St Louis encephalitis arrives in New York City fficials in the New York City Department of Health are investigating the first cases of St Louis encephalitis to be reported in the city. As of Sept 7, the disease had been serologically confirmed in five patients. Two of these patients, aged 80 and 87 years, have died. Nearly 40 additional case reports are being investigated.
New Yorkers on alert for mosquitos
The original cluster of three patients with unusual neurological findings was reported on Aug 23 to the city health department by an infectious-disease specialist at a local hospital in the borough of Queens. While these cases were being assessed, another three cases were reported from the same hospital and
a neighbouring hospital. The outbreak continues to be centred in Queens, but nearly half of the suspected cases are from the boroughs of Manhattan and the Bronx. Immediately after case confirmation, the city began a targeted public-education campaign in which 150 000 leaflets and 17 000 cans of insect repellent were distributed to residents in the affected neighbourhoods. In addition, the city has instigated a massive mosquito control campaign involving aerial and ground spraying with the insecticides malathion and pyrethroid. State and federal health authorities are assisting in these efforts. As yet the source of the outbreak is unknown. Health officials suspect that one or more infected migratory bird species may have introduced the arbovirus responsible for St Louis encephalitis into local bird and Culex pipiens mosquito populations. The authorities in New York City and in surrounding counties have increased encephalitis surveillance, mosquito trapping, and arbovirus testing in response to the outbreak.
News in brief Dyslexia gene The heterogeneity of dyslexia was confirmed this week with the localisation of a second gene for dyslexia (J Med Genet 1999; 36: 664–69). A gene on chromosome 6 was previously linked to dyslexia, but studies in a large Norwegian family, in which dyslexia is inherited as an autosomal dominant trait, now implicate a second gene on chromosome 2. A genetic test to identify children at high risk of dyslexia would allow remedial therapy to be started early when the language areas of the brain are at a plastic stage of development, explain the authors. Hold the knife Adenoidectomy or adenotonsillectomy should not be first-line treatments for children with recurrent acute otitis media, say Jack Paradise (Children’s Hospital of Pittsburgh, PA, USA) and colleagues. The authors base their assertion on the results of two randomised trials in which they tested the efficacy of the operations. “Our study showed limited and short-term efficacy” of both operations, and “given the risks, morbidity, and costs of these procedures”, neither should be the first surgical intervention in recurrent ear infection (JAMA 1999; 282: 945–53).
David H Frankel
Low-dose thalidomide seems to be effective in multiple myeloma
halidomide given at relatively low, tolerable doses reduces tumour burden in patients with relapsing or progressing multiple myeloma, according to results presented at the International Myeloma Workshop last week (Sept 1–5, Stockholm, Sweden). “Nothing untoward happened in the way of side effects”, says lead investigator Brian Durie (Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA). “Thalidomide is working well enough now for us to think about using it as a first or second-line treatment”, rather than as a last resort. At the meeting, Durie presented data from an ongoing, open-label phase II study in which patients were given 50–400 mg thalidomide daily for a minimum of 8 weeks. Eight of 24 (24%) patients responded, some for up to 6 months; nine patients could not tolerate the drug. Side-effects
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included somnolence, tremor, confusion, dizziness, nausea, bone pain, rash, and constipation. The findings are consistent with those of an earlier study, adds Durie. A formal dose finding study is now underway which will also investigate whether responders to low doses of drug are any different from non-responders. “Progress in the treatment of multiple myeloma over the past two decades has really been minimal. From that standpoint, these findings would have to be considered quite encouraging”, says Harmon Eyre of the American Cancer Society. The incidence of multiple myeloma is increasing in younger age groups, and up to 15% of patients are now younger than 45 years old, adds Susie Novis of the International Myeloma Foundation (IMF; http://www.myeloma.org). “Having a relatively non-debilitating and non-invasive option for
therapy could enable patients and their families to stay together longer as a healthy, functioning unit”, she says. “We’re excited, but given the history of thalidomide, quite worried, as well”, observes Eric Low, head of IMF’s UK affiliate. UK trials of thalidomide in multiple myeloma have been recruiting easily, he adds, but the exact doses patients are taking isn’t clear. “There is tremendous variability. Physicians basically are giving as high a dose as the person can tolerate. My hope is that now people will start receiving lower doses.” Low is also concerned that many UK patients are receiving thalidomide outside clinical trials. “The only way to work out the most appropriate and effective dose to give, and in what patients it should be given, is in an official clinical trial”, he asserts. Marilynn Larkin