Malaria Control and Public Health

3. Centers for Disease Control and Prevention. Updated interim U.S. case definition for severe acute respiratory syndrome (SARS). [cited 2003 Sep 26]. Hung IF, Poon LL, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Evaluation of reverse transcription–PCR assays for rapid diagnosis of severe acute respiratory syndrome associated with a novel coronavirus. WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study. Wong CK, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. To the Editor: Malaria continues to cause disease and death in millions of persons living in areas of the world where it is endemic, despite 4 decades of research on vaccines, new drugs, and alternative methods of control. Still, by far the most effective method for reducing and controlling the impact of this disease is indoor residual spraying (IRS) of insecticides. The most cost-effective and safe insecticide has been, and in many instances still is, dichlorodiphenyl-trichloroethane (DDT). This intervention is continually under scrutiny, and we address these issues in this letter. Chen and Rogan (1) claim that DDT causes reduced duration of lac-tation and increased incidence of preterm births, and they posit that DDT used for malaria control would do as much harm as good. The validity of their arguments requires substantial evidence of a causal relationship between DDT and adverse consequences of DDT IRS for malaria control. Chen and Rogan dismiss a field study on births and duration of lacta-tion in South African mothers, some of whom occupied houses sprayed with DDT for malaria control (2). However, if claims of large numbers of adverse health effects of DDT IRS are correct, then the study should have detected large differences between DDT-exposed and unexposed populations. According to Chen and Rogan, the median duration of breastfeeding could be as low as 3–4 months when mothers are exposed to high levels of DDT. Thus, a cross-section of breast-feeding infants in the DDT-exposed population should, on average, have been considerably younger than in the unexposed population. In fact, the average age of breastfeeding infants was slightly greater in the DDT-exposed population (8.3 months versus 7.7 months). For both populations, only an insignificant fraction of mothers could not donate milk. Furthermore, twice the level of dichlordiphenylethylene (DDE, metabolic breakdown product of DDT) that is claimed to cause reduced duration of …