September 1992 (vol. 8, #6) 1601 N Tucson Blvd #9, Tucson AZ 85716 c 1992 Physicians for Civil Defense

As a consequence of change in public mores, there is an epidemic of disease that produces no solid natural immunity, has no vaccine, and mutates rapidly. The disease already causes about 3.5 million casualties annually, worldwide, especially among children in Africa.

This description might fit AIDS, although the mortality of AIDS is not yet so high (cumulative deaths have reached 1.5 million). But this disease is malaria one of the age-old infectious diseases now making a comeback largely eclipsed by the publicity about AIDS. The resurgence is not caused by the fantasized destruction of the ozone layer or a still more fanciful ``AIDS-like immune deficiency'' in the Planet. Many microbes are outwitting our antibiotics. More importantly, standard public health measures are breaking down or being actively thwarted, often in the name of a new Planetary morality.

Swamp-Borne Diseases

In a burst of optimism due to the remarkable effectiveness of DDT and chloroquine, malaria was once targeted for extinction. However, the US has banned or restricted DDT and substitute pesticides and outlawed or heavily regulated the drainage of swamps (``wetlands''). Chloroquine-resistant falciparum malaria is found throughout the world, except in the Dominican Republic, Haiti, Central America west of the Panama Canal, the Middle East, and Egypt. Resistance to the newer drug Fansidar is also reported from Thailand, Burma, Cambodia, the Amazon basin, and sub-Saharan Africa, and strains resistant to everything except quinine have been isolated in Cambodia. According to an AP report, 385 UN personnel contracted malaria in Cambodia last month. Returning home, they could spread resistant organisms throughout the world.

The scientific establishment is pinning its hopes on a malaria vaccine. A ``safe and effective'' synthetic vaccine has been announced (Infectious Disease News, Sept. 1992). A field trial in 15,000 subjects showed safety and antibody formation however, no data whatsoever were presented on the incidence of malaria (J Infect Dis 1992;166:139-44). As demonstrated by AIDS and various parasitic diseases, especially kala-azar, high titers of antibodies are not necessarily protective. Previous enthusiastic reports about malaria vaccines have been fraudulent (Robert Desowitz, The Malaria Capers, Norton, 1991). Perhaps the inherent difficulties have at last been overcome, but this remains to be proved.

Migratory birds resting in protected wetlands harbor mosquito-borne viral diseases, especially Western equine and St. Louis encephalitis. Chickens serve as ``sentinels'' for these diseases, and seroconversions have been occurring all over Southern California. WEE has also been isolated from mosquitoes in Arizona. Human outbreaks of the disease in Bakersfield were at first misdiagnosed as aseptic meningitis, which causes similar clinical findings but is spread by fecal-oral contact or droplets, not by mosquitoes.

Swamps in the southeastern US coastal plain are a major source of atypical Mycobacteria, which cause about 2000 human infections annually. A substantial fraction of AIDS patients have disseminated mycobacterial infections (Am Rev Respir Dis 1992;145:271-275).

Instead of draining swamps as a public health measure, Planetary morality dictates ``wetlands'' protection and restoration, even at the expense of taking private property or incurring public debt. The cost of the 850-acre Bolsa Chica Wetlands Project in Orange County is estimated to be $102 million, including $29.7 million to buy out an oil reserve, $43.3 million to bring in fresh water, and $15.7 million for cutting a new access to the sea (LA Times 8/16/92).

Water-Borne Disease

The cholera epidemic that began in Peru in 1991 continues unabated. More than 600,000 cases and 5,000 deaths have been reported from 20 countries, including 15 cases indigenous to the US (MMWR 9/11/92).

Many less serious illnesses are probably carried in water despite modern treatment standards. Coliform bacteria are monitored; viruses are not. In Montreal, persons drinking unfiltered tap water had a 30% higher incidence of gastroenteritis compared with those who used an $800 under-the-sink, reverse osmosis filter.

One obvious answer is to add more disinfectants such as chlorine. However, the EPA won't permit higher chlorine concentrations because chlorine reacts with organic matter in the water to form tiny concentrations of potential carcinogens. The EPA spends about $775,000 for research on protozoans, bacteria, and viruses and $20 million on chemicals.

``We may be spending millions...going after mice and letting the elephants get through,'' commented Betty Olson of the University of California Irvine (Sacramento Bee 8/16/92).

It is rumored that chlorine disinfectants may be the next target of the Natural Resources Defense Council.

Air-Borne Disease

The ``captain of all these men of death'' tuberculosis is literally stalking the streets again. About 33% of the world's population harbors Mycobacterium tuberculosis, and each year 2.9 million succumb to it. A steady decline in TB in the US was reversed in 1985, and 26,283 new cases were reported in 1991, an increase of 18%. The increase is not confined to groups at high risk for AIDS; TB cases in US-born children under the age of five increased by 34% from 1987 to 1990. The majority of patients with TB have acquired the infection from nonintimate contacts. It is spread by droplet infection, and there is no ``threshold.'' Animal studies have shown that one organism can cause infection; you can catch it on the bus.

There is an additional ominous note: the emergence of drug-resistant strains. One-third of all cases surveyed in New York City in 1991 were resistant to one or more drugs, and resistance has been reported from at least 36 states. The case fatality rate for multi-drug resistant TB is 40 to 60%, the same as for untreated disease. continued, p. 2