Some fear Md. lost chance on Pfiesteria Opportunity to gauge health risk quickly 'probably missed'

'Vigorous' probe urged

Epidemiologic study is not expected to begin until spring

October 25, 1997|By Douglas Birch | Douglas Birch,SUN STAFF

While Maryland has been praised for its aggressive response to Pfiesteria piscicida, the state might have lost a chance to quickly gauge how much of a public health risk the toxic microbe poses.

"I think we've probably missed the window of opportunity," said Dr. Alfred Sommer, dean of the Johns Hopkins University School of Hygiene and Public Health and a member of the governor's panel studying Pfiesteria.

"The best we can do now is to plan a very aggressive strategy so that we're ready to go as soon as the Pfiesteria season returns."

At Sommer's suggestion, the panel voted this week to include a call for "vigorous and wide-scale clinical and epidemiologic studies" in its report to the governor, due early next month.

But it now seems that the earliest an epidemiologic study could begin is spring, and investigators might have to wait for a new cluster of cases to begin their medical detective work.

Sommer said Maryland deserves praise overall for its quick efforts to investigate health claims -- something that didn't happen in North Carolina, for example, where officials were slow to acknowledge that Pfiesteria might be making people sick.

"I don't want to take away credit from the fact that for the first time they [Maryland officials] have in fact identified and clinically documented that this disease really does exist and seems to be related to water sources of exposure," he said.

But he added: "If we were better primed, we probably could have gotten a lot more out of this previous exposure."

Tracking an outbreak of disease is like hunting for a serial killer. Epidemiologists want to know the identity of the culprit, how many people were attacked and who might be next. Most of all, they're interested in heading off future attacks.

In August, the state health department mustered a team of doctors from the University of Maryland and Hopkins to investigate health complaints among people working and playing the Pocomoke River.

Members of the team, who initially were skeptical, were surprised to find that some suffered from a striking pattern of symptoms, which might be Pfiesteria-related.

Those symptoms include impaired short-term memory, headaches, confusion and skin rashes.

Maryland health officials were urged to conduct their own epidemiologic study, but they chose not to.

'Not sufficient time'

"There was not sufficient time or resources to be able to have the luxury of putting together another team to design and plan a study," said Dr. Martin P. Wasserman, the state health secretary.

And, he said, he wanted to avoid future arguments -- like the one that erupted between Virginia and Maryland over whether Pfiesteria was really making people sick.

Instead, Wasserman approached the U.S. Centers for Disease Control and Prevention in Atlanta. The CDC has asked Congress for $7 million to study Pfiesteria in seven East Coast states and the District of Columbia.

That money has not been approved, and congressional sources say it is likely to be trimmed.

Estimated cost: $1 million

Asked how much a go-it-alone study would have cost Maryland, Wasserman said: "I don't know, but a lot more than we had in our budget." The CDC has estimated the cost at about $1 million per state.

Maryland has laid the groundwork for an investigation. So far, 146 people have called to report suspicious symptoms to a state registry. Doctors think about 30 of those might be Pfiesteria-related.

One member of the Maryland-Hopkins medical team, Dr. Trish M. Perl, an epidemiologist at Hopkins, said she is applying for private funds to conduct her own investigation. She declined to comment on the state's decision or to describe her proposed work in detail.

No sure answers

Wasserman pointed out that epidemiologic studies don't always yield unequivocal results.

Last year, scientists at East Carolina University interviewed 254 North Carolina crabbers working in areas where Pfiesteria attacks were common. The study found that they did not get sick more often than crabbers working elsewhere.

"That told you there was no problem," Wasserman said. "Those were the first studies I saw. Those were the first studies I quoted."

Sommer has urged the state to go it alone if Congress balks at approving the CDC study.

"Next spring, we should not be futzing around and organizing multistate research," he said.

Pub Date: 10/25/97

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