Progress Slows in Detection of New TB Cases

WASHINGTON — Progress in detecting new cases of tuberculosis is slowing, threatening to increase the risks of transmitting drug-resistant strains, the World Health Organization said Monday.

From 2005 to 2006, the rate of increase in detecting new cases fell to 3 percent from an average of 6 percent in the preceding five years (2001-5), the health organization said in its 12th annual report on global tuberculosis control. The agency, a unit of the United Nations, released the report in advance of World Tuberculosis Day, next Monday.

Globally, there were 9.2 million new cases and 1.7 million deaths from tuberculosis in 2006, the latest year for which statistics are available. Of these, 700,000 cases and 200,000 deaths were among people infected with H.I.V., the virus that causes AIDS. The figures are based on data that 202 countries and territories provided.

The African, Southeast Asian and Western Pacific regions accounted for 83 percent of total cases reported. India, China, Indonesia, South Africa and Nigeria rank as the top five countries in terms of absolute numbers of tuberculosis cases. The African region has the highest incidence rate per capita, 363 per 100,000.

The new statistics are worrisome because “the more cases that are detected early interrupt transmission and provide a better chance of cure, and that ultimately has a greater impact on the incidence of the disease,” Dr. Mario C. Raviglione, the agency’s director of tuberculosis control, said in an interview.

The slowing is partly a result of the inability of some national programs that had been making rapid strides to continue at the same pace, he said by telephone in a news conference from his agency’s headquarters in Geneva.

In most African countries, there has been no increase in the detection of tuberculosis cases through government programs. Also, nongovernmental faith-based and community groups detect and treat an unknown number of cases that they do not report to health officials.

Many cases of tuberculosis are not detected among people whose deaths are attributed to other diseases, like AIDS.

All such factors increase the work needed to reach the poorest people among whom transmission rates might be higher, Dr. Raviglione said.

Countries must either create facilities to detect more cases or “depend more and more on the private sector” because “more and more we are realizing that nongovernmental agencies and faith-based organizations that contribute to caring for AIDS cases now have an increased role in tuberculosis,” he said.

The W.H.O. said there was a shortfall of $2.5 billion of the $4.8 billion needed this year for overall tuberculosis control in low- and middle-income countries.

Chest Pain May Signal Cocaine Use in Young Patients

Cocaine use can sometimes be the hidden culprit when young or otherwise healthy patients complain to doctors of chest pain, according to a new scientific statement released Monday by the American Heart Association (AHA).

Physicians need to query patients as to whether they may have used the drug in such cases, the experts said.

For patients with a suspected heart attack, doctors need to rule out cocaine use because exposure to the drug can affect their treatment, committee chair Dr. James McCord, cardiology director of the chest pain unit of the Henry Ford Medical System in Detroit, said in a prepared statement. He noted that two standard heart attack treatments -- beta-blockers and clot-busting drugs -- can be dangerous if a patient has been using cocaine.

Increased blood pressure due to recent cocaine use can increase the risk of bleeding into the brain when a patient is given clot-busting drugs, the experts explained. Normally, beta-blockers can lower blood pressure without constricting the arteries of typical heart attack patients. But beta-blockers can have the opposite effects -- higher blood pressure and constricted arteries -- in people who've used cocaine.

While research shows that cocaine-related chest pain tends to occur within three hours of using the drug, the chemical remnants of cocaine can remain in the body for at least 18 hours and continue to cause problems, said McCord, who noted that between 1999 and 2002, cocaine-related emergency department visits increased by 47 percent. People ages 35-44 account for 37 percent of all cocaine-related visits to emergency departments, he added.

Since most cocaine-associated chest pain is not a heart attack, cocaine users with chest pain should be monitored in an observation unit for nine to 12 hours, the statement recommends.

"If the patients are alert and can talk to you, typically you want to tell them, 'Look, it is important for us to know if you are taking cocaine because it could change the way we treat you,'" McCord said. "If a patient is unconscious, a drug test could be done at the physician's discretion."

While patients are in an observation unit, there's also an opportunity for healthcare providers to offer drug-cessation counseling.

"Currently, the level of drug counseling available in most observation units, particularly at night, amounts to a pamphlet on drug abuse and referral phone numbers. This is an area where we can do a better job," McCord said. "We should use that hospital visit as a teachable moment to educate these patients on how they can improve their health and offer them counseling and referral programs for drug cessation."

The new AHA statement also addresses the issue of stents, which are used to prop open arteries in order to help restore blood flow to the heart. Long-term cocaine users with a coronary artery blockage should receive bare-metal stents instead of drug-eluting [emitting] stents. That's because people with a long history of cocaine use may not adhere to schedules for taking medications aimed at preventing drug-eluting stents from becoming blocked, the statement says.

What The Poling Autism Case Means

March 13, 2008 | For the past decade, advocacy groups have claimed that vaccines cause autism, a behavior and language disorder, in children. At the center of the debate is a compound called thimerosal,health club a mercury-based preservative that was used in most vaccines until around 2001. Many of the advocates, including Robert F. Kennedy Jr. in Salon, have accused doctors, drug companies and the federal government of hiding the truth about thimerosal and its connection to autism.

Despite the charges, multiple studies have demonstrated no connection between thimerosal (or anything else about vaccines) and autism. health club In the past nine months alone, at least three studies have shown that thimerosal has no relationship to autism or any other neurological disorders. One study, published in the January issue of Archives of General Psychiatry, looked at autism rates in California after the removal of thimerosal. Not only did the rates not go down, they continued to rise. For these reasons, the government and most doctors stand by the belief that vaccines are effective and safe.

However, last week, the U.S. government awarded compensation to a Georgia family, the Polings, who had sued the government (along with 5,000 other families whose children have autism), claiming vaccines had caused autism in their now 9-year-old daughter, Hannah. As the decision made headlines, health club antivaccine groups claimed victory and vindication, and parents fretted over whether to vaccinate their children.

This is the real danger of this case. As a pediatrician, I hate to see parents pass up the chance to give their kids vaccines, which have saved countless lives, prevented some of the deadliest diseases in human history and remain safe. health club So what should we make of the Poling decision? Let me take it one point at a time.

What did the government decide?

For many years now, the federal government has set aside funds for children who have been injured by vaccines. Doctors and other health professionals can report adverse outcomes to the government, and parents can file claims in federal "vaccine court." The court's judges, known as special masters, review claims. If they find a child was injured by a vaccine, they award compensation to that child.

In this case, "CHILD [Hannah Poling] v. Secretary of Health and Human Services," the court "concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder. Therefore, respondent recommends that compensation be awarded to petitioners."

Does that mean vaccines caused Hannah to become autistic?

No. Look again at the court statement: Hannah has "an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autistic spectrum disorder." Throughout the document health club, both Hannah's doctors and lab results support the diagnosis of mitochondrial disorder.

Not a diagnosis of autism?

Right. Mitochondrial disorder does not equal autism. Generally speaking, mitochondria are the parts of our cells that help generate energy. When they fail, the body's cells go awry, which can lead to failures in any number of normal body functions. There are at least 40 known mitochondrial disorders, and probably many more we haven't yet found. But it's clear from the transcript of the court's decision that this was not a case of vaccines causing autism. Rather, this is a case where the court deemed it plausible that vaccines aggravated an underlying disease caused by bad mitochondria, health club and that some of the symptoms Hannah showed were similar to autism. As you'll see below, there are even questions about that conclusion.

Report Criticizes FDA Over Spinach Packers

nearly half of all federal inspections of facilities that package fresh spinach revealed serious sanitary problems, but the Food and Drug Administration did not take "meaningful" enforcement action, a House committee report released yesterday found.

The most common problems uncovered by FDA inspections of 67 facilities included inadequate restroom sanitation, health club litter piles and indoor condensation posing a risk of food contamination by microorganisms. Inspectors also found buildings vulnerable to rodent infestation and workers with uncovered hair and poor hygiene.

Twenty serious outbreaks of E. coli have been traced to fresh lettuce or spinach since 1995. One of the most troublesome was a 2006 outbreak in bagged spinach processed by California-based Natural Selection Foods that sickened more than 200 people and was linked to three deaths.

The FDA acknowledged gaps in its food safety efforts after that episode. But the report by the House Oversight and Government Reform Committee says the problems were worse: It showed that spinach facilities were inspected about once every 2.4 years despite federal guidelines that say most should have been visited at least annually.

The FDA did not refer any of the problem facilities to its internal enforcement authorities, nor did the agency send warning letters or seek injunctions. It did refer one inspection to state authorities, health club the report said.

"The inspection reports . . . raise serious questions about the ability of FDA to protect the safety of fresh spinach and other fresh produce," committee investigators wrote. "It appears that FDA is inspecting high-risk facilities infrequently, failing to take vigorous enforcement action when it does inspect and identify violations, and not even inspecting the most probable sources of many outbreaks."

FDA spokeswoman Kimberly Rawlings said the agency is seeking legislative authority to implement a food protection plan that would target some produce and other high-risk foods that have been tied to serious illnesses health club. "Despite recent concerns, the food supply in the U.S. continues to be one of the safest in the world and this includes fresh produce," Rawlings wrote in an e-mail.

Authorities tied the 2006 outbreak to cattle or feral pig feces found in the fields of spinach grower Mission Organics. But the House report revealed that FDA inspections found repeated problems at several facilities operated by Natural Selection Foods years before the outbreak.

"FDA at no time required the firm to correct these conditions at any of its facilities, health club even after laboratory tests indicated the presence of microbial contamination at the exact site later implicated in the 2006 outbreak," the report's authors wrote.

Samantha Cabaluna, a spokeswoman for Natural Selection Foods, said the company has cooperated with federal and state authorities. She said parts of the committee's report are inaccurate, including a passage that alleged a July 2001 inspection found listeria bacteria in a Natural Selection Foods facility that was later tied to the 2006 E. coli outbreak. The company was not operating at that facility in 2001, she said.

"We continually search for new ways to improve food safety and note all observations provided by FDA inspectors during their audits," Cabaluna said in a statement. "Any corrective actions are immediately addressed."

Std Data Come As No Surprise, Area Teenagers Say

Elizabeth Alderman, adolescent specialist at the Children's Hospital at Montefiore Medical Center in New York, was astounded by a federal report this week showing that two out of five teenage girls who have had sex have experienced at least one sexually transmitted infection health club.

Lorena Granados, a junior at W.T. Woodson High School in Fairfax County, was not the least bit surprised.

"A lot of girls fall in love, and it doesn't seem they care about protection," she said yesterday. "It's 'What am I going to enjoy right now?' Or they'll say, 'I know he hasn't been with anybody. He's clean.' Or, 'He'll stop before we go too far.' "

That same attitude shows up in doctors' offices, Alderman said yesterday.

"Kids are not comfortable disclosing what they do," she said. "Or when they do come in, every single one will tell you they or their partner are using a condom. Obviously, many are not."

The study, released by the Centers for Disease Control and Prevention, analyzed data on 838 girls ages 14 t0 19 who took part in a 2003-04 government health survey. Overall, one in four girls in the sample, which officials said was nationally representative, had a sexually transmitted disease. The teens were tested for four infections: chlamydia, trichomoniasis, herpes simplex and the human papillomavirus.

There was a big difference by race: Nearly half of the black teens had at least one STD, compared with 20 percent among whites and Mexican Americans health club.

About half of the teens acknowledged having sex, though studies indicate that by the time they finish the first year of college, more than two-thirds of young women have engaged in intercourse.

The report follows other studies indicating that girls today are as active sexually as boys -- and it suggests that many girls are paying a price for that health club.

In 2005, the CDC reported that slightly more than half of teenage girls and boys had engaged in oral sex, which carries the risk of herpes and HPV, among other infections. Still another survey disclosed this year that after 16 years of decline, the birthrate among 15- to 19-year-olds has started rising.

"When you look at the grand sweep of data, it's a rather sobering picture," said Bill Albert, deputy director of the National Campaign to Prevent Teen and Unplanned Pregnancy in the District.

Sobering, as in the fact that Khadijah Marrow, an eighth-grader at Thomas Johnson Middle School in Lanham, knows a friend who has had a sexually transmitted disease.

Jennifer Corbett Dooren And Jared A. Favole

A federal panel backed a proposed Amgen Inc. drug to treat a rare blood-platelet illness, and sales restrictions would be included out of concern that the drug might contribute to other serious blood disorders.

The drug would be sold under the proposed brand name Nplate to treat immune thrombocytopenic purpura, or ITP,health club an autoimmune bleeding disorder marked by below-normal levels of platelets. Platelets help form clots to stop bleeding, and Nplate is designed to increase platelet levels in a different manner than other treatments. If approved, the product would likely be injected weekly in a doctor's office.

The Food and Drug Administration panel unanimously said Nplate had a favorable risk-benefit profile; its vote amounts to a recommendation that the FDA approve the drug. The agency usually follows its panels' advice health club.

Richard Pazdur, director of the FDA's oncology product office, said the agency believes Nplate works at raising platelet levels but has safety concerns that not yet addressed from current clinical data.

The studies have involved about 300 patients treated an average of about 37 weeks health club.

Amgen has proposed a risk-management program that would restrict distribution to doctors treating patients with ITP in hopes it would discourage off-label use.

"We conclude the benefits outweigh the risks," said Dietmar Berger, Amgen's senior vice president of global regulatory affairs and safety.

Study Disputes Need For Widespread Hospital Mrsa Testing

The medical community is united in its concern over the rapid spread of drug resistant staph bacteria in hospitals. But it's divided over what to do.

Some experts believe hospitals need to test large numbers of patients and isolate and treat people who prove positive, to prevent the bacteria's spread. Other experts argue this is inefficient.

Now, a new study in the Journal of the American Medical Association lends weight to the second point of view. It finds that widespread screening of patients for MRSA -- methicillin-resistant stapholoccocus aureus -- in a Swiss hospital did not reduce the number of hospital-acquired infections and wasn't cost effective.

"It wasn't what we expected. We were very surprised," said lead author Dr. Stephan Harbarth in a telephone interview Tuesday afternoon.

The results are sure to fuel an ongoing debate in the U.S. over how best to control the growing epidemic of MRSA infections, which kill nearly 19,000 people a year -- a higher death toll than AIDs, according to a much-publicized article published last October.

The debate has been roiling in Illinois, which last year became the first state to enact a law requiring hospitals to test all at-risk patients for MRSA.

The new report out of Switzerland appears to give ammunition to experts who question the value of this strategy.

The Swiss researchers screened 10,193 surgery patients admitted to the University of Geneva Hospitals between October 2004 and May 2006; a control group of more than 10,000 surgery patients was admitted without the tests.

To reduce the risk of MRSA transmission, the Geneva Hospital put patients who tested positive for the bacteria in isolation, scrubbed them with disinfectants, and gave them antibiotics.

Yet, even with all these interventions, the rates of hospital-acquired MRSA infections didn't differ significantly for the two groups, the study found.

"This is what we've been saying all long," said Kathy Warye, chief executive officer of the Association for Professionals in Infection Control and Epidemiology, a group that opposes efforts to mandate MRSA testing.

While screening patients can be a valuable, it's not a "magic wand" and it's not always the best way to deploy a medical institution's resources, said Dr. Stephen Weber, director of infection control at the University of Chicago Hospitals.

Given the results of the new study, "legislative mandates for MRSA screening are probably not appropriate," and Illinois should reconsider its new law, said Dr. Robert Weinstein, chief of infection control at Stroger Hospital.

Other experts said the Swiss study had several limitations and cautioned against interpreting its findings too broadly.

Dr. Barry Farr, a MRSA expert, noted the Swiss hospital didn't screen patients on medical wards, who probably served as a reservoir of MRSA infections within the institution and skewed the study's results.

About one-third of surgery patients at the Swiss hospital had surgery before measures could be taken to control potential MRSA infections; that may have contributed to the findings, said Dr. Karen Kaul, chair of molecular pathology at Evanston Northwestern Healthcare.

The three hospitals associated with that system -- Evanston, Glenbrook and Highland Park Hospitals -- have cut MRSA infection rates by more than half since August 2005, when they began universal screening of all newly admitted patients, she said. At Loyola University Medical Center, which began universal screening in late November, preliminary data indicates that infection rates have dropped 62 percent, said Dr. Jorge Parada, the hospitals' medical director for infection control.

Water Tests Ordered After AP Series

The governor of Illinois ordered screening of the state's waterways for pharmaceuticals Wednesday in reaction to an Associated Press investigation into the presence of trace amounts of medicines in U.S. drinking water.

The announcement by Gov. Rod Blagojevich came as the New York City Council scheduled an emergency committee hearing and as water providers across the nation assured residents that their water is safe to drink — even if it hasn't been tested.

Blagojevich said he had ordered the state's environmental agency to begin screening waterways for pharmaceuticals and to promote safer disposal of medicines. The governor also announced that the state will partner with Chicago officials to test that city's drinking water.

The AP series reported that Chicago was one of the largest U.S. cities that does not test its drinking water.

Blagojevich also directed state health officials to further assess the effects of any pharmaceutical contamination on human health.

In New York City, where the AP reported that trace concentrations of heart medicine, infection fighters, estrogen, anti-convulsants, a mood stabilizer and a tranquilizer have been detected in the upstate source of the city's water, the City Council has scheduled an emergency public hearing for April 3. The AP reported that despite the test results in the watershed, the city does not test its downstate drinking water.

"I'm very concerned about the possible effects of even traces of pharmaceuticals in our drinking water," said Councilman James G. Gennaro, a Democrat from Queens who heads the council's environmental protection committee.

Senate hearings have been scheduled by Sens. Frank Lautenberg, D-N.J., and Barbara Boxer, D-Calif., and other members of Congress have called for the appointment of a task force and additional research.

"The Associated Press investigation was illuminating and a great service, but it was not an official governmental study, and I doubt your agency will act on an outside group's findings," wrote Sen. Bob Menendez, D-N.J., in a letter sent Wednesday to EPA Administrator Stephen L. Johnson. "If there are pharmaceuticals in our water, our government should be fully aware of the problem and working to correct it."

The EPA released a statement in response to the AP series. "EPA appreciates any opportunity to raise the public's awareness about the safe disposal of prescription drugs and environmental responsibility," said spokesman Timothy Lyons. "The agency's work to protect the nation's water supply and enhance human health is ongoing, and we are pleased to see the interest Americans have taken in this effort."

The five-month-long project by the AP National Investigative Team, published this week, found that drugs — mostly the residue of medications taken by people, excreted and flushed down the toilet — have gotten into the drinking water supplies of at least 24 major metropolitan areas, from Southern California to northern New Jersey.

The risks from decades of persistent exposure to random combinations of low levels of pharmaceuticals are unknown. While no proof has been found of human health effects, recent studies have detected alarming adverse effects on human cells and wildlife.

Officials in other cities and water agencies also pressed for testing — and others demanded that any test results be disclosed.

The most pervasive response, repeated by officials in communities around the country, was that although their water hasn't been tested for pharmaceuticals, there is no reason to be concerned.

From Cheyenne, Wyo., to Jacksonville, Fla., and in dozens of communities elsewhere, water department officials reminded consumers that the traces of pharmaceuticals being found nationwide are minute and that the quality of their water exceeds all EPA water standards. However, the EPA does not have any standards for pharmaceuticals in water.

Calls for action appeared on newspaper editorial pages.

"Why isn't there a national standard that would ensure more rigorous testing? The Environmental Protection Agency should be taking leadership on this," said a Philadelphia Daily News editorial.

The Cleveland Plain Dealer said that water studies are underway in its region, but that "more can and must be done, from widespread sampling of area waters and federal standards for pharmaceutical sampling to far more intensive research on ways to remove such residues from drinking water. The public's health demands nothing less."

In some cases, providers who had not disclosed to the AP what they found in their water opted to tell their local news media after the investigative story came out.

For example, the Santa Clara Valley Water Agency — which previously would not specify which pharmaceuticals were detected in its watershed — has since told local reporters those compounds included ibuprofen, anti-convulsants and anti-inflammatories.

Water officials in Des Moines, Iowa, Cape Cod in Massachusetts and in Southern California's Inland Empire region, not part of the AP survey, told reporters about pharmaceuticals that had been detected in their water supplies, as well.

"Just as water utilities need data to make informed decisions, we believe that consumers should have the information they need to make personal health decisions," said Diane VanDe Hei, executive director of the Association of Metropolitan Water Agencies, a group representing the largest publicly owned drinking water suppliers in the United States.

In some locales, officials said they were already gathering data or would like information to be compiled.

"It will equip us with the scientifically sound information that is necessary to shape future courses of action to ensure public health and protect the environment," said Kathleen McGinty, the state environmental secretary for Pennsylvania, where 56 different pharmaceuticals or byproducts were detected in Philadelphia's drinking water.

Water managers in Fresno, Calif., held a meeting this week to allay public concerns about the area's drinking water but said the city doesn't plan to change its water treatment process in the wake of the AP investigation.

The city has not tested for pharmaceuticals in and around its wastewater treatment plant because it doesn't have the appropriate testing technology, said city spokeswoman Rhonda Jorn.

"We are very confident that we do have safe drinking water," Jorn said. "Of course, we'd be more than happy to test for pharmaceuticals in the water should the EPA make that technology available to us."

The AP's findings also have made their way to the late-night TV talk show circuit.

"Right here in Los Angeles they found high levels of anti-anxiety medication in the water, but health officials say, 'Oh, don't worry about it,' " said Jay Leno during a monologue Monday night on his NBC-TV program. "Well, we can't worry about it. It's in the water!"

Flu Outbreak Shuts Hong Kong Schools For Two Weeks

More than half a million Hong Kong schoolchildren stayed at home on Thursday after the government shut all kindergartens and primary schools for two weeks to contain an outbreak of flu.

A government-appointed panel of experts is probing the deaths of three children, aged 2, 3 and 7, over the last two weeks. The two older children were infected with seasonal flu, while the cause of illness in the youngest child is unknown.

The health scare has not been linked to H5N1 bird flu but the government's decision on Wednesday night to close the schools brought back memories of 2003, when an outbreak of Severe Acute Respiratory Syndrome hit Hong Kong.

Health Secretary York Chow said the government closed the schools because the numbers of young children getting infected seemed higher this year.

"Our main concern is the infection of young children. The percentage of young children getting influenza this season seems to be higher," he said at a press briefing. "The second is the mortality ... if there're two deaths related to flu even before the peak, then we need to do something to minimise the numbers in the weeks to come," he said, referring to two of the three children -- a girl aged 3 and a boy aged 7.

The government disclosed two new cases on Thursday, a 3-year-old boy WHO was in stable condition in hospital and a 21-month-old boy who died in late February after being admitted to hospital with flu-like symptoms. His cause of illness is unknown.

Mrs Kwan, a mother of a 10-year-old student, was worried.

"You can see that many people in Hong Kong are a bit scared of such viruses. It's not like before when kids would just have regular cough and fever. Now, you just don't know how serious any outbreak might be. I am very worried," she said.

Experts say there was no reason to panic.

"This year, there seem to be slightly more flu cases. But from what I can see, we get a bad flu year every few years. I don't think it is very unusual or different from previous years," said Leo Poon, a virologist from the University of Hong Kong. (Reporting by Tan Ee Lyn and James Pomfret; Editing by Nick Macfie)

Calcium may increase heart attack risk

Calcium supplements may increase the risk of heart attack in healthy post-menopausal women, a University of Auckland study found.First author Mark J. Bolland said while calcium supplementation is commonly prescribed to post-menopausal women to maintain bone health, there is little research on calcium and vascular disease.

The study involved 1,471 healthy post-menopausal women age 55 years or older who had previously taken part in a study to assess the effects of calcium on bone density and fracture rates.The women were randomly allocated either a daily calcium supplement or placebo. Dietary calcium intake was assessed and women were seen every six months during a five-year period.

The study, published in the British Medical Journal, found heart attacks were more commonly reported in the calcium group. Stroke or sudden death was also more common in this group.The findings are not conclusive, but suggest that high calcium intake might have an adverse effect on vascular health. If confirmed by other studies, the effect could outweigh beneficial effects of calcium on bone, the researchers said.In the meantime, the potentially detrimental effect should be balanced against the likely benefits of calcium on bone, particularly in elderly women, the researchers said