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HICNet Medical News Digest      Tue, 06 Jun 1995        Volume 08 : 
Issue 23

Today's Topics:

  [MMWR]  Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995
  Essential Fatty Acid May Protect Against Stroke
  Home Exercise Helps Older Adults Protect their Hearts
  Primary Care Conference

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To: hicnews
1995

     Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995

     On May 6, 1995, CDC was notified by health authorities
and the U.S. Embassy in Zaire of an outbreak of viral
hemorrhagic fever (VHF)-like illness in Kikwit, Zaire (1995
population: 400,000), a city located 240 miles east of
Kinshasa. The World Health Organization and CDC were invited
by the Government of Zaire to participate in an
investigation of the outbreak. This report summarizes
preliminary findings from this ongoing investigation.
     On April 4, a hospital laboratory technician in Kikwit
had onset of fever and bloody diarrhea. On April 10 and 11,
he underwent surgery for a suspected perforated bowel.
Beginning April 14, medical personnel employed in the
hospital to which he had been admitted in Kikwit developed
similar symptoms. One of the ill persons was transferred to
a hospital in Mosango (75 miles west of Kikwit). On
approximately April 20, persons in Mosango who had provided
care for this patient had onset of similar symptoms.
     On May 9, blood samples from 14 acutely ill persons
arrived at CDC and were processed in the biosafety level 4
laboratory; analyses included testing for Ebola antigen and
Ebola antibody by enzyme-linked immunosorbent assay, and
reverse transcription-polymerase chain reaction (RT-PCR) for
viral RNA. Samples from all 14 persons were positive by at
least one of these tests; 11 were positive for Ebola
antigen, two were positive for antibodies, and 12 were
positive by RT-PCR. Further sequencing of the virus
glycoprotein gene revealed that the virus is closely related
to the Ebola virus isolated during an outbreak of VHF in
Zaire in 1976 (1).
     As of May 17, the investigation has identified 93
suspected cases of VHF in Zaire, of which 86 (92%) have been
fatal. Public health investigators are now actively seeking
cases and contacts in Kikwit and the surrounding area. In
addition, active surveillance for possible cases of VHF has
been implemented at 13 clinics in Kikwit and 15 remote sites
within a 150-mile radius of Kikwit. Educational and
quarantine measures have been implemented to prevent further
spread of disease.

Reported by: M Musong, MD, Minister of Health, Kinshasa, T
Muyembe, MD, Univ of Kinshasa; Dr. Kibasa, MD, Kikwit
General Hospital, Kikwit, Zaire. World Health Organization,
Geneva. Div of Viral and Rickettsial Diseases, and Div of
Quarantine, National Center for Infectious Diseases;
International Health Program Office, CDC.

Editorial Note: Ebola virus and Marburg virus are the two
known members of the filovirus family. Ebola viruses were
first isolated from humans during concurrent outbreaks of
VHF in northern Zaire (1) and southern Sudan (2) in 1976. An
earlier outbreak of VHF caused by Marburg virus occurred in
Marburg, Germany, in 1967 when laboratory workers were
exposed to infected tissue from monkeys imported from Uganda
(3). Two subtypes of Ebola virus--Ebola-Sudan and
Ebola-Zaire--previously have been associated with disease in
humans (4). In 1994, a single case of infection from a newly
described Ebola virus occurred in a person in Cote d'Ivoire.
In 1989, an outbreak among monkeys imported into the United
States from the Philippines was caused by another Ebola
virus (5) but was not associated with human disease.
     Initial clinical manifestations of Ebola hemorrhagic
fever include fever, headache, chills, myalgia, and malaise;
subsequent manifestations include severe abdominal pain,
vomiting, and diarrhea. Maculopapular rash may occur in some
patients within 5-7 days of onset. Hemorrhagic
manifestations with presumptive disseminated intravascular
coagulation usually occur in fatal cases. In reported
outbreaks, 50%-90% of cases have been fatal (1-3,6).
     The natural reservoirs for these viruses are not known.
Although nonhuman primates were involved in the 1967 Marburg
outbreak, the 1989 U.S. outbreak, and the 1994 Cote d'Ivoire
case, their role as virus reservoirs is unknown.
Transmission of the virus to secondary cases occurs through
close personal contact with infectious blood or other body
fluids or tissue. In previous outbreaks, secondary cases
occurred among persons who provided medical care for
patients; secondary cases also occurred among patients
exposed to reused needles (2). Although aerosol spread has
not been documented among humans, this mode of transmission
has been demonstrated among nonhuman primates. Based on this
information, the high fatality rate, and lack of specific
treatment or a vaccine, work with this virus in the
laboratory setting requires biosafety level 4 containment
(3,7).
     CDC has established a hotline for public inquiries
about Ebola virus infection and prevention ([800] 900-0681).
CDC and the State Department have issued travel advisories
for persons considering travel to Zaire. Information about
travel advisories to Zaire and for air passengers returning
from Zaire can be obtained from the CDC International
Travelers' Hotline, (404) 332-4559.

References
1. World Health Organization. Ebola haemorrhagic fever in
Zaire, 1976: report of an international commission. Bull WHO
1978;56:271-93.
2. Baron RC, McCormick JB, Zubeir OA. Ebola virus disease in
southern Sudan: hospital dissemination and intrafamilial
spread. Bull World Health Organ 1981;61:997-1003.
3. Peters CJ, Sanchez A, Rollin PE, Ksiazek TG, Murphy FA.
Filoviridae: Marburg and Ebola viruses. In: Fields BN, Knipe
DM, Howley PM, eds. Field's virology. 3rd ed. New York:
Raven Press, Ltd, 1996 (in press).
4. McCormick JB, Bauer SP, Elliott LH, Webb PA, Johnson KM.
Biologic differences between strains of Ebola virus from
Zaire and Sudan. J Infect Dis 1983;147:264-7.
5. Jarling PB, Geisbert TW, Dalgard DW, et al. Preliminary
report: isolation of Ebola virus from monkeys imported to
USA. Lancet 1990;335:502-5.
6. CDC. Management of patients with suspected viral
hemorrhagic fever. MMWR 1988;37(no. S-3).
7. Peters CJ, Sanchez A, Feldmann H, Rollin PE, Nichol S,
Ksiazek TG. Filoviruses as emerging pathogens. Seminars in
Virology 1994;5:147-54.


------------------------------

To: hicnews

American Heart Association National Center
    For more information, annw@amhrt.org

AHA journal report:

Essential fatty acid, alpha-linolenic, may protect against stroke
    May 2, 1995                       NR 95-4279 (Stroke/Simon)**


    DALLAS, May 2 -- To reduce the risk of stroke, you may want
to include a few walnuts or a modest amount of soybean or canola
oil in your diet, say California researchers.
    These foods contain a "good fat" called alpha-linolenic acid,
which a new study suggests may help lower the risk of stroke.
    "There is potentially some benefit in reducing the risk of
stroke if these oils are used in the diet," says Joel Simon,
M.D., M.P.H.  The lead author of the report in the May issue of
the American Heart Association's scientific journal Stroke, he is
assistant professor of medicine and epidemiology and
biostatistics at the University of California, San Francisco.
    Fatty acids are the building blocks of fats and oils.  A
small amount of alpha-linolenic acid, a polyunsaturated fatty
acid, is "essential" in the human diet because the body cannot
produce it from other fats.
    "Our findings suggest that higher serum levels of the
essential fatty acid alpha-linolenic acid are independently
associated with a lower risk of stroke in middle-aged men at high
risk for cardiovascular disease," conclude the scientists.
    The UCSF study included 96 men who had had a stroke and 96
healthy men serving as controls.  Intake of stearic acid (found
mainly in animal products and chocolate) and alpha-linolenic acid
(found in vegetable oils) were determined by measuring their
concentrations in the blood.
    Most studies determine fatty acid dietary intake with
questionnaires, but this can be imprecise.  "Instead, we looked
at the serum level, which better reflects dietary intake," points
out Simon.
    The subjects were part of the the Multiple Risk Factor
Intervention Trial (MRFIT), a study looking at the effects of
smoking cessation and lowering cholesterol levels and blood
pressure in men at high risk for coronary heart disease.
    The UCSF study found that men who had high blood pressure and
smoked had increased stroke risk.  But researchers were surprised
to find a "provocative" effect from intake of alpha-linolenic
acid.  For every 0.13 percent increase in alpha-linolenic acid in
the blood, the risk of stroke dropped 37 percent.  On the other
hand, an increase in stearic acid levels was associated with an
increased risk of stroke.  Researchers measured 16 fatty acids in
all.
    The specific effect of alpha-linolenic acid is not
understood.  But a family of fatty acids derived from it -- the
omega-3 fatty acids -- is known to have beneficial effects on the
clotting system.  Thrombotic stroke occurs from clots forming or
becoming lodged in the arteries that feed blood to the brain.
Alpha-linolenic acid -- as well as other omega-3 fatty acids --
may help reduce the chances of clots forming and a stroke
occurring, suggest the UCSF researchers.
    The main dietary sources of alpha-linolenic acid are canola,
soybean and walnut oils.  Other members of the omega-3 fatty acid
family are obtained through the consumption of seafood.  These
fatty acids have been shown to reduce blood clotting through
their effects on platelets, disk-shaped blood particles that form
clots.
    Because the study included only middle-aged men, Simon says
the results may not be generalizeable to women or to other age
groups.  And regardless of the findings, the mainstay of stroke
prevention still holds: eating a variety of vegetables and
fruits, keeping blood pressure low and not smoking.
    The AHA cautions that people should not focus on single
nutrients in planning what they eat and that balance is the key
to health.  Also this study was describing what these men were
eating as they entered the study.  This type of research does not
carry as much weight as an investigation in which dietary changes
are made and studied.
    Authors of the UCSF study are Josephine Fong, M.S.; John
Bernett Jr., Ph.D.; and Warren Browner, M.D., M.P.H.
                               ###



.
---
Internet: david@mailhost.smhsi.com
Telephone: +1-602-860-1121       FAX: +1-602-451-1165


------------------------------

To: hicnews

American Heart Association National Center
    For more information, annw@amhrt.org

Moderate home exercise helps older adults protect their hearts
    May 14, 1995                      NR 95-4284 (Circ/Exercise)*

    DALLAS, May 15 -- Home-based, moderate-intensity exercise
sessions at least twice weekly may help older adults reap the
cardiovascular benefits of physical activity, say researchers at
Stanford University School of Medicine in Palo Alto, Calif.
    And frequency of activity seems to be more cardioprotective
than exercise intensity, the scientists add.
    "Identifying strategies for facilitating sustained exercise
participation at a level sufficient to provide these health
benefits remains a major public health challenge," the scientists
write in their report, published in the May 15 issue of the
American Heart Association journal Circulation.  But changing the
intensity and environment of exercise have been found to
influence participation rates, they add.
    Moderate activity carried out for less than a year can
increase blood levels of high-density-lipoprotein cholesterol
(HDL, the "good" cholesterol) of young adult women.  But little
data is available to indicate the time frame, frequency and
intensity of activity required to achieve similar results in
older women and men.
    Abby C. King, Ph.D., assistant professor of medicine and
health research & policy, and her colleagues followed 269
sedentary adults (149 men and 120 post-menopausal women) who were
50 to 65 years old at the beginning of the study during a two-
year exercise program.  All participants were free of
cardiovascular disease and had not participated in regular
physical activity during the preceding six months.
    Study subjects were randomly assigned to one of four groups:
high-intensity, group-based exercise training; high-intensity,
home-based exercise training; lower-intensity, home-based
exercise training; and a one-year delayed-treatment control group
that participated in an exercise training program during the
second year.
    Group-based exercise training consisted of three 60-minute
sessions per week in which the major endurance activity was
walking/jogging, with some use of stationary bicycles and
treadmills.  During the first six weeks, study subjects increased
exercise intensity to 73-88 percent of peak heart rate.
    Individuals in the high-intensity, home-based program
followed similar exercise prescriptions.  They kept activity logs
and regularly communicated with staff members.  During the second
year they received monthly self-assessment and informational
materials related to relapse prevention.
    Members of the lower-intensity, home-based program exercised
at 60-73 percent of peak heart rate for five 30-minute sessions
per week.  During the second year they also received monthly
information packets.
    Those in the control group entered the physical activity
program of their choice during the second year.
    Even though patient adherence decreased during the second
year in the lower-intensity home-based program to an average of
2.4 sessions per week, HDL increases above those obtained at the
beginning of the study were markedly pronounced compared to the
other regimens, the scientists report.
    After analyzing the influence of exercise frequency on HDL
levels, the investigators found that subjects who achieved a
minimum of two exercise sessions per week experienced similar
increases in HDL regardless of the level of intensity.
    "The similar pattern of differences shown across the three
training regimens support the concept that frequency of exercise
participation across an extended time period rather than its
intensity may be important in influencing HDL cholesterol levels
in this age group," the scientists write.
    Furthermore, 51.7 percent of men and women in the home-based
lower-intensity program showed HDL increases of at least five
milligrams per deciliter.  Only about a third of the participants
in the other exercise programs had similar increases.
    The suggestion that a longer time frame and reasonable
frequency of ongoing exercise participation may be required to
achieve HDL cholesterol increases in older adults underscores the
importance of physical activity regimens that are convenient and
enjoyable enough to be adequately sustained over time, King and
her colleagues say.
    But the researchers point out that "the community being
studied was largely white and well educated.  Investigations in
different populations are necessary to better determine the
generalizability of these results."
    King's colleagues in this study were: William L. Haskell,
Ph.D.; Deborah R. Young, Ph.D.; Roberta K. Oka, D.N.Sc.; and
Marcia L. Stefanick, Ph.D.
---
Internet: david@mailhost.smhsi.com
Telephone: +1-602-860-1121       FAX: +1-602-451-1165

_
                               



------------------------------

To: hicnews

The Primary Care Conference & Exhibition (PCCE) will be held on
June 23-25 at the Pennsylvania Convention Center, Philadelphia.
This is the first conference held exclusively for the primary care team.
All members of this team (both physicians and nonphysician health care
professionals) are invited to attend.

Speakers will include former US Surgeon General, C. Everett Koop, MD, 
ScD;
Dr. Vivian W. Pinn, Associate Director of the National Institutes of 
Health
(NIH) for Research on Women's Health; and Dr. Samuel O. Their, President 
of
Massachusetts General Hospital and Professor of Medicine at Harvard 
Medical
School.

Dr. Thier's keynote lecture will be "Challenges Facing Primary Care
Practitioners in the '90s".  Reorganization of health care, driven by
economic pressures is accelerating the growth of managed care and the
move to capitation.  These forces are changing the incentives for those
delivering care to favor vertically integrated health systems 
coordinated
by primary care physicians (PCPs).

PCPs were, until recently, below specialists in the hierarchy and 
rewards
of medical care.  Those PCPs must now assume a leadership role in health 
care
delivery that requires a sense of the responsibility of the profession 
for
education and research as well as for excellent care.  The diplomacy and
vision
with which PCPs assume their new role may well determine the 
configuration of
U.S. medicine for the next several decades.

There will be numerous presentations, exhibits, plenary sessions, and 
clinical
workshops to attend while you visit the PCCE.  In addition, there are
breakfast
and luncheon "Meet the Professor" sessions that allow a small, informal 
group
of
attendees to meet with Conference faculty.  There are also several 
exciting
programs available to entertain your family with the sights of 
Philadelphia
while you are attending the sessions.

More information is available at 
http://www.ep.cursci.com/~pcce/contents.html
The following table of contents will give you a glimpse of what to 
expect
at the PCCE.

The Primary Care Conference & Exhibition (PCCE)

    I.  Invitation from Sherwood L. Gorbach, MD
           Chairman of the Executive Advisory Board
            Invitation from the PCCE Executive Committee

   II.  PCCE Benefits and Highlights
         Conference Program Objectives and Accreditation
         PCCE SCHEDULE AT A GLANCE:
          Friday, June 23, 1995
          Saturday, June 24, 1995
          Sunday, June 25, 1995
         Special presentation by C. Everett Koop, MD, ScD
         Keynote Lecturer biographies of
     Vivian W. Pinn, MD and Samuel O. Thier, MD

  III.  Conference Program Overview/Content
         Special Presentation by C. Everett Koop, MD, ScD
         Keynote Lecture Content
         PCCE Plenary Sessions
         PCCE Clinical Workshops
         PCCE "Meet the Professor" Sessions

  IV.   PCCE Exhibition Information
         PCCE Call for Posters

   V.   Travel and Hotel Information

  VI.   Philadelphia Sightseeing
         Map
         General Information and History

 VII.   PCCE Family Programs
         Family Program Registration Form

VIII.   Create your own PCCE Schedule

  IX.   PCCE Registration Information
         PCCE Registration Form
         Useful Information About the PCCE

   X.   PCCE Faculty Index



------------------------------

End of HICNet Medical News Digest V08 Issue #23
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135

                                                                                                                        
