HEALTH & SCIENCE: MAD COW DISEASE COULD TRIGGER PATIENT
CONCERNS THAT PUBLIC HEALTH CONTROLS HAVE PREVENTED THE FATAL ILLNESS FROM DEVELOPING A FOOTHOLD IN THE UNITED STATES.

April 23, 2001

AMNews staff

Susan J. Landers,.

Washington -- Mad cow disease has transformed the diets of many Europeans,

and foot-and-mouth disease is giving pause to tourists contemplating a

summer trip to Great Britain.

The same thing could have happened in the United States, but it didn't.

Still, the recent prominence of these news stories may trigger questions

about nutrition, safety and even symptoms in the exam room.

Richard T. Johnson, MD, a neurologist at Johns Hopkins University Schoolo f

Medicine, in Baltimore, offered an example. The parents of a young woman

asked about her inability to do well in algebra. She had just completed a

semester in Ireland, where mad cow disease had been identified. Could her

learning difficulty be a sign that she had been exposed while abroad? Not a

chance, said Dr. Johnson, who also serves as a special adviser to the

National Institute of Neurological Disorders and Stroke.

Laypeople are quite aware the disease exists, he said. But physicians can

tell their patients that the United States has never experienced a caseo f

mad cow disease, otherwise known as bovine spongiform encephalopathy.

The quarantine and the safeguards to prevent the disease from getting into

this country are reasonable, said Dr. Johnson. "I think most of us feel

there is more that can be done, but the safeguards are working at this

point."

"However, we can't say that it can't happen, because it can happen," he

said. But even if a cow comes down with the disease, it is unlikely to

spread. A whole second set of regulations comes into play at that point.

"And most of those are intact," said Dr. Johnson.

In addition, patients need to understand that BSE is very different from

foot-and-mouth disease, which is also spreading in many European countries.

The latter, which afflicts cloven-hoofed animals such as cows, sheep, goats

and deer, poses virtually no risk of human infection. The last case of

foot-and-mouth disease in the United States occurred in 1929.

Nonetheless, even the possibility that mad cow could arrive here and lead to

an outbreak of the invariably fatal human form, variant Creutzfeldt-Jakob

disease, or vCJD, has led government officials to examine the safeguardsn ow

in place.

Congressional concern was evident during an April 4 Senate commerce

subcommittee hearing.

"While the risks may be low, we cannot be complacent," said Sen. Peter G.

Fitzgerald (R, Ill).

Preventive measures that were adopted several years ago by federal agencies

and the meat industry, as well as a wide ocean between the United Statesa nd

Great Britain, were credited during the hearing with halting the disease's

spread to this country.

The precautions have included bans on imports of beef, sheep, goats and

other ruminant animals from numerous affected countries as well as

prohibitions on blood donations from people who have lived in affected

areas.

Vaccine manufacturers were also recently warned to be more vigilant int heir

use of bovine materials from countries harboring BSE after several

manufacturers were found to have ignored earlier recommendations to avoid

such products.

But, "the United States does not face the same situation as does Europe,"

said William D. Hueston, DVM, PhD, professor at the Virginia-Maryland

Regional College of Veterinary Medicine in Blacksburg, Va. He testified

before the Senate panel.

To date there have been more than 170,000 cases of BSE reported in Europe,

with the majority occurring in Great Britain, noted Fitzgerald.

Keeping the door barred The development of vCJD in humans has been traced to

the consumption of beef products contaminated by the central nervous system

tissue of a cow carrying BSE, according to researchers at the National

Institute of Neurological Disorders and Stroke.

The disease is distinct from the classic, but also fatal, Creutzfeldt-Jakob

disease, which has remained stable at infection rates of about one casep er

million.

The incubation period for vCJD is lengthy, with estimates ranging fromf ive

to 20 years. And since the 1986 start of an epidemic of BSE in the United

Kingdom, there has been a wave of vCJD among humans, according to the

January-February issue of Emerging Infectious Diseases.

Since 1995, 97 cases of vCJD have been confirmed, primarily in Great

Britain, with a few in other countries, said researchers.

To eliminate the risks of transmission from these locations, the U.S. Dept.

of Agriculture has, since 1989, prohibited the importation of live, hoofed

animals or their products from countries where BSE exists in native cattle.

In December 1997, the ban was extended to include hoofed animals, and

products derived from them, from all of Europe.

Alfonso Torres, a USDA deputy administrator, told the panel that the USDA

monitors animals imported before the ban went into effect for signs oft he

disease. And Canada and Mexico have implemented safeguards to ensure that

infected animals do not cross their borders.

Precautions have also been taken to prevent the transmission of vCJD via

blood donations from apparently healthy individuals who may be incubating

the disease. Anyone who has lived in or visited the United Kingdom for a

cumulative period of six months or more during 1980 to 1996 is

excluded from donating blood. In January, a Food and Drug Administration

advisory committee recommended that the ban on blood donations be expanded

to include those who lived in France, Ireland or Portugal for a cumulative

period of 10 years.

Some people also worry about risks posed by vaccines that include bovine

products. But the FDA considers the chance of exposure in this manner tob e

"remote and theoretical." The AMA's Council on Scientific Affairs also

assessed the risk in 1999 and concluded that adequate guidelines existedt o

prevent high-risk bovine materials from contaminating products intendedf or

human use.

And although several vaccine manufacturers were recently found to have

disregarded the FDA guidelines that materials from countries affected byB SE

no longer be used, the FDA advisory committee agreed that the risk of

disease transmission via these vaccines, which include polio and diphtheria,

tetanus and pertussis, is extremely small.

But such failures point up the need for the government to regulate rather

than issue recommendations, Peter Lurie, MD, MPH, deputy director of Public

Citizen's Health Research Group, told the Senate panel. He urged the

government to take more forceful action to ensure compliance with existing

recommendations and rules.

SCARED OF MAD COW NOW? : THE SHEEP THAT TRIGGERED AMERICA'S
FIRST MAD COW CRISIS ARE ALL GONE. BUT THE HARD QUESTIONS THEY RAISED REMAIN.

April 30, 2001

Fortune

David Stipp

http://www.fortune.com/indexw.jhtml?channel=artcol.jhtml&doc_id=201818&page=1&_DARGS=%2Fartcol.jhtml.2_A&_DAV=artcol.jhtml

According to this story, a decade ago, in a publicity stunt to convincet he

world that mad cow disease couldn't infect humans, British Agriculture

Minister John Gummer fed his 4-year-old daughter a hamburger on the steps of

Parliament. Later it became clear that the message in that photo op was

terribly wrong. The girl never got sick, but dozens of other people did,

succumbing to an invariably fatal disease that riddled parts of their brains

with microscopic holes. The ensuing mad cow crisis has cost Britain alone

some $7.5 billion and prompted the slaughter of more than 175,000 cattle.

It has killed about 100 people and potentially doomed tens of thousandsm ore

who may be infected but haven't yet shown symptoms. Around the world, mad

cow has evolved into a menace that just won't die--as soon as the threat

wanes in one place, it pops up in another.

The story says that the latest uproar was in northern Vermont, where two

flocks of imported sheep--one in the Mad River Valley, of all places--were

suspected of harboring the disease. This was America's first skirmish with

mad cow, and the U.S. Department of Agriculture took pains to show it isn't

about to follow Mr. Gummer into the annals of ignominy. Though there was

only circumstantial evidence that the sheep posed a serious risk, the agency

seized them in late March and trucked them off to slaughter.

Critics assert that the USDA overreacted, pressured by a $50-billion-a-year

American beef industry anxious to protect its valuable mad cow-free status.

No

one can deny that if just one mad cow is found in the U.S., beef producers

will

see demand drop faster than you can say "tofu." But what happened in Vermont

was more complex than that. Like bear markets, mad cow affairs are alla bout

uncertainty, which allows worst-case scenarios to loom large, precipitating

drastic acts. In seizing the sheep, the USDA acted with the same kind of

anxious intensity that investors have shown selling stocks during recent

bouts of "mad Dow."