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Dr.Urbani
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SARS and Carlo Urbani

Brigg Reilley, M.P.H., Michel Van Herp, M.D., M.P.H., Dan Sermand, Ph.D., and Nicoletta Dentico, M.P.H.

http://content.nejm.org/cgi/content/full/348/20/1951


On February 28, the Vietnam French Hospital of Hanoi, a private hospital of about 60 beds, contacted the Hanoi office of the World Health Organization (WHO). A patient had presented with an unusual influenza-like virus. Hospital officials suspected an avian influenzavirus and asked whether someone from the WHO could take a look. Dr. Carlo Urbani, a specialist in infectious diseases, answered that call (Figure). In a matter of weeks, he and five other health care professionals would be dead from a previously unknown pathogen.

We now know that Hanoi was experiencing an outbreak of severe acute respiratory syndrome (SARS). Dr. Urbani swiftly determined that the small private hospital was facing something unusual. For the next several days, he chose to work at the hospital, documenting findings, arranging for samples to be sent for testing, and reinforcing infection control. The hospital established an isolation ward that was kept under guard. Dr. Urbani worked directly with the medical staff of the hospital to strengthen morale and to keep fear in check as SARS revealed itself to be highly contagious and virulent. Of the first 60 patients with SARS, more than half were health care workers. At a certain moment, many of the staff members made the difficult decision to quarantine themselves. To protect their families and community, some health care workers put themselves at great personal risk, deciding to sleep in the hospital and effectively sealing themselves off from the outside world.

In some ways, the SARS outbreak in Hanoi is a story of what can go right, of public health\'s coming before politics. First-line health care providers quickly alerted the WHO of an atypical pneumonia. Dr. Urbani recognized the severity of the public health threat. Immediately, the WHO requested an emergency meeting on Sunday, March 9, with the Vice Minister of Health of Vietnam. Dr. Urbani\'s temperament and intuition and the strong trust he had built with Vietnamese authorities were critical at this juncture. The four-hour discussion led the government to take the extraordinary steps of quarantining the Vietnam French Hospital, introducing new infection-control procedures in other hospitals, and issuing an international appeal for expert assistance. Additional specialists from the WHO and the Centers for Disease Control and Prevention (CDC) arrived on the scene, and Médecins sans Frontières (MSF, or Doctors without Borders) responded with staff members as well as infection-control suits and kits that were previously stocked for outbreaks of Ebola virus. The Vietnam French Hospital has been closed temporarily, and patients with SARS are cared for in two wards of the public Bach Mai Hospital, with the assistance of a team from MSF. No new cases in health care workers have been reported, and the outbreak in Vietnam appears to be contained. By dealing with the outbreak openly and decisively, Vietnam risked damage to its image and economy. If it had decided to take refuge in secrecy, however, the results might have been catastrophic.

Dr. Urbani would not survive to see the successes resulting from his early detection of SARS. On March 11, he began to have symptoms during a flight to Bangkok. On his arrival, he told a colleague from the CDC who greeted him at the airport not to approach him. They sat down at a distance from each other, in silence, waiting for an ambulance to assemble protective gear. He fought SARS for the next 18 days in a makeshift isolation room in a Bangkok hospital. Dr. Carlo Urbani died on March 29, 2003.

SARS is a pandemic of our global age. In just a few weeks, SARS had spread through air travel to at least three continents. Conversely, in the same amount of time, researchers working in no fewer than 10 countries have collaborated to identify the virus, sequence its genome, and take steps toward rapid diagnosis. It is now hoped that the large strides taken in basic research will quickly lead to therapeutic advances or a vaccine.

Health care workers continue to be on the front line. Apart from the index patient, all the patients in the Vietnamese outbreak who died were doctors and nurses. In Hong Kong, approximately 25 percent of patients with SARS have been health care professionals, including the chief executive of the hospital authority. The intensive care wards are full — a situation that is exacerbated by the staffing difficulties presented by the hundreds of SARS cases affecting medical personnel. It is becoming difficult to import additional infection-control equipment, since countries where the suits are manufactured are holding onto their stocks as they brace themselves for outbreaks of SARS within their own borders. Once effective drug therapy has been found, similar problems may arise with availability and distribution, especially if the effective treatment turns out to involve a relatively rare and expensive drug, such as ribavirin.

It remains to be seen whether the number of new SARS outbreaks will ebb or whether what we have seen to date is indeed the leading edge of a much larger pandemic. Currently, the attack rate in Hong Kong is approximately 2 cases per 10,000 population over the course of two months. This rate compares favorably with the seasonal attack rates of influenza-like illness, which reached 50 cases per 10,000 population in one week this winter in Europe.

In 1999, Dr. Urbani was president of MSF–Italy and a member of the delegation in Oslo, Norway, that accepted the Nobel Peace Prize. Although he would be gratified that so much has been accomplished with respect to SARS in such a short time, he would certainly point out that the other diseases he worked with — such as the human immunodeficiency virus and AIDS, tuberculosis, and malaria, which kill millions of people each year — deserve to be treated with similar urgency. Whatever the future direction of SARS, it is clear that Dr. Urbani\'s decisive and determined intervention has bought precious time and saved lives. We remember Dr. Urbani with a mixture of pride in his selfless devotion to medicine and unspeakable grief about the void his departure has left in the hearts of his colleagues around the world.



Source Information

From Médecins sans Frontières (Doctors without Borders) U.S.A. (B.R.), Belgium (M.V.H.), Vietnam (D.S.), and Italy (N.D.)

***********************************************************************************

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http://en.wikipedia.org/wiki/Carlo_Urbani

Carlo UrbaniCarlo Urbani (Castelplanio, Italy October 19, 1956 – Bangkok, Thailand March 29, 2003) was an Italian physician and the first to identify severe acute respiratory syndrome (SARS) as a new and dangerously contagious disease. His early warning to the World Health Organization (WHO) touched off a massive response that probably helped save the lives of millions of people around the world.

In 2003, Urbani was called in to The French Hospital of Hanoi to look at patient Johnny Chen, an American businessman who had fallen ill with what doctors thought was a bad case of the flu. Urbani realized that Chen did not have the flu, but that what he did have was probably new and highly contagious. Urbani immediately notified WHO, triggering the most effective response to a major epidemic in history. Urbani persuaded the Vietnamese Health Ministry to begin isolating patients and screening travelers, thus slowing the early pace of the epidemic. On March 11, he flew from Hanoi to a conference in Bangkok, Thailand and fell ill with SARS while on the plane. A colleague who met him at the airport called an ambulance. After 18 days of intensive care in a Bangkok hospital, his wife only able to speak to him through an intercom, Urbani died at the age of 46.

Urbani received his medical degree from the University of Ancona and worked for a time as a general practitioner, before starting a career in infectious diseases. He was a past president of the Italian chapter of Médecins Sans Frontières and was one of the individuals who accepted the 1999 Nobel Peace Prize on behalf of that organization. He was employed by the World Health Organization and based in Hanoi, Vietnam, where he mainly worked on combatting parasitic diseases, but was generally expert on infectious diseases. He was married and had three children.

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共有1条评论
1   [USMedEdu 于 2009-04-19 07:54:03 提到] [FROM: 10.]
发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: 歐巴尼醫師的傳奇
发信站: BBS 未名空间站 (Sun Apr 19 05:16:22 2009)


醫師也可以得到和平獎—歐巴尼醫師的傳奇

卡羅˙歐巴尼醫師傳奇出版了。這位最先發現SARS並為之捐軀的醫師現在已經家喻戶曉
、舉世聞名,作為一個公共衛生醫師,同時也是SARS受害者,讀了歐巴尼醫師傳奇後,
不能不感同身受,不能不有感而發。

歐巴尼醫師在尚未因SARS犧牲前,並非默默無名,他曾在1999年以『無疆界醫生組織』
主席的身份,在奧斯陸領取當年的「諾貝爾和平獎」。當時我任職疾病管制局局長,曾
寫了一封信向他們道賀,表達敬意及支持,他們也親切回信。在此之前,當我作台北市
衛生局局長時,曾贊助過『無疆界醫師組織』的攝影展,當時展出這些醫師在照顧不幸
的人的一些畫面,令人望之落淚。台灣醫界聯盟基金會也曾協助要訓練一些『無疆界醫
生』,可惜當年沒有一個人報名。這也就是為什麼後來我會提倡延後服國防役,希望醫
學生畢業後能選擇海外衛生外交役,並延後三年,待完整訓練包括熱帶醫學訓練後才開
始服役。一方面訓練較成熟,也較能自我保護,一方面拓展眼界,又無主治醫師安定後
怕病人流失之疑慮。台灣沒有『無疆界醫師組織』的分部,一直是我心中之憾,看到他
們得到諾貝爾獎,非常高興。

歐巴尼領的不是醫學獎,而是和平獎。歐巴尼眼中的醫學及研究不是高貴高薪的醫學,
而是服務患者、弱者的工具。他說:『醫生不只是醫病,而是醫人,是要把病患所有的
問題都承擔下來,不但要恢復他的健康,更要恢復他做人的尊嚴與活下去的慾望』。因
此,他要去有需要的地方,不是要坐在辦公室作高貴的研究。他的偶像是史懷哲,他挺
身對抗藥商、政客,他甚至批評其他的非官方組織,最後,『無疆界醫生組織』得到世
人的肯定。歐巴尼在頒獎典禮上說:『這(諾貝爾)獎是表揚一個理想,一個認為健康
與尊嚴是人類共享的權利。努力承擔,就近照顧不幸患者,是得獎的原因…。』因此,
照顧病患成為一個高度的政治表述,他們得到了『和平獎』。

回想起十年前,台大愛滋病團隊得到衛生署及厚生會、民生報合辦的醫療貢獻獎,首次
的團體獎時,我代表發言,我指出只有傻瓜才會主動出來照顧愛滋病患,就像只有傻瓜
才會拋棄天之驕子的待遇,去非洲蠻荒行醫救人。但是世界就是靠這些傻瓜才能運轉,
才能進步,才能提升。讀這本卡羅˙歐巴尼醫師傳奇,讓我們更肯定他的為人,更感受
德不孤必有鄰的鼓舞。

由於有歐巴尼醫師奮不顧身的投入,SARS才能及早發現,全世界才能及早提高警覺。
SARS,這一個二十一世紀最嚴重的新興傳染病,能以感染8423人,死亡916人收場,世
人都應該感謝歐巴尼醫師,如果沒有他,此病毒的危害可能不只十倍。因此我在4月20
日台灣舉辦的全世界第一個國際SARS研討會上,我公開要求所有與會人士起立默哀一分
鐘,以示醫界、公衛界對他的懷念與尊崇。在閉幕典禮時,我並提出以100萬美元成立
歐巴尼基金會的宣示,以對SARS作更多的研究及宣導。這本『歐巴尼醫師傳奇』精確而
生動地描繪了一個充滿愛心、幽默、不屈不撓的醫師,以及其捍衛弱勢推動『藥品人人
買得起』運動,並生動描述他與SARS的最後一戰。這是一本讓人讀了笑、淚交織的好書
。身為前衛生署長及台大的老師,我衷心期盼每個醫師均要讀此書,每個醫學院也應將
之作為醫學生的指定的教材。


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 173.70.]


发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Re: 歐巴尼醫師的傳奇
发信站: BBS 未名空间站 (Sun Apr 19 05:16:38 2009)

Carlo Urbani (Castelplanio, Italy October 19, 1956 – Bangkok, Thailand
March 29, 2003) was an Italian physician and the first to identify severe
acute respiratory syndrome (SARS) as a new and dangerously contagious
disease. His early warning to the World Health Organization (WHO) touched
off a massive response that probably helped save the lives of millions of
people around the world.

In 2003, Urbani was called in to The French Hospital of Hanoi to look at
patient Johnny Chen, an American businessman who had fallen ill with what
doctors thought was a bad case of the flu. Urbani realized that Chen did not
have the flu, but that what he did have was probably new and highly
contagious. Urbani immediately notified WHO, triggering the most effective
response to a major epidemic in history. Urbani persuaded the Vietnamese
Health Ministry to begin isolating patients and screening travelers, thus
slowing the early pace of the epidemic. On March 11, he flew from Hanoi to a
conference in Bangkok, Thailand and fell ill with SARS while on the plane.
A colleague who met him at the airport called an ambulance. After 18 days of
intensive care in a Bangkok hospital, his wife only able to speak to him
through an intercom, Urbani died at the age of 46.

Urbani received his medical degree from the University of Ancona and worked
for a time as a general practitioner, before starting a career in infectious
diseases. He was a past president of the Italian chapter of Médecins Sans
Frontières and was one of the individuals who accepted the 1999 Nobel Peace
Prize on behalf of that organization. He was employed by the World Health
Organization and based in Hanoi, Vietnam, where he mainly worked on
combatting parasitic diseases, but was generally expert on infectious
diseases. He was married and had three children.

His life and professional experience have been narrated by former WHO
colleagues Marco Albonico and Lorenzo Savioli in the book "Le malattie
dimenticate" ("Neglected diseases") published by Feltrinelli in 2004.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 173.70.]



发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Re: 歐巴尼醫師的傳奇
发信站: BBS 未名空间站 (Sun Apr 19 05:20:09 2009)

SARS and Carlo Urbani
Brigg Reilley, M.P.H., Michel Van Herp, M.D., M.P.H., Dan Sermand, Ph.D.,
and Nicoletta Dentico, M.P.H.


On February 28, the Vietnam French Hospital of Hanoi, a private hospital of
about 60 beds, contacted the Hanoi office of the World Health Organization (
WHO). A patient had presented with an unusual influenza-like virus. Hospital
officials suspected an avian influenzavirus and asked whether someone from
the WHO could take a look. Dr. Carlo Urbani, a specialist in infectious
diseases, answered that call. In a matter of weeks, he and five other health
care professionals would be dead from a previously unknown pathogen.

We now know that Hanoi was experiencing an outbreak of severe acute
respiratory syndrome (SARS). Dr. Urbani swiftly determined that the small
private hospital was facing something unusual. For the next several days, he
chose to work at the hospital, documenting findings, arranging for samples
to be sent for testing, and reinforcing infection control. The hospital
established an isolation ward that was kept under guard. Dr. Urbani worked
directly with the medical staff of the hospital to strengthen morale and to
keep fear in check as SARS revealed itself to be highly contagious and
virulent. Of the first 60 patients with SARS, more than half were health
care workers. At a certain moment, many of the staff members made the
difficult decision to quarantine themselves. To protect their families and
community, some health care workers put themselves at great personal risk,
deciding to sleep in the hospital and effectively sealing themselves off
from the outside world.

In some ways, the SARS outbreak in Hanoi is a story of what can go right, of
public health's coming before politics. First-line health care providers
quickly alerted the WHO of an atypical pneumonia. Dr. Urbani recognized the
severity of the public health threat. Immediately, the WHO requested an
emergency meeting on Sunday, March 9, with the Vice Minister of Health of
Vietnam. Dr. Urbani's temperament and intuition and the strong trust he had
built with Vietnamese authorities were critical at this juncture. The four-
hour discussion led the government to take the extraordinary steps of
quarantining the Vietnam French Hospital, introducing new infection-control
procedures in other hospitals, and issuing an international appeal for
expert assistance. Additional specialists from the WHO and the Centers for
Disease Control and Prevention (CDC) arrived on the scene, and Médecins
sans Frontières (MSF, or Doctors without Borders) responded with staff
members as well as infection-control suits and kits that were previously
stocked for outbreaks of Ebola virus. The Vietnam French Hospital has been
closed temporarily, and patients with SARS are cared for in two wards of the
public Bach Mai Hospital, with the assistance of a team from MSF. No new
cases in health care workers have been reported, and the outbreak in Vietnam
appears to be contained. By dealing with the outbreak openly and decisively
, Vietnam risked damage to its image and economy. If it had decided to take
refuge in secrecy, however, the results might have been catastrophic.

Dr. Urbani would not survive to see the successes resulting from his early
detection of SARS. On March 11, he began to have symptoms during a flight to
Bangkok. On his arrival, he told a colleague from the CDC who greeted him
at the airport not to approach him. They sat down at a distance from each
other, in silence, waiting for an ambulance to assemble protective gear. He
fought SARS for the next 18 days in a makeshift isolation room in a Bangkok
hospital. Dr. Carlo Urbani died on March 29, 2003.

SARS is a pandemic of our global age. In just a few weeks, SARS had spread
through air travel to at least three continents. Conversely, in the same
amount of time, researchers working in no fewer than 10 countries have
collaborated to identify the virus, sequence its genome, and take steps
toward rapid diagnosis. It is now hoped that the large strides taken in
basic research will quickly lead to therapeutic advances or a vaccine.

Health care workers continue to be on the front line. Apart from the index
patient, all the patients in the Vietnamese outbreak who died were doctors
and nurses. In Hong Kong, approximately 25 percent of patients with SARS
have been health care professionals, including the chief executive of the
hospital authority. The intensive care wards are full — a situation that is
exacerbated by the staffing difficulties presented by the hundreds of SARS
cases affecting medical personnel. It is becoming difficult to import
additional infection-control equipment, since countries where the suits are
manufactured are holding onto their stocks as they brace themselves for
outbreaks of SARS within their own borders. Once effective drug therapy has
been found, similar problems may arise with availability and distribution,
especially if the effective treatment turns out to involve a relatively rare
and expensive drug, such as ribavirin.

It remains to be seen whether the number of new SARS outbreaks will ebb or
whether what we have seen to date is indeed the leading edge of a much
larger pandemic. Currently, the attack rate in Hong Kong is approximately 2
cases per 10,000 population over the course of two months. This rate
compares favorably with the seasonal attack rates of influenza-like illness,
which reached 50 cases per 10,000 population in one week this winter in
Europe.

In 1999, Dr. Urbani was president of MSF–Italy and a member of the
delegation in Oslo, Norway, that accepted the Nobel Peace Prize. Although he
would be gratified that so much has been accomplished with respect to SARS
in such a short time, he would certainly point out that the other diseases
he worked with — such as the human immunodeficiency virus and AIDS,
tuberculosis, and malaria, which kill millions of people each year —
deserve to be treated with similar urgency. Whatever the future direction of
SARS, it is clear that Dr. Urbani's decisive and determined intervention
has bought precious time and saved lives. We remember Dr. Urbani with a
mixture of pride in his selfless devotion to medicine and unspeakable grief
about the void his departure has left in the hearts of his colleagues around
the world.


Source Information

From Médecins sans Frontières (Doctors without Borders) U.S.A. (B.R.),
Belgium (M.V.H.), Vietnam (D.S.), and Italy (N.D.)


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 173.70.]




 
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