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zt 發現SARS並為之捐軀的歐巴尼醫師的傳奇
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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)








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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.

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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

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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