Study sees rise in men not washing hands
Mon, 17 Sep 2007 20:28:34 GMTBy MARILYNN MARCHIONE, AP Medical Writer
CHICAGO - The gender gap has widened when it comes to hygiene, according to the latest stakeout by the "hand washing police." One-third of men didn't bother to wash after using the bathroom, compared with 12 percent of women, said the researchers who spy on people in public restrooms. They reported their latest findings Monday at a meeting of infectious disease scientists.
Two years ago, the last time the survey was done, only one-quarter of men didn't wash, compared with 10 percent of women.
"Guys need to step up to the sink," said Brian Sansoni, spokesman for the Soap and Detergent Association, which co-sponsors the survey and related education campaigns.
The latest study was based on observations last month of more than 6,000 people in four big cities.
Frequent hand washing is the single best thing people can do to avoid getting sick, from colds and the flu to germs lurking in food, doctors say. And a recent Harris Interactive survey found 92 percent of Americans said they usually or always wash up after using the bathroom.
But researchers for the American Society for Microbiology found that only 77 percent actually do, when it comes to public restrooms. That's a 6 percent decline from a similar study in 2005.
The dirty details:
_Atlanta's Turner Field baseball stadium again was the worst. Only 57 percent of guys there washed up, compared to 95 percent of women.
_New York was Second City to Chicago in cleanliness. In restrooms at the Windy City's Shedd Aquarium and Museum of Science and Industry, 81 percent of men and women combined washed their hands, compared to 79 percent at the Big Apple's Penn and Grand Central train stations.
_At San Francisco's Ferry Terminal Farmers Market, 62.5 percent of men lathered up. Women did better, with 84 percent.
Carry sanitizer gels and wipes in case the means to wash your hands aren't handy, suggested microbiologist Judy Daly of Primary Children's Medical Center in Salt Lake City, who led the project.
"These are a marvelous addition to plain soap and water," she said.
Telephone surveys by the research firm Harris Interactive show little shift in attitudes over previous polls in 2003 and 2005. The latest was of 1,001 adults from Aug. 17-20.
Nearly three-fourths of Americans said they always wash up after changing a diaper, 78 percent said they do so after handling or eating food; 42 percent after petting a dog or cat, 25 percent after handling money, and 34 percent after coughing or sneezing.
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On the Net:
Microbiology meeting: http://www.icaac.org
Hand washing info: http://www.washup.org
Vaccine tied to superbug ear infection
Mon, 17 Sep 2007 20:56:46 GMTBy MARILYNN MARCHIONE, AP Medical Writer
CHICAGO - A vaccine that has dramatically curbed pneumonia and other serious illnesses in children is having an unfortunate effect: promoting new superbugs that cause ear infections.
On Monday, doctors reported discovering the first such germ that is resistant to all drugs approved to treat childhood ear infections. Nine toddlers in Rochester, N.Y., have had the germ and researchers say it may be turning up elsewhere, too.
It is a strain of strep bacteria not included in pneumococcal vaccine, Wyeth's Prevnar, which came on the market in 2000. It is recommended for children under age 2.
Doctors say parents should continue to have their toddlers get the shots because the vaccine prevents serious illness and even saves lives. But the new resistant strep is a worry.
"The best way to prevent these resistant infections from spreading is to be careful about how we use antibiotics," said Dr. Cynthia Whitney, chief of respiratory diseases at the federal Centers for Disease Control and Prevention.
Avoiding antibiotics when they are not needed is the best way to ensure they will work when they are, she said.
Prevnar prevents seven strains responsible for most cases of pneumonia, meningitis and deadly bloodstream infections. But dozens more strep strains exist, and some have flourished and become impervious to antibiotics since the vaccine combats the more common strains.
If the new strains continue to spread, "it tells us the vaccine is becoming less effective" and needs to be revised, said Dr. Dennis Maki, infectious diseases chief at the University of Wisconsin-Madison Hospitals and Clinics.
Wyeth anticipated this and is testing a second-generation vaccine. But it is at least two years from reaching the market, and the new strains could become a public health problem in the meantime if they spread hard-to-treat infections through day care centers and schools.
"I don't think the new strains are moving fast enough to call it a race, but the fact is that certain strains are increasing," said Peter Paradiso, a scientist at Wyeth Vaccines, the Collegeville, Pa., division that makes Prevnar.
"It is very worrying," said Dr. Keith Klugman, an infectious diseases specialist at Emory University. "With the eradication of all the other types in the vaccine, this one is emerging."
Several research teams reported on the situation Monday at microbiologists meeting.
A different pneumonia vaccine has long been available for adults but it doesn't work in children, so Prevnar was hailed as a breakthrough. It is used in dozens of countries and had sales of more than $1.5 billion last year. In the United States, it is given as four shots between 2 months and 15 months.
Before the vaccine, many babies and toddlers developed pneumonia, meningitis and serious blood infections that led to hearing loss, brain damage and even death. Drug-resistant ear infections also were a problem.
"Prevnar has done a remarkable job. Over the last seven years, it's prevented thousands and thousands of infections," not just in vaccinated kids but also in unvaccinated family members, said the CDC's Whitney.
But it is a unique vaccine because it covers only seven of the 90-odd strains of the germ. By contrast, measles is caused by one type of virus. Booster shots are needed for chickenpox, mumps and measles because immunity wanes, not because the germ changed.
Prevnar, however, is losing its punch because strains not covered by the vaccine are filling the biological niche that the vaccine strains used to occupy, and they are causing disease.
One strain in particular, called 19A, is big trouble. A new subtype of it caused ear infections in the nine Rochester children, ages 6 months to 18 months, that were resistant to all pediatric medications, said Dr. Michael Pichichero, a microbiologist at the University of Rochester Medical Center.
The children had been unsuccessfully treated with two or more antibiotics, including high-dose amoxicillin and multiple shots of another drug. Many needed surgery to place ear tubes to drain the infection, and some recovered only after treatment with a newer, powerful antibiotic whose safety in children has not been established.
Pichichero refused further comment because he has submitted a report to a medical journal. His work was paid for by antibiotic maker Abbott Laboratories and the Thrasher Foundation, which funds projects related to child health.
All 19A strep subtypes tend to be resistant to some drugs and have been growing in prevalence:
_Scientists from a drug company and two labs analyzed more than 21,000 bacterial samples from around the nation and found 19A increasing. Among children 2 and under, the portion of samples that were this strain rose to 15 percent in 2005-2006, from 4 percent in the previous three years.
_A British lab tracking respiratory infections in U.S. kids found that the 19A strain accounted for 40 percent of drug-resistant cases.
_University of Iowa researchers found 19A accounted for 35 percent of penicillin-resistant infections in 2004-05, compared with less than 2 percent the year before the new vaccine came out.
Because these bacteria easily swap gene components to become even more hardy, "new types may emerge that can both escape containment by vaccine and spread throughout the world," Dr. Daniel Musher of Baylor College of Medicine wrote in the New England Journal of Medicine last year.
Some think Prevnar might be destined to be like flu shots that must be periodically updated to reflect new strains causing illness. But each tweak requires new safety studies and more expense.
Wyeth expects to finish testing its updated vaccine next year and to seek federal approval in early 2009. Review can take a year or more, Paradiso said.
British-based GlaxoSmithKline has a similar vaccine in final-phase testing that targets 10 strains common in Europe and other regions.
Clinton calls for universal health care
Mon, 17 Sep 2007 21:19:39 GMTBy BETH FOUHY, Associated Press Writer
DES MOINES, Iowa - Democrat Hillary Rodham Clinton called for universal health care on Monday, plunging back into the bruising political battle she famously waged and lost as first lady on an issue that looms large in the 2008 presidential race.
"This is not government-run," the party's front-runner said of her plan to extend coverage to an estimated 47 million Americans who now go without.
Her declaration was a clear message to Republicans, the insurance industry, businesses and millions of voters who nervously recall what sank her effort at health care reform 13 years ago in her husband's first term — fear of a big-government takeover.
In unveiling her plan, she called for a requirement for businesses to obtain insurance for employees, and said the wealthy should pay higher taxes to help defray the cost for those less able to pay for it. She put the government's cost at $110 billion a year.
Mindful of the lessons of her failed attempt, Clinton said that under her new plan anyone who is content with their health coverage can keep what they have. She insisted no new government bureaucracy would be created even as it seeks to cover tens of millions uninsured.
"I know my Republican opponents will try to equate health care for all Americans with government-run health care," Clinton said. "Don't let them fool us again. This is not government-run."
The New York senator said her plan would require every American to purchase insurance, either through their jobs or through a program modeled on Medicare or the federal employee health plan. Businesses would be required to offer insurance or contribute to a pool that would expand coverage. Individuals and small businesses would be offered tax credits to make insurance more affordable.
"I believe everyone — every man, woman and child — should have quality, affordable health care in America," Clinton told an audience at a medical center in Iowa, the early voting state that launches the nomination process.
As the front-runner, Clinton drew swift criticism from Democratic and Republican rivals, including party foes Bill Richardson and John Edwards who argued she was merely following their lead in offering a similar plan.
Clinton framed her quest as a moral imperative in which individuals, businesses, the insurance industry and the federal government each had a role to play. She said her plan would be bipartisan and would only be successful through negotiation — a sharp departure from her earlier effort.
Then, the Clinton health care task force met in secret and tried to drive legislation through Congress. Now, Clinton, a senator for seven years, spoke of compromise although she vowed to accomplish her goal in her first term if elected.
"She's running against essentially not just the other candidates but her own plan. She's trying to convince you that this is a new Clinton plan," said Robert Blendon, a professor of public health at Harvard Medical School.
To pay for her plan, Clinton said the tax cuts for Americans making $250,000 that were enacted under President Bush would be allowed to expire. She also projected she would identify $56 billion in savings through computerized record keeping, reducing the price of prescription drugs and cutting Medicare overpayments to hospitals and CEOs.
Despite the focus on letting people who are happy with their insurance keep what they have, her plan would raise taxes on some coverage for the wealthy.
The current exclusion from taxes of employer-provided health premiums would be limited for those who make more than $250,000 and have "very generous" plans. For such people, a portion of the premiums paid by the employer could become taxable income for the employee.
Joking that her proposals "won't make me the insurance industry's woman of the year," Clinton said companies would no longer be able to deny coverage for pre-existing conditions or genetic predisposition to certain illnesses.
The centerpiece of Clinton's latest effort is the so-called "individual mandate," requiring everyone to have health insurance just as most states require drivers to purchase auto insurance. Such a mandate has detractors at both ends of the political spectrum, and questions abound over how it would be enforced.
"Perhaps more than anybody else I know just how hard this fight will be," said the New York senator.
Clinton adviser Laurie Rubiner said the mandate could be enforced in a number of ways, such as denying certain tax deduction to those who refused to buy insurance. But she stressed that a specific mechanism would be worked out once the plan was passed.
Rival John Edwards has also offered a plan that includes an individual mandate, while the proposal outlined by Barack Obama does not. Obama has insisted individuals can't be forced to buy insurance until its costs are substantially reduced.
Obama released a statement Monday saying Clinton's plan is similar to one he proposed in the spring. He took a swipe at the Clinton administration's closed-door sessions on health care in the 1990s, saying "the real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change."
For his part, Edwards said that on his first day in office he will submit legislation that would pull health insurance for the president, members of Congress and all political appointees unless they pass universal health care within six months.
Republican Mitt Romney, in New York City for a fundraising stop, criticized Clinton's proposal, saying, "'Hillary care' continues to be bad medicine ... in her plan, we have Washington-managed health care. Fundamentally, she takes her inspiration from European bureaucracies."
The plan that Romney helped institute while governor of Massachusetts requires the same individual insurance mandate as Clinton's and uses state subsidies to help reduce the cost of private coverage. Since then, Romney has said he would leave it up to the states to decide whether they supported such a mandate.
Said Republican Rudy Giuliani's campaign: "Senator Clinton's latest health scheme includes more government mandates, expensive federal subsidies and more big bureaucracy — in short, prescription for an increase in wait times, a decrease in patient care and tax hikes to pay for it all."
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Associated Press Writer Ashley M. Heher in Chicago and Nedra Pickler in Washington contributed to this report.
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http://www.hillaryclinton.com
Infection probed in gene therapy death
Mon, 17 Sep 2007 20:32:11 GMTBy ANDREW BRIDGES, Associated Press Writer
WASHINGTON - A virus used in a gene therapy experiment likely didn't cause the death of an Illinois woman suffering from rheumatoid arthritis, although it can't be completely ruled out, government health advisers said Monday.
Advisers to the National Institutes of Health said that a massive fungal infection is near the top of the list of likely culprits in the death of Jolee Mohr.
Mohr, 36, died at University of Chicago Medical Center on July 24, several weeks after receiving the second injection of trillions of genetically altered viruses at the Arthritis Center in Springfield, Ill., as part of a gene therapy study for rheumatoid arthritis.
Doctors have since struggled to determine how she died, though a massive Histoplasma capsulatum infection appears to be a leading cause. Advisers to the National Institutes of Health met Monday to hear autopsy results and other evidence to determine what role — if any — the injected virus also may have played.
The genetically engineered virus was used as a vector or vehicle to carry a new gene into Mohr's body, helping it to make a protein that would ease her arthritis pain. Mohr had suffered from arthritis since her 20s.
"We can't to 100 percent certainty exclude the vector but as was presented, the data would suggest that it's unlikely to be playing a role," said Dr. Howard Federoff of Georgetown University Medical Center, chairman of the Recombinant DNA Advisory Committee. Federoff said the fungal infection, called histoplasmosis, was "near the top" of the lists of likely causes for Mohr's death.
The fungus is commonly found in the Midwest. At the time of her death, Mohr was taking drugs to treat her arthritis that also can suppress her immune system, which would have weakened her body's ability to fend off an infection.
Mohr also had taken both antiviral and antibiotic drugs in the days before she received the second shot. Panelists questioned whether Mohr should have received that shot, since she appeared already to have been complaining of sickness, including fatigue.
It will take several weeks to complete tests that would show if any of the injected viruses migrated beyond Mohr's right knee. If none is found, that would make it even less likely the virus played a role.
The experiment's sponsor, Targeted Genetics Corp. of Seattle, has halted the study and the 126 other patients are being evaluated. A tearful Robb Mohr pleaded with the panel's members to keep the study on hold until they could figure out what killed his wife.
"There is just no answer to the biggest question I have to the members of the committee: Would my wife still be alive if she didn't participate in the study? If anyone up there can answer that with any certainty, please don't put anyone in the American public in my shoes," he said.
Federoff said the panel could not yet answer that question but that it would seek to bring closure at another meeting set for December, though he cautioned that uncertainties could linger. The panel expects to have the results of blood tests in hand by that time.
"I don't think the data are in," said Mohr's attorney, Alan Milstein, who also represented the family of Jesse Gelsinger. The Arizona teenager's 1999 death is the only reported fatality definitively linked with a U.S. gene therapy study.
Jolee Mohr fell ill the day after being injected in her right knee. She was initially treated in Springfield, Ill., but transferred to Chicago on July 18. She arrived with a puzzling array of symptoms.
"We were at an initial clinical loss for the cause of all the current problems," said Dr. Kyle Hogarth, who treated her in the intensive care unit.
She died 10 days later after being removed from life support. A nearly 8-pound pool of blood in her abdomen had crowded out her kidneys and was pressing on her lungs, according to autopsy results — presented after Robb Mohr had left his front-row seat in the auditorium. The source of that bleeding remains unknown but likely hastened her death, doctors said. The autopsy also found signs of fungal infection in her liver, lungs, bone marrow and elsewhere.
Targeted Genetics officials previously have said Mohr might have died of the fungal infection.
The study was designed primarily to assess the safety of the gene therapy treatment. Panel members also discussed ways of preventing study participants from confusing that short-term goal with the longer-term goal of finding a cure for their condition.
