Good hygiene can stop staph infections
Thu, 08 Nov 2007 03:09:30 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Drug-resistant staph infections that have made headlines in recent weeks come from what the nation's top doctor calls "the cockroach of bacteria" — a bad germ that can lurk in lots of places, but not one that should trigger panic.
"This isn't something just floating around in the air," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, told members of Congress on Wednesday.
It takes close contact — things like sharing towels and razors, or rolling on the wrestling mat or football field with open scrapes, or not bandaging cuts — to become infected with the staph germ called MRSA outside of a hospital, she said. But MRSA is preventable largely by common-sense hygiene, Gerberding stressed.
"Soap and water is the cheapest intervention we have, and it's one of the most effective," she told a hearing of the House Committee on Oversight and Government Reform.
At issue is methicillin-resistant Staphylococcus aureus, a form of the incredibly common staph family of germs. About one in every three people carries staph aureus in their noses. In about 1 million people, the type they carry is MRSA.
"I like to think of it as the cockroach of bacteria," Gerberding said, pointing out MRSA's ability to live on various surfaces and spread by catching a ride on an unwashed hand.
Over time, germs evolve to withstand treatment. Most staph is no longer treatable by the granddaddy of antibiotics, penicillin. By the 1960s, staph also began developing resistance to a second antibiotic, methicillin.
So MRSA is not a new problem. What is new is public anxiety about it.
MRSA mostly causes skin infections, such as boils and abscesses. But it can sometimes spread to cause life-threatening blood infections. Last month, the CDC reported the first national estimate of serious MRSA infections — 94,000 a year. It's not clear how many people die, but one estimate put the MRSA death toll at more than 18,000, slightly higher than U.S. deaths from AIDS.
There are two distinct strains of MRSA, a type spread in hospitals and other health facilities and a genetically different type spread in communities. The vast majority of victims are hospital patients; only 14 percent of serious MRSA infections are the kind spread in the community.
But the CDC's report coincided with the death of a 17-year-old Virginia high school student, prompting a spate of reports of MRSA infections in schools. That prompted lawmakers to pepper Gerberding with questions Wednesday:
_Should schools close for cleaning if a student gets MRSA? That's not medically necessary, Gerberding said. Bleach and a list of other germicides can be used in routine cleaning of areas and equipment where bacteria cluster.
"There's no need to go in and disinfect a whole school because that isn't how this organism is transmitted," she said.
_How worried should parents be? Some 200 children a year will get serious MRSA, and the vast majority will be treated successfully, Gerberding said. Community-spread MRSA is still easily treated by many other routine antibiotics. So wash and bandage cuts, and seek prompt medical care if they show signs of infection.
Most outbreaks of community-spread MRSA occur not in schools but in prisons, where inmates share toiletries and lack or don't use soap.
_Should every patient entering a hospital be tested for MRSA, and isolated if they harbor it? Some hospitals have begun that, but current guidelines call for that step only if hospitals fail to reduce MRSA infections by less drastic means, Gerberding said.
Her concern: "Patients in isolation get less care." Doctors and nurses check on them less. They get more bed sores, opening the body to other life-threatening germs.
There is a biological conundrum: Hospital-based MRSA is more common, vulnerable to fewer antibiotics than the strain spread in communities, and those already-ill patients are more likely to die from it. Yet, the community strain of MRSA may be somewhat stronger, possibly explaining why otherwise healthy people sometimes succumb.
It's a strain called USA300, and if it penetrates the skin it can cause key immune cells — white blood cells — to explode, setting off a chain reaction of inflammation, Gerberding explained. This strain, unlike most hospital MRSA, also produces a toxin known as PVL, and scientists are furiously investigating its role.
New antibiotics are important, but won't solve MRSA or the myriad other drug-resistant bacteria, she said.
Germs "will always be one step ahead of our drugstores," Gerberding said. "We have to get back to the basics" — wash your hands and cover your cuts.
AIDS vaccine doesnt guard against virus
Thu, 08 Nov 2007 03:09:53 GMTBy LINDA A. JOHNSON, AP Business Writer
TRENTON, N.J. - New data on an experimental AIDS vaccine that failed to work shows volunteers who got the shots were far more likely to get infected with the virus through sex or other risky behavior than those who got dummy shots.
The new details, released Wednesday by drugmaker Merck & Co., don't answer the crucial question of whether failure of the vaccine also spells doom for many similar AIDS vaccines now in testing.
And researchers weren't sure why more of the vaccinated volunteers wound up getting HIV than those who got dummy shots.
"One of the possibilities is that the increase in the number of infections was related to the vaccine," meaning it could have made people more susceptible to HIV infection, said Dr. Keith Gottesdiener, vice president of clinical research at Merck Research Laboratories. He couldn't say how likely that was but said other factors, even coincidence, could be the explanation.
Merck, based in Whitehouse Station, N.J., announced on Sept. 21 that it was stopping the study because the vaccine didn't work. It was a stunning setback in the push to develop an AIDS vaccine.
The vaccine is made from a common cold virus with three synthetic HIV genes tucked inside. It's designed to stimulate the immune system to kill any HIV-infected cells encountered in the future.
However, the researchers found that volunteers with pre-existing immunity to this particular cold virus were much more likely to get infected with HIV if they got the AIDS vaccine than if they got the dummy shot.
Some 3,000 people, mostly gay men and female sex workers, had volunteered to get the experimental vaccine or dummy shots. All were warned to protect themselves from AIDS exposure.
At the time the study was halted in September, Merck said 24 of 741 volunteers who got the vaccine in one segment of testing later developed HIV; 21 of 762 participants who got dummy shots also were infected.
New data released Wednesday showed that to date, 49 of 914 vaccinated men became infected with HIV, compared with 33 of the 922 men who got dummy shots. Only one woman and a small number of heterosexual men were infected.
"In my mind, this doesn't damn anything," said Dr. Anthony Fauci, head of National Institute of Allergy and Infectious Diseases, said of the vaccine's failure. "It tells you you need to be very careful with every aspect" of vaccine design and testing. The international testing was partly funded by the National Institutes of Health.
Merck's head of medical affairs for vaccines, Mark Feinberg, said it could be a few years before further data mining and results of other drugmakers' vaccine tests clear up the mystery.
In trading Wednesday, Merck shares fell $1.79, or 3.2 percent, to $54.20 amid a broad decline in the stock markets.
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On the Net: http://www.merck.com
HIV Vaccine Trials Network: http://www.hvtn.org
Delegates to discuss combatting TB AIDS
Thu, 08 Nov 2007 01:15:15 GMTBy CLARE NULLIS, Associated Press Writer
CAPE TOWN, South Africa - Old drugs, outdated tests, empty promises, new threats. Such is the bleak reality surrounding an international tuberculosis conference opening Thursday in a city scarred by a killer combination of TB and AIDS: an already nightmarish scenario worsened by the spread of virtually untreatable strains.
The 3,000 delegates will spend four days discussing the challenges posed by the dual epidemics of TB and HIV — which are still often treated separately, although they feed off each other. About one-third of the world's 40 million people infected with the AIDS virus have TB, the vast majority of them in Africa. TB kills more than 1.6 million people every year.
"Unlike bird flu, the global threat of HIV/TB is not hypothetical — it is here now. But the science and coordination needed to stop it are utterly insufficient," said Veronica Miller, director of The Forum for Collaborative HIV Research, in a report released ahead of the Cape Town conference.
The only available vaccine was invented more than 85 years ago and fails to protect most people beyond childhood. Antibiotics used to fight TB are more than 40 years old. Testing methods used in most developing countries were developed 120 years ago, are notoriously slow and often fail to spot TB in AIDS patients.
Health activists charge that rich countries and their pharmaceutical industries have shown little interest in developing more effective drugs because TB primarily affects poor people in poor countries.
In a report issued Wednesday, the New York based advocacy Treatment Action Group accused the United States and other donor nations of backsliding on commitments made last year to step up the fight against TB.
It said that international spending for TB research and development remained stagnant at US$413 million — less than half the amount called for in a much-vaunted 2006 Global Plan to Stop TB to increase funding for research on new TB diagnostics, drugs.
The contribution from the U.S. National Institutes of Health — the biggest funder — declined slightly to US$120 million, it said. Mark Harrington, executive director of the Treatment Action Group, said that with the U.S. budget problems and overspending in Iraq, TB wasn't "even on the radar" of the U.S. administration.
"Current funding levels for TB research and development are vastly out of proportion with the scope of the TB epidemic," said Dr. Mario Raviglione, Director of the World Health Organization's Stop TB Department.
The Treatment Action Group said the lack of funding was especially alarming given the global spread of multidrug resistant TB and extensively drug-resistant TB, which was identified in 2006 and is now present in more than 40 countries.
The spread of the drug resistant forms of TB is largely the result of poorly managed TB care and patients who don't take the full six-month course of treatment.
In South Africa, for instance, the cure rate for patients who stick to their treatment is just 50 percent, while WHO's target is 85 percent. In some areas, it is as low as 30 percent, according to Greg Hussey, head of the University of Cape Town's Institute for Infectious Diseases. People who are not properly cured are prone to develop multidrug resistant TB, which requires a two year treatment regimen.
South Africa hit the headlines last year when an outbreak of HIV and extensively drug-resistant TB was identified in 53 people at a clinic in Tugela Ferry in KwaZulu-Natal. All but one patient died within two weeks.
Because of the poor diagnostics, there are no reliable statistics on the number of South Africans who have been infected with extensively drug-resistant TB. The majority of them die before they can be tested or treated, according to Gilles van Cutsem, a project coordinator for Medecins Sans Frontieres in the poor Cape Town suburb of Khayelitsha, one of the hardest hit areas.
Little is known about the situation in neighboring countries like Swaziland and Mozambique, which also have high HIV and TB rates but don't have proper surveillance or laboratory facilities.
Report Abstinence programs dont work
Thu, 08 Nov 2007 01:09:48 GMTBy H. JOSEF HEBERT, Associated Press Writer
WASHINGTON - Programs that focus exclusively on abstinence have not been shown to affect teenager sexual behavior, although they are eligible for tens of mil lions of dollars in federal grants, according to a study released by a nonpartisan group that seeks to reduce teen pregnancies.
"At present there does not exist any strong evidence that any abstinence program delays the initiation of sex, hastens the return to abstinence or reduces the number of sexual partners" among teenagers, the study concluded.
The report, which was based on a review of research into teenager sexual behavior, was being released Wednesday by the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy.
The study found that while abstinence-only efforts appear to have little positive impact, more comprehensive sex education programs were having "positive outcomes" including teenagers "delaying the initiation of sex, reducing the frequency of sex, reducing the number of sexual partners and increasing condom or contraceptive use."
"Two-thirds of the 48 comprehensive programs that supported both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavior effect," said the report.
A spending bill before Congress for the Department of Health and Human Services would provide $141 million in assistance for community-based, abstinence-only sex education programs, $4 million more than what President Bush had requested.
The study, conducted by Douglas Kirby, a senior research scientist at ETR Associates, also sought to debunk what the report called "myths propagated by abstinence-only advocates" including: that comprehensive sex education promotes promiscuity, hastens the initiative of sex or increases its frequency, and sends a confusing message to adolescents.
None of these was found to be accurate, Kirby wrote.
Instead, he wrote, such programs improved teens' knowledge about the risks and consequences of pregnancy and sexually transmitted diseases and gave them greater "confidence in their ability to say 'no' to unwanted sex."
The sponsors of the study praised Kirby for his "thorough research" and for being "fair and evenhanded," but they also acknowledged that ETR Associates developed and markets several of the sex education curricula reviewed in the report. Several of the previous studies that were reviewed also were written by Kirby.
The report noted that there continues to be "too high levels of sexual risk-taking among teens" with 47 percent of all high schools students reporting having sex at least once and 63 percent saying they have engaged in sex by the spring semester of their senior year.
"Many teenagers do not use contraceptives carefully and consistently," said the report. About 40 of every 1,000 girls age 15 to 19 gave birth in 2005, the last year for which data was available, the report said.
Put down that fork Being fat is still unhealthy
Thu, 08 Nov 2007 00:07:47 GMTBy Julie Steenhuysen
CHICAGO - Being overweight may not kill you, but it could lead to obesity, U.S. health experts cautioned on Wednesday in response to research suggesting that being a bit heavy does not raise the risk of death.
A study published in the Journal of the American Medical Association found that being overweight did not increase the risk of dying from heart disease and cancer.
It also was linked with a significantly decreased rate of death from non-cancer and non-heart related causes, such as accidents or diseases like Alzheimer's.
Experts noted that the research only looked at death rates, not overall health. It did find that obesity was associated with a significantly higher risk of death from heart disease.
&;You should not take heart in the idea that if you are only overweight you are OK,&; said Dr. Robert Kushner, a professor of medicine at Northwestern University who specializes in nutrition and diet.
&;Given time, there is a high likelihood you will be obese because people gain weight as they age in this country,&; Kushner said in a telephone interview.
He said many studies have shown that as one starts gaining weight, health risks develop. &;We've done very well at medicating people to keep the medical complications at bay, which allows people to live longer,&; he said.
The study, conducted by Katherine Flegal of the U.S. Centers for Disease Control and Prevention, looked at specific causes of deaths in relation to body mass index, a ratio of height and weight.
A BMI of 25 to less than 30 is considered overweight, while a BMI of 30 or greater is considered obese.
The researchers found that people in the overweight category were no more likely than healthy-weight people to develop heart disease or cancer and had far fewer deaths from other causes, such as accidents or diseases such as Parkinson's or Alzheimer's.
&;Among overweight people there were fewer deaths from those causes than expected,&; Flegal said in a telephone interview.
&;There is some evidence that there might be something about nutritional reserves ... that makes you a better able to withstand an adverse situation,&; she said.
The study did find significant risks linked to obesity, including a higher risk of death from heart disease, diabetes and kidney disease, and several cancers that have been linked with obesity, such as breast, colon and pancreatic cancer.
Flegal said the study was not intended to alter any public health recommendations. &;Everybody should eat right, be active and not smoke,&; she said.
Dr. Louis Aronne, an obesity expert at New York-Presbyterian Hospital/Weill Cornell Medical Center, said it would be &;dangerous as a society to assume it is OK to be overweight.&;
