of safe water supply and sewage disposal in a locality. The virus is very resistant and even boiling does not destroy it.

There is fever, loss of appetite, vomiting and pain in the upper abdomen. Loss of appetite and a feeling of being ill is out of proportion to the fever. Even the smell or sight of food may

make the child sick. In 4—5 days the urine becomes dark in colour, and later the eyes and skin become yellow. Gradually 4he appetite returns and the fever comes down.

The child should remain in bed as long as he has fever and feels ill. Once his appetite returns he can play about in the house, but should not go to nursery school till jaundice has disappeared and he feels quite well.

In the acute stage the child should be encouraged to drink sweet drinks such as orange juice, or sweet lemon drinks or any sherbet. Sugarcane juice is excellent. Sugar is good for the recovery of the liver. As the appetite returns, ordinary household food can be given, but you should cut down on butter, oil and fried food. There is no need to give only boiled food, as was advised earlier.

INFECTIONS (Protection against). The baby has to be protected against all diseases possible. Cooking the food hygienically and protecting it from dust and flies is helpful in preventing diarrhoea. Do not expose a child to sudden chill, like giving him a bath in a draughty place or changing him in a cold room if he has w et his clothes at night. This can lead to a cold and chill, which may even lead to congestion of the chest. If he gets wet in the rain,

. change his clothes as soon as you can. Make sure you do not take the baby with you while visiting a friend or relative who has an illness such as fever, cough or a rash. The baby may catch the infection easily. As far as possible protect the baby from being in contact with other children who suffer from coughs and colds measles, chickenpox, mumps or any other infectious disease. This is not always possible, because someone or the other either at home or in the neighbourhood has a cough or a cold.

INFLUENZA. Influenza is also commonly called 'flu. It starts as a heavy cold, with fever and cough. There is headache and bodyache and extreme weakness and malaise. It spreads rapidly from one person to the other. The incubation period is only 1 to 2 days. The management consists of bed rest, general management for fever with aspirin, and for cough with steam inhalation or a cough linctus. There is a variety of vapourubs which, when rubbed on the chest and neck, also seem to give relief. There is no specific treatment.

MUMPS. Mumps is a communicable virus disease, that usually attacks one or both parotid glands located near the angle of the jaw. It commonly occurs between 5 and 15 years of age. The incubation period, i.e., the period between acquiring the infection and the first symptoms, is usually three weeks. One attack gives immunity.

There is pain on opening the mouth or chewing, a moderate degree of fever, loss of appetite, headache and body pain. Both

sides of the face may swell at the same time or there may be a gap of a few days between one side and the other. The swelling lasts about -6— 7 days.

Mumps may affect testicles in boys and ovaries in girls, resulting in sterility. This is rare before puberty, and so it is best if children acquire the disease at a younger age. Treatment consists of bed rest during fever, mouthwashes to keep the mouth clean and aspirin for fever and pain.

Mumps can now be prevented by immunizing the child with mumps vaccine, but it is not yet available in India.

PNEUMONIA. Pneumonia is an acute inflamation of the lung. It may be caused by bacteria or viruses. It may fo llow a cold and bronchitis, or may come on suddenly. It may also be a complication of measles or whooping cough. The child looks ill, has fever, cough, and very rapid breathing. He may also complain of pain in the chest. An X-ray examination will confirm the presence of pneumonia. A doctor should be consulted, and depending on the severity the child may be treated at home or admitted to a hospital. If his breathing is very rapid, he may need oxygen. Most pneumonias can be treated with antibiotics and the disease rs not as dangerous as it used to be some years ago. Pneumonia can be dangerous in a malnourished child, or in very young children, especially if it is due to an organism called staphylococcus. Viral pneumonia cures gradually. The child should be kept in bed, given plenty of fluids and a highly nourishing diet.

POLIOMYELITIS. Poliomyelitis is a contagious disease caused by a virus, which enters the body with food and contaminated water. The virus is passed in the stools of the infected person and if hygienic measures are poor and the disposal of faeces is not done properly, the infection spreads to water and food. The illness begins as common cold, with aches and pains and stiffness of the back and neck, and the child recovers in a few days without anyone realizing that he had poliomyelitis. In some cases, however, the nerves get affected and the child develops paralysis of any part of the body, usually a limb. Sometimes the whole body gets affected and the child may have difficulty in breathing because of the involvement of chest muscles.

It is a frightening disease but one should remember that with proper management, there is considerable or even complete recovery

days while there is fever, pain and tenderness. No injection should be given at this,stage. Once the acute stage has passed, physiotherapy (exercises and massage), should be started with the advice of the treating doctor. This is a long-drawn-out affair and you

must be patient and keep up your morale as well as that of the child's. If you are going to sit with a long face and 4ears in your eyes, the child is hot going to be encouraged. There are no drugs for the treatment of polio. В complex injections do not help. Physiotherapy is the only answer.

Since the virus is passed in the stools, during the illness, there should be proper disposals of stools in the flush, and disinfection of bedsheets and clothes if they get soiled with faeces.

The disease can be prevented by polio vaccine, as suggested in the immunization schedule.

RHEUMATIC FEVER. Rheumatic fever is an exceedingly variable disease and affects the joints, the heart and other parts of the body. The common age incidence is between 5 and 14 years. It is considered a reaction of the body to a streptococcal infection of the throat which has been inadequately treated, or not treated at all. The child has fever, pain or swelling in the joints which may be mild or severe. The pain and swelling travels from one joint to the other, and lasts 2—3 days, the usual joints affected are wrists, elbows, knees and ancles. The seriousness of the disease lies in the fact that it may affect the heart, in which case the child looks very ill and pale, has a rapid pulse and also breathes rapidly. He may develop puffiness in the face and swelling in his body. On the other hand the disease may be mild, passed off as "aches and pains", but even a mild attack can affect the heart, which may be discovered later in a routine examination because of a "murmur" in the heart. - Any child who has pain in the joints, slight fever and tiredness, should be examined to make sure about rheumatic fever. There is always a danger of serious sequelae, once the heart is involved.

Once the heart is affected, treatment is long and protracted and the child has to be under the careful observation of a pediatrician or a cardiologist. The attacks of rheumatic fever tend to recur, and may endanger the heart further, or the heart may get affected in a subsequent attack even if it was not affected earlier. Recurrence of rheumatic fever can be prevented by giving the child an injection of a special type of penicillin, once a month for several years. This will naturally have to be done under the supervision of a doctor.

Adequate treatment of tonsillitis will prevent rheumatic fever, and therefore it is a preventable disease.

A child with rheumatic fever needs a prolonged period of rest. Every effort must be made to keep him cheerful and well occupied with toys and reading material. Since he will miss school for several weeks, some thought should be given to teaching him at