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Tuesday, December 25, 2012

Getting Polio Campaigns Back on Track

The following is an excerpt from an article in:


The New York Times
Tuesday, December 25, 2012

Getting Polio Campaigns Back on Track

By DONALD G. McNEIL Jr.

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets?

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies.

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.

That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules.

Vaccination efforts are also under threat in other Muslim regions, although not this violently yet.

In Nigeria, another polio-endemic country, the new Islamic militant group Boko Haram has publicly opposed it, although the only killings that the news media have linked to polio were those of two police officers escorting vaccine workers. Boko Haram has killed police officers on other missions, unrelated to polio vaccinations.

In Mali, extremists took over half of the country in May, declaring an Islamic state. Vaccination is not an issue yet, but Mali had polio cases as recently as mid-2011, and the virus sometimes circulates undetected.

Resistance to polio vaccine springs from a combination of fear, often in marginalized ethnic groups, and brutal historical facts that make that fear seem justified. Unless it is countered, and quickly, the backlash threatens the effort to eradicate polio in the three countries where it remains endemic: Pakistan, Afghanistan and Nigeria.

In 1988, long before donors began delivering mosquito nets, measles shots, AIDS pills, condoms, deworming drugs and other Western medical goods to the world’s most remote villages, Rotary International dedicated itself to wiping out polio, and trained teams to deliver the vaccine.

But remote villages are often ruled by chiefs or warlords who are suspicious not only of Western modernity, but of their own governments.

For more, visit www.nytimes.com.

Saturday, December 22, 2012

Alabama to End Isolation of Inmates With H.I.V.

The following is an excerpt from an article in:


The New York Times
Saturday, December 22, 2012

Alabama to End Isolation of Inmates With H.I.V.

By ROBBIE BROWN

A federal judge on Friday ordered Alabama to stop isolating prisoners with H.I.V.

Alabama is one of two states, along with South Carolina, where H.I.V.-positive inmates are housed in separate prisons, away from other inmates, in an attempt to reduce medical costs and stop the spread of the virus, which causes AIDS.

Judge Myron H. Thompson of the Middle District of Alabama ruled in favor of a group of inmates who argued in a class-action lawsuit that they had been stigmatized and denied equal access to educational programs. The judge called the state’s policy “an unnecessary tool for preventing the transmission of H.I.V.” but “an effective one for humiliating and isolating prisoners living with the disease.”

After the AIDS epidemic of the 1980s, many states, including New York, quarantined H.I.V.-positive prisoners to prevent the virus from spreading through sexual contact or through blood when inmates tattooed one another. But most states ended the practice voluntarily as powerful antiretroviral drugs reduced the risk of transmission.

For more, visit www.nytimes.com.

Dangerous Abscesses Add to Tainted Drug’s Threat

The following is an excerpt from an article in:


The New York Times
Saturday, December 22, 2012

Dangerous Abscesses Add to Tainted Drug’s Threat

By DENISE GRADY

YPSILANTI, Mich. — Dr. David Vandenberg admitted three patients to St. Joseph Mercy Ann Arbor hospital on Tuesday, and called a fourth with news that left her in tears: She had a large abscess deep inside her back, near her spine, and would need surgery as soon as possible.

The patients were part of a second, growing wave of serious infections from the same tainted drug that caused a nationwide meningitis outbreak. The drug, contaminated with a fungus, was injected near the spine to treat chronic back or neck pain.

This public health disaster, in its third month, is far from over. Meningitis seems to have waned, but spinal infections near the injection site are on the rise. They can be dangerous and hard to detect. At least 200 have occurred, and more are expected because nearly 14,000 people had injections from tainted lots of the drug.

On Thursday, the Centers for Disease Control and Preventionurged doctors to look harder for these infections — to consider M.R.I. scans even in patients who did not feel worse after the injection, but whose existing back or neck pain simply did not get better. This advice was more aggressive than previous recommendations, which had called for scans only if patients had new or worsening symptoms. The new message could lead to thousands of additional scans, and will almost certainly find new cases.

“We know we’re not out of the woods,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the C.D.C. “People could still be harboring or developing infections in their spines now.”

The disease outbreak, first detected in September, was caused by contaminated batches of a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. The company was shut down and has been under investigation by state and federal authorities, and on Friday night announced that it had filed for Chapter 11 bankruptcy protection. The filing seeks to establish a fund to compensate individuals and families affected by the outbreak.

So far, 620 people in 19 states have fallen ill, most with meningitis or spinal infections, or both; 39 have died. Infections inside joints have also occurred. Nearly all the illnesses have been caused by a black mold called Exserohilum. The treatment is a long course of antifungal drugs, which can have dangerous side effects.

For more, visit www.nytimes.com.

Friday, December 21, 2012

CDC What's New on the Influenza Site

Received December 21, 2012

CDC What's New on the Influenza Site

January Zoonoses Articles now online

January Zoonoses Articles now online

January Tuberculosis and other mycobacteria Articles now online

January Tuberculosis and other mycobacteria Articles now online

January Staphylococci Articles now online

January Staphylococci Articles now online

January Respiratory Infection Articles now online

January Respiratory Infection Articles now online

January Parasite Articles now online

January Parasite Articles now online

January Influenza Articles now online

January Influenza Articles now online

January HIV/AIDS and Other Retroviruses Articles now online

January HIV/AIDS and Other Retroviruses Articles now online

CDC Influenza Activity Update

Received December 21, 2012.

CDC Influenza Activity Update

January Enteric Infection Articles now online

January Enteric Infection Articles now online

January 2012 Bacteria, Bioterrorism and Preparedness Articles now online

January 2012 Bacteria, Bioterrorism and Preparedness Articles now online

EPA Updates Rule for Pathogens in Drinking Water, Sets Limit for E. Coli

EPA Press Release:

FOR IMMEDIATE RELEASEDecember 20, 2012

EPA Updates Rule for Pathogens in Drinking Water, Sets Limit for E. Coli


WASHINGTON
- The U.S. Environmental Protection Agency (EPA) has updated the rule for pathogens in drinking water, including setting a limit for the bacteria E. coli to better protect public health.

The Revised Total Coliform Rule ensures that all of the approximately 155,000 public water systems in the United States, which provide drinking water to more than 310 million people, take steps to prevent exposure to pathogens like E. coli. Pathogens like E. coli can cause a variety of illnesses with symptoms such as acute abdominal discomfort or, in more extreme cases, kidney failure or hepatitis.

Under the revised rule, public drinking water systems are required to notify the public if a test exceeds the maximum contaminant level (MCL) for E. coli in drinking water. If E. coli or other indications of drinking water contamination are detected above a certain level, drinking water facilities must assess the system and fix potential sources and pathways of contamination. High-risk drinking water systems with a history of non-compliance must perform more frequent monitoring. The revised rule provides incentives for small drinking water systems that consistently meet certain measures of water quality and system performance.

Public water systems and the state and local agencies that oversee them must comply with the requirements of the Revised Total Coliform Rule beginning April 1, 2016. Until then, public water systems and primacy agencies must continue to comply with the 1989 version of the rule.

The Safe Drinking Water Act requires that EPA review each National Primary Drinking Water Regulation, such as the Total Coliform Rule, at least once every six years. The outcome of the review of the 1989 Total Coliform Rule determined that there was an opportunity to reduce implementation burden and improve rule effectiveness while at the same time increasing public health protection against pathogens in the drinking water distribution systems. EPA’s revised rule incorporates recommendations from a federal advisory committee comprised of a broad range of stakeholders and considers public comments received during a public comment period held in fall 2010.

For more information:
http://water.epa.gov/lawsregs/rulesregs/sdwa/tcr/regulation.cfm

R 204

Thursday, December 20, 2012

U.N. Suspends Polio Campaign in Pakistan After Killings of Workers

The following is an excerpt from an article in:


The New York Times
Thursday, December 20, 2012

U.N. Suspends Polio Campaign in Pakistan After Killings of Workers

By DECLAN WALSH and DONALD G. McNEIL Jr.

LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.

Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.

The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.

At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.

The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.

The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.

On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.

For more, visit www.nytimes.com.

Wednesday, December 19, 2012

Attackers in Pakistan Kill Anti-Polio Workers

The following is an excerpt from an article in:


The New York Times
Wednesday, December 19, 2012

Attackers in Pakistan Kill Anti-Polio Workers

By DECLAN WALSH and DONALD G. McNEIL Jr.

ISLAMABAD, Pakistan — Gunmen shot dead five female health workers who were immunizing children against polio on Tuesday, causing the Pakistani government to suspend vaccinations in two cities and dealing a fresh setback to an eradication campaign dogged by Taliban resistance in a country that is one of the disease’s last global strongholds.

“It is a blow, no doubt,” said Shahnaz Wazir Ali, an adviser on polio to Prime Minister Raja Pervez Ashraf. “Never before have female health workers been targeted like this in Pakistan. Clearly there will have to be more and better arrangements for security.”

No group claimed responsibility for the attacks, but most suspicion focused on the Pakistani Taliban, which has previously blocked polio vaccinators and complained that the United States is using the program as a cover for espionage.

The killings were a serious reversal for the multibillion-dollar global polio immunization effort, which over the past quarter century has reduced the number of endemic countries from 120 to just three: Pakistan, Afghanistan and Nigeria.

Nonetheless, United Nations officials insisted that the drive would be revived after a period for investigation and regrouping, as it had been after previous attacks on vaccinators here, in Afghanistan and elsewhere.

Pakistan has made solid gains against polio, with 56 new recorded cases of the diseases in 2012, compared with 192 at the same point last year, according to the government. Worldwide, cases of death and paralysis from polio have been reduced to less than 1,000 last year, from 350,000 worldwide in 1988.

But the campaign here has been deeply shaken by Taliban threats and intimidation, though several officials said Tuesday that they had never seen such a focused and deadly attack before.

For more, visit www.nytimes.com.

Thursday, December 6, 2012

WHO | Yellow fever in Sudan - update

WHO | Yellow fever in Sudan - update

Nursing the Flu With Help From Apps

The following is an excerpt from an article in:


The New York Times
Thursday, December 06, 2012

Nursing the Flu With Help From Apps

By KIT EATON

I wasn’t my usual self earlier this week. Some nasty flu bug had beaten me, reducing your usual quirky, chipper columnist to a feverish, bedridden shadow. It’s never fun being ill, and I’ve never been a good patient because all the sensible advice to stay warm, hydrated and in bed leads to boredom.

During this bout I was much better behaved because my smartphone, jammed with entertaining apps and Internet access, was a great sickbed companion. Apps can do more than keep you company; they can give you medical advice. And as the season of coughs and sneezes settles in, an app may even help you determine what’s wrong.

For a medical app that covers a plethora of icky illnesses, WebMD is probably your best bet (free for iPhone, iPad and Android). It’s jammed with data, and can present it to you in a number of ways. A hypochondriac’s dream, the app’s Symptom Checker first asks that you tap on the corresponding part of an image of the body and then, choosing from detailed lists, specify which symptom you have. Once you select a symptom, the app leads you through a short question-and-answer session to refine your input, like exactly what kind of cough you have. You can input a number of symptoms, perhaps adding sneezes, for example, and then press the “view possible conditions” button.

The app lists all the conditions your symptoms may match, so you need to read each one earnestly to see if it describes your situation. It’s written in plain language, and links help you find treatment or more information online. A tab takes you to pages describing symptoms in more detail, and another takes you to detailed articles about the condition.

For more, visit www.nytimes.com.

Friday, November 30, 2012

Former Employee of Exeter Hospital Indicted in Connection with Hepatitis C Outbreak


FBI Press Release:




Former Employee of Exeter Hospital Indicted in Connection with Hepatitis C Outbreak

U.S. Attorney’s OfficeNovember 29, 2012
  • District of New Hampshire(603) 225-1552
CONCORD, NH—David M. Kwiatkowski, 33, a former employee of Exeter Hospital, has been indicted for his alleged role in causing the Hepatitis C outbreak that infected patients in New Hampshire as well as other states, announced United States Attorney John P. Kacavas.
Kwiatkowski has been charged with seven counts of tampering with a consumer product and seven counts of obtaining controlled substances by fraud. The charges relate to suspected thefts of the controlled substance fentanyl, a powerful anesthetic used in various medical procedures. In addition to stealing fentanyl and depriving patients in his care of the intended analgesic effect of the drug, Kwiatkowski allegedly caused over 30 individuals in New Hampshire and elsewhere to become infected with Hepatitis C, a blood-borne virus that can cause serious damage to the liver. According to the Centers for Disease Control and Prevention (CDC), Hepatitis C causes more deaths annually in the United States than HIV.
According to the indictment, Kwiatkowski was employed for several years as a health care worker in Michigan. Beginning in 2007, he became a traveling health care technician employed in various states, including New York, Pennsylvania, Maryland, Arizona, Kansas, Georgia, and New Hampshire.
The indictment alleges that Kwiatkowski was infected with Hepatitis C and that he was aware that he carried the disease since at least June 2010. He began working at Exeter Hospital in April 2011.
The indictment alleges that Kwiatkowski devised a scheme to obtain fentanyl for his personal use and abuse. He is charged with surreptitiously taking syringes of fentanyl, prepared and intended for patients scheduled to undergo a medical procedure, and replacing them with syringes that he had previously stolen and filled with saline. Kwiatkowski used the stolen syringes to inject himself, causing them to become tainted with his infected blood, before filling them with saline and then replacing them for use in the medical procedure. Consequently, instead of receiving the prescribed dose of fentanyl, patients instead received saline tainted by Kwiatkowski’s infected blood. Kwiatkowski, on the other hand, would inject himself with the fentanyl dose prescribed for the patient but secreted from the procedure.
The patients who received the tainted saline thus were exposed to Kwiatkowski’s Hepatitis C virus. The indictment alleges that more than 30 people in New Hampshire and elsewhere have become infected with the same strain of Hepatitis C carried by Kwiatkowski.
Kwiatkowski was arrested on July 19, 2012, in Massachusetts. He thereafter was transported to New Hampshire where he has remained in custody.
If convicted on the pending charges, Kwiatkowski faces up to 10 years in prison for each count of tampering with a consumer product and up to four years in prison for each count of obtaining controlled substances by fraud. Each offense also is punishable by a fine of $250,000 and a term of supervised release following any sentence of imprisonment.
This investigation, which remains active and ongoing, has involved the cooperative efforts of federal, state, and local law enforcement entities, including the Federal Bureau of Investigation; the Office of Inspector General of the U.S. Department of Health and Human Services; the Drug Enforcement Administration; Office of Criminal Investigations of the Food and Drug Administration; the Office of Inspector General of the Department of Veterans Affairs; the New Hampshire Attorney General’s Office; the New Hampshire State Police; and the Exeter, New Hampshire Police Department. Assistance also has been provided by the New Hampshire Drug Task Force; the Marlborough, Massachusetts Police Department; the Boxborough, Massachusetts Police Department; and the United States Attorney’s Office in the District of Massachusetts.
A complaint or indictment is merely an allegation, and a defendant is presumed innocent unless and until proven guilty.

WHO | Novel coronavirus infection - update

WHO | Novel coronavirus infection - update

Raising awareness on World Aids Day, Schlumberger

Raising awareness on World Aids Day, Schlumberger

WHO | Ebola in Uganda - update

WHO | Ebola in Uganda - update

Tuesday, November 27, 2012

Panel Lukewarm on Hepatitis C Screening for Baby Boomers

The following is an excerpt from an article in:


The New York Times
Tuesday, November 27, 2012

Panel Lukewarm on Hepatitis C Screening for Baby Boomers

By ANDREW POLLACK

An influential advisory committee has given only lukewarm support to a government recommendation that all baby boomers be tested for hepatitis C.

In a draft opinion Monday, the United States Preventive Services Task Force said that clinicians may “consider offering” hepatitis C screening to adults born between 1945 and 1965.

That falls short of the recommendation made in August by the Centers for Disease Control and Prevention that all adults in that age group should get a one-time test to see if they are infected.

The task force is made up of outside experts appointed by the government, and its recommendations can in some cases carry more weight than those of the C.D.C. Had hepatitis C screening for baby boomers received a stronger recommendation from the task force, health plans would have been required to pay for it under the 2010 Affordable Care Act, with no charge to the patient.

Some advocates of wider screening said they feared the new opinion would be used by insurers to deny reimbursement for testing and would slow efforts to ferret out hidden cases of hepatitis C at a time when more effective and tolerable treatments are being developed.

For more, visit www.nytimes.com.

Sunday, November 25, 2012

Indian Prostitutes’ New Autonomy Imperils AIDS Fight

The following is an excerpt from:


The New York Times
Sunday, November 25, 2012

Indian Prostitutes’ New Autonomy Imperils AIDS Fight

By GARDINER HARRIS

MUMBAI, India — Millions once bought sex in the narrow alleys of Kamathipura, a vast red-light district here. But prostitutes with inexpensive mobile phones are luring customers elsewhere, and that is endangering the astonishing progress India has made against AIDS.

Indeed, the recent closings of hundreds of ancient brothels, while something of an economic victory for prostitutes, may one day cost them, and many others, their lives.

“The place where sex happens turns out to be an important H.I.V. prevention point,” said Saggurti Niranjan, program associate of the Population Council. “And when we don’t know where that is, we can’t help stop the transmission.”

Cellphones, those tiny gateways to modernity, have recently allowed prostitutes to shed the shackles of brothel madams and strike out on their own. But that independence has made prostitutes far harder for government and safe-sex counselors to trace. And without the advice and free condoms those counselors provide, prostitutes and their customers are returning to dangerous ways.

Studies show that prostitutes who rely on cellphones are more susceptible to H.I.V. because they are far less likely than their brothel-based peers to require their clients to wear condoms.

In interviews, prostitutes said they had surrendered some control in the bedroom in exchange for far more control over their incomes.

“Now, I get the full cash in my hand before we start,” said Neelan, a prostitute with four children whose side business in sex work is unknown to her husband and neighbors. (Neelan is a professional name, not her real one.)

“Earlier, if the customer got scared and didn’t go all the way, the madam might not charge the full amount,” she explained. “But if they back out now, I say that I have removed all my clothes and am going to keep the money.”

India has been the world’s most surprising AIDS success story. Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic’s focal point. In 2002, the C.I.A.’s National Intelligence Council predicted that India would have as many as 25 million AIDS cases by 2010. Instead, India now has about 1.5 million.

An important reason the disease never took extensive hold in India is that most women here have fewer sexual partners than in many other developing countries. Just as important was an intensive effort underwritten by the World Bank and the Bill and Melinda Gates Foundation to target high-risk groups like prostitutes, gay men and intravenous drug users.

But the Gates Foundation is now largely ending its oversight and support for AIDS prevention in India, just as efforts directed at prostitutes are becoming much more difficult. Experts say it is too early to identify how much H.I.V. infections might rise.

For more, visit www.nytimes.com.

Wednesday, November 21, 2012

New H.I.V. Cases Falling in Some Poor Nations, but Treatment Still Lags

The following is an excerpt from an article in:


The New York Times
Wednesday, November 21, 2012

New H.I.V. Cases Falling in Some Poor Nations, but Treatment Still Lags

By DONALD G. McNEIL Jr.

New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.

The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.

“We are moving from despair to hope,” he said.

Despite the good news from those countries, the agency’s annual report showed that globally, progress is steady but slow. By the usual measure of whether the fight against AIDS is being won, it is still being lost: 2.5 million people became infected last year, while only 1.4 million received lifesaving treatment for the first time.

“There has been tremendous progress over the last decade, but we’re still not at the tipping point,” said Mitchell Warren, the executive director of AVAC, an advocacy group for AIDS prevention. “And the big issue, sadly, is money.”

Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.

The two most important financial forces in the fight, the multinational Global Fund for AIDS, Tuberculosis and Malaria and the domestic President’s Emergency Plan for AIDS Relief, were both created in the early 2000s and last year provided most of the $16.8 billion spent on the disease. But the need will soon be $24 billion a year, the groups said.

“Where is that money going to come from?” Mr. Warren asked.

For more, visit www.nytimes.com.

Tuesday, November 13, 2012

WHO | Yellow fever in Sudan

WHO | Yellow fever in Sudan

Antibiotics Are a Gift to Be Handled With Care

The following is an excerpt from an article in:


The New York Times
Tuesday, November 13, 2012

Antibiotics Are a Gift to Be Handled With Care

By PERRI KLASS, M.D.

I should start by saying as clearly as I can that I love antibiotics. Recently I had dinner with a pediatrician friend, and she told me the story of the day's sickest child. Before she sent the child to the emergency room in an ambulance, she told me, she gave her 50 milligrams per kilogram of ceftriaxone, a powerful antibiotic.

"You probably saved her life," I said, and my friend nodded; it was possible. Antibiotics represent a huge gift in the struggle against infant and child mortality, a triumph (or actually, many triumphs) of human ingenuity and science over disease and death, since the antibiotic era began back in the fourth and fifth decades of the 20th century.

But new research is looking at questions about the complex effects of antibiotics - on bacteria, on individual children and on populations - building on a greatly increased awareness of how powerful antibiotics can be, and how important it is to use them judiciously.

Over the past 15 years or so, spurred by new realizations - and new fears - about the risks of breeding resistant strains of bacteria, pediatricians in the United States have, as a group, cut back dramatically on prescribing antibiotics in situations where they may not be necessary. And parents, as a group, have become less likely to demand them.

"It's actually been a remarkable change in practice from the mid-'90s on," said Dr. Jonathan Finkelstein, a pediatrician at Boston Children's Hospital who studies antibiotic use and antibiotic resistance, "and we did that by physicians and patients recognizing that antibiotics are quite effective, quite safe, but there's no such thing as a free lunch, and as with any other medical decision, we have to weigh the risks and benefits of every treatment."

For more, visit www.nytimes.com.

Wednesday, November 7, 2012

CDC ACIP-VFC: Vaccine Resolutions Update

CDC ACIP-VFC: Vaccine Resolutions Update

Alarm Over India’s Dengue Fever Epidemic

The following is an excerpt from an article in:


The New York Times
Wednesday, November 07, 2012

Alarm Over India’s Dengue Fever Epidemic

By GARDINER HARRIS

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Dr. Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India’s capital, where areas of standing water contribute to the epidemic’s growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

Among them was Neelam, who said her two grandchildren were deathly ill inside. Eight-year-old Sneha got the disease first, followed by Tanya, 7, she said. The girls’ parents treated them at home but then Sneha’s temperature rose to 104 degrees, a rash spread across her legs and shoulders, and her pain grew unbearable.

“Sneha has been given five liters of blood,” said Neelam, who has one name. “It is terrible.”

Officials say that 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded for all of 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Dr. Scott Halstead, a tropical disease expert focused on dengue research.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s actual toll. The government only counts cases of dengue that come from public hospitals and that have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

For more, visit www.nytimes.com.

Tuesday, October 30, 2012

A Weak Spot in H.I.V’s Armor Raises Hope for a Vaccine

The following is an excerpt of an article in:


The New York Times
Tuesday, October 30, 2012

A Weak Spot in H.I.V’s Armor Raises Hope for a Vaccine

By DONALD G. McNEIL Jr.

The search for a vaccine against AIDS has been long and fruitless — mostly because the virus mutates so fast.

As is well known, flu vaccines have to be reformulated every year because influenza viruses mutate so steadily. But the human immunodeficiency virus, which causes AIDS, mutates as much in a single day as flu virus does in a year, presenting scientists with an almost insurmountable challenge.

This month, South African researchers announced that they had found a vulnerable spot on the virus’s outer shell that might present a good vaccine target, and that they had also learned, for the first time, at what stage of an infection it develops. They found only two women whose virus had the vulnerability — and it wasn’t the same virus that first infected them, but a mutant that developed a few months later.

The research, published by Nature Medicine on Oct. 21, was praised as “very interesting” by several AIDS experts.

“It’s a combination of good science and ‘Boy, did we get lucky,’ ” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “They had all these blood samples and virus samples.”

The researchers, led by Dr. Salim Abdool Karim, president of South Africa’s Medical Research Council and best known for pioneering work on vaginal microbicides, screened hundreds of blood samples given at regular intervals by 79 women who had been in earlier clinical trials at his Durban clinic and had become infected during the trials.

“What we have that’s unique,” Dr. Karim said, “is that for the first time, we understand how a person can make broadly neutralizing antibodies.”

For more, visit www.nytimes.com.

Scientists Move Closer to a Long-Lasting Flu Vaccine

The following is an excerpt from an article in:


The New York Times
Tuesday, October 30, 2012

Scientists Move Closer to a Long-Lasting Flu Vaccine

By CARL ZIMMER

As this year’s flu season gathers steam, doctors and pharmacists have a fresh stock of vaccines to offer their patients. The vaccines usually provide strong protection against the virus, but only for a while. Vaccines for other diseases typically work for years or decades. With the flu, though, next fall it will be time to get another dose.

“In the history of vaccinology, it’s the only one we update year to year,” said Gary J. Nabel, the director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases.

That has been the case ever since the flu vaccine was introduced in the 1950s. But a flurry of recent studies on the virus has brought some hope for a change. Dr. Nabel and other flu experts foresee a time when seasonal flu shots are a thing of the past, replaced by long-lasting vaccines.

“That’s the goal: two shots when you’re young, and then boosters later in life. That’s where we’d like to go,” Dr. Nabel said. He predicted that scientists would reach that goal before long — “in our lifetime, for sure, unless you’re 90 years old,” he said.

Such a vaccine would be a great help in the fight against seasonal flu outbreaks, which kill an estimated 500,000 people a year. But in a review to be published in the journal Influenza and Other Respiratory Viruses, Sarah Gilbert of Oxford University argues that they could potentially have an even greater benefit.

Periodically, a radically new type of flu has evolved and rapidly spread around the world. A pandemic in 1918 is estimated to have killed 50 million people.

With current technology, scientists would not have a vaccine for a new pandemic strain until the outbreak was well under way. An effective universal flu vaccine would already be able to fight it.

“Universal vaccination with universal vaccines would put an end to the threat of global disaster that pandemic influenza can cause,” Dr. Gilbert wrote.

For more, visit www.nytimes.com.

Monday, October 29, 2012

Massachusetts Shuts Down Another Compounder

The following is an excerpt from an article in:


The New York Times
Monday, October 29, 2012

Massachusetts Shuts Down Another Compounder

By ABBY GOODNOUGH

BOSTON — Massachusetts shut down another compounding pharmacy after a surprise inspection last week found conditions that called into question the sterility of its products, state officials said Sunday.

The pharmacy, Infusion Resource in Waltham, voluntarily surrendered its license over the weekend, said Dr. Madeleine Biondolillo, director of the Bureau of Health Care Safety and Quality at the Massachusetts Public Health Department. Inspectors who visited Infusion Resource on Tuesday found “significant issues with the environment in which medications were being compounded,” Dr. Biondolillo said during a news conference here. She would not disclose details, but said that in another troubling discovery, patients had apparently been receiving intravenous medications at the pharmacy, against state regulations.

The findings led the state to immediately issue a cease-and-desist order, Dr. Biondolillo said, preventing Infusion Resource from dispensing any drugs. But she added that as of yet, there was no evidence of any contaminated drugs produced there.

The latest shutdown comes amid a continuing investigation of New England Compounding Pharmacy, the company believed responsible for a national meningitis outbreak in which 25 people have died, at least 344 others have fallen ill and as many as 14,000 people are thought to have been exposed. State and federal inspections in recent weeks found unsanitary conditions at New England Compounding, from surfaces coated with mold and bacteria to residue on sterilization equipment.

New England Compounding has suspended operations and laid off most of its employees.

For more, visit www.nytimes.com.

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Saturday, October 27, 2012

Poor Sanitation Found at Pharmacy Linked to Meningitis Outbreak

The following is an excerpt from:


The New York Times
Saturday, October 27, 2012

Poor Sanitation Found at Pharmacy Linked to Meningitis Outbreak

By SABRINA TAVERNISE and ANDREW POLLACK

WASHINGTON — A federal inspection of a company whose tainted pain medicine has caused one of the worst public health drug disasters since the 1930s found greenish-yellow residue on sterilization equipment, surfaces coated with levels of mold and bacteria that exceeded the company’s own environmental limits, and an air-conditioner that was shut off nightly despite the importance of controlling temperature and humidity.

The findings, made public on Friday by the Food and Drug Administration, followed a report from Massachusetts regulators on Tuesday and offered disturbing new details in an emerging portrait of what went wrong inside the New England Compounding Center, the pharmacy at the heart of a national meningitis outbreak in which 25 people have died, 313 more have fallen ill and as many as 14,000 people are believed to have been exposed.

Instead of producing tailor-made drugs for individual patients, as the law allowed, the company turned into a major drug maker that supplied some of the most prestigious hospitals in the country, including ones affiliated with Harvard, Yale and the Mayo Clinic, all with minimal oversight from federal regulators.

Federal officials also drew attention to the company’s proximity to a recycling plant where excavators and freight trucks heaped old mattresses, plastics and other materials, generating large amounts of dust. The plant, which is owned by one of the same people as the pharmacy, has not always complied with regulations and has drawn complaints, according to records in Framingham, Mass., where the company is located.

And as the death toll continues to rise, the F.D.A.’s commissioner, Dr. Margaret Hamburg, who was appointed by President Obama, has stayed mostly silent.

Some observers said that weighing in loudly and publicly on a contentious issue was simply not Dr. Hamburg’s style. Others said that it was because the agency was preparing a criminal case and would not want to endanger that with statements construed to be prejudicial. David Kessler, a former F.D.A. commissioner, pointed to the impending presidential election and efforts to keep the outbreak from becoming a political issue.

For more, visit www.nytimes.com.

Thursday, October 25, 2012

With Meningitis Outbreak, a Spotlight on Family Behind Compounding Pharmacy

The following is an excerpt from an article in:


The New York Times
Thursday, October 25, 2012

With Meningitis Outbreak, a Spotlight on Family Behind Compounding Pharmacy

By ABBY GOODNOUGH, SABRINA TAVERNISE and ANDREW POLLACK

A $4.2 million, four-bedroom Boston penthouse overlooking the Charles River in the Back Bay neighborhood. A $3.5 million home in Southborough, Mass., with more than 11,000 square feet, a home theater and an indoor saltwater pool. A $2.35 million vacation home on Cape Cod.

For the Conigliaro family of Massachusetts, owners of these properties, the past decade had been one of business success and rising personal prosperity.

Starting with a recycling company created by one brother in 1990, the family branched into pharmaceuticals, riding changes in the health care landscape to become a major supplier of tailor-made drugs to hospitals, clinics and doctor’s offices across the nation.

But those family enterprises are now under intense scrutiny by federal and state authorities and personal-injury lawyers. A pharmaceutical compounding company that is part of the family portfolio — the New England Compounding Center — was the source of a fungus that led to a meningitis outbreak that as of Wednesday had killed 24 and sickened 317.

Massachusetts officials said Tuesday that during an inspection this month investigators had found dirty mats and hoods, a leaky boiler, dark debris floating in vials of medicine, and evidence that the lab was not leaving enough time to properly sterilize some of its products.

Officials have pledged to revoke the licenses of Barry J. Cadden, a brother-in-law who was the head pharmacist at New England Compounding, and of the pharmacy itself. And production at the family’s larger pharmaceutical company, Ameridose, has been suspended and is also being investigated.

As the cases mount, the Conigliaros have stayed out of the public eye, speaking only through a longtime lawyer.

But the release of records by the Massachusetts Department of Public Health on Monday, as well as interviews with former employees of the drug companies, offer new details about the family and how the businesses operated.

Since the national outbreak began in September, most of the scrutiny has been focused on two founders of New England Compounding, Gregory Conigliaro, an entrepreneur who has run a major recycling operation for two decades, and Mr. Cadden, the pharmacist who married Mr. Conigliaro’s sister Lisa, also a pharmacist.

For more, visit www.nytimes.com.

Wednesday, October 24, 2012

CDC Safe Healthcare Blog: Outbreak - CDC Investigates Fungal Meningitis Cases

CDC Safe Healthcare Blog: Outbreak - CDC Investigates Fungal Meningitis Cases

Sterility Found Lacking at Drug Site in Meningitis Outbreak

The following is an excerpt of an article in:


The New York Times
Wednesday, October 24, 2012

Sterility Found Lacking at Drug Site in Meningitis Outbreak

By ABBY GOODNOUGH

BOSTON — The compounding pharmacy blamed for a deadly national meningitis outbreak repeatedly failed to follow standard procedures to keep its facility clean and its products sterile, Massachusetts officials said Tuesday, painting a harrowing picture of a company that flouted crucial rules as it hurried to ship drugs around the country.

One finding in particular stands out: the pharmacy, the New England Compounding Center, shipped some orders of the drug implicated in the outbreak without waiting for the final results of sterility testing. And while company records indicate the tests found no contamination, regulators said they were skeptical of the company’s methods.

Records suggest that the company failed to sterilize products for “even the minimum amount of time necessary to ensure sterility,” said Dr. Madeleine Biondolillo, director of the Bureau of Health Care Safety and Quality at the Massachusetts Public Health Department.

The findings raise questions about whether the meningitis outbreak could have been averted, or reduced in magnitude, had proper procedures been followed.

“This was preventable,” said Eric S. Kastango, president of Clinical IQ, a consulting firm that counsels compounding pharmacies. “They failed to properly sterilize this medicine that had to be sterilized. That’s huge.”

Mats used to trap dust and dirt just outside the company’s clean rooms were “visibly soiled with assorted debris,” according to a report released Tuesday by the state’s Board of Registration in Pharmacy, and hoods in the sterile compounding area were not properly cleaned. A leaking boiler next to a clean room “created an environment susceptible to contaminant growth,” Dr. Biondolillo said during a news conference at the State House here.

Investigators are also looking into “the environmental conditions surrounding the business,” she said, including a recycling center on the same property in Framingham, Mass., and owned by the same family. At the same time, the state and the Food and Drug Administration are investigating two related drug companies, Ameridose of Westborough and Alaunus Pharmaceutical of Framingham, which have many of the same owners.

For more, visit www.nytimes.com.

Monday, October 22, 2012

November Influenza Articles now online

November Influenza Articles now online

November 2012 issue Emerging Infectious Diseases now online

November 2012 issue now online

November Vector-borne Infection Articles now online

November Vector-borne Infection Articles now online

November Virus Articles now online

November Virus Articles now online

November Parasite Articles now online

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November Tuberculosis and other mycobacteria Articles now online

November Tuberculosis and other mycobacteria Articles now online

November CME Articles now online

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November Fungi Articles now online

November Fungi Articles now online

November HIV/AIDS and Other Retroviruses Articles now online

November HIV/AIDS and Other Retroviruses Articles now online

November 2012 Bacteria, Bioterrorism and Preparedness Articles now online

November 2012 Bacteria, Bioterrorism and Preparedness Articles now online

November Enteric Infection Articles now online

November Enteric Infection Articles now online

November Zoonoses Articles now online

November Zoonoses Articles now online

Meningitis Exposure Patients Wait and Worry

The following is an excerpt from an article in:


The New York Times
Monday, October 22, 2012

Meningitis Exposure Patients Wait and Worry

By DENISE GRADY

Cathy Literski could tell something was wrong just from her mother’s voice on the telephone.

Her mother had learned that a steroid drug injected into her spine for back pain might have been contaminated with a fungus that could cause meningitis. Mrs. Literski had recently had the same type of injections herself, at the same pain clinic in Brighton, Mich. For a moment, neither woman could speak.

“I think we’re both terrified that the other one is going to come down with it,” Mrs. Literski, 57, said. “She’s worried sick about me, and I’m worried sick about her. She’s 80 years old, and if she were to come down with it, she would have very little chance of survival.”

It will be weeks, maybe even months, before the two women know if they are in the clear, past the incubation period for this type of meningitis, which can cause strokes.

About 14,000 people in the United States are in the same nerve-racking situation: knowing they might have been infected, waiting to see if they get sick. So far, 282 have contracted meningitis, and 23 have died, in a national outbreak linked to a contaminated drug made by the New England Compounding Center in Framingham, Mass. A few other patients have developed joint infections from having the drug, methylprednisolone, injected into knees, hips, shoulders or elbows.

Three lots of the drug, more than 17,000 vials, were shipped to 23 states. The meningitis and other infections are not contagious.

As the case count rises day by day, experts are racing to see if they can determine which patients among all those exposed are most likely to contract meningitis. If they can identify the high-risk patients, doctors can follow them intensively with spinal taps and other tests in hopes of detecting the disease and treating it early enough to prevent its dreadful complications.

As early as Monday, health officials may be able to offer doctors a method to estimate a patient’s risk and help decide how aggressive the follow-up should be, Dr. Marion Kainer of the Tennessee Health Department said on Friday during a telephone conference.

For more, visit www.nytimes.com.

Meningitis lawsuits begin in tainted steroid shots : Stltoday

Meningitis lawsuits begin in tainted steroid shots : Stltoday

Saturday, October 20, 2012

David Quammen’s ‘Spillover’ Owes Much to Faulkner

The following is an excerpt from an article in:


The New York Times
Saturday, October 20, 2012

David Quammen’s ‘Spillover’ Owes Much to Faulkner

By CHARLES McGRATH

“Don’t have the monkey,” David Quammen said before lunch the other day at Casa Mono, a Catalan restaurant on Irving Place in Manhattan. “Or if you do, order it medium-well.”

There was a haunch of some strange salted and air-cured mammal on the bar, but despite the restaurant’s name (Casa Mono means Monkey House in Spanish), there is no monkey on the menu, and a good thing too. As Mr. Quammen points out in his scary but hard-to-put-down new book, “Spillover: Animal Infections and the Next Human Pandemic,” eating tainted chimpanzee meat is a good way to come down with the Ebola virus.

Ebola is just one of many horrific diseases that turn up in “Spillover.” Some of the others are SARS, AIDS, bubonic plague, Lyme disease, West Nile fever, Marburg virus, swine flu, bird flu and Hendra virus, or horse measles. What they have in common is that they are all zoonoses — animal infections that jump over into humans — and the book’s unsettling thesis is that such crossovers are bound to happen with more frequency, and possibly greater virulence, as people increasingly encroach on formerly wild and undisturbed habitats.

“We’re shaking loose viruses and dislodging them from their natural ecological limitations, places where they aren’t very abundant and have competition, even within a single animal,” Mr. Quammen said. “We introduce them into a new, rich habitat called the human population, where they can flourish more abundantly and cause more trouble.”

Mr. Quammen, who is 64 but looks much younger, grew up in Cincinnati but has lived for the last 40 years in Montana. He is wiry and tanned, and though Dwight Garner, reviewing “Spillover” in The Times, called him “not just among our best science writers but among our best writers, period,” you could easily mistake him for a fishing guide or a field biologist. “Spillover,” which took Mr. Quammen some 12 years to write, has chapters on virology, scientific history, even on math, but in most of the book he is not just in the lab or the library but also in remote locations all over Central Africa, Malaysia and China. He loves arduous travel, he said over lunch, and he enjoys the company of adventurous scientists.

In the book some of them become as vivid as characters in a Michael Crichton scientific thriller, or as obsessed as the questers in a Rider Haggard novel, only in search of pathogens instead of buried treasure.

For more, visit www.nytimes.com.

Tuesday, October 16, 2012

Wider Meningitis Risk From Tainted Drugs Feared

The following is an excerpt from an article in:


The New York Times
Tuesday, October 16, 2012

Wider Meningitis Risk From Tainted Drugs Feared

By DENISE GRADY and SABRINA TAVERNISE

Health officials are warning that more people may be at risk from contaminated drugs made by a Massachusetts company linked to a growing meningitis outbreak.

The Food and Drug Administration reported on Monday that the company’s products may have also caused other types of infections in patients who have had eye operations or open-heart surgery.

The new warning is based on only two cases, and it was not known for sure whether the company’s drugs had caused the infections. Officials did not say how many people may be at risk, but the number is potentially significant, and a statement from the agency warned doctors, “The F.D.A. recognizes that some health care professionals may receive a high volume of calls from patients or be concerned about having to notify many patients as a result of today’s announcement.”

The company, the New England Compounding Center in Framingham, Mass., has already been linked to a meningitis outbreak that has killed 15 patients and infected 199 others in 15 states. The drug implicated in that outbreak is methylprednisolone acetate, a steroid used in spinal injections for back and neck pain. The drug is believed to have been contaminated with a fungus called Exserohilum, which causes a type of meningitis that is severe but not contagious.

Now, several other drugs made by the company are also possible suspects in infections. A heart-transplant patient exposed to a product that is used during open-heart surgery developed a chest infection with a different fungus, Aspergillus, the Food and Drug Adminstration said. The product is a cardioplegic solution, which is chilled and poured into the opened chest to stop the heart while surgeons work on it. Such solutions have caused problems in the past, according to the F.D.A., which reported that it issued a warning letter in 2006 to a firm that had produced a solution that caused fatal infections in three heart-surgery patients.

The agency emphasized that the heart case was still being investigated, and that it was possible that the infection had come from a source other than the cardioplegic solution. A second heart-surgery patient who had an Aspergillus infection and was initially reported to have received a solution made by the New England Compounding Center had been treated with solution made by another company.

For more, visit www.nytimes.com

Monday, October 15, 2012

HPV Vaccine Does Not Alter Sexual Behavior, Study Finds

The following is an excerpt from an article in:


The New York Times
Monday, October 15, 2012

HPV Vaccine Does Not Alter Sexual Behavior, Study Finds

By ANAHAD O'CONNOR

Coni Butler, an accountant in Austin, Tex., and a devout Catholic, encourages her three children to remain celibate before marriage. But that did not stop her from getting them vaccinated against human papillomavirus, or HPV, a sexually transmitted disease that raises the risk of some cancers.

Ms. Butler had her son and two daughters vaccinated between ages 12 and 15. She was not deterred by widespread concerns that the vaccine might encourage promiscuity.

"We talk about remaining chaste until they get married, but there's always the possibility that one bad choice could lead to devastating consequences," she said. "I tell my friends that you pray for the best, but you plan for the worst."

Since public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex. But research published on Monday in the journal Pediatrics may help ease those fears.

Looking at a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.

"We're hopeful that once physicians see this, it will give them evidence that they can give to parents," said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. "Hopefully when parents see this, it'll be reassuring to them and we can start to overcome this barrier."

For more, visit www.nytimes.com.

Saturday, October 13, 2012

Workers Cite Concerns at Firms Tied to Meningitis

The following is an excerpt from an article in:


The New York Times
Saturday, October 13, 2012

Workers Cite Concerns at Firms Tied to Meningitis

By SABRINA TAVERNISE and ANDREW POLLACK

BOSTON — One pharmacist said she quit because she was worried that unqualified people were helping prepare dangerous narcotics for use by hospitals. A quality control technician said he tried to stop the production line when he noticed that some labels were missing, but was overruled by management. A salesman said he and his colleagues were brought into the sterile lab to help out with packaging and labeling during rush orders, something they were not trained for.

They all used to work at Ameridose, a drug manufacturing company with many of the same owners as the New England Compounding Center, the pharmacy at the center of a national investigation into a meningitis outbreak now in 12 states.

State and federal health officials say they have no reason to believe that Ameridose sent out contaminated products, and have not recalled any. But regulators asked the company on Wednesday to suspend production to allow them to conduct an on-site investigation, because their inquiry “includes concerns for quality and safety across the corporate entity,” the Massachusetts Department of Public Health said.

Paul Cirel, a lawyer representing Ameridose, declined to discuss the statements made by the former employees. “What some anonymous, maybe disgruntled, ex-employees say to you that is not said to us by the F.D.A. or any regulator, I just can’t go there right now,” he said. “If it becomes a claim that a regulator puts to us, then we will address it.”

Mr. Cirel, of Boston-based Collora L.L.P., added that the suspension was voluntary and would be in place until Oct. 22.

In all, eight former employees were interviewed, three from New England Compounding and five from Ameridose. Three of those former workers said the companies were run with good attention to safety.

Thomas DiAdamo, who was a salesman for New England Compounding for about two years, said, “When I heard about this I was shocked, because they were meticulous about safety.”

He said Barry Cadden, New England Compounding’s chief pharmacist, who is also a shareholder in Ameridose and who lost his pharmacist license this week, told him, “ ‘We do not make mistakes.’ Something must have happened that was out of his control.”

For more, visit www.nytimes.com.

Sunday, October 7, 2012

Deadly meningitis outbreak increases to 91 cases

Deadly meningitis outbreak increases to 91 cases

Scant Drug Maker Oversight in Meningitis Outbreak

The following is an excerpt from an article in:


The New York Times
Sunday, October 07, 2012

Scant Drug Maker Oversight in Meningitis Outbreak

By DENISE GRADY, ANDREW POLLACK and SABRINA TAVERNISE

Eddie C. Lovelace, a Kentucky judge still on the bench into his late 70s, had a penchant for reciting Shakespeare from memory and telling funny stories in his big, booming voice. But a car accident last spring left him with severe neck pain, and in July and August he sought spinal injections with a steroid medicine for relief.

Instead, Judge Lovelace died in Nashville in September at age 78, one of the first victims in a growing national outbreak of meningitis caused by the very medicine that was supposed to help him. Health officials say they believe it was contaminated with a fungus.

The rising toll — 7 dead, 57 ill and thousands potentially exposed — has cast a harsh light on the loose regulations that legal experts say allowed a company to sell 17,676 vials of an unsafe drug to pain clinics in 23 states. Federal health officials said Friday that all patients injected with the steroid drug made by that company, the New England Compounding Center in Framingham, Mass., which has a troubled history, needed to be tracked down immediately and informed of the danger.

“This wasn’t some obscure procedure being done in some obscure hospital,” said Tom Carroll, a close friend to the Lovelace family, and their lawyer. “They had sought out a respected neurosurgeon who had been referred by their family doctor, at a respected hospital,” he said, referring to the St. Thomas Outpatient Neurosurgery Center. “How does this happen?”

The answer, at least in part, is that some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies.

“The Food and Drug Administration has more regulatory authority over a drug factory in China than over a compounding pharmacy in Massachusetts,” said Kevin Outterson, an associate professor of law at Boston University.

The outbreak has also brought new scrutiny to the widely used procedure that Judge Lovelace and millions of Americans undergo each year.

Patients most likely assumed there was strong evidence that the procedure itself works. But the Cochrane Collaboration, an international group of medical experts, reviewed the data last year and found there was “no strong evidence for or against” the injections. Patients exposed to the drug in the current outbreak may have risked their health or even their lives for an elusive goal.

For more, visit www.nytimes.com.

Wednesday, October 3, 2012

‘Spillover,’ by David Quammen, on How Animals Infect Humans

The following is an excerpt from a book review in the New York Times:


The New York Times
Wednesday, October 03, 2012

‘Spillover,’ by David Quammen, on How Animals Infect Humans

By DWIGHT GARNER

SPILLOVER

Animal Infections and the Next Human Pandemic

By David Quammen

587 pages. W. W. Norton & Company. $28.95.

Linguists have a good eye for where language has been, but it’s rarely easy to see into its future. In his powerful and discomfiting new book, “Spillover: Animal Infections and the Next Human Pandemic,” the science writer David Quammen cites a dismal word we’ll be getting used to in the coming decades, whether we like it or not: zoonosis.

A zoonosis in an animal infection that, through a simple twist of fate, becomes transmissible to humans. Maybe that twist is a needle prick, or contact with an exotic animal or hiking downwind of the wrong farm.

“It’s a mildly technical term,” he admits, but probably not for long. “It’s a word of the future, destined for heavy use in the 21st century.”

Ebola and bubonic plague are zoonoses. So are, he writes, in a list that peals off the tongue like a distraught Allen Ginsberg poem or an outstanding list of death metal band names, “monkeypox, bovine tuberculosis, Lyme disease, West Nile fever, Marburg virus disease, rabies, hantavirus pulmonary syndrome, anthrax, Lassa fever, Rift Valley fever, ocular larva migrans, scrub typhus, Bolivian hemorrhagic fever, Kyasanur forest disease, and a strange new affliction called Nipah encephalitis, which has killed pigs and pig farmers in Malaysia.”

AIDS, he adds, that destroyer of 30 million people, is of zoonotic origin.

In “Spillover” Mr. Quammen investigates many of these diseases, some more than others. He describes the baffled horror of initial outbreaks and then tracks calmly backward. He talks to virologists, doctors, field biologists and survivors about how the animal-to-human infection came to pass. He hopscotches the globe like a journalistic Jason Bourne. Often there aren’t doctors left to be interviewed. The medical personnel who first came into contact with sick patients are frequently dead.

Among these diseases, the devils we know are bad enough. Mr. Quammen also thinks determinedly about what he calls the NBO’s — the Next Big Ones. “Will the Next Big One come out of a rain forest or a market in southern China?” he asks. “Will the Next Big One kill” 30 million or 40 million people? He makes you dread that sneeze at the back of the bus.

For more, visit www.nytimes.com.



Meningitis Cases Are Linked to Steroid Injections

The following is an excerpt from an article in:


The New York Times
Wednesday, October 03, 2012

Meningitis Cases Are Linked to Steroid Injections

By DENISE GRADY

Dr. April Pettit, an infectious diseases specialist at Vanderbilt University, was worried about her patient. He had been ill with meningitis for two weeks, he was not getting better, and she could not figure out why. Antibiotics, the usual treatment, were not helping. Bacteria, the usual suspects, could not be found.

On the morning of Sept. 18, as she and a colleague were examining the patient and talking to his family, a pager buzzed. It was the hospital lab, with an answer at last — but a troubling one.

A culture of the patient’s spinal fluid had revealed a fungus, Aspergillus. The patient was so ill that he could no longer communicate, so Dr. Pettit spoke to the family.

“I told them it was a very unusual cause of meningitis in healthy people, and that we needed to try to figure out how he got this infection,” she said.

Had he done anything unusual in the weeks before he became ill? she asked. The answer alarmed her. He had had a steroid injection in his spinal area to relieve back pain — a common treatment, administered to millions of people in the United States every year.

Dr. Pettit called the State Health Department.

She is now credited with being the clinician who recognized the “index case” in what has become a frightening outbreak of meningitis that has killed two people and sickened 12 others who also received steroid injections in their spines for pain. Doctors suspect that the steroid medicine was contaminated with the fungus. The meningitis does not spread from person to person.

Officials said it was not possible to predict the extent of the outbreak yet. Thirteen of the patients have been in Tennessee, and one in North Carolina. Two of the cases were new as of Tuesday, and health officials have said that there could be more cases and that other states could be affected.

For more, visit www.nytimes.com.

Sunday, September 30, 2012

New Virus May Be Dangerous but Seems Not Easily Spread

The following is an excerpt from an article in:


The New York Times
Sunday, September 30, 2012

New Virus May Be Dangerous but Seems Not Easily Spread

By MARC SANTORA

A new strain of a potentially deadly virus related to SARS, which has killed one man in Saudi Arabia and left a Qatari man critically ill in London, does not appear to spread easily from person to person, the World Health Organization says.

Still, officials are urging vigilance, saying that health workers around the world should be on the lookout for anyone with acute respiratory syndrome and requiring hospitalization who had been in the Middle East, where the virus first surfaced, or in contact with a suspected or confirmed case within the last 10 days. On Saturday, the health organization, which was rushing to develop a diagnostic test, said that doctors should test for the virus only if the patient is severely ill, so as not to overburden the health care system.

For more, visit www.nytimes.com.

Friday, September 21, 2012

Better Hepatitis C Treatment Is Costly for Texas Prisons

The following is an excerpt from an article in:


The New York Times
Friday, September 21, 2012

Better Hepatitis C Treatment Is Costly for Texas Prisons

By BRANDI GRISSOM

Tattooing is ubiquitous behind bars, despite — or perhaps because of — the fact that it is banned.

“It’s just unbelievable how creative they can be,” said Michele Deitch, a prisons expert at the University of Texas at Austin’s LBJ School of Public Affairs. “They can jerry-rig pens to become needles. They use the dyes in paper products.”

But the practice carries with it more than the risk of punishment — it can also spread hepatitis C.

The prison population is particularly prone to this viral disease, which is transmitted largely through infected blood and can lead to liver cirrhosis and cancer. Not only do inmates have a penchant for illicit tattoos, but they are also likelier than the general population to have engaged in high-risk behavior like intravenous drug use outside of prison. Prison health officials estimate that as many as 50,000 of the state’s more than 150,000 inmates could be infected with hepatitis C.

The cost to treat Texas inmates with hepatitis C is expected to soar by as much as 380 percent next year, a result of the growing prevalence of the disease among inmates and a more effective, but more expensive, treatment protocol. Legislators, already facing a strained budget, will have to find millions more dollars to pay for this care.

Not all inmates are tested for hepatitis C when they enter the prison system. They are tested if they have other clinical indicators, like H.I.V. or a history of intravenous drug use. In a 2007 report, health providers for the Texas Department of Criminal Justice said they had identified and were managing care for about 20,000 inmates with hepatitis C.

Dr. Stephanie Zepeda, the director of pharmacy services for University of Texas Medical Branch Correctional Managed Care, which oversees treatment of inmates, said she provided medication therapy for about 400 hepatitis C patients per month, at a cost to the state of about $2.8 million per year. Not all patients with the disease receive the medication, and the therapy can last from three months to a year.

The current protocol is composed of two drugs, and its cure rate is about 40 percent, Dr. Zepeda said. But new medical guidelines call for the use of a third medication, which can be one of two different drugs. One of them would increase the cost of hepatitis C treatment in prisons to more than $8 million a year, the other to more than $13 million, Dr. Zepeda said.

Dr. Zepeda said that adding a third drug raised the cure rate to 70 percent. But the drugs are not only expensive, they are also complicated to administer.

“It’s great from a humanistic standpoint,” Dr. Zepeda said. “But it’s, practically, a challenge for the correctional system.”

For more, visit www.nytimes.com.

CDC What's New on the Influenza Site

CDC What's New on the Influenza Site

CDC Influenza Activity Update

CDC Influenza Activity Update

Wednesday, September 19, 2012

Centers for Disease Control and Prevention (CDC) Rabies Update

Centers for Disease Control and Prevention (CDC) Rabies Update

CDC’s infection tracking system launches new capabilities for nursing homes, dialysis clinics and hospitals

CDC’s infection tracking system launches new capabilities for nursing homes, dialysis clinics and hospitals

Unpredictability in Dallas West Nile Virus Outbreak

The following is an excerpt from an article in:


The New York Times
Wednesday, September 19, 2012

Unpredictability in Dallas West Nile Virus Outbreak

By MANNY FERNANDEZ

DALLAS — Jay Wortham found it under the cabinet below the kitchen sink after his mother died in August — a blue bottle of insect repellent.

His mother, Margorie Wortham, 91, died of West Nile virus, the mosquito-borne illness that has spread across this city and other parts of the country, killing 118 people and sickening nearly 3,000 others nationwide.

Mr. Wortham believes that his mother was bitten by an infected mosquito one hot day in July while she sat on an old wooden bench under a pecan tree in her backyard. Though she had often used the bug repellent, she was not wearing any that day.

Here in Dallas County, the West Nile outbreak’s hardest-hit county in the United States, a few missed pumps of bug spray can haunt the relatives of those who die from the virus.

“I wish I had taken her this instead of a vodka and Coke,” said Mr. Wortham, 59, holding the bottle in his hands. “I ask that other people don’t make the same mistake.”

Ms. Wortham and 14 other people have died in Dallas County from the virus since July. Nine were men, and six were women. The youngest were in their 40s, and the oldest in their 90s.

Charles H. Pistor Jr., 81, was a well-known figure in Dallas — a retired banking executive, former vice chairman of the board of trustees at Southern Methodist University and past president of the Dallas Assembly civic group.

Dr. Tom M. McCrory, 92, a retired eye surgeon, died eight days after Mr. Pistor in July.

Dema Miller lived in the Dallas suburb of Irving and was one week shy of her 84th birthday when she died in August.

Local and federal health officials said the outbreak that has killed 57 people and sickened hundreds of others in Texas appeared to be waning, with Dallas County seeing a decrease in new cases in recent weeks. Still, the friends and relatives of the county’s fatal victims remain in a state of grief, coming to terms with the seeming randomness of healthy middle-aged people and active retirees cut down by ever-present insects.

For more, visit www.nytimes.com.

Tuesday, September 18, 2012

Waiting and Worrying After Yosemite Hantavirus Outbreak

The following is an excerpt from an article in:


The New York Times
Tuesday, September 18, 2012

Waiting and Worrying After Yosemite Hantavirus Outbreak

By PETER JARET

Bears were the only thing to worry about during our stay at a tent cabin in Yosemite National Park in August, or so my husband and I thought. We scrupulously emptied the car of food and anything a bear might mistake for food, including empty wrappers and scented items like soap. We cleaned every crumb of trail mix from our tent. We stashed everything that might attract a bear in metal lockers provided by the park.

As it turns out, we should have been worrying about a much less obvious threat.

By the time Steven and I returned home, the news reports had begun to appear. An outbreak of hantavirus infection in Curry Village, a popular camping area in Yosemite Valley, had killed two people. Four others had been sickened. But we had camped at Tuolumne Meadows, one of the High Sierra Camps at the far eastern border of the park, miles from Curry Village. We had nothing to worry about.

Then, on Sept. 6, an e-mail arrived: an official notification from Yosemite National Park. “You are receiving this advisory because you have recently stayed in the High Sierra Camps at Yosemite National Park, and we want to inform you — and any members of your party — about a potential public health matter that has been brought to our attention.”

Gulp.

Another case of hantavirus infection had been identified, this one in a camper who had stayed in the High Sierra area where we’d camped. “It is recommended that if a recent visitor to Yosemite National Park exhibits any symptoms,” the e-mail went on, “that they seek medical attention immediately and advise their health care professional of the potential exposure to hantavirus.”

Weirdly, the e-mail featured an inviting panoramic photograph of the Yosemite peaks towering against a clear blue sky.

As a science writer, I knew hantavirus could be swiftly lethal. The virus and the disease it causes, called hantavirus pulmonary syndrome was first discovered in 1993, when a terrifying outbreak began to unfold in the Four Corners area of New Mexico, Colorado, Utah and Arizona. One of the first cases was a healthy 19-year-old man who was a marathon runner. A day after coming down with flulike symptoms, he went to an emergency room. Three days later he was dead. Medical detectives soon discovered that the man’s fiancée had died days earlier, also from a runaway respiratory infection.

Researchers have since learned that deer mice transmit the virus in their droppings, urine and saliva. People become infected when they inhale particles contaminated with the virus. The first symptoms are varied — fatigue, fever, chills and muscle ache — but the infection can progress within 10 days to coughing, nausea, respiratory difficulty and death.

For more, visit www.nytimes.com.

Thursday, August 23, 2012

West Nile Outbreak Shaping Up as Worst Ever in U.S., Authorities Say


The following is an excerpt from an article in 



The New York Times
Thursday, August 23, 2012

West Nile Outbreak Shaping Up as Worst Ever in U.S., Authorities Say

By DONALD G. McNEIL Jr.

The nation is heading toward the worst outbreak of West Nile disease in the 13 years that the virus has been on this continent, federal health authorities said Wednesday.

But it is still unclear where and how far cases will spread. Dallas declared an emergency last week, and West Nile deaths have been concentrated in Texas and a few nearby states, including Louisiana, Mississippi and Oklahoma, as well as South Dakota.

So far this year, there have been 1,118 cases and 41 deaths reported to the Centers for Disease Control and Prevention, Dr. Lyle R. Petersen, director of the agency’s division of vector-borne diseases, said Wednesday in a telephone news conference.

“That’s the highest number of cases ever reported to the C.D.C. by the third week of August,” he added. “And cases are trending upward.”

For more, visit www.nytimes.com.