Study results in Hepatology indicate that safe biopsy is a rational and validated method for staging liver fibrosis in hepatitis C with a marked reduction in the need for liver biopsy. It is an attractive tool for large-scale screening of hepatitis C virus carriers.
The staging of liver fibrosis is pivotal for defining the prognosis and indications for therapy in hepatitis C. Although liver biopsy remains the gold standard, several noninvasive methods are under evaluation for clinical use. Researchers validated the recently described sequential algorithm for fibrosis evaluation biopsy. The safe biopsy detects significant fibrosis and cirrhosis by combining the AST-to-platelet ratio index and Fibrotest-Fibrosure, thereby limiting liver biopsy to cases not adequately classifiable by noninvasive markers.
The researchers enrolled hepatitis C virus patients in nine locations in Europe and the U.S. The diagnostic accuracy of safe biopsy versus histology, which is the gold standard, was investigated. The reduction in the need for liver biopsies achieved with safe biopsy was also assessed. Safe biopsy identified significant fibrosis with 90 percent accuracy, and reduced the number of liver biopsies needed by 47 percent. Safe biopsy had 93 percent accuracy for the detection of cirrhosis, obviating 82 percent of liver biopsies. A third algorithm identified significant fibrosis and cirrhosis simultaneously with high accuracy and a 36 percent reduction in the need for liver biopsy. The patient's age and body mass index influenced the performance of safe biopsy, which was improved with adjusted Fibrotest-Fibrosure cutoffs.
The team found that 10 percent of cases had discordant results for significant fibrosis with safe biopsy versus histology, whereas 8 percent of cases were discordant for cirrhosis detection. The research team also found that 71 of the former cases and 56 of the latter cases had a Fibroscan measurement within two months of histological evaluation. Fibroscan confirmed safe biopsy findings in 83 percent and 75 percent, respectively.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Showing posts with label disease. Show all posts
Showing posts with label disease. Show all posts
Friday, August 27, 2010
Sunday, June 7, 2009
“QUALITY METRICS” IS NOW BECOMING THE STANDARD OF MEDICAL CARE
The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even detrimental to the patient.
In Massachusetts, there are not only carrots but also sticks to adhere to quality metrics. Physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt.
Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.
And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down.
Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients.
Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
In Massachusetts, there are not only carrots but also sticks to adhere to quality metrics. Physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt.
Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.
And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down.
Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients.
Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
Thursday, May 14, 2009
Does Cancer Screening Really Help All?
No evidence so far that it helps with certain cancers reports Robert W. Rebar, MD [Journal Watch General Medicine, 2009].
As much one would like to believe that early detection for all automatically leads to better care, that is not always the case. Although it is true that finding and treating cancer at an early stage will help in some cases — such as colon cancer and Pap smears that reduce deaths from cervical cancer — the data are less conclusive for at least three other cancers.
Ovarian carcinoma
Ovarian carcinoma is the leading cause of death from gynecologic malignancies in the U.S., reports Robert W. Rebar, MD largely because diagnosis usually is not made until disease is advanced.
In a study funded by the National Cancer Institute, of more than 30,000 women in the study’s screening arm who underwent at least one annual screen, 11.1% had at least one positive test result. The positive predictive value of the tests ranged from 1.0% to 1.3% during different screening rounds, and 4.7 to 6.2 cancers per 10,000 women were identified with screening. The ratio of surgeries to detected invasive ovarian cancer cases was 19.5 to 1.
Unfortunately 72% of cancers were late stage. Because the prevalence of ovarian cancer is low, false positives are numerous and screening leads to surgery for many women who do not have cancer. The benefits of screening will outweigh the harms seems unlikely.
Prostate cancer
In an op-ed in USA Today (4/23/09), Kevin Pho, MD, a primary-care physician in New Hampshire, questions whether "early screening" is "always in the patient's best interest." Dr. Pho cited two studies appearing in the New England Journal of Medicine that examine "the effects of prostate cancer screening."
In one study, "sponsored by the National Institutes of Health," researchers "found that such screening did not decrease deaths." Meanwhile, "the second study showed that for every death prevented, 50 men would suffer from over-diagnosis." To put the problem in context: Only 3% of men die from prostate cancer; 97% will die from something else.
Almost one-third of those treated for prostate cancer suffer from significant side effects, including impotence and urinary incontinence. Taken together, the study found that the benefit was minimal, and far from definitive.
Breast Cancer[see Part II in my series of article on Mammagraphy http://drperryhookman.blogspot.com/2009/05/mammography-different-after-age-65-full.html]
Dr. K.Pho notes that "similar issues influence breast cancer screening decisions" and that physicians "cannot be sure of which cancers are dangerous." As a result, "for every life saved from breast cancer, 10 more lives will be affected by" biopsy or breast surgery. He concludes, There cannot be a one-size-fits-all approach" to preventive care.Because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. For every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures.
Other cancers
The uncertainty surrounding tests is true of other cancers, including lung, skin (malignant melanoma), testicular and pancreatic (pancreatic adenocarcinoma), where little compelling evidence has shown that early screening is beneficial.
My opinion
The problem associated with these studies showing questionable or no benefit to a longer life for cancer victims is the statistics themselves. Statistics are still statistics and you are you. Some lives have been saved from early screening. But for every inspiring story of a person cured from cancer made possible by early detection, there are untold stories of many more who suffer from the side effects of unnecessary invasive procedures stemming from false positive test results.
But when only 1% of a certain population of 100 benefits that 1% may be you-and as far as you’re concerned you are 100% of the study.
Another example is that mammograms detect a number of slow-growing tumors that will never be harmful. But because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. Although it’s true that for every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures, yours may be the life that’s saved.
Unless you believe with Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who says, "I place considerable value on not suffering the side effects of treatment" and "death is not the only outcome that matters," you may choose not to undergo these uncertain screening procedures.
But at least you will be making an informed decision. As Dr. Pho states “patients must be better informed of the potential consequences either choice can bring.”
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
As much one would like to believe that early detection for all automatically leads to better care, that is not always the case. Although it is true that finding and treating cancer at an early stage will help in some cases — such as colon cancer and Pap smears that reduce deaths from cervical cancer — the data are less conclusive for at least three other cancers.
Ovarian carcinoma
Ovarian carcinoma is the leading cause of death from gynecologic malignancies in the U.S., reports Robert W. Rebar, MD largely because diagnosis usually is not made until disease is advanced.
In a study funded by the National Cancer Institute, of more than 30,000 women in the study’s screening arm who underwent at least one annual screen, 11.1% had at least one positive test result. The positive predictive value of the tests ranged from 1.0% to 1.3% during different screening rounds, and 4.7 to 6.2 cancers per 10,000 women were identified with screening. The ratio of surgeries to detected invasive ovarian cancer cases was 19.5 to 1.
Unfortunately 72% of cancers were late stage. Because the prevalence of ovarian cancer is low, false positives are numerous and screening leads to surgery for many women who do not have cancer. The benefits of screening will outweigh the harms seems unlikely.
Prostate cancer
In an op-ed in USA Today (4/23/09), Kevin Pho, MD, a primary-care physician in New Hampshire, questions whether "early screening" is "always in the patient's best interest." Dr. Pho cited two studies appearing in the New England Journal of Medicine that examine "the effects of prostate cancer screening."
In one study, "sponsored by the National Institutes of Health," researchers "found that such screening did not decrease deaths." Meanwhile, "the second study showed that for every death prevented, 50 men would suffer from over-diagnosis." To put the problem in context: Only 3% of men die from prostate cancer; 97% will die from something else.
Almost one-third of those treated for prostate cancer suffer from significant side effects, including impotence and urinary incontinence. Taken together, the study found that the benefit was minimal, and far from definitive.
Breast Cancer[see Part II in my series of article on Mammagraphy http://drperryhookman.blogspot.com/2009/05/mammography-different-after-age-65-full.html]
Dr. K.Pho notes that "similar issues influence breast cancer screening decisions" and that physicians "cannot be sure of which cancers are dangerous." As a result, "for every life saved from breast cancer, 10 more lives will be affected by" biopsy or breast surgery. He concludes, There cannot be a one-size-fits-all approach" to preventive care.Because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. For every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures.
Other cancers
The uncertainty surrounding tests is true of other cancers, including lung, skin (malignant melanoma), testicular and pancreatic (pancreatic adenocarcinoma), where little compelling evidence has shown that early screening is beneficial.
My opinion
The problem associated with these studies showing questionable or no benefit to a longer life for cancer victims is the statistics themselves. Statistics are still statistics and you are you. Some lives have been saved from early screening. But for every inspiring story of a person cured from cancer made possible by early detection, there are untold stories of many more who suffer from the side effects of unnecessary invasive procedures stemming from false positive test results.
But when only 1% of a certain population of 100 benefits that 1% may be you-and as far as you’re concerned you are 100% of the study.
Another example is that mammograms detect a number of slow-growing tumors that will never be harmful. But because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. Although it’s true that for every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures, yours may be the life that’s saved.
Unless you believe with Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who says, "I place considerable value on not suffering the side effects of treatment" and "death is not the only outcome that matters," you may choose not to undergo these uncertain screening procedures.
But at least you will be making an informed decision. As Dr. Pho states “patients must be better informed of the potential consequences either choice can bring.”
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Wednesday, May 13, 2009
Farrah Fawcett Documentary
This Friday May 15 former "Charlie's Angels" actress Farrah Fawcett will appear on most NBC TV stations in her documentary about her terminal disease. Please be sure to see it. Fawcett has been working on this documentary, "A Wing and a Prayer," for NBC about her cancer battle. Ms Fawcett age, 62, received a diagnosis of anal cancer in 2006.
he American Cancer Society estimates that 5,000 new cases of anal cancer are diagnosed each year and about 680 people die from it annually. Meanwhile, colorectal cancer has 148,000 new cases and about 50,000 deaths each year. Anal cancer it treatable, but becomes more difficult to treat if tumor spreads Anal cancer affects more women and the illness is usually found in people who are in their early 60's.
What are the symptoms?
• More than half of anal cancer patients experience bleeding as a symptom. Others have no symptoms or report common conditions, such as “hemorrhoids, fissures, or warts.”
• Symptoms also include itching or pain in that area. The most common thing people think it's a hemorrhoid and unfortunately do nothing significant about it.
• changes in the diameter of stool,
• abnormal discharge,
The following stages are used to describe anal cancer:
In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called “carcinoma in situ.” In stage I, cancer has formed and the tumor is 2 centimeters or smaller. In stage II, the tumor is larger than 2 centimeters. In stage IIIA, the tumor may be any size and has spread to either: lymph nodes near the rectum; or nearby organs, such as the vagina, urethra, and bladder. In stage IIIB, the tumor may be any size and has spread: to nearby organs and to lymph nodes.
In stage IV, the tumor may be any size and cancer may have spread to more distant lymph nodes or organs and has spread to distant parts of the body.
What are the risk factors for anal cancer?
• A suppressed immune system,[e.g.HIV, certain medications]
• HPV, [human papilloma virus], Thus getting vaccinated is a step in prevention.
• STDs [sexually transmitted disease]
• Being over 50 years old
People tend to view anal cancer negatively, because they associate the cancer with a few of its publicized risk factors -- such as sexually transmitted diseases or anal sex—but it is only one of the risk factors, not the only risk factors.
When anal cancer is caught early, chemotherapy and radiation are highly effective. But if the cancer doesn't respond to treatment and spreads to other areas of the body, the five-year survival rate plummets to less than 20 percent.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
he American Cancer Society estimates that 5,000 new cases of anal cancer are diagnosed each year and about 680 people die from it annually. Meanwhile, colorectal cancer has 148,000 new cases and about 50,000 deaths each year. Anal cancer it treatable, but becomes more difficult to treat if tumor spreads Anal cancer affects more women and the illness is usually found in people who are in their early 60's.
What are the symptoms?
• More than half of anal cancer patients experience bleeding as a symptom. Others have no symptoms or report common conditions, such as “hemorrhoids, fissures, or warts.”
• Symptoms also include itching or pain in that area. The most common thing people think it's a hemorrhoid and unfortunately do nothing significant about it.
• changes in the diameter of stool,
• abnormal discharge,
The following stages are used to describe anal cancer:
In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called “carcinoma in situ.” In stage I, cancer has formed and the tumor is 2 centimeters or smaller. In stage II, the tumor is larger than 2 centimeters. In stage IIIA, the tumor may be any size and has spread to either: lymph nodes near the rectum; or nearby organs, such as the vagina, urethra, and bladder. In stage IIIB, the tumor may be any size and has spread: to nearby organs and to lymph nodes.
In stage IV, the tumor may be any size and cancer may have spread to more distant lymph nodes or organs and has spread to distant parts of the body.
What are the risk factors for anal cancer?
• A suppressed immune system,[e.g.HIV, certain medications]
• HPV, [human papilloma virus], Thus getting vaccinated is a step in prevention.
• STDs [sexually transmitted disease]
• Being over 50 years old
People tend to view anal cancer negatively, because they associate the cancer with a few of its publicized risk factors -- such as sexually transmitted diseases or anal sex—but it is only one of the risk factors, not the only risk factors.
When anal cancer is caught early, chemotherapy and radiation are highly effective. But if the cancer doesn't respond to treatment and spreads to other areas of the body, the five-year survival rate plummets to less than 20 percent.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Tuesday, May 12, 2009
Something Worse Than Swine Flu Is Gaining On Us
Last year, 131 cases of measles were reported nationally, the most since 1996, according to the U.S. Centers for Disease Control and Prevention in contrast to the first seven years of the decade, when only 63 cases were reported.
Experts say measles may be reestablishing itself in US. according the Washington Times (5/6/09, Goff) which reports, "While the uproar continues over a potential swine flu pandemic, there is a quiet controversy brewing about the return of an old disease that had once been nearly eradicated in the United States.”
Many people have the impression it is not a serious disease, but Measles kills three out of 1,000 people who develop it.
We should remember that 50 years ago - more than 100,000 children were hospitalized and 500 died annually. While in the decade before the U.S. measles vaccine program began in 1963, an estimated 3 million to 4 million people in this country were infected annually. Between 400 and 500 people died, 48,000 were hospitalized and another 1,000 developed a chronic disability from measles-related encephalitis, according to the CDC.
This is a brief review of Measles to remind us of what we may be facing if, as stated by a noted pediatrician, "this uptick in measles could be the sign of something bigger."
Many physicians have forgotten or have never experienced how dangerous measles could be.
Measles virus infection can cause a variety of clinical syndromes including:
• Severe measles,
• giant cell pneumonia, and
• measles inclusion body encephalitis in immunocompromised patients.
The incubation period of measles is generally asymptomatic and lasts from 10 to 14 days. The appearance of symptoms typically include fever, malaise, and anorexia, followed by conjunctivitis, coryza, and cough. Patients may develop an exanthem known as Koplik's spots. These hich are 1 to 3 mm whitish, grayish, or bluish elevations with an erythematous base, seen on the buccal mucosa typically opposite the molar teeth. The characteristic skin rash is maculopapular and blanches, beginning on the face and spreading centrifugally to involve the neck, upper trunk, lower trunk and extremities. The lesions may become confluent, especially in areas such as the face where the rash develops first.
This cranial-to-caudal progression of the rash is considered characteristic of measles.
Complications of Measles include
• Pneumonia — Patients with measles can develop secondary bacterial or viral pneumonia. In addition
• Coinfection with other viruses can occur especially with para influenza, and adenovirus, but also with cytomegalovirus, enterovirus, influenza, and respiratory syncytial virus.Measles has also been associated with the subsequent development of bronchiectasis, which can predispose to recurrent respiratory infections
• Acute disseminated encephalomyelitis — (ADEM, also known as post infectious or postvaccination encephalomyelitis); Post infectious encephalomyelitis presents soon after the initial clinical manifestations of measles have resolved. Past experience with measles epidemics identified a 10 to 20 percent mortality associated with ADEM. Furthermore, many survivors have residual neurologic abnormalities including behavior disorders, mental retardation, and epilepsy.
• Tracheobronchitis — Measles virus can involve the upper respiratory tract and cause laryngotracheobronchitis (ie, croup), with its attendant complications.
• Otitis media — When patients with measles develop otitis media, it is usually due to bacterial superinfection caused by the same bacterial pathogens that normally cause this infection.
• Since measles is a disseminated infection, involvement of other organ systems can occur, including corneal ulceration, myocarditis, pericarditis, hepatitis, mesenteric lymphadenitis, diarrhea, and appendicitis.
• Subacute sclerosing panencephalitis whereas subacute sclerosing panencephalitis (SSPE) presents seven to ten years after initial infection. It is a progressively fatal degenerative disease of the central nervous system. Its pathogenesis is not well understood, but persistent infection of the central nervous system with a genetic variant of measles virus may be involved. The typical patient with SSPE is under 20 years of age and develops SSPE seven to ten years after measles infection.
Why Is This Increased Frequency Of Measles Happening Now?
• A study in the United States in 1982 found a progressive fall in the number of cases of SSPE from 0.61 cases per million population in 1970 to 0.06 in 1980. The decline in SSPE cases paralleled the decline of measles cases, but with a lag time of several years.
• The estimated incidence of SSPE was 8.5 cases per one million cases of measles that occurred during 1960-1974.
• However, a follow-up study of cases of biopsy-proven SSPE identified from 1992 to 2003, suggests that the risk of this disease may now be 10-fold higher.
There was a resurgence of measles infection in the United States in 1989 to 1991 due to low overall vaccination rates.
• In 2008, CDC data indicate that "131 cases of measles were reported nationally, the most since 1996," with 63 of those incidences occurring in the "first seven years of the decade."
• The "CDC said that as of 2006, the most recent year numbers are available, 93 percent of American children had received the measles vaccine."
Yet, infectious disease experts say a vaccination rate of 95 percent is necessary to keep highly contagious diseases, such as measles, from becoming re-established in the US.
Moreover, because vaccine rates are much lower in many countries, even developed European countries," people's globe-trotting habits mean that Americans are far from protected.
This led the chief of infectious disease at the Children's Hospital of Philadelphia to opine that the U.S. may be seeing the crest of the vocal anti-vaccine movement, which has gained momentum over the past decade. The movement has been spurred by a feared link between vaccines and autism—which affects one in 150 children in the United States.
In 1998, a study by British researcher Andrew Wakefield looked at 12 children with autism and suggested that the onset of their symptoms was linked to receiving the MMR vaccine. Though it was later discovered that Dr. Wakefield misrepresented some of the data, his findings had a major impact.
As an example of what mis-information can do-Measles vaccination rates in the United Kingdom dropped almost immediately. In 1998, the year Dr. Wakefield's research was published in the Lancet medical journal, there were only 56 measles cases. The current rate of full MMR vaccine coverage for British children is only 77 percent. This resulted in 1,348 cases of measles in the U.K. last year, up 36 percent from 2007.
In the past decade, at least 20 studies have shown no link between the MMR vaccine and autism. And February 2009, a special federal court after a thorough review ruled in three test cases that there was no link between the vaccine and autism.
Despite the above factual evidence that measles vaccine does not cause autism and court rulings corroborating these facts, this growing anti-vaccine movement has not been dissuaded. In California, as in other states there are clusters of unvaccinated children, most of who are from upper-middle-class neighborhoods with supposedly educated parents. They have opted not to protect their children from measles.
“Vaccine refusal,” says the May 7, 2009 NEJM, “ not only increases the individual risk of disease but also increases the risk for the whole community. As a result of substantial gains in reducing vaccine-preventable diseases, the memory of several infectious diseases has faded from the public consciousness and the risk–benefit calculus seems to have shifted in favor of the perceived risks of vaccination in some parents' minds. If the enormous benefits to society from vaccination are to be maintained, increased efforts will be needed to educate the public.
SUMMARY & OPINION
In summary, vaccines are one of the greatest advances in medical history and in just the past 50 years, polio, measles, rubella, mumps, and Haemophilus influenzae type B disease have nearly disappeared in the U.S. Parents, however, are increasingly choosing to refuse vaccination of their children because of the fear of autism caused by vaccination, despite no credible evidence of an association.
• In the early 1980s, all 50 states required immunization.
• Rates of exemptions, however, for required school immunizations began to increase from about 1% in 1991 to 1.5% to 2.5% in 2004 despite the fact that unvaccinated children are significantly more likely to contract measles and pertussis than vaccinated children.
• Unvaccinated children are more likely to be white, live in higher-income households, and have a married mother with a college education.
• The Pediatric Committee on Bioethics advises against discontinuing care for families that refuse vaccines, 40% of pediatricians report that they will no longer provide care to families who refuse all vaccines.
• In view of the shift in perception about the safety of vaccines, we must remind our patients — and ourselves — that immunizations are responsible for saving more lives than virtually any other medical advance.
• Parental doubts about the safety of childhood vaccinations therefore are leading to outbreaks of largely eradicated diseases like measles and whooping cough.
A U.S. measles outbreak last year -- almost exclusively among unvaccinated people -- has sparked concern about places where many parents opt out of having their children vaccinated.
Too many abstainers can put a town at risk. Parents must realize that if children live in a community that has a cluster of refusers, their risk of getting a vaccine-preventable disease goes up, just by virtue of who they play with.
Eradicating a disease requires vaccinating a large percentage of the nearby population to stop infections from spreading -- what's called "herd immunity." Parents must understand that schools with many abstainers have been linked to outbreaks.
As an example in Colorado, schools with an outbreak of whooping cough in the 1990s had an average of 4.3% of students who had opted out of vaccination, compared with 1.5% at schools without an outbreak.
So stay alert for the post-Swine flu pandemics-the used to be common and very dangerous—Measles, Whooping Cough and all the rest of the killer diseases of the pre-vaccination era.
REFERENCES:
Recommended Immunization Schedules
http://www.cispimmunize.org/IZSchedule_Childhood.pdf
http://www.cispimmunize.org/IZSchedule_Adolescent.pdf
http://www.cispimmunize.org/IZSchedule_Catchup.pdf
JW Pediatr Adolesc Med Jan 28 2009
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Monday, May 11, 2009
Was Napoleon poisoned?
Some conspiracy theorists believe Napoleon Bonaparte was poisoned with arsenic 188 years ago.
After his defeat at the battle of Waterloo in 1815, Napoleon was exiled to St. Helena, an island in the South Atlantic Ocean. He died in 1821 at age 52. During most of his exile, Napoleon lived with a retinue of about twenty people who included some who had a motive for wanting to murder him. Even Napoleon was paranoid about his illness during the last months of his life. He specifically requested that an autopsy be performed on him in the event of his death with “particular focus” on what was in his stomach at the time of death. The autopsy report listed gastric cancer as the cause of death. But the rumors continued.
A number of Napoleon's staff had kept locks of the Emperor's hair, which were passed down the generations, sometimes coming up for auction. In the 1960s a Glasgow University forensic scientist Professor Hamilton Smith, who had developed the nuclear techniques to record very small levels of arsenic showed that small quantities of arsenic were present in Napoleon's hair. Thus the rumors continued that Napoleon had been murdered.
I just came across an article written by my good friend Dr. Genta, a Texas pathologist-gasteoenterologist. He and fellow researchers analyzed Napolean’s original autopsy reports, Napoleon's medical history, memoirs from his doctors and other documents.
Dr. Genta and Swiss and Canadian researchers decided to see for themselves, having been intrigued by the idea that Napoleon could have changed the history of our world by escaping exile. For their study, they relied on current medical knowledge and historical data.
The autopsy reports showed that Napoleon lost a lot of weight in his last months, a sign of severe illness. His stomach was filled with a dark material resembling coffee grounds, which indicated that gastrointestinal bleeding could have been the immediate cause of death.
Researchers compared the data with images of 50 benign ulcers and 50 gastric cancers. They concluded that Napoleon had a stage III gastric cancer, which today has less than a 50% survival rate of one year and less than 20% survival for five years.
"He was sentenced to death [by the cancer]," Dr. Genta said who also speculated that Napoleon likely had a history of chronic Helicobacter pylori gastritis, which probably increased his risk of gastric cancer.
Will Genta’s study finally let Napoleon rest in peace?
Doubtful. "The conspiracy theories will continue," says Dr. Genta.
If Napoleon had escaped and returned to power, his illness would have made for only a brief reign. "There was no need to poison him," Dr. Genta said. "He would have died in a short time."
So where did the arsenic in Napoleon’s hair come from? would’ve asked Dr. Watson
What was the name of the house lived in by Napoleon on St. Helena? replied the great detective.
It was Longwoood House. What has that got to do with it? responded the puzzled Watson.
Elementary my dear Watson, would’ve said Sherlock Holmes.
If you look at the decorating log of that house like I did you would see that the wallpaper of Napoleon’s bedroom was green. And in the weeks prior to Napoleon’s death the weather was hot and humid according an almanac of that day.
Scheele's Green was a coloring pigment that had been used in fabrics and wallpapers from about 1770. It was named after the Swedish chemist who invented it. The pigment was easy to make and was a bright green color but under certain circumstances the copper arsenite could be deadly. Napoleon’s wallpaper contained Scheele's Green which when it became damp and moldy in hot and humid weather, the mold could carry out a chemical process to convert the copper arsenite into a gas which would have been present in the hair of people who lived in the room.
REFERENCES
Jones, DEH, Ledingham, KWL "Arsenic in Napoleon's Wallpaper" Nature, Vol. 299 Oct. 14, 1982 p. 626-7.
After his defeat at the battle of Waterloo in 1815, Napoleon was exiled to St. Helena, an island in the South Atlantic Ocean. He died in 1821 at age 52. During most of his exile, Napoleon lived with a retinue of about twenty people who included some who had a motive for wanting to murder him. Even Napoleon was paranoid about his illness during the last months of his life. He specifically requested that an autopsy be performed on him in the event of his death with “particular focus” on what was in his stomach at the time of death. The autopsy report listed gastric cancer as the cause of death. But the rumors continued.
A number of Napoleon's staff had kept locks of the Emperor's hair, which were passed down the generations, sometimes coming up for auction. In the 1960s a Glasgow University forensic scientist Professor Hamilton Smith, who had developed the nuclear techniques to record very small levels of arsenic showed that small quantities of arsenic were present in Napoleon's hair. Thus the rumors continued that Napoleon had been murdered.
I just came across an article written by my good friend Dr. Genta, a Texas pathologist-gasteoenterologist. He and fellow researchers analyzed Napolean’s original autopsy reports, Napoleon's medical history, memoirs from his doctors and other documents.
Dr. Genta and Swiss and Canadian researchers decided to see for themselves, having been intrigued by the idea that Napoleon could have changed the history of our world by escaping exile. For their study, they relied on current medical knowledge and historical data.
The autopsy reports showed that Napoleon lost a lot of weight in his last months, a sign of severe illness. His stomach was filled with a dark material resembling coffee grounds, which indicated that gastrointestinal bleeding could have been the immediate cause of death.
Researchers compared the data with images of 50 benign ulcers and 50 gastric cancers. They concluded that Napoleon had a stage III gastric cancer, which today has less than a 50% survival rate of one year and less than 20% survival for five years.
"He was sentenced to death [by the cancer]," Dr. Genta said who also speculated that Napoleon likely had a history of chronic Helicobacter pylori gastritis, which probably increased his risk of gastric cancer.
Will Genta’s study finally let Napoleon rest in peace?
Doubtful. "The conspiracy theories will continue," says Dr. Genta.
If Napoleon had escaped and returned to power, his illness would have made for only a brief reign. "There was no need to poison him," Dr. Genta said. "He would have died in a short time."
So where did the arsenic in Napoleon’s hair come from? would’ve asked Dr. Watson
What was the name of the house lived in by Napoleon on St. Helena? replied the great detective.
It was Longwoood House. What has that got to do with it? responded the puzzled Watson.
Elementary my dear Watson, would’ve said Sherlock Holmes.
If you look at the decorating log of that house like I did you would see that the wallpaper of Napoleon’s bedroom was green. And in the weeks prior to Napoleon’s death the weather was hot and humid according an almanac of that day.
Scheele's Green was a coloring pigment that had been used in fabrics and wallpapers from about 1770. It was named after the Swedish chemist who invented it. The pigment was easy to make and was a bright green color but under certain circumstances the copper arsenite could be deadly. Napoleon’s wallpaper contained Scheele's Green which when it became damp and moldy in hot and humid weather, the mold could carry out a chemical process to convert the copper arsenite into a gas which would have been present in the hair of people who lived in the room.
REFERENCES
Jones, DEH, Ledingham, KWL "Arsenic in Napoleon's Wallpaper" Nature, Vol. 299 Oct. 14, 1982 p. 626-7.
Saturday, May 2, 2009
FOOD BORNE EPIDEMICS KILL 5,000 AMERICANS EACH YEAR.
The latest Swine flu scare is concentrating the minds of us all to illnesses initiated from animals in our food chain. We remained glued to CNN reporting on deaths from Swine flu. At this writing, only one death has occurred even though more are tragically expected. However, what we must also realize is that the US has regular epidemics of food borne illnesses, which annually kill hundreds of Americans.
Mead PS et al. [Food-related illness and death in the United States. Emerg Infect Dis. 1999 Nov-Dec; 5(6):840-2.] estimates that food borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.
Recent reported food-borne illnesses include Cyclosporiasis associated with imported raspberries, hepatitis A associated with green onions, Salmonella serotype Saint Paul infections associated with multiple raw produce items, Shiga toxin-producing Escherichia coli in beef cattle and their products and Salmonella infections associated with peanut butter and peanut butter-containing products.
L. R. Schiller [Food-borne infections in 2009 echoes this. Gastroenterology and Hepatology 6, 197-198 (April 2009) |doi:10.1038/nrgastro.2009.40]
Schiller tells us that the recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, it is increasingly difficult to control outbreaks and minimize their effect on health.
We live in a germy world, says Schiller. We have more bacterial cells in and on our bodies than we do human cells, and every day we are exposed to countless microorganisms: in the air that we breathe, on the surfaces we touch, in the water we drink, and in the food, we eat. Most of the time human mechanisms and barriers against germs work well, but sometimes they are weak or, in some cases, microorganisms evolve counterstrategies, and we become ill.
Despite 21st century improved sanitation, fecal–oral transmission of disease is still prevalent, even in the Western world, and as many as 9,000 Americans die each year from food-borne illnesses. Why? Globalization of food sources has made cases of imported disease more likely. Outbreaks of Cyclospora from imported raspberries, hepatitis A from green onions, salmonellosis from peppers, and Escherichia coli from meat and fruit juice have all been reported in the US.
A global network, which facilitates the spread of food-borne diseases. The centralization of food production has increased the potential for cross-contamination during processing, and broadened the distribution of contaminated products to millions of people.
The outbreak of Salmonella typhimurium associated with peanut butter and products containing it that took place in the US and Canada between September 2008 and January 2009 is a good example of this problem. A reported 529 people from 43 American states and 1 person from Canada were infected, and the contamination may have contributed to eight deaths. Prompt recognition of the outbreak by the Centers for Disease Control's PulseNet surveillance staff and local public-health partners led to identification of the source of the outbreak—a peanut processing plant in Georgia. What can be learned from this experience? About 40,000 laboratory-confirmed. However, only an estimated 3% of salmonella infections are laboratory-confirmed; therefore, about 1.2 million cases probably occur each year. During the 2003–2007 periods, an average of 18 S. typhimurium outbreaks was reported to the US Center for Disease Control each year. Industrialized food production thus can place millions at risk.
What might have been only a local problem with the recent peanut butter infections was magnified as its plant produced peanut butter and other peanut products that were distributed to over 2,000 food companies in the US and 23 other countries. This necessitated over 400 peanut-containing products were recalled because of potential contamination.
Food processing says Schiller must include sufficient safeguards to ensure that contaminants are not introduced during manufacture and that the integrity of systems is checked at critical junctures. If not then we can expect pandemics of food-borne illnesses to worsen. Clean transport and maintenance of a cold chain (when necessary) are essential and proper handling, cooling and preparation of food at stores and restaurants should be mandatory. In the home --clean preparation, avoidance of cross-contamination, thorough cooking, and chilling can all reduce the chance of pathogenic, food-borne bacteria being ingested. A simple step such as using a disposable paper towel on top of a cutting board will decrease the chances of the next food item on that cutting board from being infected too.
“We needn’t have been so surprised by the swine flu, and we must make sure that we are not caught off guard by the epidemics that will certainly follow it,” said
Nathan Wolfe, the director of the Global Viral Forecasting Initiative in an April 30, 2009 NYT OP-ED PIECE “How to Prevent a Pandemic”
He continued-
“Many federal agencies — including the Centers for Disease Control and Prevention, the United States Agency for International Development and the Department of Defense — as well as the World Health Organization are looking for ways to stop pandemics early. Nevertheless, much more work is needed. To establish a worldwide safety net, we would need to devote more resources to expanding disease surveillance in people and in wild and domestic animal populations throughout the world. Our current global public health strategies are reminiscent of cardiology in the 1950s — when doctors focused solely on responding to heart attacks and ignored the whole idea of prevention.”
According to reports “State and federal officials intensifying their response to the swine flu outbreak with President Obama asking Congress for $1.5 billion in supplemental funding.
”Since Obama’s staff director has been quoted as saying something to the effect that “a crisis should be taken advantage of, perhaps this is the time to spend some of this money answering the question of where in the community are various infectious agents being harbored, and also how to curtail the transmission of infectious agents.
Mead PS et al. [Food-related illness and death in the United States. Emerg Infect Dis. 1999 Nov-Dec; 5(6):840-2.] estimates that food borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.
Recent reported food-borne illnesses include Cyclosporiasis associated with imported raspberries, hepatitis A associated with green onions, Salmonella serotype Saint Paul infections associated with multiple raw produce items, Shiga toxin-producing Escherichia coli in beef cattle and their products and Salmonella infections associated with peanut butter and peanut butter-containing products.
L. R. Schiller [Food-borne infections in 2009 echoes this. Gastroenterology and Hepatology 6, 197-198 (April 2009) |doi:10.1038/nrgastro.2009.40]
Schiller tells us that the recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, it is increasingly difficult to control outbreaks and minimize their effect on health.
We live in a germy world, says Schiller. We have more bacterial cells in and on our bodies than we do human cells, and every day we are exposed to countless microorganisms: in the air that we breathe, on the surfaces we touch, in the water we drink, and in the food, we eat. Most of the time human mechanisms and barriers against germs work well, but sometimes they are weak or, in some cases, microorganisms evolve counterstrategies, and we become ill.
Despite 21st century improved sanitation, fecal–oral transmission of disease is still prevalent, even in the Western world, and as many as 9,000 Americans die each year from food-borne illnesses. Why? Globalization of food sources has made cases of imported disease more likely. Outbreaks of Cyclospora from imported raspberries, hepatitis A from green onions, salmonellosis from peppers, and Escherichia coli from meat and fruit juice have all been reported in the US.
A global network, which facilitates the spread of food-borne diseases. The centralization of food production has increased the potential for cross-contamination during processing, and broadened the distribution of contaminated products to millions of people.
The outbreak of Salmonella typhimurium associated with peanut butter and products containing it that took place in the US and Canada between September 2008 and January 2009 is a good example of this problem. A reported 529 people from 43 American states and 1 person from Canada were infected, and the contamination may have contributed to eight deaths. Prompt recognition of the outbreak by the Centers for Disease Control's PulseNet surveillance staff and local public-health partners led to identification of the source of the outbreak—a peanut processing plant in Georgia. What can be learned from this experience? About 40,000 laboratory-confirmed. However, only an estimated 3% of salmonella infections are laboratory-confirmed; therefore, about 1.2 million cases probably occur each year. During the 2003–2007 periods, an average of 18 S. typhimurium outbreaks was reported to the US Center for Disease Control each year. Industrialized food production thus can place millions at risk.
What might have been only a local problem with the recent peanut butter infections was magnified as its plant produced peanut butter and other peanut products that were distributed to over 2,000 food companies in the US and 23 other countries. This necessitated over 400 peanut-containing products were recalled because of potential contamination.
Food processing says Schiller must include sufficient safeguards to ensure that contaminants are not introduced during manufacture and that the integrity of systems is checked at critical junctures. If not then we can expect pandemics of food-borne illnesses to worsen. Clean transport and maintenance of a cold chain (when necessary) are essential and proper handling, cooling and preparation of food at stores and restaurants should be mandatory. In the home --clean preparation, avoidance of cross-contamination, thorough cooking, and chilling can all reduce the chance of pathogenic, food-borne bacteria being ingested. A simple step such as using a disposable paper towel on top of a cutting board will decrease the chances of the next food item on that cutting board from being infected too.
“We needn’t have been so surprised by the swine flu, and we must make sure that we are not caught off guard by the epidemics that will certainly follow it,” said
Nathan Wolfe, the director of the Global Viral Forecasting Initiative in an April 30, 2009 NYT OP-ED PIECE “How to Prevent a Pandemic”
He continued-
“Many federal agencies — including the Centers for Disease Control and Prevention, the United States Agency for International Development and the Department of Defense — as well as the World Health Organization are looking for ways to stop pandemics early. Nevertheless, much more work is needed. To establish a worldwide safety net, we would need to devote more resources to expanding disease surveillance in people and in wild and domestic animal populations throughout the world. Our current global public health strategies are reminiscent of cardiology in the 1950s — when doctors focused solely on responding to heart attacks and ignored the whole idea of prevention.”
According to reports “State and federal officials intensifying their response to the swine flu outbreak with President Obama asking Congress for $1.5 billion in supplemental funding.
”Since Obama’s staff director has been quoted as saying something to the effect that “a crisis should be taken advantage of, perhaps this is the time to spend some of this money answering the question of where in the community are various infectious agents being harbored, and also how to curtail the transmission of infectious agents.
Monday, April 27, 2009
How to Confirm Suspected Swine Flu
Swine Flu information resources that are frequently updated:
Google maps has a nice tool for tracking swine flu.
http://maps.google.com/maps/ms?ie=UTF8&hl=en&t=p&msa=0&msid=106484775090296685271.0004681a37b713f6b5950&z=2
There's also HealthMap which tracks all kinds of outbreaks:
http://www.healthmap.org/en
For those of you who follow events on social media sites, CDC has a Twitter feed that contains updates on the Swine Flu:
http://twitter.com/cdcemergency
If you are interested in the view from overseas - European Centre for Disease Prevention and Control
http://ecdc.europa.eu/
Swine Flu Virus-What I Tell My Patients
Many of my patients are calling for more information about about the new Swine Flu. This is what I tell them.
Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.
How is this New Virus Transmitted?
The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.
The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.
Precautions
The usual precautions for patients apply:
• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.
Contagious period
People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at http://www.cdc.gov/swineflu/.
Symptoms
The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.
Treatment
The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.
Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.
How is this New Virus Transmitted?
The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.
The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.
Precautions
The usual precautions for patients apply:
• Sneeze and cough into tissues and throw the tissues in the trash.
• Wash your hands or use alcohol-based hand cleaners frequently.
• On greeting people, don’t shake hands or exchange kisses.
Contagious period
People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at http://www.cdc.gov/swineflu/.
Symptoms
The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.
Treatment
The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.
• Swine Flu Update: What to Expect from Doctors & Public Health Professionals
• Swine Flu Update: What to Expect from Doctors & Public Health Professionals from the Centers for Disease Control and Prevention; 1600; Clifton Rd; Atlanta, GA 30333; 800-CDC-INFO; (800-232-4636); TTY: (888) 232-6348
• cdcinfo@cdc.gov
Doctors
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
State Public Health Laboratories
Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.
Public Health /Animal Health Officials
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.
Guidance Documents
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
• Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET
• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009
• cdcinfo@cdc.gov
Doctors
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
State Public Health Laboratories
Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.
Public Health /Animal Health Officials
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.
Guidance Documents
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
• Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET
• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009
Sunday, April 26, 2009
Swine Flu Public Health Emergency –What To Look For; What To Do.
A public health emergency was declared today in the U.S. as 20 cases of the disease were confirmed in this country. The Centers for Disease Control, in a news conference in Washington stated, “We expect to see more cases of swine flu. Homeland Security Secretary Janet Napolitano, speaking at the same news conference called the emergency declaration a “declaration of emergency preparedness.” However, experts at the WHO will wait until Tuesday before meeting to decide if it should increase its rating of the seriousness of the pandemic potential from the current level three to level four - which would indicate a "significant increase in risk of a pandemic.” Officials said they had confirmed eight cases in New York, seven in California, two in Kansas, two in Texas and one in Ohio, and that the cases looked to be similar to the deadly strain of swine flu that has killed more than 80 people in Mexico and infected 1,300 more. This was amid further reports of potential new cases from New Zealand to Hong Kong to Spain, raising concerns about the potential for a global pandemic. Canada also confirmed six cases of the flu. Swine flu was also likely in 10 New Zealand students.
WHAT TO LOOK FOR:
The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.
WHAT TO DO if pandemic is declared by WHO
-Interim Guidance for Swine influenza A (H1N1)
• Wash hands frequently
• stay home
• don't board airplanes, if you feel sick
• Keep sick children out of school.
• Use Facemasks
• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask)
• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor.
• Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible.
• If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
• Ask your doctor whether you are a candidate for Tamiflu or Relenza.
• Do not take any drugs or medications prophylactic ally without your doctor’s permission.
WHAT TO LOOK FOR:
The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.
WHAT TO DO if pandemic is declared by WHO
-Interim Guidance for Swine influenza A (H1N1)
• Wash hands frequently
• stay home
• don't board airplanes, if you feel sick
• Keep sick children out of school.
• Use Facemasks
• Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
• If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask)
• An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.
• Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor.
• Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
• Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.
• Avoid re-using disposable facemasks and N95 respirators if possible.
• If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
• After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
• Ask your doctor whether you are a candidate for Tamiflu or Relenza.
• Do not take any drugs or medications prophylactic ally without your doctor’s permission.
Saturday, April 25, 2009
FACTS ABOUT THE NEW SWINE FLU EPIDEMIC
Is Mexico city ground zero for a global epidemic of a new kind of flu — a strange mix of human, pig and bird viruses?
The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Most of Mexico’s dead are young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
FACTS:
• Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.
• Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
• From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.
• Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.
• The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.
• Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.
• Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.
• The caseload of those sickened has grown to 1,004 in Mexico.
• The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.
• If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.
• The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.
• This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.
This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.
UP-TO-DATE ACTIONS ON SWINE FLU
The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.
• The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.
• No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
• Actually producing the vaccines could take months.
• The relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.
• anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.
• When a new virus emerges, it can sweep through the population.
• The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.
• Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.
LINKS TO MORE FACTS
General Information about Swine Flu
Questions and answers and guidance for treatment and infection control
Human Swine Flu Investigation Apr 24, 2009
Information about the investigation of human swine flu in California
Swine Influenza: General Information
Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.?
Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork?
The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Most of Mexico’s dead are young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.
FACTS:
• Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.
• Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
• From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.
• Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.
• The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.
• Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.
• Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.
• The caseload of those sickened has grown to 1,004 in Mexico.
• The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.
• If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.
• The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.
• This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.
This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.
UP-TO-DATE ACTIONS ON SWINE FLU
The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.
• The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.
• No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
• Actually producing the vaccines could take months.
• The relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.
• anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.
• When a new virus emerges, it can sweep through the population.
• The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.
• Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.
LINKS TO MORE FACTS
General Information about Swine Flu
Questions and answers and guidance for treatment and infection control
Human Swine Flu Investigation Apr 24, 2009
Information about the investigation of human swine flu in California
Swine Influenza: General Information
Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.?
Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork?
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