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World Health Organization Reports ~14,000 Cases of Swine Flu Worldwide

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Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009. The virus is infecting people and is spreading from person-to-person, sparking a growing outbreak of illness in the United States. An increasing number of cases are being reported internationally as well.

It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.

It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses. Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks.

Country Cumulative total
  		 Newly confirmed since the last reporting period
  Cases Deaths Cases Deaths
Argentina 19 0 14 0
Australia 39 0 20 0
Austria 1 0 0 0
Bahrain 1 0 1 0
Belgium 7 0 0 0
Brazil 9 0 0 0
Canada 921 1 0 0
Chile 86 0 12 0
China 22 0 2 0
Colombia 16 0 0 0
Costa Rica 33 1 0 0
Cuba 4 0 0 0
Denmark 1 0 0 0
Ecuador 28 0 4 0
El Salvador 11 0 5 0
Finland 2 0 0 0
France 16 0 0 0
Germany 17 0 0 0
Greece 1 0 0 0
Guatemala  5 0 1 0
Honduras 1 0 0 0
Iceland 1 0 0 0
India 1 0 0 0
Ireland 1 0 0 0
Israel 9 0 1 0
Italy 23 0 4 0
Japan 360 0 10 0
Korea, Republic of 21 0 0 0
Kuwait 18 0 0 0
Malaysia 2 0 0 0
Mexico 4541 83 367 3
Netherlands 3 0 0 0
New Zealand 9 0 0 0
Norway 4 0 0 0
Panama 76 0 0 0
Peru 27 0 0 0
Philippines 2 0 0 0
Poland 3 0 0 0
Portugal 1 0 0 0
Russia 2 0 0 0
Singapore 1 0 1 0
Spain 138 0 2 0
Sweden 3 0 0 0
Switzerland 3 0 0 0
Thailand 2 0 0 0
Turkey 2 0 0 0
United Kingdom 137 0 0 0
United States of America 6764 10 0 0
Grand
Total		 13398 95 444 3

Chinese Taipei has reported 4 confirmed cases of influenza A (H1N1) with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.

Cumulative and new figures are subject to revision

Source: WHO, May 27, 2009 (international cases table); CDC (background information)

Genetic Link Between Heart Disease and Gum Disease

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BBC News reports that a genetic link between gum disease and heart attacks has been found by researchers in Germany.
Periodontitis (gum disease) is known to be associated with heart disease but how exactly they are linked is unknown.

Now the University of Kiel team has found a common gene mutation in people with periodontitis and heart attack patients, a conference heard.

Source: BBC, May 25, 2009
news.bbc.co.uk/1/hi/health/8063512.stm

Drinking While Pregnant Still a Problem

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Exposure to alcohol is a known cause of birth defects, yet the number of women who drink alcohol while pregnant is not decreasing, according to a 15 year-study by the Centers for Disease Control and Prevention. Approximately 1 in 8 women drank any amount of alcohol while pregnant, the study says.

The drinking patterns persisted despite repeated warnings from surgeons general about the dangers of drinking alcohol while pregnant. The surgeons general have told pregnant women, and women who may become pregnant to abstain from alcohol consumption in order to eliminate the chance of giving birth to a baby with alcohol related birth defects.

The CDC analysis, as well as a study also published today by the U.S. Substance Abuse and Mental Health Services Administration shows that far too many women use substances (especially alcohol) during their pregnancies.

The CDC study, “Alcohol Use Among Women of Childbearing Age, United States, 1991-2005,” is in the CDC′s Morbidity and Mortality Weekly Report.

The CDC study also found that 1 of every 50 pregnant women engaged in binge drinking each year during the 15 years.

“Exposure to alcohol can cause lifelong physical and mental disabilities that are preventable by avoiding alcoholic drinks while pregnant,” said Edwin Trevathan, director of the CDC′s National Center on Birth Defects and Developmental Disabilities. “All women should know that there is no known safe amount of alcohol to drink or safe time to drink it during pregnancy. We encourage all women to pay attention to the surgeon general warnings.”

The study found that pregnant women most likely to report any alcohol use were 35-44 years of age (17.7 percent), college graduates (14.4 percent), employed (13.7 percent), and unmarried (13.4 percent). Pregnant women who binge drink were more likely to be employed and unmarried than were pregnant women who did not binge drink. This study did not examine the reasons why women are still drinking while pregnant.

Any alcohol use was defined as at least one drink of any alcoholic beverage in the past 30 days. Binge drinking was defined as having five or more drinks on at least one occasion in the past 30 days.

“By screening and advising women about the risks of drinking while pregnant, health care providers can play a key role in reducing rates of fetal alcohol syndrome,” said Clark Denny, a CDC epidemiologist and primary author of the study. “This study revealed that there is still a great need for health care professionals to routinely ask all women who are pregnant or at risk of being pregnant about their alcohol consumption.”

The study examined data from 533,506 women aged 18-44 years, of whom 22,027 reported being pregnant at the time of the interview. The data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a state-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. Data are collected monthly in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam.

source: CDC, 5/21/09

Prilosec, Nexium and Prevacid Tied to Higher Risk of Pneumonia

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A new study has found that hospital patients who are given proton pump inhibitors–drugs that help prevent acid reflux–are at higher risk for pneumonia than those who are not given these medications.

The drugs — including Nexium, Prilosec and Prevacid — are often recommended for intensive-care patients to prevent stress ulcers, and in recent years they have been given to many other hospital patients, in large part because they are widely perceived to be safe. Experts estimate that 40 percent to 70 percent of inpatients now receive acid-suppressive drugs during a hospital stay, with about half receiving them for the first time.

Source: New York Times, May 26, 2009
nytimes.com/2009/05/27/health/27drugs.html

Test Well Water Once a Year for Children’s Health

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Private well water should be tested yearly, and in some cases more often, according to new guidance offered by the American Academy of Pediatrics (AAP).

Researchers at the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, took a lead role in working with the AAP to develop these recommendations and draft a new AAP policy statement about the things parents should do if their children drink well water. The recommendations call for annual well testing, especially for nitrate and microorganisms such as coliform bacteria, which can indicate that sewage has contaminated the well.

The recommendations point out circumstances when additional testing should occur, including testing when there is a new infant in the house or if the well is subjected to structural damage.

“Children are especially vulnerable to waterborne illnesses that may come from contaminated wells,” said Walter J. Rogan, M.D., an epidemiologist at NIEHS and lead author on the policy statement and technical report that appears in the June issue of Pediatrics. The new policy statement, “Drinking Water from Private Wells and Risks to Children,” offers recommendations for inspection, testing and remediation of wells providing drinking water for children.

“With few exceptions, well owners are responsible for their own wells,” said Rogan. Private wells are not subject to federal regulations and are only minimally regulated by states. With proper care, well water is safe; however, wells can become contaminated by chemicals or pathogenic organisms.

Nitrate, which comes from sewage or fertilizer, is the most common contaminant in wells. The presence of nitrates can be a problem particularly for infants under three months who can not metabolize nitrate. Water with a nitrate concentration of more than 1.0 milligrams per liter should not be used to prepare infant formula or given to a child younger than one year. The policy statement suggests using bottled water for infants when nitrate contamination is detected, or when the source of drinking water is not known.

The policy statement and accompanying technical report point out that water contamination is inherently local, and that families with wells need to keep in contact with state and local health experts to determine what should be tested in their community. For example, some parts of the country may have arsenic, radon, salt intrusion or agricultural runoff that may get into the water supply.

“As people move out of urban and suburban areas into areas that are not reached by municipal water supplies, it is more important than ever that people know who to contact in their local health department to get information about local groundwater conditions,” said N. Beth Ragan of NIEHS, who served as consultant on these reports. A compilation of state by state telephone and Web-based resources of local experts is included in the technical report. Approximately one-sixth of U.S. households now get their drinking water from private wells.

NIEHS Director Linda Birnbaum, Ph.D., says she is pleased that NIEHS researchers took the lead in writing this statement, and continue their longstanding liaisons with the American Academy of Pediatrics to develop state-of-the-science technical reports that can have a direct impact on public health.

“This statement will be extremely useful to many audiences — especially pediatricians,” Birnbaum said. “Pediatricians needed a one-stop shopping document that they can share with parents who have concerns about their children�s sources of drinking water.”

Source: NIH, May 26, 2009

Pool Chemical Injuries Threaten Thousands

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Pool chemical injuries account for as many as 5,200 emergency room visits each year. A new study by the Centers for Disease Control and Prevention shows that these injuries are preventable, and during 2007 almost half of those injuries occurred at a residence.

According to the study, published in CDC′s Morbidity and Mortality Weekly Report (MMWR), persons can be injured by inhaling fumes when they open pool chemical containers, attempting to pre-dissolve pool chemicals, or handling them improperly. Persons can also be injured when chemicals splash into the eyes. These preventable injuries typically occur during the summer swimming season, from Memorial Day to Labor Day, and can occur in or out of the pool.

In addition to pool chemical injuries, thousands of people each year suffer from recreational water illnesses. The study was released ahead of CDC′s National Recreational Water Illness Prevention Week, May 18-24. The week aims to raise awareness about healthy swimming behaviors, including ways to prevent recreational water illnesses and injuries. Recreational water illnesses are illnesses spread by swallowing, inhaling vapors, or having contact with contaminated water in swimming pools, water parks, spas, interactive fountains, lakes, rivers, or oceans.

“Pool chemicals make the water we swim in safer by protecting us from germs, but these same chemicals can also cause injuries if they are not properly handled,” said Michele Hlavsa, the study′s lead author and epidemiologist at CDC.

Public pool operators and residential pool owners can protect themselves and swimmers by always securing pool chemicals, reading product names and manufacturer′s directions before each use, using appropriate protective gear including safety glasses and gloves, and never mixing chlorine products with each other, with acid, or with any other substance.

The study looked at 36 pool chemical-associated health events reported to the New York state Department of Health for recreational water venues, such as pools, water parks, and interactive water fountains, during 1983-2006.

Swimming is the second most popular sports activity in the United States, with approximately 339 million swimming visits to recreational water venues.

The best way to prevent recreational water illnesses is to keep germs out of the pool in the first place. Everyone can help create healthy swimming experiences by not swimming when ill with diarrhea, not swallowing pool water, taking kids on bathroom breaks and practicing good hygiene.

Source: CDC, May 23, 2009

Samsca Approved by FDA to Treat Hyponatremia

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The U.S. Food and Drug Administration has approved Samsca tablets (tolvaptan) to treat hyponatremia, an abnormally low concentration of sodium in the blood.

“With the approval of Samsca, physicians will have an additional tool to treat hyponatremia,” said Norman Stockbridge, M.D., director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research.

Samsca is approved to treat hyponatremia associated with congestive heart failure, liver cirrhosis, and the syndrome of inappropriate antidiuretic hormone secretion.

When sodium levels drop in the fluid outside of cells throughout the body, water moves into cells to balance the sodium levels and causes the cells to swell. Swelling of the brain cells is thought to cause many of the symptoms of hyponatremia. Those symptoms may include fatigue, weakness, headache, nausea, confusion or decreased consciousness, and convulsions. Severe hyponatremia, which has not been studied with Samsca, can lead to coma and death.

Samsca helps raise sodium levels in the blood by removing extra body water in the urine. Patients using the drug in clinical trials had a greater degree of increase in sodium levels in the blood compared with patients taking a pill containing no active drug (placebo).

Samsca is being approved with a boxed warning to alert health care professionals and patients that the drug should be started only in a hospital where blood sodium can be monitored closely. Too rapid a rise in sodium can cause a serious condition called osmotic demyelination syndrome (ODS). ODS can lead to coma or death and can also cause symptoms such as trouble speaking, trouble swallowing, drowsiness, confusion, mood changes, seizures and trouble controlling body movement with muscle weakness in the arms and legs.

Although no cases of ODS were seen in clinical trials of Samsca, ODS is a known risk and it is essential that physicians be aware of it and avoid rapid rises in sodium. Additionally, the FDA is requiring a Risk Evaluation and Mitigation Strategy that requires a patient Medication Guide be given out when the drug is dispensed. The Medication Guide will provide information about the drug’s benefits and risks.

The most common adverse reactions with use of Samsca reported by patients in clinical trials include thirst, dry mouth, weakness, constipation, making large amounts of urine, urinating often, and increased blood sugar levels.

Samsca is marketed by Otsuka Pharmaceuticals Co. Ltd., Tokyo, Japan.

Source: FDA, May 22, 2009

Swine Flu Information

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Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.

Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.

From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified.

Human Swine Influenza Investigation

April 25, 2009 19:30 EDT

Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S. in San Diego County and Imperial County, California as well as in San Antonio, Texas. Internationally, human cases of swine influenza A (H1N1) virus infection have been identified in Mexico.

U.S. Human Cases of Swine Flu Infection
State # of laboratory confirmed cases
California 7 cases
Texas 2 cases
Kansas 2 cases
TOTAL COUNT 11 cases
International Human Cases of Swine Flu Infection
See: World Health Organization

Last Updated: As of April 25th, 2009 7:30 p.m. EDT

Investigations are ongoing to determine the source of the infection and whether additional people have been infected with similar swine influenza viruses.

CDC is working very closely with state and local officials in California, Texas, as well as with health officials in Mexico, Canada and the World Health Organization. On April 24th, CDC deployed 7 epidemiologists to San Diego County, California and Imperial County, California and 1 senior medical officer to Texas to provide guidance and technical support for the ongoing epidemiologic field investigations. CDC has also deployed to Mexico 1 medical officer and 1 senior expert who are part of a global team that is responding to the outbreak of respiratory illnesses in Mexico.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. There are many things you can to do preventing getting and spreading influenza:

There are everyday actions people can take to stay healthy.

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Source: Centers for Disease Control (CDC)

Promising Procedure Injects Stem Cells Directly Into Patient’s Heart

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In a ground-breaking procedure, surgeons at The Methodist Hospital in Houston injected highly concentrated stem cells directly into a patient’s heart, providing an intense, direct hit on damaged heart tissue.

This technique may be more successful in regenerating healthy heart tissue than current methods that use a catheter to put standard stem cells through the bloodstream into the heart. The 58-year old patient is expected to be discharged this weekend.

“Some patients have such severe heart failure that their only current option is a heart transplant,” said Dr. Brian Bruckner, cardiac surgeon at the Methodist DeBakey Heart & Vascular Center in Houston. “We hope that stem cells will stimulate angiogenesis, the growth of new blood vessels, restore mechanical function in diseased heart tissue, and return patients to a much better quality of life without a transplant.”

In a novel process, the patient’s strongest and most robust stem and progenitor cells, derived from the patient’s own bone marrow, are amplified up to 1,000 times before they’re injected back into the patient’s heart. In the procedure, Dr. Bruckner made a small incision in the left side of the patient’s chest and administered approximately 25 injections of concentrated stem cells into the patient’s heart. All patients in the trial will be followed for 12 months after the injections.

There are currently 5.5 million people in the U.S. suffering from chronic heart failure. A subset of these patients has dilated cardiomyopathy (DCM), a chronic heart disease in which the patient’s heart can not pump effectively enough to deliver blood and oxygen to the vital organs in the body. Patients with DCM typically experience severe limitations to physical activity and shortness of breath.

“Without a new approach to treatment of these patients, they will continue to decline and less than 40 percent will survive five years,” said Bruckner, principal investigator for the trial. “We hope this trial will provide a completely new and viable treatment for them.”

Dr. Michael Reardon, chief of cardiac surgery at Methodist, and Dr. Matthias Loebe, transplant surgeon at Methodist, are co-investigators on the trial. Dr. Kevin Lisman is the patient’s referring cardiologist.

Source: Methodist Hospital, Houston, Texas

Trauma Victims’ Post-Operational Survival Chances Improved by Antioxidant Therapy

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Many trauma patients do not survive the post-operational stage due to multiple-organ failure, but a recent study has shown that post-operational survival can be improved by antioxidant therapy.

In a study presented at the 2008 Clinical Congress of the American College of Surgeons (ACS), Bryan A. Cotton, MD, FACS, stated that “implementation of high-dose antioxidant protocol (vitamins C, E, and selenium) resulted in a reduction of pulmonary complications, in general, as well as infectious complications, including central line and catheter-related infections.”

Dr. Cotton, assistant professor of surgery at Vanderbilt University Medical Center, Nashville, TN, observed that when an abdominal wound opens up, the result is not just an infection to be treated with antibiotics. Sometimes the wounds open up, requiring reconstruction with expensive agents. Dr. Cotton observed a remarkable decrease in abdominal wall complications—including abdominal compartment syndrome and surgical site infections.

“This is a high mortality, high morbidity, may-never-return-to-work-again problem in a young healthy patient,” he said. “Abdominal wall complications are enormous, yet we noted a reduction in some of these complications with implementation of antioxidants. Importantly, the biggest difference was in those patients who had a predicted mortality exceeding 50 percent.”

Dr. Cotton and his colleagues at Vanderbilt showed that this high-dose antioxidant protocol accounted for an amazing 28% reduction in mortality in acutely injured patients. Length-of-stay, hospital and ICU, was also reduced. Dr. Cotton explained how an acute injury imposes a huge strain on the body, which releases oxygen molecules called free radicals, that cause damage at the cellular level called oxidative stress. Antioxidants work as a team in mopping up some of the oxidative stress waste byproducts, reducing the stressors that cause harm. Depletion of antioxidants is one of the mechanisms that explains why we are vulnerable. Antioxidant therapy replenishes those troops to help keep us safe.

“Antioxidant therapy is so simple and that’s what throws people off,” Dr. Cotton said. A trial conducted by Avery B. Nathens, MD, MPH, showed that some inflammatory states and responses were remarkably improved in patients who had received antioxidants versus those who did not. “Based on these results, we were inspired to initiate a study with vitamins C and E. When we looked at the literature, however, there were some concurrent studies showing that selenium had an impact too, especially on sepsis and other infectious complications. So we combined all the existing research and did a cost analysis. When we learned it would cost only $11 a patient for a seven-day course of antioxidants, we decided to give it a try.”

This retrospective study followed a total of 4,279 patients admitted to the Vanderbilt University Medical Center trauma unit during the study period. High-dose antioxidant protocol was administered to all acutely injured patients (2,258 individuals) admitted to the center between October 1, 2005, and September 30, 2006. This treatment included 1,000 mg. vitamin C (ascorbic acid) -tocopherol acetate), each routinely given everyaand 1,000 IU vitamin E (DL- eight hours by mouth, if the patient could take it that way. In addition, 200 mcg. selenium was given once daily intravenously. Patients received these supplements upon arrival, and they were continued for seven days or until discharge, whichever happened first. Patients who were pregnant or had serum creatinine levels >2.5mg/dL did not receive antioxidants.

A comparison cohort was made up of all patients (2,021 individuals) admitted to the trauma center between October 1, 2004, and September 30, 2005—prior to implementation of the antioxidant protocol. While pneumonia and renal failure were similar between the groups, the incidence of abdominal compartment syndrome was significantly less (90 versus 31), as were catheter-related infections (75 versus 50) and surgical site infections (101 versus 44). Pulmonary failure—meaning the patient could not get off the ventilator—was less as well (721 versus 528).

Dr. Cotton is now prescribing high-dose antioxidants only to the most seriously ill patients in the ICU, as they seem to derive the greatest benefit. He and his colleagues will now focus on dose adjustments and length of administration to see if the doses and duration they are currently using are optimal. They have been approached by several groups that are interested in collaborating and investigating these agents as part of multiinstitutional trials and expanding their use to critically ill nontrauma patients.

“While we are all looking for that magic bullet to cure some of the horrible things that can happen after someone is injured or has an operation, we have something at our disposal,” Dr. Cotton said. “It might not be that magic bullet, but it is a very inexpensive and safe way to reduce complications and mortality in the sickest patients.”

Assisting Dr. Cotton with this study were Aviram Giladi, BS; Bryan R. Collier, DO, FACS; Lesly A. Dossett, MD; and Sloan B. Fleming, PharmD, all from Vanderbilt. He received no funding for this research.

Source: American College of Surgeons