Never say never

I was fortunate to get a seat in a conference hall at the Corinthia San Gorg Hotel among a varied gathering, medical or otherwise, and listened rapturously and nostalgically to a brief but excellent overview about the ever-present danger of some infectious biological agent being unleashed by some misguided terrorist(s) or introduced unknowingly into Malta by some infected person unaware of the potential medical time-bomb being introduced among the native population.

The speaker was Barbara Bannister, director of the Infectious Diseases Department at the Royal Free Hospital London and responsible for the maximum security investigation, diagnosis and management of suspected highly infectious and contagious diseases that arise/may arise and are referred to her department.

To give a recent example, there were a few patients in the UK who were suspected of or who may have been exposed to the newly discovered Sars virus infection. Some proved to be influenza and this was summer definitely not the influenza favourite season. Blood tests showed some who were seropositive for Sars but clinically negative for this new disease. For the present Sars appears to be contained and controlled but no one knows whether it will surface again.

The speciality of infectious diseases has been sadly neglected in the recent past for two main reasons: the availability of antibiotics and vaccines. However, the anthrax outbreak in the US (coinciding with the destruction of the twin towers of The World Trade Centre) and the newly emergent Sars epidemic have stimulated renewed interest in this speciality which is vital as regards this special specific matter of biological terrorist weapons, for obvious reasons.

Who among us has seen a case of anthrax or can quickly and expeditiously differentiate between smallpox, chickenpox, allergical reactions, drugs side effects, etc etc? A delay in the correct diagnosis and proper strict isolation and management of a smallpox patient will have dire consequences especially for us (non vaccinated) medical and paramedical attendants and, naturally, for other people.

Be aware. Never say never. Be prepared.

Touching over some of the specific, individual microbiogical candidate biological agents and toxins, Dr Bannister went over the characteristics, diagnosis and management of anthrax, plague and tularemia which present a similar "pulmonary" diagnostic problem for the clinician. Of these three, plague would be the more dangerous because it can be transmitted easily by aerosols from an infected patient. The development of an anthrax infection would be marked not only by the black scar (cigarette burn) but also by a characteristic massive tissue oedema. Fortunately anthrax is sensitive to many antibiotics but not to the third generation cephalosporins. Botulinum toxin may not be easy to utilise as biological weapon.

Moving on to some of the virus candidate agents, smallpox has to be seriously considered because of its dreadful past history as a killer of mankind (and nowadays a virgin unvaccinated population). In fact, both in the US and in the UK some selected groups are at this very moment in the process of being given the vaccine, just in case they may be called upon at a moment's notice to deal with a smallpox outbreak.

Some of the viral haemorrhagic fever viruses can also be considered as biological terrorist weapons including lassa, marburg and ebola; the latter having a very high mortality. Specific treatment for these three VHF's is non-existent and no vaccine is available. (On a personal note, I was involved in the only case of ebola infected in England. Interferon was administered but I think the life of the patient was saved by the transfusion of plasma obtained from a convalescent patient in Zaire. In Bulgaria a vaccine has been prepared for Crimean Congo viral haemorrhagic fever but one is not certain that it is effective. Altogether, a most interesting and informative talk delivered very professionally by a polished speaker who fielded very expertly and efficiently the pertinent questions made by the audience.

Oh! I forgot to mention that Dr Bannister very graciously skipped over brucellosis because she felt that would be bringing coal to Newcastle in view of the Maltese audience.

Thanks you very much, Dr Bannister. Come again.

The event was organised by the Malta Association of Public Health Medicine with the collaboration of Technoline Ltd.