Infectious Diseases


Nearly every woman I know can recall one or more instances in which she was sexually assaulted, harassed, threatened, inappropriately touched or even raped.


Yet few told anyone about it at the time, or reported it to the police.
I have clear memories of three such episodes from my childhood, one of which involved a man who owned a store in my neighborhood. Not knowing at age 11 anything about reproduction (in 1952, expectant teachers had to take leave when they “showed”), I was terrified that I could become pregnant from having been forced to touch his penis.

I had trouble sleeping, and I avoided the block where the store was. Yet, fearing that the assault was somehow my fault, I said nothing to my parents.
Experts on sexual assault and rape report that even today, despite improvements in early sex education and widespread publicity about sexual assaults, the overwhelming majority of both felony and misdemeanor cases never come to public or legal attention.

It is all too easy to see why. More often than not, women who bring charges of sexual assault are victims twice over, treated by the legal system and sometimes by the news media as lying until proved truthful.
“There is no other crime I can think of where the victim is more victimized,” said Rebecca Campbell, a professor of psychology at Michigan State University who for 20 years has been studying what happens legally and medically to women who are raped. “The victim is always on trial. Rape is treated very differently than other felonies.”

So, too, are the victims of lesser sexual assaults. In 1991, when Anita Hill, a lawyer and academic, told Congress that the Supreme Court nominee Clarence Thomas had sexually harassed her repeatedly when she worked for him, Ms. Hill was vilified as a character assassin and liar acting on behalf of abortion-rights advocates.

Credibility became the issue, too, for Nafissatou Diallo, an immigrant chambermaid who accused the head of the International Monetary Fund, Dominique Strauss-Kahn, of forcing her to perform fellatio in a Manhattan hotel room.Prosecutors eventually dropped the case after concluding that Ms. Diallo had lied on her immigration form and about other matters, though not directly about the encounter with Mr. Strauss-Kahn.
When four women, two of whom identified themselves publicly, said they had been sexually harassed by Herman Cain, the Republican presidential hopeful, they, too, were called liars, perhaps hired by his opponents.

Charges of sexual harassment often boil down to “she said-he said” with no tangible evidence of what really took place. But even when there is DNA evidence of a completed sexual act, as there was in the Strauss-Kahn case, the accused commonly claim that the sex was consensual, not a crime.
“DNA technology has not made a dramatic change in how victims are treated,” Dr. Campbell said in an interview. “We write off a lot of cases that could be successfully prosecuted. It’s bunk that these cases are too hard to prosecute.”

Victims must be better supported with better forensics, investigations and prosecutions, Dr. Campbell said. “This is a public safety issue. Most rapists are serial rapists, and they must be held accountable.”

In one study, published in 1987 in the Journal of Interpersonal Violence, 126 admitted rapists had committed 907 rapes involving 882 different victims.
Rapists are not the only serial sexual offenders. Witness the all-too-frequent revelations of sexual abuse of children involving multiple victims and persisting for decades even when others in positions of authority knew it was going on.

In the latest such scandal, an assistant football coach at Penn State University stands accused of molesting 10 boys. The charges led to the firing of a revered head coach, Joe Paterno, and forced the resignation of the university president for failing to take more immediate action.
The Risks

Last year, according to the Department of Justice, 188,280 Americans were victims of sexual violence.

Among female victims, nearly three-quarters are assaulted by men they know — friends, acquaintances or intimate partners, according to federal statistics.
But fewer than 40 percent of rapes and sexual assaults are reported to the police. Underreporting is more common among male victims and women raped by acquaintances or domestic partners. Only one-quarter of rapes are committed by strangers.

The result of underreporting and poor prosecution: 15 of 16 rapists will never spend a day in jail, according to the network. Dr. Judith A. Linden, associate professor of emergency medicine at the Boston University School of Medicine, reported in The New England Journal of Medicine in September that in the United States, “fewer than half of rape cases are successfully prosecuted.”

Victims may be reluctant to report a rape because they are embarrassed, fear reprisals and public disclosure, or think they won’t be believed. “Victims often think they somehow brought it on themselves,” said Callie Rennison, a criminologist at the University of Colorado in Denver. “Rape is the only crime in which victims have to explain that they didn’t want to be victimized.”

These feelings are especially common among college women who may have been drinking alcohol or taking illicit drugs when raped by a date or acquaintance.

Victims may not realize that any form of sexual behavior that is not consented to and that causes discomfort, fear or intimidation is considered sexual assault in most jurisdictions. That includes indecent exposure, unwanted physical contact (including kissing and fondling) and lascivious acts, as well as oral and anal sex and vaginal rape, whether with a body part or an instrument.

A minor — in general, 16 or 17, depending on the state — can legally consent to sexual activity. A person of any age who is forced or threatened, developmentally disabled, chronically mentally ill, incapacitated by drugs or alcohol, unconscious or preparing to undergo a medical procedure cannot legally consent to sexual activity.

Among young children, girls and boys are equally at risk of being sexually abused. But as they age, girls increasingly become targets; among adults, women represent about 90 percent of cases.

Experts have long debated whether rape should be seen as an act of aggression and control or the product of an irresistible sexual urge. To the victim, the distinction is moot.

The consequences can include pregnancy and sexually transmitted disease; feelings of helplessness, hopelessness and low self-esteem; self-blame and depression; substance abuse and eating disorders; fears of intimacy; numbness;post-traumatic stress disorder (nightmares, flashbacks, anxiety attacks, difficulty functioning); borderline personality disorder; unexplained physical problems; and even suicide.

Thus, even if rape victims choose not to report the attacks, prompt medical attention and psychological counseling can be critically important to their long-term well-being.

 

* Text by JANE E. BRODY, NYT, December 12, 2011

Swine flu may hospitalize 1.8 million patients in the U.S. this year, filling intensive care units to capacity and causing “severe disruptions” during a fall resurgence, scientific advisers to the White House warned.

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Swine flu, also known as H1N1, may infect as much as half of the population and kill 30,000 to 90,000 people, double the deaths caused by the typical seasonal flu, according to the planning scenario issued yesterday by the President’s Council of Advisers on Science and Technology. Intensive care units in hospitals, some of which use 80 percent of their space in normal operation, may need every bed for flu cases, the report said.

The virus has sickened more than 1 million people in the U.S., and infections may increase this month as pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta. If swine flu patients fill too many beds, hospitals may be forced to put off elective surgeries such as heart bypass or hernia operations, said James Bentley with the American Hospital Association.
“If you have 1.8 million hospital admissions across six months, that’s a whole lot different than if you have it across six weeks,” said Bentley, a senior vice-president of the Washington-based association, which represents 5,000 hospitals.
The scenario projections were “developed from models put together for planning purposes only,” said Tom Skinner, a spokesman for the CDC, at a briefing in Atlanta today. “At the end of the day, we simply don’t know what this upcoming flu season is going to look like. It could be severe, it could be mild, we just don’t know.”

Past Pandemics
The models were based on past pandemics, and the CDC is working on new projections based on the latest data gathered from swine flu patients, Skinner said. Those estimates should be available “soon,” he said, without further specifying.
President Barack Obama was urged by his scientific advisory council to speed vaccine production as the best way to ease the burden on the health care system. Initial doses should be accelerated to mid-September to provide shots for as many as 40 million people, the panel said in a report released yesterday. Members also recommended Obama name a senior member of the White House staff, preferably the homeland security adviser, to take responsibility for decision-making on the pandemic.
“This isn’t the flu that we’re used to,” said Kathleen Sebelius, U.S. health and human services secretary. “The 2009 H1N1 virus will cause a more serious threat this fall. We won’t know until we’re in the middle of the flu season how serious the threat is, but because it’s a new strain, it’s likely to infect more people than usual.”

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Clinical Trials
Data from clinical trials to assess the safety and effectiveness of swine flu vaccines will start to become available in mid-September, health officials reported Aug. 21. Full results from the two-dose trials won’t be available until mid-October.
“We are making every preparation effort assuming a safe and effective vaccine will be available in mid-October,” Sebelius said today at the CDC’s Atlanta offices.

H1N1 has already reached more than 170 countries and territories in the four months since being identified, the Geneva-based World Health Organizationsaid. Swine flu causes similar symptoms as seasonal strains. It has so far resulted in worse than normal flu seasons, with increased hospitalizations and cases of severe illness, the WHO said in an Aug. 12 release.
New Zealand and Australia, in the midst of their normal flu seasons, have reported intensive care units taxed to capacity by swine flu patients. The experience provides clues to what the U.S., Europe and Japan may see when the H1N1 virus returns.


President’s Advisers
The president’s advisory council describes as a “plausible scenario,” that 30 percent to 50 percent of the U.S. population will be infected in the fall and winter. As many as 300,000 patients may be treated in hospital intensive care units, filling 50 percent to 100 percent of the available beds, and 30,000 to 90,000 people may die, the group’s report said.

“This is a planning scenario, not a prediction,” according to the report. “But the scenario illustrates that an H1N1 resurgence could cause serious disruption of social and medical capacities in our country in the coming months.”
Peter Gross, chief medical officer at Hackensack University Medical Center in New Jersey, said if the group’s scenario comes true, “I think every hospital in America is going to be in a crunch. We’ll be hard pressed to deal with those predictions,” he said.

‘Overblown’ Estimates
The estimates seem “overblown,” Gross said, given that swine-flu outbreaks in 1968 and 1957 failed to cause as many deaths, even with medical technology and disease surveillance less advanced than today.
“Influenza, you can make all the predictions you want, but it’s more difficult than predicting the weather,” Gross said yesterday in a telephone interview, after the advisory report was made public. “If influenza was a stock, I wouldn’t touch it.”
The 775-bed hospital is planning for an outbreak, upping its order of flu medications and discussing where to put patients if the worst occurs, Gross said.

The President’s Council of Advisers on Science and Technology is chaired byJohn Holdren, the director of the White House Office of Science and Technology, Eric Lander, the head of the Broad Institute of Massachusetts Institute of Technology and Harvard University in Cambridge, Massachusetts, and Harold Varmus, the chief executive officer of Memorial Sloan-Kettering Cancer Center in New York.
The 21-member group of scientists and engineers, created by Congress in 1976, advises the president on policy involving scientific matters.

New Estimates
Seasonal flu usually kills about 36,000 Americans, Skinner said. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, saidMike Shaw of the CDC.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“We don’t know whether the number of severe illnesses will be much greater, but we do know that it’s a new virus and therefore people are very vulnerable,” said Anne Schuchat, director of the CDC’s Center for Immunization and Respiratory Diseases, in an interview yesterday.


Disease Burden
About 100 million people in the U.S. get the annual flu shot, Schuchat said. Pregnant women, who have “a disturbingly high burden of disease” from swine flu, only get vaccinated for seasonal flu about 15 percent of the time. Pregnant women are a top priority for vaccinations, she said.
Seasonal flu usually kills about 36,000 Americans. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, said Mike Shaw, associate director of laboratory science at the CDC’s flu division.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“People who get infected with this strain happen to be the healthiest members of our society,” said Shaw in a presentation yesterday at the agency.
The H1N1 strain is genetically related to the 1918 Spanish Flu that killed an estimated 50 million people. Variations of the Spanish Flu circulated widely until about 1957, when they were pushed aside by other flu strains. People whose first exposure to a flu virus was one of those Spanish Flu relatives may have greater immunity to the current pandemic, Shaw said.


* Text by Tom Randall and Alex Nussbaum, August 25, 2009

With the number of confirmed U.S. swine flu cases double the 20 it was yesterday, the government says that it is closely monitoring the swine flu outbreak and is preparing for further spread.

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“This is obviously the cause for concern and requires a heightened state of alert, but it’s not a cause for alarm,” President Obama said today at the National Academy of Sciences (NAS).

In the U.S., 40 cases have been confirmed by the U.S. Centers for Disease Control and Prevention (CDC) in five different states: New York, California, Texas, Ohio and Kansas. All individuals have recovered, including the one that was hospitalized, Richard Besser, acting director of the Center for Disease Control (CDC), said in a press conference today. Twenty of the cases have stemmed from a New York City preparatory school. Although that’s more than twice the number originally reported, the additional cases were a result of further testing rather than continued spread of the flu, Besser noted. The CDC is distributing kits to test for swine flu in affected states, and as testing ramps up, Besser said, “I expect we will see other cases across the country.”

New cases are being reported in Canada and across the Atlantic, according to a report by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. As of April 26, six confirmed cases of swine flu in Canada and one in Israel had been reported. An informal map of cases worldwide is being collected by a biomedical researcher in Pittsburgh.

Meanwhile, the European Union has issued a travel warning to citizens, urging them to avoid nonessential travel to the U.S. or Mexico, reports The New York Times. The CDC will be distributing information cards at U.S. ports of entry to inform travelers about the flu’s symptoms and precautions that should be taken to avoid it. Later today, the CDC will also issue a travel advisory recommending that all nonessential travel to Mexico be avoided.

“This is a serious event, and we’re taking it seriously,” Besser said. “This situation is evolving very quickly,” he said, and a clear picture of how the disease is spreading may not be available for another week or two.

Although a vaccine for the flu strain, which is similar to those responsible for the 1918 and 1957 outbreaks, is likely months away, biotechnology companies are anxious to get to work, notes FierceBiotech, a biotech industry newsletter. The CDC is discussing whether to include strains of this flu in next year’s flu vaccines.

By dubbing the outbreak a public health emergency yesterday, the government authorized states to release 25 percent of their antiviral drugs from the Strategic National Stockpile, which means that 11 million courses of the drugs are en route to the affected states, said Besser.

Although the drugs could help treat those infected with the virus, Besser noted that, “there’s no single action that will control an outbreak… It starts with personal responsibility, but it doesn’t end there.” He recommended that people take standard precautions such as frequent hand washing, covering coughs and sneezes and staying home from work and school if feeling ill.

At the speech to the NSA, Obama concluded, “If there was ever a day that reminded us of our shared stake in science and research, it is today.”

By Katherine Harmon

Fast treatment manufactured from flu survivors’ antibodies could pave the way to more effectively thwarting pandemics

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A new method for swiftly producing proteins to fight infections could mean the difference between life and death during future pandemics. Researchers report in Nature today that they have perfected a way to manufacture monoclonal antibodies capable of destroying diseases such the avian flu, which have the ability to swap genes with human flu varieties and jump from birds to people.

Their research is a dramatic advance, because it marks the first time that scientists were able to rapidly generate the disease-killing proteins, according to study co-author Patrick Wilson, an immunologist at the Oklahoma Medical Research Foundation (OMRF) in Oklahoma City. He says that researchers could one day spare scores of lives and nip potential epidemics in the bud by whipping up a treatment within a month from natural antibodies that survivors developed against the threatening disease.

Until now, he says, it took as long as three months to produce enough monoclonal antibodies to protect huge populations, because the immune system only pumps out small quantities in response to infections.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the new work a “significant advance,” noting in a statement that it “opens the way to producing [monoclonal antibodies] that potentially could be used diagnostically or therapeutically” for the flu as well as other infectious diseases such as hepatitis C and the human immunodeficiency virus (HIV), which can lead to full-blown AIDS.

The new technique, pioneered by Wilson and fellow researchers at the Emory University School of Medicine in Atlanta, saves time by using antibodies produced by so-called B cells (white blood cells that produce and then ferry them to infection sites to battle invading germs) in response to vaccines instead of to actual infections.

According to Wilson, monoclonal antibodies from (deliberately infected) animals were routinely used in the first half of the 20th century to try to treat diphtheria (an upper-respiratory illness that killed roughly 15,000 people annually in the early 1920s until a vaccine was formulated against it in 1924) and tetanus (a potentially fatal infection also known as lockjaw, because one of the muscles it destroys is in the jaw). There were, however, compatibility issues: The human immune system in most cases viewed the animal antibodies as alien and rejected them—or lacked the ammunition to destroy them, thereby making patients sicker.

To avoid these problems, researchers have been trying to perfect and speed up procedures for extracting monoclonal antibodies from humans, replicating them in a lab, and then injecting them into victims suffering from the diseases they were formed to fight. The key to collecting these antibodies has been to remove B cells that bear them from survivors of, say, a particular flu strain—or alternatively, someone who has been vaccinated against the flu (because the flu vaccine contains a weakened version of the virus).

Until now, scientist have run into problems trying to recreate large enough quantities quickly enough to spare lives. Wilson says the process traditionally has taken so long that by the time enough new B cells were generated, the flu strain targeted already had mutated into a form no longer vulnerable to the captured crop of antibodies.

In the new method, the researchers isolated B cells from humans who had been vaccinated against—and therefore had built up specific antibodies to—the seasonal flu. But instead of prodding extracted B cells to proliferate, Wilson says, the teams simply plucked the antibody-producing genes from them and inserted those into existing B-cell lines, thereby increasing their protein output.

The type of B cells that the scientists tapped for the coveted proteins are known as antibody-secreting plasma cells (ASCs). ASCs are among the first-line defenders that the immune system sends out when it detects an infection (including weakened vaccine versions). These cells are tasked with scoping out potential danger and signaling the backup germ fighters required to knock out invading armies. ASCs are short-lived, because they serve more as scouts than as combat soldiers.

The teams found that up to 80 percent of the ASCs that they isolated during their peak (seven days after vaccination) contained monoclonal antibodies to the flu strain they had injected.

“The reason this is so exciting is that the same kind of B cell could be present in people [who] have primary infections,” says Wilson, noting that researchers thus far have only showed this works with antibodies created in response to vaccines. The team now plans to test the method on people infected with the flu or another virus.

Antonio Lanzavecchia, director of the Institute for Research in Biomedicine in Bellinzona, Switzerland, stresses that the effectiveness of Wilson’s technique depends on the relatively short time span during which ASCs are active.

Lanzavecchia believes that his own research is more promising: He has harvested antibodies against both severe acute respiratory syndrome (SARS) and avian flu using so-called memory B cells, which are immune cells that store antibodies from all vaccines and previously beaten viruses—and remain in the blood permanently.

“If you have a spontaneous disease, you have only a short window of time where you can get [ASCs],” he says, “so targeting memory B cells [from someone who has beaten the illness] may be an advantage.”

The problem is, Wilson says, that a person has relatively few memory B cells—”on the order of one in thousands”—making the process of extracting antibodies from them a time-consuming task, because they first must be located.

“We are making new antibodies that [are potentially more effective because they] are binding to very specific strains of a virus,” he says. He adds that the new technique might also be employed to pin down the flu strain someone has by testing the effectiveness of extracted antibodies against it.

Wilson says that the new technique could become widely available in a few years if it is proved safe and effective during human clinical trials.

By Nikhil Swaminathan