The ‘July Effect’: Worst Month For Fatal Hospital Errors, Study Finds

Posted by admin on June 4, 2010

The ‘July Effect’: Worst Month For Fatal Hospital Errors, Study Finds
Study Finds More Fatal Medication Errors in July, Just When New Residents Arrive
By LAUREN COX
June 3, 2010—

There is an old saying among some doctors — do not let your friends and family schedule a surgery in July.

July is the month when graduates, fresh out of medical school, report to residencies in teaching hospitals. Anecdotally, at least, it’s been a time when medical errors peak.

A new study decided to see if the so-called “July Effect” was real.

Researchers from the University of California at San Diego investigated more than 62 million U.S. death certificates between 1979 and 2006. Of those, 244,388 deaths were caused by a medication errors in a hospital.

Month to month, the statistics showed a relatively equal chance for a fatal medication error — except at teaching hospitals in the month of July.

The study found that fatal medication errors spiked by 10 percent in July in counties with a high number of teaching hospitals, but stayed the same in areas without teaching hospitals.

The findings appear in the current issue of the Journal of General Internal Medicine.

David Phillips, the lead author of the study, said he was careful to rule out medication deaths caused by unexpected allergic reactions. He also didn’t include medication deaths that happened outside of the hospital, which might be the fault of the patient, and which previous research has found is often related to mixing medication and alcohol at home.

“If you have people dying from medication deaths and nobody thinks there is an error, that doesn’t spike in July. So there’s something going on in teaching hospitals in July, and the most common thing people think of was residents starting,” said Phillips, a professor of sociology at the University of California at San Diego.

Phillips said his study, which looked at computerized death certifications, had an advantage of looking at death certificates across the country, in a variety of hospital settings.

“With that we can safely generalize to the whole country,” said Phillips, who researched the study with co-author Gwendolyn Barker. “The disadvantage is that you don’t have very much detailed information per death certificate.”

That means the study only suggests that new residents are to blame. Further studies looking at hospital records might find a direct link to residents’ mistakes, or no link.

Doctors Well Aware of July Troubles
“It doesn’t surprise me when you got new residents,” said Dr. David Orentlicher, a medical doctor and professor of law at Indiana University.

Orentlicher said many aspects of starting a new residency might put people at risk for medical errors. Residents are inexperienced, often sleep-deprived — working 36-hour shifts in many cases — and simply may need to learn the system at a new hospital.

“You’ve got people who are inexperienced. You’ve also got people who are trying to learn a new system,” said Orentlicher.

For example, Orentlicher said he remembered from his own residency that it can be difficult to take over a new group of patients at the start of a shift.

“When you are transitioning and you are handing off patients to a new provider, not all of the information is communicated,” he said.

Orentlicher noted that in recent years, many teaching hospitals have offered better supervision of residents, and implemented new policies to prevent mistakes from sleep deprivation.

“There have been some improvements, but I think some of what this shows is the importance of having safeguards built into the system,” said Orentlicher.

An example would be the measure by anesthesiologists to design different tubing for different bottles of gas. Orentlicher said for years a certain number of deaths were caused by assistants mixing up lines to gas tanks before anesthesiologists got to work. But new connecting tubes it made it impossible to plug an oxygen line into the wrong tank.

July Effect May be Difficult to Address
“You should try to make sure humans don’t make mistakes, but humans are humans, so knowing that people make mistakes, how are you going to prevent it?” he said.

Orentlicher suggested focusing on using computer software to scan and check for prescription errors, or dosage errors.

“That’s the kind of thing you need to do. You are always going to have inexperienced residents and you can give them more sleep and you can give them more supervision,” he said.

Dr. Joanne Conroy, chief health care officer for the Association of American Medical Colleges, agreed July is a hectic month. But she also wondered if it was possible to pin the mistakes on new residents.

“Even though we associated July with new residents, actually there are a lot of new caregivers in July,” said Conroy. “It’s probably a time where there are a lot of health professionals assuming new responsibilities. Everybody moves up.”

Conroy also wanted to see data specific to the last five years in teaching hospitals. In that time, she said hospitals have implemented many new policies that increased supervision of residents, tailored responsibilities to the ability of the new doctor and allowed for more sleep.

“The study brings up more questions than it gives answers, but it’s certainly not anything we are ignoring and dismissive of at all,” said Conroy.

Copyright © 2010 ABC News Internet Ventures

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Pesticides and Produce

Posted by admin on June 2, 2010

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Lettuce recalled due to possible E. coli contamination

Posted by admin on May 12, 2010

Lettuce recalled due to possible E. coli contamination
Freshway Foods of Sidney, Ohio, announced May 6 a voluntary recall of certain romaine lettuce products because of the possible connection between the recalled romaine lettuce and an outbreak of foodborne illness. FDA supports this action by Freshway Foods. The outbreak, which is still under investigation, involves cases in Michigan, Ohio, and New York of illnesses due to infection with E. coli O145.

On May 5, 2010, the New York state Public Health Laboratory, Wadsworth Center, in Albany reported finding E. coli O145 in an unopened bag of Freshway Foods shredded romaine lettuce being recalled.

A Freshway Foods press release says the recalled shredded romaine lettuce was sold to wholesalers, foodservice outlets, and some in-store salad bars and delis in the following areas: Alabama, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, and Wisconsin.

The recalled shredded romaine lettuce has a “best if used by” date of May 12 or earlier. The Freshway Foods press release advises restaurants, distributors, and retailers to throw out or refrain from using shredded romaine lettuce from Freshway Foods with these “use by” dates. Additionally, Freshway Foods is advising consumers not to eat “grab and go” salads sold in-store salad bars and delis at Kroger, Giant Eagle, Ingles Markets, and Marsh stores.

Multiple lines of evidence have implicated shredded romaine lettuce from one processing facility as a source of infections in a multistate outbreak to which this recall may be related. To date, 19 confirmed cases of E. coli O145 illnesses have been reported from Michigan, Ohio, and New York. These illnesses include 12 individuals who have been hospitalized, and three with a potentially life threatening complication called hemolytic uremic syndrome.

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Potentially deadly fungus spreading in US, Canada

Posted by admin on April 23, 2010

Potentially deadly fungus spreading in US, Canada 22 Apr 2010 22:21:58 GMT
Source: Reuters
* Fungus is unique genetic strain

* Climate change may aid its spread

WASHINGTON, April 22 (Reuters) – A potentially deadly strain of fungus is spreading among animals and people in the northwestern United States and the Canadian province of British Columbia, researchers reported on Thursday.

The airborne fungus, called Cryptococcus gattii, usually only infects transplant and AIDS patients and people with otherwise compromised immune systems, but the new strain is genetically different, the researchers said.

“This novel fungus is worrisome because it appears to be a threat to otherwise healthy people,” said Edmond Byrnes of Duke University in North Carolina, who led the study.

“The findings presented here document that the outbreak of C. gattii in Western North America is continuing to expand throughout this temperate region,” the researchers said in their report, published in the Public Library of Science journal PLoS Pathogens at http://dx.plos.org/10.1371/journal.ppat.1000850.

“Our findings suggest further expansion into neighboring regions is likely to occur and aim to increase disease awareness in the region.”

The new strain appears to be unusually deadly, with a mortality rate of about 25 percent among the 21 U.S. cases analyzed, they said.

“From 1999 through 2003, the cases were largely restricted to Vancouver Island,” the report reads.

“Between 2003 and 2006, the outbreak expanded into neighboring mainland British Columbia and then into Washington and Oregon from 2005 to 2009. Based on this historical trajectory of expansion, the outbreak may continue to expand into the neighboring region of Northern California, and possibly further.”

The spore-forming fungus can cause symptoms in people and animals two weeks or more after exposure. They include a cough that lasts for weeks, sharp chest pain, shortness of breath, headache, fever, nighttime sweats and weight loss.

It has also turned up in cats, dogs, an alpaca and a sheep.

Freezing can kill the fungus and climate change may be helping it spread, the researchers said.

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H1N1: A Lesson To Remember

Posted by admin on April 14, 2010

H1N1: A Lesson To Remember
04/13/2010 02:36PM

One year has passed since the first signs of a new influenza virus surfaced and started moving through the human population. In fact, it was on this day a year ago that the unfortunate first death related to Novel H1N1 influenza occurred in Oaxaca, Mexico.

A week later, April 24 to be exact, the reported cases started adding up and the new influenza virus was identified as containing human, avian and swine strains.

Unfortunately for the pork industry, and really all of animal agriculture, the virus was quickly and inaccurately labeled “swine flu.” Whether tying that label to the virus was done for sensational reasons, ignorance or laziness, the damage was underway.

The general media latched on to the “swine flu” label, emphasizing it at every turn. What’s more, social media took hold and created its own viral atmosphere, spreading misinformation wider and deeper than previously imagined. Indeed, Novel H1N1 was the first true exposure to the power of social media outlets among today’s public and the pork industry paid a heavy price.

In reality, the Novel H1N1 virus was not circulating in swine herds nor moving from pigs to people, rather it was people that would eventually expose a limited number of pigs to the virus.

Some consumers backed away from pork at the meat case, but as more clarity unfolded, those shoppers did return. The longer-lasting impact was in the export market as pork sales came to a screeching halt. Most foreign buyers started buying U.S. pork again by mid-year, but China took the hardest stance, just recently agreeing to re-open its market.

In the end, the Novel H1N1 episode is estimated to have cost the U.S. pork industry between $500 million and $1 billion. It came at time when hog prices were staged to begin their seasonal climb and pork producers desperately needed a profit opportunity.

So what are some the take-way lessons from the Novel H1N1 2009 episode?

• The export market offers a tremendous opportunity to expand your market, help feed the world and grow your industry, but it’s a volatile proposition. Those doors are quick to close whether the reasons are justifiable or not.

• When considering long-term threats to your industry or business, think well outside of your comfort zone. As one pork industry observer recently noted, prior to last April a human virus that could hurt pork demand was not on the list of possible threats to the U.S. pork industry.

• It’s not an exclusive club, meaning this type of incident is not exclusive to the pork industry; don’t think for a minute that such a scenario couldn’t happen to your product.

• We’re in a different communication age. Whether it’s 24-hour news or social media, fighting through the clutter and getting accurate messages out is harder than ever. Hats off to the pork industry and the federal government’s agricultural, human health and food agencies for trying to quell the rumors, distribute the facts and get the media to be more accurate in its reporting. But hopefully the response will be quicker and sharper the next time. (And you can bet there will be a next time.)

• Disease and contamination surveillance and traceback within the United States needs to be a priority, and that has taken an unfortunate setback with the demise of the National Animal Identification System. Will effective nationwide state-run systems emerge to take its place? I’m betting no, until a harsher challenge hits a wider range of species.

• Globally, governments and food and animal agriculture industries need to work together on these issues. That includes reporting, diagnosing and containment strategies.

• Closer to home, U.S. public health and animal health sectors need to work together, the building blocks of which are now being placed with the “One Health” initiative.

Novel H1N1 influenza virus cost the U.S. pork industry dearly, but it’s lessons are too easy to ignore by unaffected animal-ag sectors, and can be too easily forgotten when prices finally rebound. I truly hope that’s not the case this time.

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Potential Risk to Blood Supply Probed

Posted by admin on April 5, 2010

Potential Risk to Blood Supply Probed
XMRV Virus Gets Attention of Health Officials, but It’s Unclear if There Is Any Danger
By AMY DOCKSER MARCUS
An infectious virus linked to two diseases is drawing the attention of public-health officials, who are investigating the potential threat to the nation’s blood supply.

It isn’t clear if the virus, known as XMRV, poses a danger, and public-health officials say there isn’t evidence of spreading infection. But because of concern over the potential for widespread infection and preliminary evidence that XMRV is transmitted similarly to HIV, officials are quickly trying to determine if action is needed to protect the blood supply

A woman donated blood last year at a hospital in Tampa, Fla. Officials are trying to find tests for a virus known as XMRV.
XMRV was discovered in 2006 when it was found in tumor samples from men with a rare form of familial prostate cancer. Research has also linked the virus to chronic fatigue syndrome and found it in measurable levels in the blood of healthy people. But the evidence isn’t conclusive, as several other studies failed to find XMRV in the blood of people with chronic fatigue syndrome, and it isn’t known how prevalent the virus is or whether it causes disease.

“These are early days trying to understand the public health significance of XMRV,” said Jay Epstein, director of the Office of Blood Research and Review at the Food and Drug Administration.

Efforts are under way to find effective tests for the virus and determine its prevalence, led by a working group funded by the National Institutes of Health and including federal agencies such as the FDA and the Centers for Disease Control and Prevention. Blood banks, academic institutions and at least one advocacy group are also involved.

The focus on XMRV is part of a growing effort to better monitor emerging infections—disorders that have either increased in humans in recent decades or are deemed a potential threat. Currently there are 12 tests used to block infectious agents from entering the blood supply, such as HIV or hepatitis C, and more screens are under study, including those for dengue, human variant Creutzfeldt-Jakob disease and agents that cause malaria. There is no FDA-licensed lab test for XMRV, and officials say they are still setting standards for diagnosing it.

Public-health officials increasingly recognize that even infections not typically found in the U.S. can quickly come here because of global travel. Many viruses also have long incubation periods, making it harder to recognize that the virus was transmitted by a blood transfusion. In an October 2009 report, a federal advisory committee on blood safety and availability concluded that biovigilance in the U.S. is a “patchwork of activities, not a cohesive national program.”

The incidence of infectious diseases being transmitted through transfusions is small, typically only a handful each year, according to the American Red Cross and data reported to the FDA. About 16 million units of whole blood and red blood cells were donated in the U.S. in 2006, the latest data available, according to the 2007 National Blood Collection and Utilization Report. The American Red Cross, which collects almost half of blood donations in the U.S., estimated that about 10,000 donors a year turn out to be infected with pathogens that officials screen for. Nearly half are hepatitis C virus.

Michael P. Busch, who runs the Blood Systems Research Institute in San Francisco and is a member of the XMRV working group, notes that everyone harbors benign viral infections. These viruses are transmitted in every blood transfusion, but aren’t known to cause diseases in recipients, says Dr. Busch. Even if XMRV is found to be present in large numbers of blood donors, Dr. Busch notes, it is still necessary to determine if XMRV causes diseases.

The working group was established after a paper was published in October in the journal Science, where researchers reported finding the virus in a majority of 101 patients with chronic fatigue syndrome. The study’s co-authors at the Whittemore Peterson Institute for Neuro-Immune Disease, the National Cancer Institute and the Cleveland Clinic,also found the virus in nearly 4% of 218 healthy people used as controls in the study.

Extrapolating from those numbers, public-health officials estimated that up to 10 million people in the U.S. and hundreds of millions of people globally could be infected with XMRV, or xenotropic murine leukemia virus-related virus.

The apparent link to CFS, which affects an estimated 17 million people world-wide, and has no specific treatments, has been closely followed by the patient advocacy community. The Whittemore Peterson institute, established by the family of a chronic fatigue patient, has started collecting blood from CFS patients who got their diagnosis following a blood transfusion and plan to launch their own study of the issue, says Annette Whittemore, founder and president of the institute.

The CFIDS Association of America, an advocacy group for chronic fatigue syndrome, set up a bank to collect biospecimens to be used in potential studies about CFS, including XMRV-related ones. Researchers at Emory University and the University of Utah published a study last week showing that XMRV may be treatable with drugs that treat HIV.

The AABB, an association of facilities that collect virtually all of the U.S. blood supply, has also set up an XMRV task force, although the virus doesn’t appear on a list of infectious agents evaluated by a special AABB transfusion-risk committee, as concerns came out after the latest list was put together.

Labs in Europe reported earlier this year that they haven’t been able to replicate the XMRV findings in patients with chronic fatigue syndrome or prostate cancer. And public-health experts say a key issue in sorting out the disparate findings is to reach agreement on tests that are sensitive and reliable in identifying XMRV in the blood.

The federal working group’s project has three phases. First, labs at six participants—including the FDA, the National Cancer Institute, the CDC, and the Whittemore Peterson lab—are using a panel of blood samples to try to establish which of the labs’ tests are sensitive and reliable enough to find XMRV in the blood. Results are expected in a few weeks.

In the second phase, also launched, a panel of around 350 different blood samples developed by Dr. Busch’s team will be sent to four different labs. Some of the samples are from chronic fatigue patients known to have XMRV. Others from healthy donors have been spiked with the virus or have tested negative. All the samples are blinded, and the study will see whether the different labs can agree on XMRV positive status for chronic fatigue patients.

A third phase may be launched later, using frozen specimens in federal repositories dating to the 1970s. These repositories link donors to recipients and will allow researchers to see if XMRV was transferred in transfusions and help determine prevalence in the past as well as today, as well as geographical clusters or associations with age and gender.

“There is a balance to what we are doing,” says Simone A. Glynn, branch chief of transfusion medicine and cellular therapies at the National Heart, Lung and Blood Institute and chairperson of the XMRV working group. “You do not want to transfuse an infectious agent that causes problems. But you do not want to take blood out of the system that is not causing any problems.”

Write to Amy Dockser Marcus at amy.marcus@wsj.com

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Rotarix rotavirus vaccine contaminated, officials say

Posted by admin on March 23, 2010

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Rotarix rotavirus vaccine contaminated, officials say
By Tom Watkins, CNN
STORY HIGHLIGHTS
Doctors have been advised to suspend use of Rotarix rotavirus vaccine
Another vaccine, RotaTeq, is still OK to use, officials say
GlaxoSmithKline, maker of Rotarix, says the contamination is not harmful

Contagious and Infectious Diseases
(CNN) — Federal health authorities recommended Monday that doctors suspend using Rotarix, one of two vaccines licensed in the United States against rotavirus, saying the vaccine is contaminated with material from a pig virus.

“There is no evidence at this time that this material poses a safety risk,” Food and Drug Administration Commissioner Dr. Margaret Hamburg told reporters in a conference call.

Rotarix, made by GlaxoSmithKline, was approved by the FDA in 2008. The contaminant material is DNA from porcine circovirus 1, a virus from pigs that is not known to cause disease in humans or animals, Hamburg said.

About 1 million children in the United States and about 30 million worldwide have gotten Rotarix vaccine, she said.

Rotavirus disease kills more than 500,000 infants around the world each year, primarily in low- and middle-income countries, she said. Before rotavirus vaccine became available, the disease was blamed for more than 50,000 hospitalizations and several dozen deaths per year in the United States, she said.

The FDA learned about the contamination after an academic research team using a novel technique to look for viruses in a range of vaccines found the material in GlaxoSmithKline’s product and told the company, Hamburg said. The drug maker confirmed its presence in both the cell bank and the seed from which the vaccine is derived, suggesting its presence from the early stages of vaccine development, she said. The FDA then confirmed the drug maker’s findings.

GlaxoSmithKline emphasized Monday that the pig virus is not known to cause illness in humans, saying “it is found in everyday meat products and is frequently eaten with no resulting disease or illness.”

“No safety issue has been identified by external agencies or GSK,” Thomas Breuer, the drug maker’s chief medical officer, said in a written statement. “GSK is committed to patient safety and to the highest manufacturing standards for all our vaccines and medicines. We are already working closely and discussing this finding with regulatory agencies around the world.”

Another vaccine, RotaTeq, is made by Merck and was approved in 2006. There is no evidence that the Merck product is affected, Hamburg said. Both vaccines are given by mouth to infants to prevent rotavirus disease, which is marked by severe diarrhea and dehydration.

Asked whether Merck would be able to meet the nation’s demand, Merck spokeswoman Pam Eisele said, “Obviously, we will work with the … FDA to evaluate supply needs.”

In the next four to six weeks, the drug agency will convene an advisory committee to make recommendations and seek input on the use of new techniques for identifying viruses in vaccine, Hamburg said.

“We’re not pulling it from the market, we’re just suspending its use during this period while we’re collecting more information,” she said. “It should not be in this vaccine product and we want to understand how it got there. It’s not an easy call and we spent many long hours debating the pros and cons but, because we have an alternative product and because the background rates of this disease are not so severe in this country, we felt that the judicious thing to do was to take a pause, to really ask the critical questions about what this material was doing in the vaccine, how it got there.”

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said “a substantial amount” of the DNA was found in the vaccine. But, he stressed, “there is no evidence that it causes any disease. … There is no evidence that it ever does anything.”

The research group that discovered the contamination has asked not to be identified pending its paper’s publication in a scientific journal, Hamburg said.

Anyone who has already received a dose of Rotarix should switch to the Merck product for the next two doses, Hamburg said. Preliminary testing of the Merck product has found no evidence of the porcine circovirus 1 DNA, she said. Doctors should be able to tell parents which of the two products their children received, she said.

Hamburg stressed that the suspension applies only to the United States. Public health officials in countries where the incidence of rotavirus is more severe may decide that the benefits of continuing to use the vaccine outweigh any concerns raised by the contamination, she said. “Such a decision would be very understandable,” she added.

A similar virus, porcine circovirus 2, also does not cause disease in humans, but it does cause disease in its pig host, Hamburg said.

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Foodborne illness costs U.S. $152 B annually

Posted by admin on March 10, 2010

Foodborne illness costs U.S. $152 B annually
Acute foodborne illnesses cost the United States an estimated $152 billion per year in healthcare, workplace, and other economic losses, according to a report published by the Produce Safety Project (PSP).

The study, “Health-Related Costs from Foodborne Illness in the United States,” was written by Robert L. Scharff, a former Food and Drug Administration (FDA) economist and current Ohio State University Assistant Professor in the Department of Consumer Sciences. The study estimates that more than a quarter of these costs, an estimated $39 billion, are attributable to foodborne illnesses associated with fresh, canned, and processed produce.

The FDA has announced that it will propose, before the end of the year, mandatory and enforceable safety standards for the growing, harvesting, and packing of fresh produce. These will be the first nationwide safety standards for fresh fruits and vegetables.

“An up-to-date cost analysis of foodborne illnesses is critical for FDA officials and lawmakers to craft the most effective and efficient reforms,” said Jim O’Hara, PSP Director. “A decade ago, we spent more than $1.3 billion annually to try to reduce the burden of foodborne illness and today we are spending even more. We need to make certain we are spending limited funds wisely and hitting our target of reducing sicknesses and deaths, and this study gives us a yardstick to measure our progress.”

Produce (fresh, canned, and processed) accounts for roughly 19,700,000 of the reported illnesses documented, at a cost of approximately $1,960 per case and $39 billion annually in economic losses. California, Texas, New York, Florida, Illinois, and Pennsylvania were the states most impacted by foodborne illness cases related to produce.

In additional to national data, the report includes data at the state level.

“The contribution of this study is that it provides more complete estimates of the health-related cost of foodborne illness in the United States by summing both medical costs (hospital services, physician services, and drugs) and quality-of-life losses (deaths, pain, suffering, and functional disability) for each of the major pathogens associated with foodborne illness,” said Scharff. “This cost includes both expenses to the person made ill such as pain and suffering losses and costs to others in society such as outlays by insurance companies that pay medical expenses.”

Scharff based his analysis on the economic principles currently used by FDA and U.S. Department of Agriculture (USDA) economists in their cost analyses. In addition, to account for uncertainty he utilized confidence intervals and sensitivity analysis. The cost of foodborne illness is calculated on both an aggregate level and a pathogen-specific level.

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Food scientists suggest that boiling shrimp may reduce shellfish allergens

Posted by admin on March 4, 2010

Food scientists suggest that boiling shrimp may reduce shellfish allergens

A study published in the Journal of Food Science shows that food scientists found that boiling shrimp for 10 min may reduce allergenic properties of total shrimp extracts. Food allergies, especially shellfish allergies, can lead to severe reactions, including life-threatening anaphylaxis. Shellfish is the number one cause of food allergy in adults in the United States and is responsible for the majority of emergency department visits. More than 1 in 50 Americans have been diagnosed with shellfish allergies, so they tend to avoid it at all costs. Tropomyosin (TM), a major allergen in seafood that triggers allergic reactions, is likely to be a better tool for the diagnosis of shellfish allergy than the total extract.

Researchers from Jimei University in Fujian, China and the Agricultural Research Service in New Orleans, La. examined shrimp extracts from both raw and boiled shrimp, which were ground and then freeze-dried. The research showed that boiling shrimp may decrease the presence of antibodies that cause an allergic reaction.

“Understanding the allergenic properties of shrimp as affected by the cooking process is critical for shrimp allergic individuals,” said lead researcher Guang Ming Liu. “Our research shows that TM seems to be an effective antigen in diagnosing shrimp allergy.”

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I think the Flu season wasn’t overhyped rather I think all the attention changed people’s behavior

Posted by admin on March 3, 2010


This article in Wall Street Journal seems to say that H1N1 was overhyped. I think it wasn’t overhyped, rather, I think all the attention it was given changed people’s behavior which lowered the size of the outbreak. Also remember that this flu killed more children than any flu in over 75 years.

This has been a flu season like few others.

Normally at this time of year, influenza is rampant in the U.S., prompting hundreds of thousands of people to stay home in the dead of winter with fever, aches and pains.

Now, after raging through college campuses and communities last summer and fall, cases of the new H1N1 swine flu virus have dwindled to a trickle, and run-of-the-mill seasonal flu has barely made an appearance. Not one state reported widespread flu illness to the Centers for Disease Control and Prevention for the week ended Feb. 20, the latest data available. The percentage of all doctors’ visits by patients with influenza-like symptoms has dropped from a high of 7.8% in late October—the largest peak since the agency began surveillance in 1997—to 1.8% in late February, well below the norm for flu season.

Doctors and flu experts say the lull is unusual. “This is typically the peak of flu,” said James Turner, executive director of the University of Virginia’s department of student health. He said the Charlottesville, Va., student health center usually sees as many as 130 students a week complaining of flu symptoms this time of year. Recently, no more than three to five students a week have been coming in with fever, cough or other signs of flu, he said.

It is not clear why there is so little flu, particularly swine flu, going around, experts say. “Surely there’s a sufficient number of people who haven’t been infected or vaccinated,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

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More interactive graphics and photos Many scientists say the answer probably has to do with how the flu virus progresses. Influenza comes and goes in waves, normally running from October through May. But pandemic viruses—new viruses that emerge and spread quickly around the globe—often move to a different rhythm, and can reach their busiest stage at unusual times like summer and early fall, although the reason for this isn’t understood. Flu has peaked in late February or early March in 20 of the past 26 flu seasons, said Lyn Finelli, the CDC’s chief of flu surveillance and outbreak response. But the latest swine flu wave started in August, and peaked in late October, before waning.

Widely publicized preventive measures such as hand washing, and the large national vaccination effort thus far, may also have played a role in the sharp drop off in H1N1 infections, but it is not clear by how much, said Anthony Fiore, a medical epidemiologist with the CDC’s influenza division.

By mid-January, swine flu had sickened about 57 million people in the U.S. and killed roughly 11,700—mostly young adults and children—from the time it emerged in late April through mid-January. Young people who ordinarily fight off flu easily ended up in intensive care units on advanced life support. Pregnant women, children, and other people at risk of flu complications stood in line for hours for vaccine, as slow production and delays prompted limited supplies.

In past years, when seasonal flu was the big worry, influenza has typically sickened about 25 million people a year, and directly killed about 8,000, according to the CDC.

The H1N1 flu virus hasn’t disappeared, and another wave could still come this winter. “We’ve had peaks [of flu] as late as May, so we’re not out of the woods yet,” said Dr. Fiore of the CDC’s influenza division. The virus could also mutate, spawning more new infections, though it hasn’t done so yet. Flu experts estimate that more than half the country’s population may still be vulnerable to the H1N1 virus, either because they haven’t been sick or gotten vaccinated.

Some recent statistics could be warning signals. A few states have reported small increases in the percentage of doctors’ visits by patients with flu-like symptoms. And the American College Health Association reported for the week ending Feb. 19 its first uptick in swine flu cases on college campuses since mid-December, to 4.1 cases per 10,000 from 2.7 cases per 10,000.

Dr. Turner, who is also president of the ACHA, said the organization plans to decide along with the CDC after getting more data this week whether to warn colleges to promote prevention measures to thwart a new wave that may be on its way. He said he is concerned that college students traveling on spring break could bring the disease back with them to campus. “If there’s anytime we’re going to see an increase in disease activity, I’d say March or early April is the time,” he said.

Flu Gazing
What’s expected for the future of the H1N1 swine flu virus.

Flu experts say it is impossible to know if or when there will be another wave of swine flu.The flu season may not be over for this year, and swine flu could still return in strength. At least half the population remains susceptible to the flu.Some scientists expect any return of the virus won’t be as severe as last fall. Millions of people are immune now, either because they were sick or have been vaccinated. Vaccine for H1N1 swine flu is still being administered, and next year’s shot will include protection against the strain, along with two other seasonal viruses. Another possibility: The H1N1 virus could mutate and make the current vaccine, as well as next fall’s version, less effective.U.S. and global health officials have recommended that the new H1N1 virus be included as one of three strains in next season’s flu vaccine. The CDC’s vaccine advisory panel also expanded its recommendation for who should get flu shots to include young and middle-aged adults, among whom death rates from the new H1N1 virus have been higher than for the elderly or children. The change means that all Americans now will be encouraged to get flu shots when the next vaccine is ready in September.

The unusual course this flu season is taking isn’t one that public health officials are eager to repeat. Not knowing when the next flu outbreak could occur will mean staying on high alert for much of the year. It would also mean another rush to get vaccine distributed quickly. The CDC, which normally starts tracking flu hospitalizations and deaths in October, will continue to monitor them this spring, summer, and early fall. “We’re going to make sure when it hits, we know about it and can describe it,” Dr. Finelli said.

Associated Press

Jack Houley, 10, received a shot of the H1N1 vaccine in Annapolis, Md., last August.
Nancy Cox, the CDC’s influenza chief, told a vaccine advisory panel last week that the pandemic H1N1 virus is likely to eventually become a seasonal strain, though it is not one yet. Globally, the pandemic virus is still circulating in tropical countries and some parts of Europe, but is waning in most places, according to the World Health Organization.

Flu experts say they don’t know why there is so little seasonal flu circulating this year. One theory doctors are debating is that people infected with H1N1 swine flu may produce a chemical in their bodies that protects them against other flu viruses.

The new virus doesn’t appear to have completely muscled out other flu viruses, as some past pandemic viruses have. While one seasonal strain appears to have succumbed to the new tide of H1N1, another that is considered particularly hard on the elderly—H3N2—has continued to circulate in pockets of the globe, albeit in small amounts.

While relatively few people are currently seeking out H1N1 shots, the CDC isn’t giving up on promoting the vaccine this winter. About 155 million doses of H1N1 vaccine have been distributed so far this flu season, and about 86 million people have been vaccinated—a few million less so far than normally get vaccinated for seasonal flu. The agency is especially urging parents with children under 10 who have only had one dose to get a second, which it says is needed for full protection.

Even if a new wave of H1N1 illness occurs, some experts believe it won’t be as large as the one last fall.

That’s because millions more people have become immune either through infection or vaccination. “I think we’ll have scattered outbreaks in communities that didn’t have it,” said Dr. Finelli.

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