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Round the World

USA: Mysterious respiratory disease

A mysterious respiratory illness that struck 18 and killed11 residents of the Navajo Indian Reservation late in Maymay be caused by a hantavirus, a class that also includes thehantaan virus that is responsible for Korean haemorrhagicfever (KHF), a sometimes fatal illness that causes renalfailure. Hantavirus has been found in three of the 18 cases.All 18 patients had been healthy and, with the exception ofone 87-year-old, ranged in age from 13 to 34. Two-thirdswere American Indians. Dubbed URDS for unknown

respiratory distress syndrome, the presenting symptoms arefever, muscle aches in the lower body, and cough, headache,or conjunctivitis. Unlike influenza, there is no running noseor lymphadenopathy. Shortness of breath occurs withinterstitial oedema in the lungs, followed by death fromsuffocation, sometimes within hours after the start of

symptoms. There is no evidence of direct person-to-persontransmission.The finding by the Centers for Disease Control and

Prevention that a hantavirus may be the cause was

announced by Dr Gary Simpson, chief of infectious diseasesfor the New Mexico Health Department. "We realise wemay be in error, but we are choosing to release the

preliminary indications because there may, in fact, betreatment implications", Simpson said. If the epidemic iscaused by a hantavirus, he said, it may represent the

emergence of a variant of the virus because the symptomsare substantially different from those previously known.According to Simpson, a toxin still has not been ruled out.CDC investigators are still examining tissues for the

presence of other infectious agents.Field mice, bank voles, and various species of rat are

among the commonest hantavirus vectors. A recent die-offof prairie dogs on the high-desert Navajo Reservation hadearlier sparked speculation that the epidemic may be due to arodent virus that somehow had infected man. In the case of

KHF, transmission to man is believed to occur via aerosolsof virus from saliva, urine, faeces, and lung secretions.Investigators believe the URDS victims may have inhaledthe virus when they came in contact with rodent droppingscontaining the virus. New Mexico health authoritiescautioned residents to avoid cleaning up rodent burrows andsweeping their houses when rodent droppings are present.Navajo medicine men have been asked to halt cleansingceremonies for fear that sweeping, which is an integral partof ceremonies, would stir up dust and droppings.

If a hantavirus is verified as the cause of URD S, it will bethe first time the virus has expressed itself clinically in theUS. The Navajo Reservation is a 24 000-square-mile tractabout the size of New Jersey which straddles the comers ofArizona, New Mexico, Utah, and Colorado. The epidemichas caused hundreds of worried residents with colds to

swamp health facilities and investigators in other westernstates to check whether cases of respiratory distress

syndrome fit the URDS pattern. Cases that seem to fit havebeen reported in Kansas, North Carolina, and California.Dr Richard Jackson, communicable disease chief for theCalifornia Department of Health Services, said studies ofthree recent unexplained cases revealed no evidence of amigration of the illness there.

Harry Nelson

USA: Nestlé sues American Academy ofPediatrics

Nestle Food Co, a unit of the Swiss company Nestle SA,filed suit in a Los Angeles federal court on May 28, chargingthat two large US baby formula producers and theAmerican Academy of Pediatrics (AAP) conspired to keepNestle and other competitors out of the US formula market.Nestle alleges that Abbott Laboratories, Mead Johnson &Co (a subsidiary of Bristol-Myers Squibb Co), and theacademy drew up a "code of marketing practices" thatdiscouraged direct advertising to consumers but endorsedthe marketing of formula milk to doctors and hospitals,which is how most prescription drugs are marketed here.Such an arrangement, Nestle charges, gave an unfairadvantage to Abbott and Mead Johnson, both of whichalready had large sales staffs with long experience sellingdirectly to doctors and hospitals. The code, therefore,created a barrier to free competition and thus violates USantitrust law, Nestle contends. Nestle spokeswoman LaurieMacDonald said Nestle decided to sue after seeing evidence,submitted in a Florida lawsuit by 27 drugstores and foodchains and the state’s attorney general, which chargedAbbott Laboratories with antitrust violations. AbbottLaboratories agreed to settle the suit for$140 million. In anofficial statement, the American Academy of Pediatricscalled Nestle’s antitrust allegations against AAP "totallyfalse". The AAP said it had recommended that infantformula companies refrain from advertising to the generalpublic because of the academy’s concern that such

advertising would discourage breast-feeding. However, in afront page story on the Florida lawsuit, the Wall StreetJournal quoted a 1986 internal AAP memo saying that theacademy’s executive committee "agreed that there is a needto make this statement reaffirming the AAP’s position onmarketing, breast milk, lay advertising, etc. If there is amarketing war, there may be a shift in industry’sdistribution of funds and the AAP may have to cut back on

anticipated income from the industry". AAP executivedirector James E. Strain said that the memo had beenwritten by AAP managers and did not accurately reflect theexecutive committee’s discussion. "We always separate ourpolicy from our connections to the industry", Strain said.Strain estimates that formula milk companies contributeabout$1 million a year to AAP’s$30 million annual budget."That amount is exceedingly small. We could do withoutthat money easily", Strain said. The AAP pointed out thatmany non-profit organisations accept corporate donationsand that such donations increase the academy’s ability toeducate doctors and to improve child health.

Michael McCarthy

Canada: A blood fractionation plant?

Arguing that it is more important to have nationalself-sufficiency in plasma than blood products, theCanadian Blood Agency (CBA) has spurned a Red Crossproposal to build a$120 million state-of-the-art bloodfractionation plant. But the Red Cross Society willcircumvent the CBA and appeal directly to the provinces forsupport, says Dr Maung Aye, Red Cross national director ofblood services.

In response to a CBA investigation into the feasibility ofbuilding a fractionation plant (Lancet 1992; 341: 1341), theRed Cross and Elkhart, Indiana-based Miles Laboratories