B. Lee Ligon

Reemergence of an unusual disease: the chikungunya epidemic.

Since the beginning of 2006, a crippling mosquito-borne disease has shown an explosive emergence in nations in the Indian Ocean area. By March 7, 2006, 157,000 people had been infected in the French island La Réunion, and the disease had spread to the islands of Seychelles, Mauritius, and Mayotte (French). Subsequently, the disease appeared in India, China, and European countries. The World Health Organization is taking measures to assist in fighting the epidemic. This article describes the disease, its recent emergence, and the current epidemic.

Monkeypox: A review of the history and emergence in the Western hemisphere

A mysterious disease was reported on May 24, 2003, when the Wisconsin Division of Public Health (DPH) received notice of a 3-year-old girl who had been hospitalized in central Wisconsin with cellulites and fever after being bitten by a prairie dog on May 13. The laboratory isolated a gram-negative bacillus, raising concerns that it might be tularemia or plague; ultimately, it was identified as an acinetobacter species and was considered to be a contaminant. Because no other such cases were reported at the time, the case was thought to be merely an isolated event. However, within two weeks, on June 2, 2003, evidence of a much wider scenario began to emerge. On that date, the Wisconsin DPH received notice from the Marshfield Laboratory that the mother of the first patient had become ill on May 26 and that electron-microscopic evidence of a poxvirus was found in a skin lesion. On that same day, another report, this time from the Milwaukee Health Department, of a strange illness was received at the DPH and described the case of a meat inspector who resided in southeastern Wisconsin and also was a distributor of exotic animals. By July 30, 2003, 72 confirmed or suspected cases of monkeypox had been reported in Wisconsin, Illinois, and Indiana and represented a large outbreak. The peak in the onset of illness occurred between May 29 and June 9, 2003, and no further cases of illness have been reported in humans since June 22, 2003. Traceback investigations from the child and other patients followed the route of introduction of monkeypox into Wisconsin to a distributor in Illinois, who had received a shipment of exotic animals imported into the United States through Texas from Ghana, West Africa.

Outbreak of Marburg hemorrhagic fever in Angola: a review of the history of the disease and its biological aspects.

Transmission of a dangerous infectious disease threatens not merely a local population but the world at large as the result of immigration and increased and faster travel. Any outbreak elicits considerable concern and demands that various precautionary methods be instituted and that the disease be contained as quickly as possible. Recently, an old disease, one that may have been present for centuries and was identified decades ago, reared its ugly head, killing more than 200 people before it was contained. Fortunately, the disease, Marburg hemorrhagic fever, was limited to a small geographic area, but the devastation of lives was much greater than that of many epidemics and was a warning of the numerous factors, including fear, lack of understanding, and deception, that can exacerbate the spread of disease and hinder implementation of restraints. This article reviews the history of the disease caused by Marburg virus and its biological components.

Caring for Evacuated Children Housed in the Astrodome: Creation and Implementation of a Mobile Pediatric Emergency Response Team: Regionalized Caring for Displaced Children After a Disaster

REPARATION: LONG-TERM RESCUE AND DISASTER-RELIEF STRATEGIES: Located only 50 miles from the Gulf Coast and Galveston, Houston, Texas, is familiar with the challenges posed by hurricanes, tropical storms, and flooding. The hospitals of Houston and Harris County are no strangers to the aftermath of such natural disasters, themselves being victims of massive damage in 2001, when the entire Houston downtown area and Texas Medical Center complex, as well as a great portion of the city, were severely damaged by unexpected and unprecedented flooding in the wake of Tropical Storm Allison. City, county, and hospital officials are ever mindful of the need to learn lessons from the past and to have disaster-relief plans in effect. Texas Childrens Hospital (TCH), in particular, has participated in numerous citywide disaster drills and is well prepared to deal with many types of disasters that may occur within its region. Indeed, the TCH emergency center (TCHEC) alone evaluates more than 80000 children per year and serves a large populous and a large geographic area. Hence, it is poised for participation in any large disaster-relief effort. Beginning on Friday, August 26, 2005, area officials and rescue and disaster-relief mechanisms were about to be tested. In the aftermath of Hurricane Katrina, Houston was faced with the sudden arrival of thousands of people, many in need of medical care. Although officials had prepared in advance for this event, a lack of pediatric provider involvement was associated with woefully inadequate strategies for providing emergency medical care for thousands of children and adolescents. The eye of Hurricane Katrina made landfall at 6:10 am and crossed the wetlands/barrier islands between New Orleans, Louisiana, and the Gulf of Mexico. By 9:00 am, officials learned that the lower Ninth Ward levee had failed to restrain the rising water of Lake Pontchartrain and that … Address correspondence to Paul Sirbaugh, DO, FAAP, Texas Childrens Hospital, Emergency Medicine Department, 6621 Fannin St, Houston, TX 77030. E-mail: sirbaugh{at}bcm.tmc.edu

Severe acute respiratory syndrome (SARS): a review of the history, epidemiology, prevention, and concerns for the future

Abstract During the first part of 2003, the world experienced the first epidemic of the 21st century with the emergence of a new and readily transmissible disease. The disease, severe acute respiratory syndrome (SARS), spread quickly and caused numerous deaths, as well as public panic. This article provides a brief review of the initial history of the epidemiology, as well as of the clinical definition, occurrence in the pediatric population, etiology, prevention, drug studies, and considerations for the future.

The Gender Medicine Team: “It Takes a Village”

Marni E. Axelrad, PhD*, Jonathan S. Berg, MD, Leslie Ayensu Coker, MD, Jennifer Dietrich, MD, MSc, FACOG, Lisa Adcock, MD, Shannon L. French, MD, Sheila Gunn, MD, B. Lee Ligon, PhD, Laurence B. McCullough, PhD, V. Reid Sutton, MD, Lefkothea P. Karaviti, MD, PhD Pediatric Service, Texas Children’s Hospital, Houston, TX 77030, USA Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA Neonatology Section, Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA Pediatrics-Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA

Joshua Lederberg, PhD: Nobel Laureate, Geneticist, and President Emeritus of the Rockefeller University

In 1958, the Nobel Prize in Physiology or Medicine went to a young man of 33 years of age for his discovery that bacteria reproduce by the mutual exchange of genes and that some viruses carry hereditary materials from one bacterial cell to another. Rather than rewarding the culmination of an individuals career, the Prize represented only the beginning of a long, fruitful, and varied one. The recipient was Dr Joshua Lederberg, whose lifelong research activity has been in the field of genetic structure and function in microorganisms. He went on to become President of Rockefeller University and a vital force in the development of computer technology and policies concerning scientific issues associated with space exploration. In addition to the Nobel Prize and the National Medal of Science, Lederberg has been awarded numerous honorary Doctor of Science and Medical Doctor degrees, as well as the LLD from the University of Pennsylvania. He has been awarded a Foreign Membership of the Royal Society, London, and he holds the rank of Commandeur in the Ordre des Arts et des Lettres of the French Republic. In February 1997, he received the Maxwell Finland Award of the National Foundation for Infectious Diseases. He is an honorary life member of the New York Academy of Medicine and received its John Stearns award for 1996. He is a past chairman and now honorary life governor of the New York Academy of Science. This article provides an overview of Dr Lederbergs life, and in doing so seeks to capture the rich thread of moral and ethical fiber and the deep concern for humanity and the environment that characterize his emphases, products no doubt of the spiritual heritage imparted to him by his devout rabbi father and mother.

Immunization for Haemophilus influenzae type b: Effects on mortality and morbidity in children under five years of age

Haemophilus influenzae is a small gram-negative pleomorphic coccobacillus. The H influenzae type b (Hib) strain is especially important because, prior to the advent of effective Hib vaccines, the organism was the cause of 95% to 98% of severe invasive infection, including meningitis, epiglottitis, cellutitis, sepsis, pneumonia, and osteomyelitis, in children less than 5 years of age. An important microbiologic feature of H influenzae is its development of resistance to a wide variety of antibiotics, including sulfonamides, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, and penicillin. Ampicillin resistance is now widespread, ranging between 5% and 40% of all isolates in various parts of the world. The current mainstays of treatment are third-generation cephalosporins, but the potential for increased resistance to them, as well as other factors, has underscored the need for prophylactic measures. Since the early 1970s, when the capsular polysaccharide of Hib was purified, characterized, and shown to be immunogenic, tremendous strides have been made worldwide to immunize children against the organism and to irradicate the bacteria. A steady decline in the incidence of Hib diseases has occurred since the introduction in 1990 of Hib conjugate vaccines for infants. Because of this rapid decline, Hib diseases among children less than 5 years of age is targeted for elimination in the United States. This article provides an overview of the discovery and characterization of the organism and a review of the literature on the impact that the Hib vaccines have had on morbidity and mortality rates among children less than 5 years of age.

Robert M. Chanock, MD: A Living Legend in the War Against Viruses

Human respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory tract viral disease of infants and children worldwide, accounting for approximately 91,000 hospitalizations of infants each year in the United States alone, at a cost of 300 million dollars, and 1 million deaths worldwide, including 4,500 in the United States. Following experiences of Morris and colleagues with a 1956 outbreak of coryza in a colony of chimpanzees and work with Finberg, Dr Robert M. Chanock first identified and characterized RSV. Subsequently, he discovered the four parainfluenza viruses. Chanock made these discoveries while he was Head of the Respiratory Virus Section of the Laboratory of Infectious Diseases (LID). In 1968, Chanock became Chief of the LID, a position he holds to this day. This article provides a brief history of the LID and presents highlights of Chanocks early personal life; his training and preparation under Albert Sabin; and his career at LID: the early years, Head of the RVS, and Chief of LID. It also summarizes the many discoveries and advances made by Chanock and other scientists working with him. These include, in addition to those noted above, a vaccine for adenovirus 4 infection, Mycoplasma pneumoniae , gastroenteritis viruses, rotavirus vaccine hepatitis, and recent progress toward a RSV vaccine. Although Robert Chanocks recognition is far too extensive to detail, several outstanding awards, as well as comments of colleagues, are noted: Squibb Award for General Excellence in the Field of Infectious Diseases (1969), National Academy of Sciences (1973), Danish Royal Academy of Sciences (1980), Robert Koch Medal of the Robert Koch Foundation (Bonn, Germany) (1981), ICN International Prize in Virology (1990), Squibb Award for Distinguished Achievement in Infectious Disease Research (1993), Albert B. Sabin Gold Medal (1995).

Creating a medical education enterprise: leveling the playing fields of medical education vs. medical science research within core missions

ABSTRACT Background: Unlike publications of medical science research that are more readily rewarded, clinician-educators’ scholarly achievements are more nebulous and under-recognized. Objective:Create an education enterprise that empowers clinician-educators to engage in a broad range of scholarly activities and produce educational scholarship using strategic approaches to level the playing fields within an organization. Design: The authors analyzed the advantages and disadvantages experienced by medical science researchers vs. clinician educators using Bolman and Deal’s (B&D) four frames of organization (structural, human resource, political, symbolic). The authors then identified organizational approaches and activities that align with each B&D frame and proposed practical strategies to empower clinician-educators in their scholarly endeavors. Results: Our medical education enterprise enhanced the structural frame by creating a decentralized medical education unit, incorporated the human resource component with an endowed chair to support faculty development, leveraged the political model by providing grant supports and expanding venues for scholarship, and enhanced the symbolic frame by endorsing the value of education and public recognition from leaderships. In five years, we saw an increased number of faculty interested in becoming clinician-educators, had an increased number of faculty winning Educational Awards for Excellence and delivering conference presentations, and received 12 of the 15 college-wide awards for educational scholarship. These satisfactory trends reflect early success of our educational enterprise. Conclusions: B&D’s organizational frames can be used to identify strategies for addressing the pressing need to promote and recognize clinician-educators’ scholarship. We realize that our situation is unique in several respects, but this approach is flexible within an institution and transferable to any other institution and its medical education program. Abbreviations: B&D: Bolman and Deal; CRIS: Center for Research, Innovation, and Scholarship; OOR: Office of Research