Measles deaths drop by 60 percent

Fri, 19 Jan 2007 03:52:49 GMT
By MARIA CHENG, AP Medical Writer
LONDON - Global measles deaths have dropped by 60 percent, health authorities announced in a report Friday, and one senior official called it a "historic victory" for public health.
Nearly 7.5 million children were saved from dying of measles between 1999 and 2005, thanks to increased immunization campaigns, the World Health Organization said. More than 360 million children aged 9 months to 15 years were vaccinated against measles during that period.

Measles is one of the most infectious diseases that exists. Though it is no longer a major problem in the West, in poor countries, the disease can kill as many as 30 percent of the children it infects, particularly in those with weakened immune systems.

"This is a historic victory for global public health," said Dr. Margaret Chan, WHO's director-general. Health authorities had hoped to cut measles mortality rates in half by 2005, but found that they had exceeded that goal by 10 percent. In Africa, the results were even more striking: measles deaths fell by 75 percent on the continent.

"It's not very often that global health initiatives not only achieve their goals, but actually exceed their goals faster than expected," said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention. The measles success achieved to date, Gerberding said, has encouraged the global community to aim even higher, as they set a new goal of reducing measles deaths by 90 percent by 2010.

According to Geneva-based WHO, the next phase of this initiative is projected to cost about $500 million, of which $150 million has already been committed.

In a study published Friday in the British medical journal The Lancet, WHO scientists estimated that the number of measles deaths fell from 873,000 in 1999 to 345,000 in 2005.

Because surveillance figures from countries are not available, WHO based its figures on a modeling system that estimates the number of measles cases based on coverage rates achieved during vaccination campaigns. Experts said the numbers should be reasonably accurate.

If the 2010 goal is met, health officials may then start considering whether it might be feasible to eradicate measles. Like smallpox and polio, an effective vaccine exists, making it a potential candidate for eradication.

Still, the problems plaguing polio, which was originally supposed to be eradicated by 2000, may undermine any proposed measles campaign.

"The continuing failure to meet the polio eradication goals will cast much skepticism and pessimism on any similar global venture for measles," said Dr. Samuel Katz, co-inventor of the measles vaccine. Katz is also an infectious diseases specialist at Duke University.

"Donor and participant fatigue take their toll," he said.

To date, the effort to eradicate polio has cost $4 billion. And while health officials are tantalizingly close to the finish line — polio incidence has been cut by 99 percent — it remains stubbornly endemic in Afghanistan, India, Nigeria and Pakistan.

Whether or not measles eradication will be attempted will depend largely on if the 2010 goal can be met.

"That will be another milestone to measure if elimination is possible," said Dr. Vance Dietz, chief of the global measles department at the CDC.

"It may be that by then, we are so far ahead that regardless of what's happened with polio, people will want to move ahead," he said.

The Measles Initiative was launched in 2001 to reduce measles deaths worldwide. Its major partners are the American Red Cross, the CDC, the U.N. Foundation, UNICEF and WHO.

Reports tally birth defects high cost

Thu, 18 Jan 2007 23:12:27 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - Birth defects lead to more than $2.5 billion a year in hospital costs alone, according to the first national studies to estimate their financial burden on U.S. families.
The reports are the most comprehensive to look at the costs of birth defects in at least 10 years, experts said.

They also will give many families their first real idea of the expense of a baby born with serious birth defects, said Dr. Nancy Green, medical director for the March of Dimes, which campaigns for birth defects prevention.

"People who are pregnant don't want to think about adverse outcomes, but these are unhappy realities," Green said. "Getting the word out about their presence and impact helps people understand better about these risks."

The risk of having a child with a birth defect is 3 to 4 out of every 100 babies born, according to March of Dimes officials.

The first study, released Thursday, was done by researchers at the University of Arkansas and the U.S. Centers for Disease Control and used 2003 data from 36 states.

They looked at what hospitals charged patients — not the actual cost of care, which is just a fraction of hospital charges. They did not include physicians' bills or other medical charges related to birth defect care.

The researchers looked at cases in which a child had one of 35 obvious and serious birth defects, and was under 10 days old at the time the baby was admitted to a hospital for care for that defect.

Certain birth defects were particularly deadly: For example, about 85 percent of babies born with anencephaly — that is, born without all or most of their brain and skull — died in the hospital. Most died within two days of birth.

Because of their brief life span and the limited options for care, the average hospital bill for one of these cases was $3,800.

The longest hospital stays were for children with surgically repaired gastroschisis, a defect involving an opening in the abdomen through which intestines stick out. The condition kept children in hospitals for 41 days, on average. The average bill was one of the highest among birth defects — about $156,000.

The most expensive condition was hypoplastic left heart, in which an infant is almost or completely missing the two left chambers of the heart. Treatment is a heart transplant or a series of reconstructive surgeries, and the condition required a 29-day stay in the hospital that cost about $200,000, on average.

"It is almost always a function of how long they were in the hospital because of the surgeries that were done," said James Robbins, the Arkansas researcher who led the study.

Some defects can be detected during pregnancy through tests like amniocentesis and ultrasound, including anencephaly, spina bifida and chromosomal abnormalities. But some heart problems are more subtle and go unrecognized until after birth, Robbins said.

Experts say pre-birth diagnosis can help families decide to search for an obstetrician or hospital specializing in high-risk births, or make financial and other plans to deal with the diagnosis.

A second study released this week, by the U.S. Agency for Healthcare Research and Quality, looked at 2004 data from 37 states.

Those researchers measured something different. They estimated what it cost hospitals to care for birth defects, which they reasoned was about 40 percent of what the hospitals charged.

And they looked not only at newborns, but at a sample of people of all ages who had hospital stays primarily for the treatment of birth defects.
They found the average age of patients was about 17 1/2 years, the average hospital stay about six days, and the average per-stay cost was $18,600. The aggregated cost for all these hospital visits was more than $2.5 billion, the researchers found.
"These are expensive — many of them are surgically treated — and the impact on society becomes large when you add this up," Green said.
The March of Dimes is planning to petition the U.S. http://www.cdc.gov/mmwr
AHRQ: http://www.ahrq.gov

FDA warns doctor over stem cell implants

Thu, 18 Jan 2007 17:36:49 GMT

WASHINGTON - A Las Vegas doctor has been implanting stem cells harvested from placentas into patients with multiple sclerosis, muscular dystrophy and other diseases in violation of federal law, according to a warning letter released by health officials Thursday.
Dr. Alfred Sapse failed to properly obtain, store, test and process the placentas, as well as screen both the suitability of the donors and the patients given the human tissue, according to the http://www.fda.gov/cber/compl/stem112206.htm

Calif. hospitals wont meet deadline

Thu, 18 Jan 2007 14:18:47 GMT
By ALICIA CHANG, AP Science Writer
LOS ANGELES - Nearly half of California hospital buildings in danger of collapsing during a major earthquake will not meet a state deadline for safety improvements, according to a study released Thursday.
Tough standards passed after the deadly 1994 Northridge earthquake required that vulnerable buildings be retrofitted or replaced by 2008, a deadline that was extended to 2013. By 2030, all hospitals must be able to stay open and treat patients after a disaster.

The report projected that nearly half of some 900 hospital buildings statewide will not meet the retrofitting deadline, even by 2030.

Complicating the matter is that the majority of weak buildings — more than 80 percent — are in the densely populated San Francisco Bay area and greater Los Angeles region. Hospitals that buckle during a quake in those areas would severely disrupt delivery of care and put patients at risk.

The study, funded by the California HealthCare Foundation and conducted by Rand Corp., does not single out hospitals, but notes the buildings are on over 300 hospital campuses across the state.

The study also projects that quake-proofing the hospital buildings by the deadlines would cost between $40 billion to $110 billion.

Although the law was well-intentioned, following through has proved to be a headache as half of the hospitals in the state are operating in the red, said Jan Emerson, spokeswoman for the California Hospital Association, which represents about 500 hospitals and health care systems.

If policymakers stay the course, the state could be forced to close noncompliant hospitals. If the state loosens some of the requirements or provides money for hospitals to comply, it would put those that have spent millions of dollars in upgrades and construction costs at a disadvantage, the report noted.

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On the Net:

Rand Corp: http://www.rand.org

California Hospital Association: http://www.calhealth.org/public/about/index.html

California Healthcare Foundation: http://www.chcf.org

Obese breast cancer patients undertreated study says

Thu, 18 Jan 2007 23:33:55 GMT

WASHINGTON - Breast cancer patients who are either obese or poorly educated are twice as likely to get lower-than-optimal doses of chemotherapy, U.S. researchers reported on Thursday.
The finding, published in the Journal of Clinical Oncology, may help explain why some women relapse and others do not, despite the availability of good treatments for the disease.

The problem appears to be with doctors who mean well and want to avoid causing side-effects in their patients, the team at the University of Rochester Medical Center in New York found.

"Simply put, this evidence shows that doctors are likely to reduce the chemotherapy levels for these women, even though there is no solid medical basis to do it," said Dr. Gary Lyman, who led the study.

They looked at the records of 764 women treated for breast cancer between 2002 and 2005 at 115 randomly selected, private oncology practices around the country.

They found that 21 percent of obese women received less than 85 percent of the standard dose for their weight. But just 10 percent of lean women were undertreated.

More than 32 percent of women who did not graduate from high school got lower-than-recommended doses, compared with 14 percent of high school or college-educated women.

"We have new therapies and cures out there for many forms of cancer and sadly, sometimes we're not curing people because they are not getting the full doses that should be standard," Lyman said in a statement.

A second study in the same journal found women who carefully chose their own breast cancer surgeon tended to get more experienced surgeons and care at specialized centers, compared to women referred by another doctor or their health plan.

The team at the University of Michigan Comprehensive Cancer Center examined the cases of 1,844 women recently diagnosed with breast cancer in Detroit and Los Angeles.

More than 60 percent of the patients said they were referred to their surgeon by another doctor, and 15 percent were referred by their health plans. About 25 percent chose their surgeon based on reputation.

Women with more education and higher incomes were more likely to have chosen their own surgeon.

Evidence shows that patients who choose any type of doctor based on their experience tend to do better. For surgery, patients recover better if they choose a hospital or clinic where the operation is performed frequently.

"Women with breast cancer should be aware that referrals from another doctor or their health plan may not connect them with the most experienced surgeons or the most comprehensive practice settings in their community," said Dr. Steven Katz, who led the Michigan study.

"Patients might consider seeking a second opinion, especially if they are advised to undergo a particular treatment without a full discussion of the options."

Bird flu mutations found

Thu, 18 Jan 2007 21:29:44 GMT
By MARIA CHENG, AP Medical Writer
LONDON - Mutations in the bird flu virus have been found in two infected people in Egypt, in a form that might be resistant to the medication most commonly used to treat the deadly disease, the World Health Organization said Thursday.
The mutations in the H5N1 virus strain were not drastic enough to make the virus infectious enough to spark a pandemic, WHO officials said. But more such mutations could prompt scientists to rethink current treatment strategies.

Samples taken from two bird flu patients in Egypt — a 16-year-old girl and her 26-year-old uncle — were not as responsive as regular H5N1 viruses to Tamiflu, a drug also know as oseltamivir that is used to treat the disease, the officials said.

The girl and her uncle died in late December, as did the man's 35-year-old sister, although she has not yet been confirmed as having had H5N1. The three — who lived together in Gharbiyah province, 50 miles northwest of Cairo — fell ill within days of one another after being exposed to sick ducks.

"Based on the information we have, we can't yet rule out human-to-human transmission," said Dr. Fred Hayden, a WHO bird flu and antivirals expert. "We need to better understand the dynamics of this outbreak."

Although people have passed the virus on to other people, such infections are rare, and most patients have been infected by direct contact with sick birds.

Scientists fear, however, that the virus could mutate into a form more easily passed between people, which could spark a flu pandemic.

The drug-resistant strains found in Egypt likely developed after the patients were hospitalized and treated with Tamiflu, with the virus responding directly to the drug, Hayden said. It was not proven, however, that that was the case, and a more worrying scenario would be if drug-resistant strains were already circulating among birds.

Although Tamiflu remains the drug of choice to treat H5N1, experts may have to consider other options if they find more resistant viruses.

Because flu viruses evolve constantly, mutations are only worrisome if they make the virus more infectious, lethal or drug-resistant.

"What the resistance tests look for are markers associated with antiviral resistance," though finding the markers did not necessarily mean Tamiflu would not work, said Dr. Angus Nicoll, flu director at the European Centre for Disease Prevention and Control.

Hayden said the mutations found in Egypt were different from Tamiflu-resistant H5N1 viruses found in patients two years ago in Vietnam. The Vietnamese strains were definitely resistant to Tamiflu, whereas the Egyptian viruses have only proven they are not as susceptible to the drug, he said.

Tamiflu-resistant viruses such as those found in Vietnam are often treatable with an older, less expensive class of antivirals, known as amantadanes. Some bird flu virus strains from Indonesia and China have also proven susceptible to amantadanes.

H5N1 first hit Egypt last year, and has since infected 18 people, 10 of whom have died.

Since the H5N1 outbreak first began in late 2003, it has decimated the Asian poultry industry and infected at least 265 people worldwide, 159 of whom have died, according to WHO.

Scabies infecting more Yellowstone elk

Thu, 18 Jan 2007 00:41:09 GMT

BOZEMAN, Mont. - The number of elk in the Yellowstone National Park region infected with scabies, a skin infestation caused by mites, is up this year, state wildlife officials say. The disease can be fatal, especially when an animal's health has been weakened for other reasons, such as old age or disease.
Scabies also can cause animals to lose all their hair, said Jim Miller, a Montana Department of Fish, Wildlife and Parks game warden.

"I've seen a lot of them that look naked," he said. "Just a little fuzz on them."

The mites that cause scabies live at the base of host hairs and pierce the skin with their mouths. This causes inflammation, hair loss and an "oozing matter which hardens into a scab and ultimately a dark crust," according to FWP information distributed this winter to Gardiner-area hunters. The type of scabies infecting elk is not a threat to humans.

Meat from infected elk isn't as tender as meat from healthy elk, park biologist Travis Wyman said.

"It tastes good, and it smells fine," he said. "But it's tougher than nails. It's like eating a football."

The number of cases in the region varies from year to year and is more common in old cows and in bulls debilitated by the rigor of the rut.

"This year it caught everybody's attention," said Tom Lemke, area biologist for FWP. "It has a higher percentage in the elk herd this year."

The infestation does not appear to play a role in the declining elk numbers in the park's northern herd, he said.

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Information from: Bozeman Daily Chronicle, http://www.bozemandailychronicle.com

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