Good Health And Wellness For Life

As Earth Warms Up, Tropical Virus Moves to Italy

CASTIGLIONE DI CERVIA, Italy — Panic was spreading this August through this tidy village of 2,000 as one person after another fell ill with weeks of high fever, exhaustion and excruciating bone pain, just as most of Italy was enjoying Ferragosto, its most important summer holiday.

“At one point, I simply couldn’t stand up to get out of the car,” said Antonio Ciano, 62, an elegant retiree in a pashmina scarf and trendy blue glasses. “I fell. I thought, O.K., my time is up. I’m going to die. It was really that dramatic.”

By midmonth, more than 100 people had come down with the same malady. Although the worst symptoms dissipated after a couple of weeks, no doctor could figure out what was wrong.

People blamed pollution in the river. They denounced the government. But most of all they blamed recent immigrants from tropical Africa for bringing the pestilence to their sleepy settlement of pastel stucco homes.

“Why immigrants?” asked Rina Ventura, who owns a shop selling shoes and purses. “I kept thinking of these terrible diseases that you see on TV, like malaria. We were terrified. There was no name and no treatment.”

Oddly, the villagers were both right and wrong. After a month of investigation, Italian public health officials discovered that the people of Castiglione di Cervia were, in fact, suffering from a tropical disease, chikungunya, a relative of dengue fever normally found in the Indian Ocean region. But the immigrants spreading the disease were not humans but insects: tiger mosquitoes, who can thrive in a warming Europe.

Aided by global warming and globalization, Castiglione di Cervia has the dubious distinction of playing host to the first outbreak in modern Europe of a disease that had previously been seen only in the tropics.

“By the time we got back the name and surname of the virus, our outbreak was over,” said Dr. Rafaella Angelini, director of the regional public health department in Ravenna. “When they told us it was chikungunya, it was not a problem for Ravenna any more. But I thought: this is a big problem for Europe.”

The epidemic proved that tropical viruses are now able to spread in new areas, far north of their previous range. The tiger mosquito, which first arrived in Ravenna three years ago, is thriving across southern Europe and even in France and Switzerland.

And if chikungunya can spread to Castiglione — “a place not special in any way,” Dr. Angelini said — there is no reason why it cannot go to other Italian villages. There is no reason why dengue, an even more debilitating tropical disease, cannot as well.

“This is the first case of an epidemic of a tropical disease in a developed, European country,” said Dr. Roberto Bertollini, director of the World Health Organization’s Health and Environment program. “Climate change creates conditions that make it easier for this mosquito to survive and it opens the door to diseases that didn’t exist here previously. This is a real issue. Now, today. It is not something a crazy environmentalist is warning about.”

Was he shocked to discover chikungunya in Italy, his native land? “We knew this would happen sooner or later,” he said. “We just didn’t know where or when.”

It certainly caught this town off guard on Aug. 9, when public health officials in Ravenna received an angry call from Stefano Merlo, who owns the gas station.

“Within 100 meters of my home, there were more than 30 people with fevers over 40 degrees,” or 104 Fahrenheit, said Mr. Merlo, 47. “I wanted to know what was going on. I knew it couldn’t be normal.”

August is not the season for high fevers, Dr. Angelini agreed, and within days of interviewing patients she was intrigued.

“The stories were so similar and so dramatic,” she said. “But we had no clue it was something tropical.”

Hard-working shopkeepers could not get out of bed because their hips hurt so much. Able-bodied men could not lift spoons to their mouths. (Months later, many still have debilitating joint pain.)

From the start, doctors suspected that the disease was spread by insects, rather than people. While almost all homes had one person who was ill, family members seemed not to catch the disease from one another.

They initially focused on sand flies, since the disease clustered on streets by the river.

Canceling their traditional mid-August vacations (in Italy, a true sign of panic), health officials sent off blood samples, called national infectious-disease experts, searched the Internet and set out traps to see what insects were in the neighborhood. The first surprise was that the insect traps contained not sand flies but tiger mosquitoes, and huge numbers of them.

The scientific survey confirmed what residents of Castiglione had come to accept as a horrible nuisance, though not a deadly threat.

“In the last three or four years, you couldn’t live on these streets because the mosquitoes were so bad,” said Rino Ricchi, a road worker who fell ill, standing at the entrance to his neatly tended garden, where mosquito traps have now replaced decorative fountains. “We used to delight in having a garden or a porch to eat dinner. You couldn’t this year, you’d get eaten alive.”

Said Dr. Angelini: “They were treating the mosquitoes like an annoyance. They knew that mosquitoes could spread tropical diseases but they had peace of mind because they knew this didn’t happen in Italy.”

Ravenna immediately set about killing the bugs in the hopes of containing the epidemic. Workers sprayed insecticides and went into each family’s garden, emptying flower pots, fountains and the rainwater collection barrels to remove the mosquitoes’ breeding ground.

By early September, there were no new cases in Castiglione di Cervia. But there were a number of mini-epidemics in the region — in Ravenna, Cesena and Rimini — set off by tiger mosquitoes there. Each was controlled in the same way.

By that point, the doctors had cataloged the patients’ symptoms and tried to match them to mosquito-borne diseases.

“We realized,” Dr. Angelini said, “we were seeing a photocopy of an outbreak on Réunion,” a French island in the Indian Ocean where more than 10,000 people have contracted chikungunya in the last two years. Blood tests confirmed the diagnosis. By summer’s end, home-grown chikungunya had been diagnosed in nearly 300 Italians.

Chikungunya is spread when tiger mosquitoes drink blood from an infected person and, if conditions are right, pass the virus on when they bite again. Tiger mosquitoes first came to southern Italy with shipments of tires from Albania about a decade ago but their habitat has expanded steadily northward as temperatures have risen.

But the doctors were baffled by how chikungunya made its way into mosquitoes in northern Italy since no one in Castiglione di Cervia had been abroad. In the past two years France, especially Paris, has had a number of imported cases of chikungunya, in travelers returning from Réunion. But the disease has never spread in France, because the mosquito cannot thrive there yet.

Eventually investigators discovered a link: one of the first men to fall ill in Castiglione di Cervia had been visited by a feverish relative in early July. That relative, an Italian, had previously traveled to Kerala, India. Chikungunya traveled to Italy in his blood, but climatic conditions are now such that it can spread and find a home here.

Now it is winter in Castiglione di Cervia, near freezing as the sun went down on a recent evening and Christmas lights glowed across the piazza. There are no mosquitoes now.

But dozens of residents still suffer from arthritis, a known complication of chikungunya.

Mr. Ricchi, the road worker, says he still has trouble clenching his fists, and his left ankle has horrible pains. Three people in the town died after getting the virus, Mr. Merlo said, although all of those victims had other illnesses as well.

From the start, townspeople noticed that the very elderly never got the disease. Now it makes sense: “If all you do is walk the 50 yards from your home to the church, there’s not much chance to get bitten,” said Mr. Ciano, the retiree.

But the biggest mystery is whether chikungunya will emerge here next summer. In the tropics, it is a year-round disease, since the mosquitoes breed continually. But the virus can winter over in mosquito eggs, too, and no one knows if there are reservoirs of sleeping eggs in some pool of water in Italy.

With climate change at hand, Dr. Bertollini said, chikungunya will surely be back somewhere in Europe again.

Sickened, and Fighting Another Cold War

They were some of the Cold War’s first warriors. Now they say they are among its last casualties, coping with cancers that may be linked to their work in Buffalo-area factories that made components for nuclear weapons half a century ago.

It took decades for the federal government to acknowledge that it exposed thousands of workers around the country to dangerous levels of radiation in factories handling nuclear materials, starting with the Manhattan Project in the 1940s and continuing, in some cases, into the 1970s.

The workers say they were never told there was any danger, and many developed cancer. In 2000, Congress approved a program to pay those sickened from exposure $150,000 each and to help with their medical bills.

But many of the workers and their families in New York now say they have been harmed twice over. First they were exposed to dangerous radiation without protective equipment when their employers were under contract with the government to do weapons work. Now the program that was set up to help them cope with cancer, they say, has turned out to be excessively complicated and arbitrary, requiring decades-old employment records that in many cases are incomplete or cannot be found.

So far, nationwide, more than 65 percent of 14,600 cases have been denied based on incomplete or missing employment records. In New York State, 55 percent of 1,021 cases have been denied on those grounds.

Many workers say they have spent years struggling with government red tape to get compensation for their illnesses. Lately they have been worried that the federal government, to contain costs, will make it even more difficult for them to receive compensation.

“I’m not angry, I’m disillusioned,” said Tom Murphy, 77, a maintenance worker at Linde Ceramics, a company in Tonawanda that processed uranium ore for the federal government’s atomic weapons program in the 1940s. After he developed skin cancer and heart problems, he filed for compensation but was denied because his work records were incomplete. He has appealed twice to the United States Department of Labor, which runs the program.

While Mr. Murphy struggles with his application, his family received posthumous compensation for his father, John P. Murphy, who also worked at the Linde plant. He died in 1973, of lung cancer linked to radiation exposure.

Mr. Murphy said that safety engineers at the plant routinely assured workers that there was nothing to worry about from radiation. “They had Ph.D.’s and were well-educated men,” Mr. Murphy said. “They knew what the repercussions over time would be.”

Retired workers in western New York say they have had a hard time meeting program requirements because they worked for companies, like Linde and Bethlehem Steel, where weapons development projects contracted by the government made up only a small part of their business. Over time, the companies changed hands or closed, making records hard to come by, thus blocking compensation for former workers.

Senators Charles E. Schumer and Hillary Rodham Clinton have complained about the way the Department of Labor has operated the program, which is known formally as the Energy Employees Occupational Illness Compensation Program.

“It’s appalling and inhumane,” Mr. Schumer said in a telephone interview. Last year, he asked the Office of the Inspector General to investigate the department and report by next spring on its handling of the program.

“I have confidence that the report will bring to light the almost pernicious activities of the department,” Mr. Schumer said. “Then we’ll see if the department can change on its own. If not, we’ll have to take action.”

Labor Department officials insist that after a slow start, the program is meeting expectations.

Over all, the program has provided some $3.4 billion in compensation across the country. That figure includes medical reimbursements and assistance through an additional effort begun in 2004 to help workers at the same plants who were disabled by diseases not linked to radiation exposure.

“We understand that people are frustrated by how long the process takes,” said Shelby Hallmark, director of workers’ compensation programs at the Department of Labor. He added that a substantial number of workers or their survivors may still not be aware of the program and have not yet filed claims, “but over all, this program is working well.”

Some sick workers in western New York, however, say too many claims are being denied without proper cause.

“For God’s sake, if somebody deserves it and has as much proof as we have, there’s no reason at all that they shouldn’t be compensated,” said Edwin Walker, 74, who worked at Bethlehem Steel in Lackawanna from 1951 to 1954. He repaired furnaces and cooling beds where uranium ingots were shaped into rods. Now he has bladder cancer. While pursuing his claim for compensation, he has become an unofficial spokesman for more than 300 Bethlehem retirees fighting for compensation and care.

“We were told that to get compensated we would have to prove that we were diagnosed with cancer and that we worked there at the time,” Mr. Walker said. “Those were the two criteria. That’s all they told us.”

It can be difficult for workers to understand how much proof the government needs. Russell Earley, 83, operated a crane at Bethlehem Steel from 1941 to 1983, when he had surgery for colon cancer. In 2006 doctors told him he had a suspicious spot on each lung. His compensation claim has been denied twice.

“They took 24 inches of intestines, sewed my rectum up and hung a colostomy bag on me,” he said. “And when they denied me, they said, ‘Sickness not bad enough.’ Can you imagine?”

Under the program, workers exposed to radiation can receive compensation two ways.

They can apply individually, using employment, medical and exposure records to link their work to the cancer they developed. Government doctors and scientists at the National Institute for Occupational Safety and Health then analyze the data to determine whether it is more likely than not that the disease was caused by the radiation. At the outset of the program in 2000, officials believed that only 10 percent of claims would be approved.

The second option is to be part of what is called a special exposure cohort. In cases where so many records have been lost or destroyed that it is impossible to accurately reconstruct radiation dosages, workers can ask the government to declare anyone who worked in a particular building where radioactive material or residue was present to be included in a cohort.

In such cases, workers with any of 22 types of cancer and other diseases are presumed to have become sick from their work at the plant. Certain survivors can also receive the compensation if the worker has died.

Antoinette Bonsignore, a lawyer who has been assisting former Linde plant workers for three years, plans to file a petition for special exposure cohort designation for hundreds of men who worked at the plant from 1947 to 1953, when radioactive debris still contaminated the workplace. Workers at the plant from 1942 to 1947 already have that status.

Ms. Bonsignore said the government has tried to make the petition process difficult.

“This is an intentional effort to cut costs, and not just a bureaucratic nightmare,” Ms. Bonsignore said.

In late 2005, the federal Office of Management and Budget sent a memo to the Department of Labor saying that it might be necessary to “contain growth in the cost of benefits” by adding layers of administrative approval.

That memo was the subject to two congressional hearings in 2006 in which Labor Department officials testified that there was no change in policy and the memo was merely a suggestion for controlling costs that was ultimately ignored.

Lewis V. Wade, a senior science adviser to the National Institute for Occupational Safety and Health, is the designated federal official on the Advisory Board on Radiation and Worker Health, which evaluates the scientific validity of decisions made in the nuclear workers’ compensation program. He said the number of special exposure cohorts had been rising because the records needed to make individual decisions about compensation were not as available as expected.

He denied that there had been any attempt to curtail the program.

“My agency has been given no instruction or in no way has been pressured to do anything but apply our science as accurately or in as timely a fashion as we can,” Mr. Wade said.

Mr. Walker, formerly of Bethlehem Steel, said any attempt to cut costs would be a betrayal of the workers who rolled up their sleeves on the assembly line when the government needed them.

“What isn’t right, isn’t right,” he said. He vowed to continue fighting against what he sees as injustices for as long as his health holds up.

“I’ll go down swinging,” he said.

Anthony DePalma reported from New York, and David Staba from Buffalo.

Everyday Items, Complex Chemistry

Holiday shoppers this season may still worry if the toys they buy contain lead after more than 10 million children’s products were recalled this year for that reason.

But some scientists are urging consumers to focus on a different problem: the lack of hazard information on the thousands of chemicals in everyday products.

“We have enormous gaps in our understanding of how these chemicals affect health and the environment.” said Michael P. Wilson, a public health scientist at the University of California, Berkeley. “And where we do have information, we see cause for concern.”

The effects of human exposure to chemicals in consumer products are difficult to ascertain and are subject to dispute. As a result, there is a growing gap in the ways governments regulate chemicals. The European Union, Canada and California, for example, are restricting the use of some chemicals before the science on their hazards is absolutely clear; the federal government is not.

For retailers and manufacturers, conflicting requirements in the global marketplace pose a challenge. Companies have two choices: make products with potentially harmful ingredients for some countries and not others or meet the strictest standards in all markets. Increasingly companies are choosing to conform to the most restrictive rules rather than wait for any scientific consensus.

Scientists are just beginning to see how long-term exposure to chemicals affects humans throughout a lifetime. Studies by the Centers for Disease Control and Prevention show that traces of hundreds of chemicals flow through the blood and urine of humans, but the center cautions that their presence does not mean that they cause harm.

Scientific research shows that thousands of chemicals in consumer products have toxic effects, but many of these studies are focused on higher levels of exposure. Less is known about the low but regular doses from everyday products in the home, like emissions from furniture glues and the absorption of cosmetics through the skin.

Industry scientists and many federal regulators say these exposures are harmless. They say that they are going to great lengths to make sure products are safe for intended uses.

“The bottom line is that there isn’t widespread evidence that exposure to consumer products is causing public health problems,” said Mike Walls, director of government affairs at the American Chemistry Council.

The United States has held on to its original 30-year-old chemical regulatory systems, which make it difficult for agencies to ban chemicals or require industry testing. While the government has worked with the industry on a voluntary basis to study as many 2,000 chemicals and phase out certain ones, it has required the study of only 200 chemicals and restricted the use of only 5 since 1976.

But that approach is being challenged by some experts who say that risks remain and that action may be necessary even when the evidence is not clear-cut.

“There’s this expectation that science can solve everything, but science can’t ever meet these expectations,” said Joel Tickner, director of the chemicals program at the Center for Sustainable Production at the University of Massachusetts, Lowell. “For some chemicals we may never be certain that they cause harm.”

The European Union is following this precautionary approach. It recently adopted regulations that have allowed it to restrict hundreds of chemicals and require the industry to test most chemicals sold on the market.

Industry officials insist that the policies in Europe will exact a great economic cost. But many scientists, including some in government and the chemical industry, argue that Washington is taking the wrong path, allowing exposure to some products that are restricted in the European Union, Canada and even several American states.

Some retailers are working to avoid this double standard, choosing to adopt the restrictions of the European Union for products sold in the United States. And in some rare cases, companies are limiting certain chemicals even before Europe does.

Dell is one of the few. The company is planning to phase out brominated flame retardants in the plastics of its products by 2009, including one known as deca that is restricted only in Sweden, Maine and Washington.

“We don’t regionalize,” said David Lear, the company’s director of environmental affairs. “We are doing this because this is where our customers want us to go.”

A Buyout for Manager of Drug Trials

The private equity arm of JPMorgan Chase, One Equity Partners, agreed on Friday to sell its stake in Quintiles Transnational, a big manager of clinical drug trials, to the company’s chief executive and other buyout firms.

Two buyout firms, Bain Capital and TPG Capital, teamed with the chief executive, Dennis B. Gillings, to take control, while the 3i Group, a British private equity firm, will take a significant stake in the deal. Temasek, the Singapore government’s sovereign wealth fund, will remain an investor.

Though Friday’s announcement did not specify a price, people briefed on the matter said it was more than $3 billion.

That would mean a substantial windfall for One Equity, which sponsored the company’s $1.7 billion buyout in 2003. That deal was also made in conjunction with Mr. Gillings.

Quintiles, which also provides nurses and sales services to drug companies, was founded by Mr. Gillings, who is also its chairman, in 1982. At the time, Mr. Gillings was a professor of biostatistics at the University of North Carolina at Chapel Hill, serving as a pharmaceutical consultant on the side.

The company took advantage of drug companies’ efforts to outsource their clinical trials work and grew through a series of acquisitions. It went public in 1994.

But Quintiles was hard hit in the economic slowdown earlier this decade, with its stock falling nearly 50 percent. Mr. Gillings first offered to buy the company in 2002 for $1.3 billion, but was rejected. After raising his bid by $400 million, he and One Equity prevailed in a crowded auction.

Quintiles, based in Research Triangle Park, N.C., has more than 19,000 employees.

TV’s Perfect Girl Is Pregnant; Real Families Talk

CONCORD, Mass. — Talk about teachable moments.

In schools and shopping malls and around the dining room table, the subject of teenage pregnancy and sex was suddenly and uncomfortably in the air as mothers and daughters and fathers, too, talked about — or tried not to talk about — the pregnancy of 16-year-old Jamie Lynn Spears, who plays the perfect, well-liked and, it is understood, virginal teenage girl on “Zoey 101” on Nickelodeon.

High school girls here wondered aloud on Thursday why no one was talking about contraception. Parents across the country, on the other hand, commiserated over the Internet about how, thanks to Ms. Spears, they were facing a conversation with their 8-, 9-, and 10-year-olds about sex.

“Nowadays, nothing’s safe, not even cartoons,” Diana Madruga, who has an 11-year-old daughter, said as she wrapped up her shift as the manager of a Dunkin’ Donuts here in the Boston suburbs.

Shopping at American Girl Place, the doll store, in Manhattan, Sharon Carruthers said she had used the news as an opportunity to talk about the dangers of teenage pregnancy with her 10-year-old daughter, Yasmine. “I want my daughter’s mind in the real world,” said Ms. Carruthers, who is from Deptford, N.J. “But this is not what my daughter is going to do in her life. She knows better. She knows right and wrong.”

Yasmine shook her head. “I never expected her, of all people, to do this,” she said, referring to the girl who in her mind is both Zoey and Jamie, the actress who plays her. “She’s supposed to be the good one in the family.”

High school girls who had already had their hearts broken by the all-too-public life of Ms. Spears’s older sister, Britney, known as a hard-partying mother of two, worried that their younger sisters would be devastated by the news — or, worse, that their sisters might think it was “cool” to be 16 and pregnant.

“She’s the idealistic little girl,” Alicia Akusis, 17, said of the television character Zoey between classes at Concord-Carlisle High School here. “She does perfect in school. Boys like her because she’s pretty, but she doesn’t deal with boys. She’s really smart, she’s really cool, she’s an empowering girl character.”

Ms. Akusis said she hoped that her younger sister and stepsister, who are both 11 and love the show, would not find out about Ms. Spears. “I don’t even want to bring it up with them,” she said. “I don’t want them to be disappointed.” It would be like their discovering that Santa Claus was not real, she said.

Ms. Akusis’s friend Mikala Viscariello, 16, was less concerned with shielding the young than with facing the realities of modern life. “There is no excuse for not using contraception,” Ms. Viscariello said.

Ms. Akusis shot back, “I don’t think she should have gotten pregnant in the first place.”

Perhaps the news of Ms. Spears’s pregnancy should not have been so surprising in what has seemed to be the year of the unwed mother in popular culture. First there was the movie “Knocked Up,” in which a 24-year-old entertainment journalist accidentally gets pregnant in a drunken evening. Now there’s “Juno,” about a 16-year-old who confronts an unplanned pregnancy and decides to have the baby.

But Nickelodeon has won wide acclaim as a sanctuary from the hypersexualized youth culture. That is what burned up Matt Younginer of Columbia, S.C., who was shopping with his 9-year-old daughter, Ansley, in Manhattan.

“She loves ‘Zoey 101,’ ” Mr. Younginer said. “It’s usually Britney Spears who would do that stuff, not Jamie Lynn. She was supposed to be one of the good, clean actresses for girls to follow after. I think it just sends an awful message for the young girls.”

Dan Martinsen, a spokesman for Nickelodeon, said Thursday that “Zoey 101” was one of its most popular shows among viewers 9 to 14.

“Nothing about the content, characters or the storytelling on our air has changed at all,” Mr. Martinsen said. He said that Nickelodeon was discussing a special on the issue with Linda Ellerbee, the television journalist who is the host of “Nick News.” “Whenever an issue becomes so prevalent that it’s inescapable,” Mr. Martinsen said, “her show is where we turn to help kids navigate and interpret and understand it.”

Ms. Akusis and her friends around the cafeteria table at Concord-Carlisle High School seemed to be doing a pretty good job of that themselves. The consensus around the table was that it was unrealistic to think that 16-year-olds would not have sex, and that someone should have talked to Ms. Spears about contraception.

The girls, who had followed the story on TV and the Internet, were also critical of Ms. Spears’s mother, who had been widely quoted as saying that one reason she was shocked by her daughter’s pregnancy was that she had always followed her curfew.

“When I heard that, I started laughing out loud,” Ms. Akusis said. “You can have sex during the middle of the day,” adding, “It’s not like there’s a time limit.”

One of her rituals, she said, was to watch “Zoey 101” with her stepsister and sister every week. “I hope they don’t cancel the show,” she said. “Zoey is still a good role model for little girls.”

Ms. Viscariello agreed. “It would be wrong to cancel her program and tell her she can’t come back because she’s pregnant.” But, she added, Ms. Spears would need to take some time off.

“You need time to figure your stuff out,” she said. “And you’re going to have to take care of a human being.”

She turned to David Prifti, who teaches photography at the high school. “Prifti, what happened when you had Amanda and Lucas? That took up a lot of you and your wife’s time, didn’t it?”

Yes it did, said Mr. Prifti, whose children are 17-year-old twins.

Later, in Mr. Prifti’s class, Greg Moseley, 18, said he was sick of hearing the name Jamie Lynn Spears. “Why do we care about Britney Spears’s little sister?” Mr. Moseley said. “Why does it make a difference? What does it mean? Nothing.”

“All this stuff is impossible to get away from,” he continued, “unless you go to Alaska and live in the woods.”

Sharon Otterman contributed reporting from New York.