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2 September 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Treating Older Adults for Flu Is Cost-Effective,
But Preventing It With a Yearly Flu Shot Is Better

This article is the subject of a video news release. Call for coordinates.

Criteria for Mass Screening for Anthrax After a Bioterrorist Attack

A study of recorded symptoms of 28 patients with inhalational anthrax and 4,694 patients with viral respiratory illnesses found that fever and cough were common in both infections (Article, p. 337). Mental confusion or loss of consciousness, shortness of breath, and nausea and vomiting more often indicated anthrax, while sore throat and runny nose more often indicated viral infection. After a large-scale bioterrorist attack, mass screening based on the criteria identified in this study could aid in rapidly identifying patients who might have inhalational anthrax in a situation in which timely treatment is essential and laboratory or radiographic testing would be difficult.

Preventing Infectious Diseases During and After International Adoption

International adoption can put family members at risk for acquiring diseases carried by the new child (Review, p. 371). This article reviews infectious diseases in adopted children and their potential for transmission. Adoptive families should prepare by updating routine immunizations, getting vaccines for hepatitis B, and possibly hepatitis A. Adoptive parents must consider the destination, prevalence of disease in the adopted child's country and the child's health status.

New Study of Hong Kong SARS Patients Finds Higher Death Rate

(This early-release article is available online at at 5 p.m. EDT, Tuesday, September 2. It will appear in a later print edition of Annals.)

A study of 267 patients with probable (40 cases) or confirmed (227 cases) SARS admitted to a Hong Kong hospital followed patients for three months after first hospitalization and found that 32 patients (12 percent) died, a higher mortality rate than in earlier reports. While all died of respiratory failure, some deaths were complicated by kidney failure (44 percent), related infections (19 percent) or septicemia (25 percent). The Hong Kong case definition differed from that of the WHO and CDC in not requiring presence of respiratory symptoms for diagnosis, but 13 percent of patients in the study did not enter with respiratory symptoms, so the researchers call for refinement of case definition as well as for a quick, reliable diagnostic test.

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