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SDI 07 Hardy/Mahoney/Repko 5 Week

1 Disease Core

Re-vamped Disease Core Defense versus each disease


The History of Medicine WHO, 2000
* 2000 b.c. Here, eat this root. * 1000 a.d. That root is heathen. Here, say this prayer. * 1850 a.d. That prayer is superstition. Here, drink this potion. * 1920 a.d. That potion is snake oil. Here, swallow this pill. * 1945 a.d. That pill is ineffective. Here, take this penicillin. * 1955 a.d. Oops ... bugs mutated. Here, take this tetracycline. * 1960-1999 a.d. 39 more "oops"... Here, take this more powerful antibiotic. * 2000 a.d. The bugs have won! Here, eat this root.

The aff portion of the file isnt as good as the neg if youre going to use the file it might help to read over it first and see which cards help you the most check them off in the little boxes so your partners know what to read. And it is a BAD idea to read surveillance and EWS checks bird flu when youre debating that aff.

SDI 07 Hardy/Mahoney/Repko 5 Week

2 Disease Core

***HIV/AIDS NEG*** ............................................................................................................................................3 AIDS Scenarios Are Exaggerated .................................................................................................................................4 AIDS in Africa = Wrong Diagnoses..............................................................................................................................5 AIDS Vaccines Fail.......................................................................................................................................................6 AIDS Is Here To Thin Out The Human Population ......................................................................................................7 AIDS Mutates = Cant Solve and It Kills Anyway .......................................................................................................8 AIDS = Spread By Military...........................................................................................................................................9 ***HIV/AIDS AFF*** ...........................................................................................................................................10 AIDS = Pandemic........................................................................................................................................................11 AIDS = Extinction.......................................................................................................................................................12 AIDS = Security and Economic Threat .......................................................................................................................13 ***H5N1/Avian Influenza NEG*** ......................................................................................................................14 H5N1 Hasnt Mutated/Wont Mutate..........................................................................................................................15 H5N1 Lives In Places Where You Cant Get It Easy..................................................................................................16 Surveillance Systems Check........................................................................................................................................17 ***H5N1/Avian Influenza AFF*** .......................................................................................................................18 H5N1 = Pandemic .......................................................................................................................................................19 AT: Wont Mutate .......................................................................................................................................................20 AT: Transmissibility Goes Up = Virus is Less Lethal.................................................................................................21 ***Malaria NEG***...............................................................................................................................................22 Cant Solve Anyway....................................................................................................................................................23 DDT Fails ....................................................................................................................................................................24 ***Malaria AFF**..................................................................................................................................................25 DDT Solves .................................................................................................................................................................26 Malaria Comes First ....................................................................................................................................................27 ***Tuberculosis NEG***.......................................................................................................................................28 Cant Solve for TB ......................................................................................................................................................29 Vaccines Useless .........................................................................................................................................................30 U.S. Action Solves Now..............................................................................................................................................31 ***Tuberculosis AFF***........................................................................................................................................32 TB = Solvable..............................................................................................................................................................33 No Action = Epidemic.................................................................................................................................................34 ***Hemorrhagic Disease [Ebola, etc.]*** ...............................................................................................................35 Hemorrhagic Diseases [Ebola, etc.] Unsolvable .........................................................................................................36 Ebola = Very Very Very Bad ......................................................................................................................................37 ***Cholera*** ...........................................................................................................................................................38 Cholera = Drug Resistant ............................................................................................................................................39 Cholera = Solvable ......................................................................................................................................................40 ***Miscellaneous Diseases*** ..................................................................................................................................41 Sleeping Sickness Already Solved ..............................................................................................................................42 Tsetse Fly Solvable......................................................................................................................................................42 ***General Disease***..............................................................................................................................................43 Viruses Extinction ....................................................................................................................................................44 Disease/Pandemics Inevitable .....................................................................................................................................45 Mutations = Bad ..........................................................................................................................................................46

SDI 07 Hardy/Mahoney/Repko 5 Week

3 Disease Core

***HIV/AIDS NEG***

SDI 07 Hardy/Mahoney/Repko 5 Week

4 Disease Core

AIDS Scenarios Are Exaggerated


[ ] The numbers of infected and dead from HIV/AIDS every year are fabricated. Professor James Chin, staff writer for The Monitor, Uganda: UN Cries Wolf About AIDS, October 15, 2006,
http://allafrica.com/stories/200707280270.html [cl] The UN agency coordinating global action against AIDS is wiping egg off its face after reluctantly admitting it had overestimated India's AIDS problem by more than halffollowing numerous similar exaggerations world-wide. In 2005 the Joint United Nation's Programme on AIDS (UNAIDS) claimed there were 5.7 million people infected with HIV in India, giving India the highest number in the world, but the Indian National AIDS Control Organisation (NACO) figures for 2006 released on Friday lowered the number to 2.5 million--and UNAIDS has had to admit the new estimate is more accurate. Director Peter Piot, speaking to an AIDS conference in South Africa in June said UNAIDS' work "...is further complicated by the mixed messages circulating around the world" and "denialist statements such as that UNAIDS overestimates the size of the epidemic...." The HIV overestimates made or accepted by UNAIDS in recent years total about 10 million--so who is telling lies? Since 2001, UNAIDS has been forced to acknowledge drastically reduced HIV prevalence estimates in over a dozen African, Caribbean and Asian countries, as a result of well-designed "population-based" HIV surveys (randomly selected samples of urban and rural populations). Kenya's HIV estimate was reduced from about 2.3 million to 1.1 million in 2003. Ethiopia's estimate was reduced from nearly two million to about a half million in 2005. Haiti's estimate of almost 250,000 HIV-infected adults in 2001 was cut to less than 100,000 in 2006. However, UNAIDS continued to defend its exaggerations up through 2006, as I pointed out earlier this year in my book 'The AIDS Pandemic: The collision of epidemiology with political correctness.' UNAIDS was quick to respond to my charges, with spin rather than substance, referring vaguely to their "scientific approach" to calculating HIV numbers and the fact they collaborate with experts and governments. They refused to acknowledge that their approach was wrong or that the figures were bogus until the Indian revision exposed both. UNAIDS has simply glossed over the new estimates as being the result of better data and improved methods that are constantly evolving. Some AIDS activists say there is no harm in overestimating the current size and potential severity of the AIDS pandemic since such exaggerations have successfully provided AIDS programmes with unprecedented global priority and support. It needs to be recognised that UNAIDS was established in 1995 as an advocacy and coordinating agency that almost immediately turned over responsibility for AIDS programme funding and technical guidance to other international agencies and donors. However, UNAIDS did not turn over responsibility for the estimation and projection of HIV/AIDS numbers. Since UNAIDS has declared itself to be primarily an advocacy agency, its objectivity in making or accepting high HIV estimates and projections needs to be questioned. UNAIDS, AIDS programme advocates and activists have certainly used inflated HIV numbers effectively in their aggressive struggle for an increasing share of the limited international health budget. This success, however, has come at the expense of other equally urgent public health needs. continued Exaggerating the numbers, whether unintentionally due to honest misunderstanding or intentionally by deliberate exaggeration, may work in the short term. In the long term, it will cause a backlash and damage support from the public and policymaker. If UNAIDS persists with ignoring inflated HIV estimates, it risks losing credibility and the support of the rich governments that fund the global fight against AIDS. Whatever the purpose, crying wolf is neither good science nor good politics.

SDI 07 Hardy/Mahoney/Repko 5 Week

5 Disease Core

AIDS in Africa = Wrong Diagnoses


[ ] AIDS is often wrongly diagnosed in Africa must solve for sanitation and indigenous disease first. Charles Geshekter, on the AIDS Advisory Panel in Africa and also a professor of African history, AIDS In Africa: The Viral Plague That Is Not, March 14, 2000, opposing viewpoints [cl]
Dire warnings that AIDS is causing an infectious disease crisis in Africa cannot be supported with hard data. In Africa AIDS is defined as a combination of symptoms that cannot be distinguished from the classic indigenous sicknesses of impoverished regions, such as tuberculosis and malaria. In fact, no HIV test is required for a positive diagnosis of AIDS. Alarming estimates of African AIDS deaths in the Western media are grossly at odds with the World Health Organization's much lower figures. Instead of stigmatizing Africans as sexually promiscuous and encouraging condom use to prevent AIDS, AIDS activists should focus on improving nutrition, water supplies, and sanitation, the underlying causes of the real health problems in Africa. The United Nations calls AIDS the "worst infectious disease catastrophe since bubonic plague." U.S. Senator Barbara Boxer advocates spending $3 billion to "fight" the alleged culprit, HIV. And delegates at [the February 2000] National Summit on Africa in Washington, D.C., pleaded for more money to wage war on AIDS, by which they also mean HIV. But the scientific data do not support the view that what is being called AIDS in Africa has a viral cause.... Let's start with a few basic facts about HIV, AIDS, African record-keeping and socio-economic realities. What are we counting? The World Health Organization defines an AIDS case in Africa as a combination of fever, persistent cough, diarrhea, and a 10 percent loss of body weight in two months. No HIV test is needed. It is impossible to distinguish these common symptomsall of which I've had while working in Somaliafrom those of malaria, tuberculosis, or the indigenous disease of impoverished lands. By contrast, in North America and Europe, AIDS is defined as 30-odd diseases occurring in people who test "HIV-positive." The lack of any requirement for such a test in Africa means that, in practice, many traditional African diseases can be and are reclassified as AIDS. Since 1994, tuberculosis itself has been considered an AIDS indicator disease in Africa.

SDI 07 Hardy/Mahoney/Repko 5 Week

6 Disease Core

AIDS Vaccines Fail


[ ] Even if researchers can isolate a possible vaccine they wont be able to test it for fear of infecting someone Larry Thompson, staff writer for the Washington Post, Why an AIDS Vaccine May Never Work: The Virus is Too Crafty for the Hoped-For Quick Fix, June 21, 1988 lexis [cl]
When the AIDS virus was first isolated in 1984, the secretary of Health and Human Services, Margaret M. Heckler, predicted that an AIDS vaccine would be available for human testing in two years. The prediction was reasonably safe and close to accurate. Something for human testing did become quickly available, but she also was implying that a vaccine for widespread use would soon be ready to stop the spread of the deadly virus. It didn't, and it won't. But in 1984, the race for an AIDS vaccine seemed pretty straightforward. The human immunodeficiency virus, HIV, the agent that causes acquired immune deficiency syndrome, had been isolated. The next step was to inject some chunk of it into people to generate immunity against the world's newest epidemic. The question was which chunk. No one wanted to inject a whole AIDS virus, even a killed one, because of the danger that it might cause disease. Attention focused instead on the proteins on the surface of the virus -- the so-called envelope proteins. A vaccine for hepatitis B, for example, is made from envelope proteins on the culprit virus and generates complete protection against that disease. The same might work for AIDS.

[ ] Researchers are on their way to a possible vaccine, but even if they accomplish that goal, AIDS mutates too fast to generate anything. Larry Thompson, staff writer for the Washington Post, Why an AIDS Vaccine May Never Work: The Virus is Too Crafty for the Hoped-For Quick Fix, June 21, 1988 lexis [cl]
The current limited human studies are designed only to prove safety, not efficacy, of the vaccines, and none of the human volunteers have been, or will be, intentionally infected with the AIDS virus to test the vaccine's protective abilities. And there's another problem. The AIDS virus mutates at a furious rate -- faster than the influenza virus, which changes often enough for public health officials to alter the flu vaccine each year. If scientists can find a way to generate a vaccine against one strain of the AIDS virus, it may not protect against another strain. Some scientists talk about the need for making a vaccine preparation that contains components from several different HIV strains, a vaccine cocktail, just as the polio vaccine protects against three different strains of polio. Although the task may seem daunting, scientist are nonetheless trying. Much progress in basic research has been accomplished. The AIDS virus has been dismantled molecule by molecule to the point where scientists now have dozens of chunks to test as a potential vaccine.

[ ] Vaccines fail because HIV mutates and researchers dont understand its defenses. And besides, the virus stays for life theres no way to circumvent that. Dorothy Lewis, professor of immunology, HIV Vaccines: The Future Looks Promising, January 1, 2007 lexis
[cl] A live, attenuated vaccine is unlikely to be made against HIV because of worries about in vivo mutations and the fact that HIV integrates into cellular DNA. This means that once it's there, it's in the DNA for the life of the cell. The principle protective mechanism for live, attenuated vaccines is thought to be production of neutralizing antibodies. Unfortunately, the reality is that the actual mechanism of protection for any vaccine is seldom completely understood. Indeed, this is a crucial issue for the design of any vaccine. How do you know if you have the right antigen? How do you know if the immune responses you can easily measure are protective? Having a "challenge" animal model to test these ideas is extremely important. At this juncture, most agree that targeting both envelope and structural proteins from the virus will be necessary for an effective vaccine against HIV. Sterilizing immunity, however, has only been observed with antibodies given before or at the time of challenge with Simian Immunodeficiency Virus (SIV). (3) T-cell vaccines induce good T-cell responses, but of course the animals still get infected with SIV. Thus far, the best control of virus replication occurred using an MVA (modified vaccinia virus Ankara) DNA prime/boost method.

SDI 07 Hardy/Mahoney/Repko 5 Week

7 Disease Core

AIDS Is Here To Thin Out The Human Population


[ ] AIDS is an immune system from nature designed to solve for the human infection. Malcolm Gladwell, author and economist and staff writer for the New Yorker, The Plague Year, July 24, 1995
lexis [cl] The emergence of aids, Ebola and any number of other rainforest agents appears to be a natural consequence of the ruin of the tropical biosphere. The emerging viruses are surfacing from ecologically damaged parts of the earth... In a sense, the earth is mounting an immune response against the human species. It is beginning to react to the human parasite, the flooding infection of people, the dead spots of concrete all over the planet, the cancerous rot-outs in Europe, Japan and the United States, thick with replicating primates, the colonies enlarging and spreading and threatening to shock the biosphere with mass extinctions. Nature has interesting ways of balancing itself. The rainforest has its own defenses. The earth's immune system, so to speak, has recognized the presence of the human species and is starting to kick back in. The earth is attempting to rid itself of an infection by the human parasite. Perhaps AIDS is the first step in a natural process of clearance.

SDI 07 Hardy/Mahoney/Repko 5 Week

8 Disease Core

AIDS Mutates = Cant Solve and It Kills Anyway


[ ] AIDS mutates too quickly to solve. [same card as above but retagged] Larry Thompson, staff writer for the Washington Post, Why an AIDS Vaccine May Never Work: The Virus is Too Crafty for the Hoped-For Quick Fix, June 21, 1988 lexis [cl]
The current limited human studies are designed only to prove safety, not efficacy, of the vaccines, and none of the human volunteers have been, or will be, intentionally infected with the AIDS virus to test the vaccine's protective abilities. And there's another problem. The AIDS virus mutates at a furious rate -- faster than the influenza virus, which changes often enough for public health officials to alter the flu vaccine each year. If scientists can find a way to generate a vaccine against one strain of the AIDS virus, it may not protect against another strain. Some scientists talk about the need for making a vaccine preparation that contains components from several different HIV strains, a vaccine cocktail, just as the polio vaccine protects against three different strains of polio. Although the task may seem daunting, scientist are nonetheless trying. Much progress in basic research has been accomplished. The AIDS virus has been dismantled molecule by molecule to the point where scientists now have dozens of chunks to test as a potential vaccine.

[ ] Even if we can generate a vaccine or a miracle drug cocktail therapy that solves, animal to human transmission of HIV is possible and kills even more efficiently than present. Mark Schoofs, staff writer for the Village Voice, The Virus, Past and Future, November 30, 1999 lexis [cl]
Because of the genetic similarity between the chimp and human viruses, it appeared that HIV had originated in chimpanzees--a theory all but confirmed in February of this year by University of Alabama researcher Beatrice Hahn, who appears to have identified the exact chimpanzee subspecies--Pan troglodytes troglodytes--that harbors HIV's mother virus. This finding is no mere historical anomaly. There is strong evidence that the virus has jumped from animals to humans on at least seven occasions. Unfortunately, the way this critically important science has been reported is undermining its credibility in Africa, the very place where most new variants of HIV are arising. When Hahn presented her findings to about 5000 AIDS researchers in Chicago, she emphasized how the virus could have passed from apes to humans through the hunting and butchering of chimpanzees--a common practice that has provided protein for rainforest Africans over many centuries. But the hunting of ''bush meat'' has become commercialized, pushing the apes toward extinction. To emphasize her point, Hahn showed slides of slaughtered chimps. The normally staid scientific audience groaned in disgust, and it wasn't long before eating chimps was compared to cannibalism in The New York Times Magazine. continued In fact, research into the origin of AIDS could help save Africans and everyone else, because the virus is still emerging: still mutating and moving from apes and monkeys into humans. Zekeng vividly remembers the 26-year-old patient he calls Miss A. In 1991, she came to his lab in Cameroon's capital, Yaounde, with ''all the symptoms of AIDS--diarrhea, fever, weight loss, swollen lymph nodes. I was 200 percent sure she would test HIV-positive.'' But she didn't. Zekeng took her blood to a sophisticated German lab and discovered that the woman was infected with a new, previously undocumented variant of HIV called Group O. It is so genetically distinct that scientists believe it didn't evolve from the main strains of HIV, but represents a separate transmission from chimps to humans. Eighteen months after Miss A came to Zekeng's office, the virus had killed her.

SDI 07 Hardy/Mahoney/Repko 5 Week

9 Disease Core

AIDS = Spread By Military


[ ] African militaries are one of the major causes to the spread of AIDS must solve first. Alex de Waal, fellow of the Global Equity Initiative at Harvard University, African Governments Must Acknowledge the Role of the Military in the Spread of AIDS, published 2006 opposing viewpoints [cl]
The African military culture is in large part responsible for the spread of AIDS throughout Africa. The soldiers of war-torn Africa, who are away from home for long periods and given authority and power over villages, often abuse their power, engage in risky sexual behaviors, and become infected with the AIDS virus. African armies have HIV infection rates that are two to five times greater than the general population, and some are thought to have rates as high as 90 percent. As these armies move from village to village, they facilitate the spread of AIDS. African leaders must respond to this crisis. Aids activists and policymakers have a taste for military metaphors. They speak of 'fighting' Aids, 'mobilising as if for war' and, more optimistically, 'vanquishing' the disease. Some diseasessmallpox and cholera are cases in pointare amenable to military-style campaigns. But sexually transmitted infections are not. Measures such as the incarceration of sex workers by the US police during World War I haven't often been effective. Policing sex rarely works. In fact, it's simpler to wage a war than to 'fight' HIV. States are designed for war-making. They have emergency powers and mobilisation capacities, while their leaders adore taking a posture of stern command. Even liberation wars, fought against states, invoke stirring slogans, promises of Utopia, and nationalist sentiment.

SDI 07 Hardy/Mahoney/Repko 5 Week

10 Disease Core

***HIV/AIDS AFF***

SDI 07 Hardy/Mahoney/Repko 5 Week

11 Disease Core

AIDS = Pandemic
[ ] HIV/AIDS is a pandemic and if we expand our efforts we could save 29 million lives experts agree. John Stover et al, all nine authors are qualified and receive funding from major aid programs, Can we reverse the HIV/AIDS pandemic with an expanded response?, July 6, 2002, available for download at thelancet.com [cl]
HIV/AIDS has reached pandemic proportions, and is one of the leading causes of death worldwide. In 2001, the Declaration of Commitment on HIV/AIDS set out several aims with respect to reducing the effect and spread of HIV/AIDS, and an expanded response in low-income and middle-income countries was initiated. Here we examine the potential effect of the expanded global response based on analyses of epidemiological data, of mathematical models of HIV-1 transmission, and a review of the impact of prevention interventions on risk behaviours. Analyses suggest that if the successes achieved in some countries in prevention of transmission can be expanded to a global scale by 2005, about 29 million new infections could be prevented by 2010.

[ ] HIV/AIDS is the leading cause of death in sub-Saharan Africa and the fourth largest killer in the world we must solve. Stover et al, all nine authors are qualified and receive funding from major aid programs, Can we reverse the HIV/AIDS pandemic with an expanded response?, July 6, 2002, available for download at thelancet.com [cl]
Since the beginning of the epidemic, estimates suggest that more than 60 million people have become infected and more than 20 million people have died of HIV/AIDS, including 3 million deaths in 2001 alone. There are 14 million orphans because of AIDS and 40 million people with HIV/AIDS. AIDS is the leading cause of death in sub-Saharan Africa and the fourth leading cause of death worldwide.1 The scale of this devastating epidemic is unprecedented in modern history and, in June, 2001, at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), the international community set global targets for reducing the spread of HIV/AIDS and alleviating its effect on the world. The Declaration of Commitment on HIV/AIDS2 sets several aims, including a reduction in HIV-1 prevalence of 25% among young people, by 2005 in the most affected countries, and by 2010 globally. We previously estimated3 that, by the year 2005, US$92 billion would be needed annually to provide an expanded response to HIV/AIDS in low-income and middle-income countries. This response includes a package of 12 essential prevention interventions (table 1) and nine different care and support activities. Of this total, an estimated US$48 billion is required for prevention. Our aim was to examine the potential effect of this programme by asking two key questionsnamely, how many new infections can be averted by timely and effective implementation of this comprehensive prevention package, and will it be enough to reverse the epidemic and achieve the aims of the expanded response?

SDI 07 Hardy/Mahoney/Repko 5 Week

12 Disease Core

AIDS = Extinction
[ ] AIDS is an epidemic that must be solved for immediately risk of extinction if we dont. Dafna Linzer, staff writer for the Associated Press, U.N. AIDS gathering draws thousands for talks on killer pandemic, June 25, 2001 lexis [cl]
One after another, African leaders at the United Nations' first global gathering on HIV/AIDS made emotional pleas for help Monday in ending the devastation wrought by the epidemic. Nigeria's president warned that entire populations face extinction. Secretary-General Kofi Annan, seeking $7-10 billion for a global AIDS fund, said AIDS spending "in the developing world needs to rise to roughly five times its present level." The Americans pledged to provide more aid, but did not say how much. Annan, a native of Ghana who has made the fight against AIDS his personal priority, opened the three-day special session by urging world leaders to set aside moral judgments and face the unpleasant facts of a disease that has killed 22 million people and ravaged many of the world's poorest nations. Kenya and Nigeria are each home to more than 2 million HIV patients. In Botswana, more than 20 percent of the adult population is infected, and in South Africa, AIDS will knock off 17 years of life expectancy by 2005. "The future of our continent is bleak, to say the least," Nigerian President Olusegun Obasanjo said. "The prospect of extinction of the entire population of a continent looms larger and larger."

[ ] AIDS must be solved for risk of extinction makes this the first impact in round. Susan Taylor Martin, staff writer for the St. Petersburg Times, In a Race Against Time, October 3, 2004 lexis
[cl] Few places have been more ravaged by AIDS than Botswana, a nation of 1.8-million where almost four of every 10 people are infected with the AIDS-causing HIV virus. Life expectancy has plunged to 37 lower than Haiti's - while the HIV rate until recently was the highest in the world. Yet few countries have been more aggressive in fighting a scourge that still inspires so much dread, fear and denial. While other African leaders reacted slowly to the continent's AIDS epidemic, President Festus Mogae warned in 2000 that AIDS could literally drive his country to extinction. Since then, Botswana's war against AIDS has drawn international support, including a huge donation from Microsoft founder Bill Gates. Doctors and researchers from Harvard, Florida International and other American universities are at work in the country. But almost three years after Botswana rolled out Africa's most ambitious program, the HIV infection rate stands at 37.4 percent, second only to that in Swaziland. "Our worry is 2010, when at the current rate of attrition the government will cease to function," says Tim Jones, manager of Princess Marina Hospital in Gaborone. The hospital has space for 507 patients, but on a recent day it overflowed with 658 - most of them infected with HIV. "We won't have enough people to keep the lights on, to pay the bills - that's how scary it is," Jones says. "It attacks people who are the most productive in society. It's an enormous race against time to find treatment, cures, a vaccine."

SDI 07 Hardy/Mahoney/Repko 5 Week

13 Disease Core

AIDS = Security and Economic Threat


[ ] AIDS is a security and economic threat taking steps to solve is key to prevent an infrastructure breakdown. Lawrence K. Altman, staff writer for the New York Times, AIDS in 5 Nations Called Security Threat, October 1, 2002 lexis [cl]
Rates of infection from the AIDS virus in five of the world's most populous countries are rising so fast that they pose potential security threats to their regions and to the United States, a group that advises the Central Intelligence Agency said here today. The countries -- China, Ethiopia, India, Nigeria and Russia -- have 40 percent of the world's population and by 2010 will have more H.I.V.-infected people than any other five countries, an agency official said. By 2010, the number of infected people in those countries will grow to an estimated 50 million to 75 million, from the current estimate of 14 million to 23 million, said the group, the National Intelligence Council. It is composed of individuals from the government and academic and private sectors. H.I.V., the AIDS virus, could harm the economic, social, political and military structure in each of the five countries, a C.I.A. official said in releasing the declassified parts of the council's report. H.I.V. would spark tensions over spending priorities, driving up health care costs and sharpening military manpower shortages, Dr. David F. Gordon, a C.I.A. official and the report's author, said at a news conference at the intelligence agency's headquarters here.

SDI 07 Hardy/Mahoney/Repko 5 Week

14 Disease Core

***H5N1/Avian Influenza NEG***

SDI 07 Hardy/Mahoney/Repko 5 Week

15 Disease Core

H5N1 Hasnt Mutated/Wont Mutate


[ ] H5N1 [the bird flu] will not mutate to allow human to human transmission its been tracked and proven, and even if it does there wont be millions of casualties Simon Elegant, staff writer for TIME Magazine, Plague 2.0, March 19, 2007,
http://www.time.com/time/2007/whats_next/9.html [cl] Bet on this for 2007: there will be no outbreak of a newly mutated, extremely infectious and lethally virulent H5N1 bird flu. Millions will not die from H5N1. This strain of flu has been tracked for almost a decade. If it hasn't managed to mutate into a form that makes it easy for human-to-human transmission by now, odds are something else is going to take the glory: another flu variant or something like the SARS outbreak in 2003. Whatever it is, it will come out of nowhere.

[ ] Nobody knows when H5N1 will mutate to allow human to human transmission. Wendy Orent, staff writer for Discover, Worrying about killer flu: Asia is brewing a deadly virus, but only with the right ingredients can it morph into an epidemic, February 2005, opposing viewpoints [cl]
Of the 15 distinct types of flu strains known to occur in birds, H5N1 is "right at the top of the list for mostwanted strains," says Richard Webby, a virologist at St. Jude Children's Research Hospital in Memphis. And yet, as deadly to humans as it is, H5N1 is also very difficult to contract. It is "particularly poor at infecting humans and worse still at transmitting from human to human," says Webby. What scientists still have not figured out about this strain is how much it must mutate before it can infect people easily. "Is it 3 amino acid changes away, or 300?" asks Webby.

[ ] There is no proof that bird flu will escalate to a human pandemic its all theoretical. Marc Siegel, professor at the NYU School of Medicine, Bird Flu: An Epidemic of Overreaction, October 11, 2005, http://www.ahrp.org/infomail/05/10/27b.php [cl]
The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected. Most human influenzas begin as bird flus, but many bird flus never change to a form that can harm us. Though flu pandemics occur on the average of three times per century, and we are clearly overdue (the last was in 1968), there is absolutely no indication that the transformation to mass human killer is about to happen. The threat is theoretical. Unfortunately, the attention it has received makes it feel like something terrible is inevitable. Why the overreaction? For one thing, direct comparisons to the Spanish flu of 1918, a scourge that killed more than 50 million people worldwide, has alarmed the public unnecessarily.

[ ] There are too many mutations possible for H5N1 human to human wont happen. Taisuke Horimoto, associate professor and Yoshihiro Kawaoka, professor, both authors at the Institute of
Medical Science and Department of Microbiology and Immunology at the University of Tokyo, Pandemic Threat Posed By Avian Influenza A Viruses, January 2001, http://cmr.asm.org/cgi/reprint/14/1/129 [cl] The antigenicity of influenza viruses changes gradually by point mutation (antigenic drift) or drastically by genetic reassortment (antigenic shift) continued Antigenic shift is caused by either direct transmission of nonhuman influenza viruses to humans or the reassortment of genes from two different influenza viruses that have infected a single cell (208). Theoretically, 256 different combinations of RNA can be produced from the shuffling of the eight different genomic segments of the virus. Genetic reassortment is well documented both in vitro and in vivo under laboratory conditions (207). More importantly, mixed infections occur relatively frequently in nature and can lead to genetic reassortment (9, 72, 221). Reemergence of a previously circulating virus is another mechanism by which antigenic shift can occur. For example, the H1N1 Russian influenza virus, which was circulating in the 1950s (127, 171), subsequently reemerged in 1977 in human populations that were immunologically naive to this subtype of virus, especially younger persons, who had not been infected with H1N1 virus in the past (107).

SDI 07 Hardy/Mahoney/Repko 5 Week

16 Disease Core

H5N1 Lives In Places Where You Cant Get It Easy


[ ] The bird flu wont transmit it lives in the intestine, not the lungs. Scripps Research Institute, Minor mutations in avian influenza virus increase chances of human infection, April 20, 2006 lexis [cl]
Receptor specificity for the influenza virus is controlled by the glycoprotein hemagglutinin (HA) on the virus surface. These viral HAs bind to host cell receptors containing complex glycans-carbohydrates-that in turn contain terminal sialic acids. Avian viruses prefer binding to a2-3-linked sialic acids on receptors of intestinal epithelial cells, while human viruses are usually specific for the a2-6 linkage on epithelial cells of the lungs and upper respiratory tract. Such interactions allow the virus membrane to fuse with the membrane of the host cell so that viral genetic material can be transferred to the cell. The switch from a2-3 to a2-6 receptor specificity is a critical step in the adaptation of avian viruses to a human host and appears to be one of the reasons why most avian influenza viruses, including current avian H5 strains, are not easily transmitted from human-to-human following avian-to-human infection. However, the report did suggest that "once a foothold in a new host species is made, the virus HA can optimize its specificity to the new host."

[ ] H5N1 [the bird flu] attacks the alveoli in the lower lung, making it difficult to contract from others. Virus Weekly, via newsrx.com, Study findings from Mahidol University broaden understanding of bird flu, July 31, 2007 proquest [cl]
"We studied autopsy specimens from 2 patients who died of infection with this virus. Apoptosis was observed in alveolar epithelial cells, which is the major target cell type for the viral replication. Numerous apoptotic leukocytes were observed in the lung of a patient who died on day 6 of illness. Our data suggest that apoptosis may play a major role in the pathogenesis of influenza (H5N1) virus in humans by destroying alveolar epithelial cells. This pathogenesis causes pneumonia and destroys leukocytes, leading to leukopenia, which is a prominent clinical feature of influenza (H5N1) virus in humans," wrote M. Uiprasertkui and colleagues, Mahidol University.

[ ] The flu virus binds to the lower respiratory tract it cant be transmitted through coughs and sneezes. Cross apply the cards that it wont mutate bird flu is essentially impossible to contract. Nicolas Wade, staff writer for The New York Times, Studies Suggest Avian Flu Pandemic Isnt Imminent, March 23, 2006,
http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1186804800&en=dbd86764364b7655&ei=5070 [cl] Two groups of researchers, in Japan and in Holland, say they have discovered why the avian flu virus is rarely if ever transmitted from one person to another. The reason, the researchers propose, is that the cells bearing the type of receptor the avian virus is known to favor are clustered in the deepest branches of the human respiratory tract, keeping it from spreading by coughs and sneezes. Human flu viruses typically infect cells in the upper respiratory tract. The avian virus would need to accumulate many mutations in its genetic material before it could become a pandemic strain, said Yoshihiro Kawaoka, a virologist at the University of Tokyo and the University of Wisconsin.

SDI 07 Hardy/Mahoney/Repko 5 Week

17 Disease Core

Surveillance Systems Check


[ ] Surveillance and early warning systems check bird flu. The Baltimore Sun, Health and Science: In Brief, August 11, 2006 [cl]
Monitoring of wild migratory birds to prevent a deadly bird flu virus is expanding to cover the entire nation and U.S. territories in the Pacific Ocean. The stepped-up testing will be done by scientists in the lower 48 states, Hawaii and other Pacific islands. They will begin keeping an eye out for the deadly H5N1 strain of the avian flu that has killed more than 100 people, mostly in Asia. In Alaska, where the first migratory birds began arriving, monitoring started just before summer. "This move to test thousands more wild birds throughout the country will help us to quickly identify, respond and control the virus if it arrives in the United States," Agriculture Secretary Mike Johanns said Wednesday. "Because we cannot control wild birds, our best protection is an early warning system." Interior Secretary Dirk Kempthorne said more coordinated monitoring by federal agencies, states and universities "will be important this fall as birds now nesting in Alaska and Canada begin their migration south through the continental United States."

[ ] Surveillance systems can be focused on H5N1 to pick up on dangerous mutations extinction scenarios wont happen. The Economist, Unhappy rebirthday; influenza, October 8, 2005 lexis [cl]
Another intriguing possibility raised by Dr Taubenberger's team is that avian viruses may adapt to humans in a predictable sequence. It seems likely that only a small number of genetic changes were required to turn bird flu into the 1918 pandemic. And it turns out that such genetic changes are also found in other human-pathogenic strains of avian viruses, such as H7N7 and H5N1. If these mutations are what allow the avian virus to replicate more easily in human cells, then it might be possible to generate a genetic "check list" of dangerous-looking mutations that would allow virus surveillance to be far better focused than it is today. Indeed, H5N1 is already picking up the kinds of mutations that made the 1918 virus dangerous. The researchers think it possible that forces similar to those at work in 1918 are driving H5N1 down a similar evolutionary path. Every time the virus infects a human, or even another mammal such as a pig or a dog, viral replication will generate further genetic changes and some of these will make the virus better at breeding in people. The one bit of good news is that it does not appear that H5N1 is very far along this path yet. The relevant mutations are still scattered among different strains. Some comfort then, but not much.

SDI 07 Hardy/Mahoney/Repko 5 Week

18 Disease Core

***H5N1/Avian Influenza AFF***

SDI 07 Hardy/Mahoney/Repko 5 Week

19 Disease Core

H5N1 = Pandemic
[ ] Avian influenza is the root cause of deadly human pandemics. Taisuke Horimoto, associate professor and Yoshihiro Kawaoka, professor, both authors at the Institute of
Medical Science and Department of Microbiology and Immunology at the University of Tokyo, Pandemic Threat Posed By Avian Influenza A Viruses, January 2001, http://cmr.asm.org/cgi/reprint/14/1/129 [cl] Influenza pandemics, defined as global outbreaks of the disease due to viruses with new antigenic subtypes, have exacted high death tolls from human populations. The last two pandemics were caused by hybrid viruses, or reassortants, that harbored a combination of avian and human viral genes. Avian influenza viruses are therefore key contributors to the emergence of human influenza pandemics. In 1997, an H5N1 influenza virus was directly transmitted from birds in live poultry markets in Hong Kong to humans. Eighteen people were infected in this outbreak, six of whom died. This avian virus exhibited high virulence in both avian and mammalian species, causing systemic infection in both chickens and mice. Subsequently, another avian virus with the H9N2 subtype was directly transmitted from birds to humans in Hong Kong. Interestingly, the genes encoding the internal proteins of the H9N2 virus are genetically highly related to those of the H5N1 virus, suggesting a unique property of these gene products. The identification of avian viruses in humans underscores the potential of these and similar strains to produce devastating influenza outbreaks in major population centers. Although highly pathogenic avian influenza viruses had been identified before the 1997 outbreak in Hong Kong, their devastating effects had been confined to poultry. With the Hong Kong outbreak, it became clear that the virulence potential of these viruses extended to humans.

SDI 07 Hardy/Mahoney/Repko 5 Week

20 Disease Core

AT: Wont Mutate


[ ] Even if it never mutates, infected animals still pose a risk. Julian Palmore, Department of Mathematics, University of Illinois, Urbana-Champaign and North American Editor-in-Chief of Defense and Security Analysis Defense and Security Analysis, June 1, 2007 google scholar
[BWC aff file] Even were the virus not to infect people by human-to-human transmission, it would spread to animal populations. In turn, infected animals, especially poultry, would pose a potential risk for humans. Clearly, the avian flu and its delivery system represent a clear and present danger to the worlds animals and, most likely, humans. It will be necessary to be on the alert for this virus for many years to come. It will not be contained or damped out without the virus mutating to a less virulent form. It is to be hoped that the combination of virus and delivery system will naturally cease to be a threat to humans.

[ ] The avian and human flu will combine to create a deadly epidemic. Ilaria Capua, National Reference Laboratory for Avian Influenza in Italy, and Dennis J. Alexander, EU
Community Reference Laboratory for Avian Influenza Avian Virology, Avian influenza and human health, January 10, 2002 google scholar [cl] For the human population as a whole the main danger of direct infection with avian influenza viruses appears to be if people infected with an avian virus are infected simultaneously with a human influenza virus. In such circumstances reassortment could occur with the potential emergence of a virus fully capable of spread in the human population, but with antigenic characteristics for which the human population was immunologically naive.

The genomic structure of a flu virus is like a necklace with a series of charms constituted of gene clusters: Replace one charm with another harvested from a different strain and, voila, a new form of the flu is spawned. Pigs, it turns out, are remarkably efficient incubators for viruses to mutate into new forms. A pig can be exposed to a flu virus transmitted by a bird and then to a second virus spread by a human. Once both viruses set up shop inside the pig, they can begin swapping genetic secrets, with the result being a viral recombination - and a novel strain of the flu.

SDI 07 Hardy/Mahoney/Repko 5 Week

21 Disease Core

AT: Transmissibility Goes Up = Virus is Less Lethal


[ ] Even low pathogenic viruses are deadly. Taisuke Horimoto, associate professor and Yoshihiro Kawaoka, professor, both authors at the Institute of
Medical Science and Department of Microbiology and Immunology at the University of Tokyo, Pandemic Threat Posed By Avian Influenza A Viruses, January 2001, http://cmr.asm.org/cgi/reprint/14/1/129 [cl] These findings defined two types of avian influenza A viruses based on their virulence: a highly virulent type that causes fowl plagues, and an avirulent type that causes only mild disease or asymptomatic infection. In rare instances, however, viruses with low pathogenicity in the laboratory cause outbreaks of severe disease in the field. Such viruses are economically important. For example, in Minnesota in 1978, over 140 turkey flocks were infected with influenza virus of low pathogenicity, resulting in an estimated loss of over 5 million dollars (148). Nonetheless, the morbidity and mortality associated with these viruses tend to be much lower than those caused by lethal viruses.

SDI 07 Hardy/Mahoney/Repko 5 Week

22 Disease Core

***Malaria NEG***

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23 Disease Core

Cant Solve Anyway


[ ] The spread of malaria is exacerbated by climate change. Paul Kingsnorth, staff writer for The Ecologist, Global Warming Will Severely Harm Human Health, March/April 1999 opposing viewpoints [cl]
While localised and regional climatic changes are likely to lead to an increase in vector-borne diseases, the average global rise in temperature will also exacerbate the same trend. Many disease-carrying insectsmost obviously the malarial mosquitothrive in warm conditions; as the world warms, they will begin to find more places in which they can breed. A 1996 report from the London School of Hygiene and Tropical Medicine illustrated this point clearly when it calculated that, of ten of the world's most dangerous vector-borne diseases (malaria, schistosomiasis, dengue fever, lymphatic filariasis, sleeping sickness, Guinea worm, leishmaniasis, river blindness, Chagas' disease and yellow fever), all but one were likely to increase, or in some way change their range as a result of climate change. Malaria is the world's most prevalent mosquito-borne disease: two million people die from it every year. But it is likely to get worse. The scientist R. Colwell has called malaria "an old disease with the potential of re-emerging as a new disease, especially in association with climate change," and virtually all experts seem to agree that one effect of climate change will be to increase the range of the malarial mosquito. The IPCC predicts that malaria will spread from affecting 45 per cent of the population, as it does today, to affecting 60 per cent by the latter half of the 21st centuryof the order of 50-80 million additional annual cases. The Hadley Centre's 1998 study predicted a significant spread in the mosquito's range, largely as a result of the warming of previously temperate areasincluding parts of Europe and North America. Malaria is also likely to spread to high altitude areas, such as the Andes, as their average temperature rises. Again, it seems that in some places this is already beginning: malaria has already begun to affect the previously mosquito-free African highlands, and upland rural areas of Papua New Guinea. Urban centres are beginning to suffer as well: many central African cities are experiencing urban malaria for the first time, and two recent cases in New York City were traced to local mosquitoes. Furthermore Paul Epstein, in studying cases of malaria linked to the recent El Nino, has found that large and deadly outbreaks across Asia were one result of climatic upheavals there. Other vector-borne diseases are likely to become more commonand hence more deadlytoo. Again, the spread is already beginning. Mosquito-borne yellow fever has recently invaded Ethiopia, and dengue fever, spreading through the Americas, has already reached Texas. Recent floods in northenya caused Rift Valley Fever, a cattle disease, to jump the species barrier and kill hundreds of people. In 1994, the pneumonic plague resurfaced in India, during a summer in which temperatures reached as high as 124 degrees Fahrenheit. We should expect more of the same as the thermometers of many nations are thrown out of kilter by man-made climate change.

[ ] Lab samples, infected blood, and previous carriers will make malaria stay a problem. Center for Disease Control, Morbidity and Morality Weekly Report Surveillance Summaries, June 8, 2007 lexis
[cl] Malaria in humans is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles sp. mosquito. The majority of malaria infections in the United States occur among persons who have traveled to or from areas with ongoing malaria transmission. In the United States, cases can occur through exposure to infected blood products, congenital transmission, or local mosquito borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.

SDI 07 Hardy/Mahoney/Repko 5 Week

24 Disease Core

DDT Fails
[ ] Mosquitoes are now resistant to DDT even pesticides wont curb malaria. Cristine Russell, staff writer for the Washington Post, Man Cures, But Diseases Adapt, March 13, 1983 lexis
[cl] Influenza is the best known case of a virus that changes so frequently that vaccines must continually be developed to keep up with it. Malaria-carrying mosquitoes also have become resistant to bug-fighting pesticides such as DDT; leprosy is becoming resistant to drugs used to treat it, and bacteria of several types have managed to retaliate against the potent antibiotic penicillin, producing their own enzymes to inactivate the drug.

[ ] DDT isnt a magic pesticide that gets rid of malaria with no repercussions consequences from its use are seen for years afterward. David Huang, research chemist and journalist speaking on Ockhams Razor, Putting Science Back Into the Environment, May 15, 2005 [cl]
The academic literature on DDT and malaria doesnt suggest that DDT is the anti-malaria silver bullet that some people make it out to be. Its just one of many options, albeit a pretty handy one. So, blaming the environmental movement for millions of malaria deaths is certainly simplistic. A look at the health and environmental impacts of DDT also reveals a rather ambiguous picture. Contrary to some claims, DDT isnt acutely toxic to humans and in fact most of the evidence regarding its health effects on humans is equivocal. Environmental concerns about its use in fighting malaria also seem misplaced, since the chemical is used in low concentrations and is only sprayed on internal walls of buildings. But theres still a great deal of uncertainty surrounding the impacts of DDT. The problem is that most of DDTs environmental and health effects are associated with its persistence; it sticks around for a long time and can gradually accumulate in an organisms tissues. DDT has been implicated in chronic effects on human health, particularly associated with neurological and reproductive functions. In fact, one epidemiological study has suggested that the increase in infant mortality due to DDTs reproductive effects could be similar to the decline in mortality from its use in malaria control.

SDI 07 Hardy/Mahoney/Repko 5 Week

25 Disease Core

***Malaria AFF**

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26 Disease Core

DDT Solves
[ ] The risks of DDT dont matter solving for malaria outweighs. The Herald, DDT: Panacea to Malaria Scourge, October 12, 2006,
http://allafrica.com/stories/200610120462.html [cl] The highest deaths were recorded in Mozambique where 120 000 cases are reported every week and more than 70 people die each week. In the 2005/6 rainy season, Botswana lost 48 people and had 500 reported cases while Swaziland recorded 60 cases a week. A total of 288 people died from malaria in Zimbabwe over the same period and the country was on average recording 5 000 cases every week. Latest statistics indicate that malaria has so far claimed 176 lives in the malaria prone Matabeleland North Province this year. Zambia recorded 5 000 deaths while South Africa recorded 40 deaths and about 1 500 cases of malaria every month over the 2005/6 rainy season. In light of this public health catastrophe, public health officials in Africa argue that the benefits of using DDT in small quantities for indoor spraying of walls and ceilings far outweigh the risks.

[ ] DDT solves its empirically proven to eradicate malaria. Bill Steigerwald, staff writer for the Pittsburg Tribune-Review, Detoxifying DDTs undeserved reputation, May 6, 2007, http://www.pittsburghlive.com/x/pittsburghtrib/opinion/columnists/steigerwald/s_506161.html [cl]
Despite these daunting statistics, the global war against malaria may finally be taking a turn for the better. The same miracle weapon that we and most of Europe employed to rid ourselves of malaria half a century ago -- the pesticide DDT -- is starting to be used more widely in Africa. DDT isn't foolproof but works wonders. Lightly sprayed twice a year on the inside walls of living quarters, it's like Kryptonite to the mosquitoes that carry malaria. In 1945 when India began using DDT, it had 800,000 malaria deaths a year; by 1960, it had a few thousand. continued It's turned out that DDT is virtually harmless to man, bird or beast. But that didn't help Africa's malaria sufferers, who for 30 years were deprived of DDT because Western relief aid was often contingent on recipient countries not using DDT. Most poor countries that needed it most stopped using it or never got it. Tens of millions died.

SDI 07 Hardy/Mahoney/Repko 5 Week

27 Disease Core

Malaria Comes First


[ ] Malaria needs to take precedence over AIDS. Olga Pierce, staff writer for United Press International, Malaria in the spotlight, September 18, 2006 lexis [cl]
After decades of complacency, world health groups are launching an unprecedented assault on the scourge of malaria, but much work remains to be done. "There has been increased attention to malaria," Natasha Bilimoria, executive director of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, told United Press International. "The world is starting to realize there are things that can be done and should be done and we're doing what we can to get the funding there." Long overlooked in the age of the AIDS epidemic, malaria sickens more than 300 million people each year and kills more than 1 million. It also exacts a heavy economic toll. The World Health Organization estimates that the disease costs Africa, which sees 80 percent of the world's cases, an estimated $12 billion per year in lost income. Even those who are not killed experience lifelong effects, especially pregnant women and children. Malaria during pregnancy can result in miscarriage and low birth weight, and children who get the disease can grow up with slowed cognitive development. "The real tragedy," Bilimoria said, "is the disease is preventable and curable."

SDI 07 Hardy/Mahoney/Repko 5 Week

28 Disease Core

***Tuberculosis NEG***

SDI 07 Hardy/Mahoney/Repko 5 Week

29 Disease Core

Cant Solve for TB


[ ] Cant solve for tuberculosis without solving for HIV, war, poverty, population density problems, migration, and the collapse of infrastructure. World Health Organization, Overcoming Antimicrobial Resistance, June 12, 2000, opposing viewpoints
The ability of HIV to accelerate the onset of acute MDR-TB has serious implications for humanity. In crowded hospitals filled with immuno-suppressed individuals, resistant TB has the potential to stalk relentlessly through a population, afflicting patients, health care workers and physicians alike. War, poverty, overcrowding, mass migration and the breakdown of existing medical infrastructures all contribute to MDR-TB's development, transmission and spread.

[ ] An easily transmitted, drug-resistant form of TB threatens to become an epidemic its untreatable with todays drugs. Stephanie Nolen, staff writer for The Globe and Mail, Extensively Drug-Resistant Tuberculosis: Potential Epidemic Looms, May 21, 2007 lexis [cl]
But the gentle doctor, a veteran of 20 years of practice in a rural town in the low hills of KwaZulu-Natal province, never considered that he was looking at a problem that some public-health experts say may be the worst threat to humanity in the past half-century. When the lab called to tell him just what was wrong with those patients, the news left him "in shivers." The Church of Scotland Hospital in Tugela Ferry, an old mission station of low, graceful stone buildings where Dr. Moll is the chief physician, now has the macabre title of "home of XDR TB" - extensively drug-resistant tuberculosis. The TB bacillus, a bug that has been pesky but totally treatable since the advent of antibiotics in the 1940s, has suddenly morphed into something virtually incurable. And the disease is spread not with a complex exchange of bodily fluids, like AIDS or Ebola, but simply by laughing, talking, coughing or breathing. Feeding off a vulnerable population and a health system staggering under the challenge of the AIDS epidemic, XDR may already have spread from South Africa, creating the danger of an uncontrollable epidemic on the continent. After Dr. Moll got the call from the lab, he started keeping track of patients with XDR. In a matter of days, it killed 52 out of 53 people who had it, most within two weeks of arriving at the hospital. Almost all of them were diagnosed posthumously, because the TB killed them before the lab ever got the diagnostics finished. "We're losing ground again, facing another untreatable condition," said Dr. Moll, a veteran of the fight with AIDS. "It's put us in a hopeless situation." continued But the phone call from the lab, when it eventually came, slammed the issue to the top of their agenda: Of the 45 samples, 10 were indeed drug-resistant. But they weren't resistant to just one or two of the drugs used against TB. They were resistant to all six medications available for use in Tugela Ferry. In other words, there was nothing to cure that TB at all. "That was so scary," Dr. Moll said. His first thought, he confessed, was personal - for himself and his staff. "Because you're talking about airborne transmission, and this means if a patient has got it, you as a doctor or a nurse working with that patient are breathing it in ... you are breathing in XDR as part of your job." Four health workers were among the 52 people who had died. continued No one seemed to understand the threat of an incurable strain of TB spreading through a community where up to 40 per cent of adults have HIV. TB is already one of the most common infections in people with HIV-AIDS, and their weakened immune systems make them terribly vulnerable to XDR.

SDI 07 Hardy/Mahoney/Repko 5 Week

30 Disease Core

Vaccines Useless
[ ] BCG may be an effective vaccine, but it is useless against the form of TB most prevalent in problem areas. States News Service, Progress, Challenges Highlighted on World Tuberculosis Day 2006, March 23, 2006
lexis [cl] The vaccine used today to prevent TB, the bacillus Calmette-Guerin (BCG) vaccine, was introduced in 1921 by Frenchmen Albert Calmette and Camille Guerin. It is the most widely administered vaccine in the world and reduces mortality from TB by about 90 percent in vaccinated children, according to T. Mark Doherty and Graham Rook in a March 17 Lancet article, Progress and Hindrances in Tuberculosis Vaccine Development. But the vaccine has little effect on pulmonary tuberculosis, they authors write, which is most common in young adults in regions where TB is endemic. In the United States, scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health in Maryland, are working to find alternative vaccines and treatment.

SDI 07 Hardy/Mahoney/Repko 5 Week

31 Disease Core

U.S. Action Solves Now


[ ] The Stop Tuberculosis Act solves for tuberculosis and increases U.S. leadership. US Fed News Service, [including US State News], Rep. Engel Tuberculosis Bill Passes Unanimously in Committee, July 31, 2007 proquest [cl]
Rep. Eliot L. Engel, D-N.Y. (17th CD), issued - the following news release: Congressman Eliot Engel's legislation, the Stop Tuberculosis Now Act of 2007 (HR 1567), to fight the mounting global tuberculosis crisis, passed unanimously in the House Foreign Affairs Committee Tuesday and now goes to the full House for a vote. The legislation, which has 95 co-sponsors, would provide increased resources to the United States Agency for International Development and the Centers for Disease Control to implement the World Health Organization's plan for TB Control. The Stop Tuberculosis Now Act aims to meet key benchmarks of tuberculosis control efforts such as halving the TB death and disease burden (from the 1990 baseline) by 2015, detecting at least 70% of cases of tuberculosis, and curing 85% of all TB cases detected. The bill is sponsored in the Senate by Sen. Barbara Boxer, where it has 11 co-sponsors. A vote in the full House is expected on this legislation in September after the August district work period. Tuberculosis is the greatest infectious killer worldwide, with 1.6 million adults per year and 1.4 million children victims. It also is a leading infectious killer among individuals with HIV/AIDS, preying on those with weakened immune systems; it is estimated that 1/3 of people with HIV infection also have tuberculosis. Rep. Engel, a senior member of the House Foreign Affairs Committee, said, "The rapid growth of TB infection and mounting epidemic of drug resistance is a serious health threat we cannot ignore. The recent case of a man with highly infectious TB traveling to Europe and back shows that we are not insulated by distance from this threat. "This bill makes a serious investment in our capacity to fight Tuberculosis globally. Locally we had a frightening instance of tuberculosis striking home when some 300 people at a Bronx hospital were exposed to an individual with TB. It is clear that we must be vigilant in our fight against TB." The legislation, which was also sponsored by Reps. Heather Wilson (R-NM) and Adam Smith (D-WA), has been endorsed by leading global health groups including the RESULTS Educational Fund, the American Thoracic Society and the Global Health Council. "With anybody able to go anywhere in the world in a day, the airborne threat of TB and drug-resistant TB can no longer be ignored," said Joanne Carter, Associate Executive Director of RESULTS Educational Fund. "We thank Representative Engel and his colleagues in the House and Senate for their unwavering leadership in the fight against TB." ATS President John Heffner, MD, said, "The American Thoracic Society applauds Reps. Engel, Wilson and Smith for their leadership on international tuberculosis control through their sponsorship of the Stop TB Now Act. The need for this legislation is urgent. The world is now facing a new global health threat in the form of extensively drug-resistant tuberculosis. The Stop TB Now Act will strengthen US leadership on international TB control by implementing the WHO plan for controlling TB globally and providing increased resources for the development of urgently needed new TB diagnostic and treatment tools."

SDI 07 Hardy/Mahoney/Repko 5 Week

32 Disease Core

***Tuberculosis AFF***

SDI 07 Hardy/Mahoney/Repko 5 Week

33 Disease Core

TB = Solvable
[ ] A new cell has been discovered that protects against TB. Vaccine Weekly, Tuberculosis Vaccines; Researchers from University of Maryland, Institute of Human Virology publish findings in tuberculosis vaccines, August 8, 2007, [cl]
Current study results from the report, "Innate-like gammadelta T cell responses to mycobacterium Bacille Calmette-Guerin using the public V gamma 2 repertoire in Macaca fascicularis," have been published. According to a study from the United States, "The V gamma 2 V delta 2 T cell subset responds to Bacille Calmette-Guerin (BCG) immunization in macaques and may be a component of protective immunity against tuberculosis. We characterized the effects of BCG on the V gamma 2 V delta 2 T cell receptor repertoire by comparing the starting population of V gamma 2 chains in cynomolgus macaques with the repertoire found after priming or booster immunization with BCG."

[ ] BCG vaccine solves empirically proven. TB & Outbreaks Weekly, Tuberculosis Vaccines; Findings from Stanford University, Department of Pediatrics advance knowledge in tuberculosis vaccines, July 31, 2007 proquest [cl]
Current study results from the report, "Unique gene expression profiles in infants vaccinated with different strains of Mycobacterium bovis bacille Calmette-Guerin," have been published. According to a study from the United States, "Vaccination with Mycobacterium bovis bacille Calmette-Guerin (BCG) has variable efficacy in preventing tuberculosis. We hypothesized that some of this variation might be due to differences among BCG strains." "To test this, neonates in Orizaba, Mexico, were vaccinated with one of three different BCG strains (BCG-Brazil [BBCG], BCG-Denmark [DBCG], or BCG-Japan [JBCG]). One year after vaccination, peripheral blood mononuclear cells (PBMC) were obtained and recall immune responses to culture filtrate proteins (CFP) of Mycobacterium tuberculosis were evaluated using quantitative real-time PCR. CFP- activated PBMC from BBCG-and DBCG-immunized children expressed high levels of cytokines characteristic of an adaptive immune response (gamma interferon, interleukin-2beta [IL-12beta], and IL-27), while those from children immunized with JBCG did not. In contrast, vaccination with JBCG resulted in significantly greater expression of cytokines characteristic of a proinflammatory immune response (IL- 1alpha, IL-1beta, IL-6, and IL-24) in PBMC activated with CFP compared to PBMC from children vaccinated with BBCG or DBCG," wrote B. Wu and colleagues, Stanford University, Department of Pediatrics. The researchers concluded: "Thus, different strains of BCG can activate different immune pathways, which may affect long-term vaccine efficacy."

SDI 07 Hardy/Mahoney/Repko 5 Week

34 Disease Core

No Action = Epidemic
[ ] Health officials need to take action now to prevent a TB epidemic. Laura MacInnis, staff writer for Reuters News Service, INTERVIEW TB strain threatens uncontrollable epidemic, March 7, 2007, http://www.reuters.com/article/homepageCrisis/idUSL0623214 [cl]
Extremely drug-resistant strains of tuberculosis could spark a "practically uncontrollable" epidemic among HIV/AIDS sufferers in areas like Africa, a World Health Organisation (WHO) official said on Tuesday. Mario Raviglione, director of the United Nations agency's Stop TB Department, said health experts needed to ensure a recently discovered strain - known as XDR-TB - did not trigger a wave of infections among those with weak immune systems. "If all the elements of good TB control are put in place, we have a chance of taking care of this disease," the Italian doctor said in an interview at the WHO's headquarters. "If we let the situation ... with XDR go out of control, as it might well do, then we are in trouble. All of our gains over the last 10 years in controlling TB would be lost." Tuberculosis, an airborne disease spread like the common cold, afflicts about 9 million people each year and kills 1.6 million. It is normally treatable with antibiotics but drug-resistant strains have emerged in past years, complicating a U.N.-backed drive to stop the spread of the disease by 2015. More than 400,000 people were found in 2004 to have developed "multi-drug resistant" strains that could not be treated with at least two key first-line tuberculosis drugs, with most cases in China, India and Russia. XDR-TB, a "super bug" which resists three or more classes of second-line tuberculosis drugs, has been identified in 28 countries worldwide, with cases concentrated in the United States, Latvia and South Korea. In South Africa, the XDR strain has killed nearly 200 people since September, mainly HIV patients unable to fend it off. Raviglione said the strain could cause widespread deaths among those with HIV/AIDS, given their susceptibility to tuberculosis and the difficulty in treating it. "Either we intervene rapidly to stop the spread of this strain, or you could foresee in the future that this strain would replace the other one," he said. "That would make it practically uncontrollable."

SDI 07 Hardy/Mahoney/Repko 5 Week

35 Disease Core

***Hemorrhagic Disease [Ebola, etc.]***

SDI 07 Hardy/Mahoney/Repko 5 Week

36 Disease Core

Hemorrhagic Diseases [Ebola, etc.] Unsolvable


[ ] Cant solve for Ebola cultural practices cant be changed. Whitney Carlson, staff writer for The Daily Universe, BYU speaker lectures on global diseases, February 8, 2007 lexis [cl]
The second type of situation is new diseases that have been alive all along. These diseases include Ebola hemorrhagic fever, which has been an epidemic in the Democratic Republic of Congo. "It's one of the more ghastly diseases today," Yuill said. Cultural practices in the Congo, such as washing the body of the dead, even if it is covered in virus-infested blood, helped spread the Ebola disease, Yuill said. He also said it is difficult to change cultural practices, especially in rural areas where people do not understand that germs can cause diseases.

[ ] Ebola is hyped up as a pandemic but the risks of contracting it are low. Malcolm Gladwell, author and economist and staff writer for the New Yorker, The Threat of Infectious Diseases Has Been Overstated, July 24, 1995 opposing viewpoints [cl]
The great Pennsylvania chicken epidemic went largely unnoticed at the time. In 1983, people did not draw analogies between the health of domestic fowl and the health of the general public. But today is a different matter. The United States is in the grip of paranoia about viruses and diseases and what happened in Pennsylvania has acquired a certain symbolism. There has been a Hollywood film, a made-for-TV-movie, a cover story in Newsweek and countless news specials and media reports on the subject of killer viruses. In the spring of 1995, a small outbreak of the African Ebola virus in Zaire [now the Democratic Republic of the Congo] drew virtually every major news organization to the hitherto unknown city of Kikwit. Richard Preston's The Hot Zone, a terrifying tale of how close America came to a major epidemic of the Ebola virus in 1989, has been on The New York Times best-seller list for thirty-seven weeks [as of July 1995]. And a well-received tome about infectious disease has also arrived from Laurie Garrett, a science reporter for Newsday, which is filled with gloomy quotations like this one, from the Nobel Prize-winning biologist Joshua Lederberg: "Are we better off than we were a century ago? In most respects we are worse off. We have been neglectful of the microbes and that is a recurring theme that is coming back to haunt us."

[ ] Global warming will spread Ebola. Bruce Agnew, director of the Discovery Institute and graduate of Stanford and UC Berkeley, Global Warming Threatens World Health, published 2003 opposing viewpoints [cl]
Most scientists who have participated in recent climatological studies agree that global warming will affect the world's ecosystems and weather patterns. In addition, rising temperatures and increased precipitation are likely to have detrimental effects on human health. Extreme weather can cause injuries and deaths, interrupt food production, and contaminate water supplies. Changing climatic conditions might enable infectious tropical diseases such as malaria, encephalitis, and Ebola to spread into new geographical areas. Refugees fleeing from famine, rising sea levels, or weather-damaged regions could move into already crowded locales, straining public health and sanitation capabilities. The nations of the world must find ways to address these climate-related public health challenges.

SDI 07 Hardy/Mahoney/Repko 5 Week

37 Disease Core

Ebola = Very Very Very Bad


[ ] Ebola is one of the deadliest viruses. It liquefies your insides. There is no vaccine or cure. Malcolm Gladwell, author and economist and staff writer for the New Yorker, The Threat of Infectious Diseases Has Been Overstated, July 24, 1995 opposing viewpoints [cl]
African Ebola is one of the deadliest of known human viruses. It kills by clotting the blood of its victims, shutting off the flow of nutrients to key parts of the body and chewing through connective tissue, so that the infected literally cough their guts out. No one knows what animal serves as Ebola's natural host, but it can jump from species to species, from guinea pigs to humans, killing virtually everything it touches. There is no cure for Ebola. And there is no vaccine. On the three occasions that it has broken out among humanstwice in Zaire and once in the Sudanit has left behind a trail of death. Only once [as of 1995] has Ebola made its way to North America and that occasion is the basis of Richard Preston's The Hot Zone....

SDI 07 Hardy/Mahoney/Repko 5 Week

38 Disease Core

***Cholera***

SDI 07 Hardy/Mahoney/Repko 5 Week

39 Disease Core

Cholera = Drug Resistant


[ ] Cholera mutates and becomes resistant to previously-effective drugs. World Health Organization, Antibiotic-Resistant Infectious Diseases Are a Major Threat, published 2005
opposing viewpoints [cl] From that first case of resistant staphylococcus, the problem of antimicrobial resistance has snowballed into a serious public health concern with economic, social and political implications that are global in scope and cross all environmental and ethnic boundaries. Multi drug-resistant tuberculosis (MDR-TB) is no longer confined to any one country or to those co-infected with HIV, but has appeared in locations as diverse as eastern Europe, Africa and Asia among health care workers and in the general population. Penicillin-resistant pneumococci are likewise spreading rapidly, while resistant malaria is on the rise, disabling and killing millions of children and adults each year. In 1990, almost all cholera isolates gathered around New Delhi (India) were sensitive to cheap, first-line drugs furazolidone, ampicillin, cotrimoxazole and nalidixic acid. Now, 14 years later, formerly effective drugs are largely useless in the battle to contain cholera epidemics. continued The bacteria that cause cholera and typhoid are also revealing the ease with which they acquire resistance. In treating people with cholera, fluid replacement is paramount, but antibiotics (especially tetracycline) play an important public health role in limiting the spread of epidemics. Salmonella typhilike shigella,is adept at accumulating cassettes of resistance genes, producing strains that withstand fast-line, second-line and now, third-line drugs. Up until 1972, chloramphenicol was the treatment of choice for typhoid fever throughout much of the Indian subcontinent. By 1992 two-thirds of reported cases were chloramphenicol-resistant, thereby necessitating treatment with expensive quinolones that are themselves losing effectiveness. Without proper treatment, typhoid is a serious and frequently relapsing disease that kills up to 10% of those infected.

[ ] Cholera treatments must include fluid replacements or patients die just providing [insert the solvency mechanism] wont solve.

SDI 07 Hardy/Mahoney/Repko 5 Week

40 Disease Core

Cholera = Solvable
Cholera is easily treated. David Perlin, Ph.D. and president/scientific director of the Public Health Research Institute, and Ann Cohen,
professor, Cholera, Scourge of the Poor, published 2002, http://www.infoplease.com/cig/dangerous-diseasesepidemics/cholera-scourge-poor.html [cl] Positive diagnosis of cholera requires identification of the bacteria from stool specimens. Fortunately, cholera can be successfully treated by rapid oral or intravenous fluid and electrolyte replacement. Antibiotic therapy can shorten the duration of the disease but does not affect the severity of an attack. Areas without a safe water supply and good sanitation are at most risk for epidemic cholera. The key to preventing its spread is limiting the growth and survival of the organism that causes it. Outbreaks can be minimized by educating the public about food and water safety, the importance of hand-washing, and the need to use toilets. When an epidemic of cholera occurs, however, total cases and deaths can be reduced by early detection and rapid initiation of treatment and control methods. Cholera epidemics are unpredictable and may recur in either the rainy or dry season. Fortunately, immunity gained from having an infection before protects a person against cholera reinfection.

[ ] Cholera is easily solved for it isnt the disease thats the problem, its the infrastructure. To successfully solve for cholera, improving the infrastructure and distribution of treatment in Africa is key.

SDI 07 Hardy/Mahoney/Repko 5 Week

41 Disease Core

***Miscellaneous Diseases***

SDI 07 Hardy/Mahoney/Repko 5 Week

42 Disease Core

Sleeping Sickness Already Solved


[ ] Researchers have discovered how to kill the parasite responsible for sleeping sickness. United Press International, news service, Put sleeping sickness bug to sleep, March 9, 2007 lexis [cl]
An Israeli researcher has found a way to kill the parasite that causes sleeping sickness. Triggering a pathway in the parasites can shut down production of a crucial molecule, killing the T. burcei parasite, Shulamit Michaeli of Bar-IIan University said in research published online in EMBO Reports. Sleeping sickness is endemic in sub-Saharan Africa, where it's estimated to affect as many as 70,000 people. It can cause skin lesions, fever, blindness and death. Researchers said the pathway could be used to eradicate other parasites and diseases, including Chagas disease, which affects 16 million to 18 million people, EMBO Reports said.

Tsetse Fly Solvable


[ ] Even minor offense creates a chain reaction that eliminates the tsetse fly. Cattand et al, a WHO contact and president of the Association Against Trypanosomiasis in Africa, Tropical
Diseases Lacking Adequate Control Measures: Dengue, Leishmaniasis, and African Trypanosomiasis, March 3, 2006, http://files.dcp2.org/pdf/DCP/DCP23.pdf [will found the page, cl] Tsetse flies have an unusual life cycle. An inseminated female nurtures the egg and larva in her uterus, depositing the mature larva on the ground, where it burrows and pupates. Thus, each female produces only one offspring at a time. She produces up to 12 during her two- to three-month adult life span. The intrinsic population growth rate is low. Even small increases in average daily mortality rates can cause population decline, even to extinction. continued For African trypanosomiasis, however, the prospects for sustainable vector control are more promising. The vectors low reproductive rate, combined with its extreme sensitivity to ultra-low doses of biodegradable insecticides, put tsetse flies among the most promising candidates for large-scale elimination. Campaigns against tsetse flies during the past century were invariably successful until they were discontinued and the controlled areas became reinvaded. Thus, the operational issue is to design large-scale international programs that can successively eliminate tsetse populations and prevent reinvasion of controlled areas, as contemplated by the African Unions Pan African Initiative.

SDI 07 Hardy/Mahoney/Repko 5 Week

43 Disease Core

***General Disease***

SDI 07 Hardy/Mahoney/Repko 5 Week

44 Disease Core

Viruses Extinction
[ ] It is functionally impossible for a virus to cause extinction if the virus is that deadly it skews the balance of sickness and healthiness needed in the host and eventually eradicates itself. The Boston Globe, Crossing the species barrier: from AIDS to Ebola, our most deadly diseases have made the leap from animals to humans, April 29, 2003,
http://www.conservationmedicine.org/news/boston_globe_2003.htm [cl] But then the virus did something that viruses are typically loathe to do: It made people so sick that many died, taking the virus with them. Usually, viruses aim to strike a survival balance in the organisms they infect: They want a home, and they want to rule it, but they don't want to destroy it. In humans, Nipah caused encephalitis, killing half of the people who developed symptoms and infecting them in such a way that the virus was unable to jump from one human to another. "For some reason, the Nipah virus didn't like the human host in the long term," said Dr. George Saperstein, chairman of the Department of Environmental and Population Health at the Tufts University School of Veterinary Medicine. "It didn't find a mechanism to survive along with the host or a reservoir to hide out between outbreaks."

[ ] Forcing the virus to mutate rapidly drives it to extinction we can solve. Cedars-Sinai Medical Center, Virus driven to extinction with cancer drug, September 6, 2002,
http://www.vetscite.org/publish/items/000801/index.html [cl] For decades, scientists have tried to figure out how to stop viruses from spreading. Their efforts have led to the development of drugs that can help to slow the spread of some infections and diseases such as AIDS by preventing viruses from reproducing. But because viruses' genetic machinery has the ability to replicate and mutate so quickly, viruses rapidly become resistant to individual anti-viral drugs. Thus, the effectiveness of these drugs is very limited. Now, researchers currently at Cedars-Sinai Medical Center, and the Universidad Autonoma de Madrid, in Spain, report that treating a common virus with a mutation-causing cancer drug caused the virus to mutate so much that it was no longer able to reproduce and was driven to extinction. The findings, reported in the current issue of the Proceedings of the National Academy of Sciences (PNAS), and preceded by a Commentary by Nobel-Prize winning Professor Manfred Eigen from the Max Planck Institut fr biophysikalische Chemie, Gttingen, Germany, may ultimately lead to new ways to treat and eliminate viral infections. "We found that a specific chemical mutagen caused the virus to mutate so much that the replication process was ultimately aborted," said Pedro Lowenstein, M.D., Ph.D., Director of the Board of Governor's Gene Therapeutics Research Institute at Cedars-Sinai Medical Center. "These findings, may lead, in the future, to ways to stop viruses from reproducing in humans in the same way." continued But for viruses to reproduce and spread, they must make many copies of their genetic material. In RNA viruses, such as those discussed here, this process occurs when a viral enzyme reads the sequence of the viruses' genome within the host cell and transcribes it into a complementary RNA or DNA sequence. Yet, the process is error-prone, as mistakes occur during replication when the genome sequence is read and transcribed, resulting in mutations in the viral genome.

SDI 07 Hardy/Mahoney/Repko 5 Week

45 Disease Core

Disease/Pandemics Inevitable
[ ] Pandemics are inevitable. Frank Ryan, a Fellow of the Royal College of Physicians, Virus X: Tracking the New Killer Plagues Out of the Present and Into the Future, published 1997
Joshua Lederbergs prediction can now be seen to be an altogether logical one. Pandemics are inevitable. Our incredibly rapid human evolution, or overwhelming global needs, the advances of our complex industrial society, all have moved the natural goalposts. The advance of society, the very science of change, has greatly augmented the potential for the emergence of a pandemic strain. It is hardly surprising that Avrion Mitchison, scientific director of Deutsches Rheuma Forschungszentrum in Berlin asks the question: Will we survive?

[ ] Disease is inevitable contaminated vaccines prove. Leonard G. Horowitz, author, Contaminated Vaccines Threaten Public Health, published 2003 opposing
viewpoints [cl] The current proliferation of unusual cancers and autoimmune illnesses is the result of large populations being inoculated with vaccines that are known to be contaminated. For example, the oral polio vaccine (OPV) is prepared in monkey kidney tissues that often contain contaminants such as herpes, the Epstein-Barr virus, and other immune-suppressing agents. This vaccine has been given to more than 100 million people around the world. Moreover, twentieth-century research into developing biological weapons and anticancer vaccineswhich entailed recombining various animal viruses may have resulted in AIDS and AIDS-related illnesses. The Food and Drug Administration does not share this information with the public due to binding nondisclosure agreements it has with the pharmaceutical industry.

SDI 07 Hardy/Mahoney/Repko 5 Week

46 Disease Core

Mutations = Bad
[ ] The capacity of pathogens to mutate is devastating. Frederick C. Robbins, winner of the Nobel Prize in Physiology or Medicine, The microbes strike back, May/June 1996 opposing viewpoints [cl]
Recently there has been considerable attention given to the subject of so-called emerging infections, of which AIDS is the most dramatic. The list includes the Ebola, Lassa and Marburg virus infections, Legionnaires' disease, Lyme disease and a variety of hemorrhagic viral diseases, among others. The term also refers to infections due to agents long recognized as infections of man - for example, the increased incidence of rapidly progressing necrotic lesions due to the group A streptococcus, the so-called "flesh-eating" bug, which normally causes sore throat (strep throat) but rarely sepsis, pneumonia or other serious infections. The capacity for microbes to mutate has greatly complicated efforts to control them. A classic example is the influenza virus, which alters its immunologic profile in response to the development of immunity in the population, with major shifts occurring at about 10-year intervals. There may also be a change in virulence, as in the influenza pandemic of 1918, which killed millions of people throughout the world. The capacity to mutate also results in antibiotic resistance in bacteria. The recent plague of multi-drug-resistant tubercle bacilli is largely responsible for a resurgence of tuberculosis - particularly devastating in patients with HIV infection, in whom it is often the terminal event.

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