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.

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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.

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.

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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.

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http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=126031&WT.mc_id=USNSF_51&WT.mc_ev=click

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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.

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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.

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Received Nov. 5, 2012.

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