CDC touts ample supply of flu vaccine
Wed, 19 Sep 2007 19:47:34 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Come one, come all: After years of shortages and confusion, this fall promises plenty of flu vaccine to go around — up to 132 million doses, more than the nation has ever produced.
The ample supplies have the government urging vaccinations not just for people at highest risk of dying from influenza, but for anyone who wants to avoid a week of aching misery.
"Flu is a formidable foe," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, said Wednesday. "It is not an illness we should be complacent about."
But new CDC data show only a fraction of people who need flu shots the most get them, including just one in five babies and toddlers. And there's wide geographic variation, with Rhode Island reporting the most high-risk adults vaccinated and Nevada the fewest.
Shots aren't the only option. Wednesday, the government ruled that it's safe for younger kids than ever before to try a nasal-spray vaccine called FluMist. Once only an option for people ages 5 to 49, FluMist now can be used by children as young as 2.
Flu usually peaks in February, so a winter vaccination isn't too late. Still, Gerberding advised seeking vaccine early in case flu begins striking before the usual November.
Indeed, there already are reports of sick schoolchildren in Hawaii, although the geographic distance makes it impossible to predict if that signals an unusually early flu season for the rest of the country.
Perhaps of more concern, CDC is closely monitoring whether a new strain that emerged near the end of Australia's flu season will cause illness here — a strain that this year's vaccine doesn't specifically target.
Each year's vaccine contains protection against three influenza strains — two Type A strains, an H1N1 and an H3N2 version, plus a milder Type B — that experts predict will cause the most illness. The vaccine isn't always a perfect match, and this year's contains a different H3N2 version than the newly emerging one, nicknamed H3N2/Brisbane-like.
Get vaccinated anyway, Gerberding stressed. The other two strains in the vaccine are causing illness around the world, and even if the newer one travels here, too, the vaccine should provide some cross-protection.
Every year, flu infects up to 20 percent of the population, causes the hospitalization of 200,000 people and kills 36,000.
Who's at highest risk? Anyone over 50 or under 5; people of any age who have asthma, heart disease, weakened immune systems or other chronic illnesses; and pregnant women.
Vaccine also is particularly recommended for relatives and caregivers of those people, and health care workers — people who may be robust enough to recover themselves, but could infect the more vulnerable before they realize they're ill.
"The day before you become sick, you're already excreting the virus," warned Dr. William Schaffner of Vanderbilt University, vice president of the National Foundation for Infectious Diseases.
That equals 218 million people who should be vaccinated each year. Nowhere near that many seek vaccine. Last year, about 18 million of the nearly 121 million doses produced weren't used and had to be thrown away.
But the CDC's new estimates of how many high-risk patients get vaccinated, gleaned from public-health surveys, shed new light on the most troubling gaps.
People 65 and older are most likely to get vaccinated, 69 percent during the 2005-2006 flu season, the latest count available.
But that's still well under the national goal of vaccinating 90 percent of seniors — even though Medicare provides them flu shots for free.
Just over a third of 50- to 64-year-olds are getting vaccinated, and just 30 percent of high-risk younger adults, CDC found.
Flu vaccine is a little more complicated for young children, because they need two doses a month apart the very first year they're inoculated. Just 21 percent of youngsters ages 6 months to 2 years were fully vaccinated, and just over one in 10 who needed two doses got both, CDC reported.
If a young child missed that necessary second dose last year, health officials are recommending that he or she make it up this year with two shots.
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On the Net:
CDC: http://www.cdc.gov/flu
National Foundation for Infectious Diseases: http://www.nfid.org
Vaccine protects against virus strains
Wed, 19 Sep 2007 21:13:04 GMTBy LINDA A. JOHNSON, AP Business Writer
TRENTON, N.J. - New data shows a vaccine against the virus that causes cervical cancer partially blocks infection by 10 strains of the virus on top of the four types the vaccine targets.
That boosts protection — at least partially — to 90 percent of strains causing the deadly cancer, according to data presented Wednesday at a medical conference by Merck & Co., maker of Gardasil.
Whitehouse Station-based Merck called it the first evidence of any vaccine providing cross-protection against other strains of the human papilloma virus, or HPV.
Dr. Stephanie Blank, a gynecological oncologist at the NYU Cancer Institute, said the finding could encourage more widespread use of Gardasil in developing countries, where some of the additional strains are more widespread and women rarely get Pap smears to detect early, curable cancers.
"That could be huge," Blank said.
Gardasil is the only cervical cancer vaccine on the market, approved for sale in 85 countries and pending approval in 40 more; it has racked up about $1 billion in sales since its June 2006 U.S. launch. GlaxoSmithKline PLC is awaiting approval of its own vaccine, Cervarix.
There are more than 60 strains of the HPV virus. About 15 are thought to cause cervical cancer; Gardasil protects against 12 of those, plus another two that cause genital warts but not cancer.
Two strains cause 70 percent of cervical cancer. Merck studies following 17,600 young women for three years found the vaccine to be 99 percent effective in blocking those strains.
New analysis of that data shows the vaccine reduced incidence of HPV-caused precancerous lesions by nearly two-thirds for the three next most common HPV strains in North America. While those three strains are less common elsewhere, together they cause about 11 percent of cervical cancer worldwide.
"There's the potential for an additional 30,000 to 40,000 cancer cases being prevented each year," mostly in developing countries, based on preliminary estimates and widespread vaccination in those regions, said Dr. Eliav Barr, head of Merck's research on infectious disease and vaccines.
There are 9,710 new cases of cervical cancer and 3,700 deaths in the U.S. each year. Worldwide, there are nearly 500,000 new cases and 233,000 deaths a year.
Dr. Jonathan Berek, chairman of obstetrics and gynecology at Stanford University School of Medicine, said he expected Gardasil to provide some protection against HPV strains not directly targeted by the vaccine, but not as much as the data shows.
"It's a reason why we should try to introduce it more broadly around the world," Berek said.
Dr. Michael Segarra of North Brunswick Pediatrics said women still need to get regular Pap smears because the vaccine doesn't cover all HPV strains, but that the extended protection will reduce anxiety in years to come as fewer women get abnormal Pap test results requiring additional testing.
Roughly 2.5 million such follow-up exams and biopsies are done each year in this country, at a cost of about $320 each.
"Any time you can reduce the possibility of getting cancer, it's very significant," added Segarra, who is vice president of the American Academy of Pediatrics New Jersey chapter.
However, Merck took heat for a behind-the-scenes campaign to get states to require sixth-grade girls to get the HPV vaccine to attend school. Merck has since dropped that campaign.
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On the Net:
Merck & Co.: http://www.merck.com
Army conducts brain tests on soldiers
Wed, 19 Sep 2007 21:21:30 GMTBy KRISTIN M. HALL, Associated Press Writer
FORT CAMPBELL, Ky. - Before they leave for Iraq, thousands of troops with the 101st Airborne Division line up at laptop computers to take a test: basic math, matching numbers and symbols, and identifying patterns. They press a button quickly to measure response time.
It's all part of a fledgling Army program that records how soldiers' brains work when healthy, giving doctors baseline data to help diagnose and treat them if they come back with a traumatic brain injury — the signature injury of the Iraq war.
"This allows the Army to be much more proactive," said Lt. Col. Mark McGrail, division surgeon for the 101st. "We don't want to wait until the soldier is getting out of the Army to say, 'But I've had these symptoms.'"
The mandatory brain-function tests are starting with the 101st at Fort Campbell and are expected to spread to other military bases in the next couple of months. Commanders at each base will decide whether to adopt the program.
The tests provide a standard, objective measurement for each soldier's reaction time, their short-term memory and other cognitive skills. That data would be used when the soldiers come home to identify mild brain trauma that can often go unnoticed and untreated.
One veterans group wants to ensure the Army doesn't use the results to deny treatment by claiming that soldiers' problems came from pre-existing conditions.
"We certainly think these tests should not be used to reduce the responsibility that the Army has to treat the soldiers who have served," said Jason Forrester, director of policy for Veterans for America.
About 7,500 Fort Campbell soldiers have completed the tests, said Dr. Robert Schlegel, a University of Oklahoma researcher who administers the 10-minute exams to soldiers as they file quickly through a testing center.
One question asks soldiers to memorize patterns on the screen and then identify them later among several different patterns. Other questions require soldiers to match numbers and symbols, or complete simple addition and subtraction problems.
"Everybody functions a bit differently in terms of how quickly they react to things, how well they process things and remember things and so forth," Schlegel said.
Brain injuries caused by explosions have become some of the most common combat wounds suffered in Iraq. Thirty percent of soldiers taken to Walter Reed Army Medical Center since 2003 suffered traumatic brain injuries, according to the Defense and Veterans Brain Injury Center.
The brain-injury center, which has seven facilities around the country, has seen 2,669 patients between 2003 and 2007. But doctors believe many less obvious brain-injury cases go undetected.
Sgt. Adam Wyatt, 22, has been close to 20 to 30 blasts from homemade bombs, rocket-propelled grenades or mortar fire during his last two deployments. But he's never been directly hit.
"The initial shock is a little disorienting," Wyatt said. "Your first thought is seeing if anyone is wounded and suppressing enemy fire."
Soldiers sometimes walk away from explosions with no obvious injuries. But the concussion from the blast can have a lingering effect that is not always immediately apparent.
"They look physically normal, but their neurocognitive performance is off," said Col. Mary Lopez, a physician specializing in occupational therapy.
Most brain injuries are mild, and soldiers can recover with rest and time away from the battlefield. But the military estimates that one-fifth of the troops with these mild injuries will have prolonged or lifelong symptoms requiring continuing care.
So little is known about traumatic brain injuries that these baseline readings could become an important cornerstone for future study.
Even the parameters of the injury are not known, like how close a soldier must be to a blast to suffer damage, or whether being knocked unconscious makes a difference, said Jordan Grafman, a neuroscience researcher at the National Institutes of Health. Without baseline information, it is hard to say soldiers are more impaired after they suffer a serious brain injury.
The Army has faced criticism for treatment of Iraqi war veterans after complaints that some soldiers with brain damage were misdiagnosed. The Government Accountability Office is investigating reports that as many as 40 soldiers at Colorado's Fort Carson were misdiagnosed with personality disorders after suffering brain damage or stress-related injuries.
Lt. Col. Mark McGrail, division surgeon for the 101st, said mild brain injury is difficult to diagnose because soldiers often don't report symptoms such as headaches, dizziness, memory problems and irritability.
"The soldiers are by and large very motivated, and they don't want their team to go back out there without them, even though they know they had their bell rung and might not be at the top of their game," McGrail said.
Some symptoms of traumatic brain injury also overlap with post-traumatic stress disorder, another common condition among Iraq war veterans. The brain-injury test could also help doctors differentiate between those conditions, Lopez said.
The brain tests have already been tried in pilot programs at Fort Bragg, N.C., with paratroopers who often suffer concussions during jumps, as well as with some soldiers who have deployed to Iraq, Afghanistan and Bosnia.
But the 101st is the first unit to use them on a large scale for every soldier preparing to deploy. The division is leaving for its third deployment, splitting between battlefronts in Iraq and Afghanistan.
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Associated Press Writer Marilynn Marchione contributed to this report from Milwaukee.
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On the Net:
Fort Campbell: http://www.campbell.army.mil/
Elderly at highest risk for suicide
Wed, 19 Sep 2007 01:18:01 GMTBy SARAH SKIDMORE, Associated Press Writer
Not long after 72-year-old Anne Beale Golsan had retired on disability from her job as a librarian, she put a stack of paid bills out for the mail, hung up a freshly pressed outfit and taped a note to the front of the house. "Don't come in by yourself. Get somebody to come with you. Sorry, Love Beale."
Her niece arrived at the house they shared in Baton Rouge, La., to find police already there. Golsan had killed herself with a gunshot to the head.
"Every single day it makes me feel like I wish I could have done something," Jane Golsan Ray said, recalling her aunt's death eight years ago. "I wish I could turn back the clock and prevent it. It doesn't get any better, it hurts every day."
The elderly are the highest risk population in the country for suicide. But few suicide-prevention programs target them — a result, advocates say, of scarce funding and lack of concern for older Americans.
And mental heath experts say the number of elderly suicides is likely to climb as baby boomers enter their twilight years.
The overall U.S. suicide rate is 11 per 100,000 people. But for those 65 and older, that figure rises to 14 per 100,000, according to the Centers for Disease Control and Prevention, which based its findings on 2004 data, the most recent available.
Older adults are less likely to seek help and are more lethal in their suicide attempts. So experts say special care is needed to reach out.
Dale Smith, 67, said he might not be alive if not for a suicide-prevention program in Spokane, Wash.
Two years ago, he attended a meeting at his retirement complex where everyone filled out a screening form for depression, a key risk factor for suicide.
Based on his answers, a caseworker and psychiatrist later visited Smith at his home, where they discussed what turned out to be a lifetime of depression. They developed a plan of medication and therapy that Smith says probably saved his life.
"I'm not unique. I think there's a lot of individuals out there who do suffer from depression and they have no clue," he said. "They just know they're not happy. They are tired, they want to pull the covers over their heads and not look at the world, and they don't know what it is."
But many older Americans have fewer options for treatment than younger people.
"It's a not-so-subtle social-political assignment of resources," said Donna Cohen, a professor in the Department of Aging and Mental Health at the University of South Florida.
Ten states passed laws last year intended to curb suicide among children and young adults. But only two — New Jersey and New Mexico — passed laws addressing suicide among the elderly, according to Suicide Prevention Action Network USA, a national advocacy group based in Washington, D.C.
Depression is underdetected at all ages, mental health groups say. But much more funding is available for treating younger people, including $82 million in federal money approved in 2004.
The situation prompted Sen. Harry Reid of Nevada, who lost his father to suicide, to propose funding more suicide-prevention programs for the elderly and changing a Medicare coverage rule that forces seniors to pay more for outpatient mental health services than other medical care.
Some advocates and mental health workers say they also have to battle a prevailing notion that depression is a normal part of aging.
"It is not natural and should be treated at all times," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.
Janice Hodge of Sandy, Ore. said she didn't realize until after her 91-year old father, Anthony Liberto, died that he had been depressed.
He was struggling to care for his 85-year-old wife, who suffered from Parkinson's disease. He did not work and he could no longer play golf, his favorite pastime. Friends and family still visited, but they say he spent much of his time lying on the couch and growing frustrated with suggestions that he place his wife of 62 years in a nursing home.
Eventually, he shot his wife and killed himself, leaving a note that read: "Sorry we had to leave this way, forgive me. Love, your Dad."
Experts say there need to be services tailored to the elderly because they handle depression differently than younger patients.
In Spokane, the program that helped Smith, called Elder Services, trains people who come in contact with the elderly — from bank tellers to postal carriers — to notice signs of trouble, such as mail piling up or bills going unpaid. Those people can then notify social workers.
In San Francisco, Patrick Arbore founded the Friendship Line in San Francisco in 1973 after seeing the lack of understanding some suicide hot line workers displayed for older people.
The line, which lets people call just to talk or get support, now handles more than 3,000 calls a month. About one-quarter of the callers have suicidal thoughts, a staffer said. But most just want a compassionate listener.
"It's about reminding people that they are still a part of their community," Arbore said. "Those connections bind us to life."
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Associated Press Writer Sarah Skidmore reported from Portland, Ore.
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On the Web:
National Institute for Mental Health on elderly suicide: http://www.nimh.nih.gov/publicat/elderlydepsuicide
Centers for Disease Control suicide information:
http://www.cdc.gov/ncipc/dvp/suicide/
Genderbending bugs take battle of sexes to new heights
Wed, 19 Sep 2007 19:03:17 GMTPARIS - Sexual relationships between humans may be complicated but they are nothing compared to the bizarre sex life of the African bat bug, the British weekly New Scientist reports in next Saturday's issue.
Renowned among entomologists for a particularly horrible form of reproduction, these insects have now been found to show &;what could be the most extreme form of transexualism yet discovered,&; it says.
Male bat bugs never use the vagina, instead piercing the female's abdomen and inseminating directly into the blood, where the sperm then swim to the ovaries.
In response to this, female bat bugs have evolved defense mechanism -- they grow a paragenital structure on their abdomen that limits the damage by guiding the male's sharp penile prong into a spongey area full of immune cells.
Scientists led by Klaus Reinhardt of the University of Sheffield, northern England, studied bat bugs in a cave on Mount Elgon, Kenya.
They were stunned to find that males had been using their penises to stab other males in an attempt at copulation, and many had scarred abdomens as a result.
In response to this, many males had been growing their own version of the defensive genitalia to protect themselves from other males.
Stranger still, when the team looked at 43 preserved female bat bugs, they found that 84 percent of them had male versions of the defence genitalia.
Females with this male version had less scarring due to penetration than other males.
Reinhardt describes it as &;a spectacular example of evolution through sexual conflict,&; New Scientist says.
&;Males started getting nobbled by other males, so they evolved the female defensive genitalia. As this reduced the amount of penis damage they were getting, females evolved the male version of the male genitals.&;
Bat bugs are blood-sucking parasites that feed on bats, but bite humans in the absence of their primary hosts. They are cousins of the bed bug.
