Long-time statin users have lower gallstone risk: MedlinePlus

Long-time statin users have lower gallstone risk

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_106033.html (*this news item will not be available after 02/24/2011)

Friday, November 26, 2010
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* Cholesterol
* Gallstones
* Statins

By Alison McCook

NEW YORK (Reuters Health) - People who take cholesterol-lowering statins for at least one to two years appear to be less likely to develop gallstones, a study of nearly two million Danish residents shows.

Among those receiving at least five prescriptions for the drugs, the risk of developing gallstones fell by 11 to 24 percent -- and the more prescriptions, the larger the decrease.

People who had just started taking statins, meanwhile, had a higher risk of developing gallstones, which form when bile stored in the gallbladder hardens into pieces of stone-like material.

That makes sense, study author Dr. Rune Erichsen of Aarhus University Hospital in Denmark told Reuters Health. People are prescribed statins to lower their cholesterol, which is one of the ingredients in gallstones. What's more, high cholesterol is tied to obesity, poor diet, and other factors that can increase the risk of gallstones.

"This is the reason that we find an increased gallstone disease risk in patients (who) just started taking statins," Erichsen said. But after a while on statins, those risks appeared to diminish, which squares with earlier research.

Some gallstones are tiny, while others can be as large as a golf ball. Often they cause no symptoms, but if they become lodged in the wrong place -- blocking the outlet from the gallbladder or pancreas, for instance -- they can cause inflammation and severe pain. Depending on the country, between six and 50 percent of adults in the Western world eventually develop some form of gallstone disease.

Statins, too, are common in the Western world. They are prescribed more than any other class of medications in the U.S. and used by about one in five adults. Their cost ranges widely, from $11 to more than $200 per month, and they have been shown to increase the rates of liver dysfunction, kidney failure, muscle weakness and cataracts in some populations.

To investigate further how statins impact gallstones, Erichsen and colleagues reviewed nationwide data collected from 1.7 million people living in Northern Denmark. Nearly 33,000 people developed gallstones between 1996 and 2008.

Reporting in the American Journal of Epidemiology, the authors found that more five percent of people who developed gallstones also took statins -- slightly more than among those without gallstones.

But after accounting for diseases tied to gallstones, such as liver and heart problems, people with at least five statin prescriptions had lower rates of gallstones than people who didn't take the drug.

Those with 20 or more prescriptions, for instance, had a 24-percent decrease in their chances of developing gallstones compared with non-users.

In an e-mail, Erichsen noted that the study cannot prove that statins directly caused the decrease.

"However, in the specific issue of statins and gallstone disease, there is compelling evidence that long-term statin use reduces the risk of gallstone disease," the researcher concluded. "Statins reduce the synthesis of cholesterol, so less cholesterol is excreted in the liver, and the risk of gallstone disease eventually seems to decrease."

SOURCE: http://link.reuters.com/tuc47q American Journal of Epidemiology, published November 17, 2010.
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Long-time statin users have lower gallstone risk: MedlinePlus

New spermicide may be as good as nonoxynol-9: MedlinePlus

New spermicide may be as good as nonoxynol-9

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_106034.html (*this news item will not be available after 02/24/2011)

Friday, November 26, 2010
Reuters Health Information Logo

Related MedlinePlus Page

* Birth Control

By Lynne Peeples

NEW YORK (Reuters Health) - A new spermicide compound, not yet available in drugstores, may be as good a contraceptive as the drug now in existing gels, films, and foams, hints a new study.

All currently available gel, film and foam spermicides, such as Encare contraceptive inserts and VCF dissolving vaginal films, contain the compound nonoxynol-9. But researchers testing a new mixture of spermicidal compounds called C31G found it to be just as effective at preventing pregnancy, and perhaps even a bit safer to use.

"Spermicides are one of the least utilized contraceptive methods," lead researcher Dr. Anne E. Burke of The Johns Hopkins University School of Medicine, in Baltimore, told Reuters Health.

However, for women who would rather not depend on a male partner's cooperation in birth control, do not want to take hormones, or who simply do not have sex all that often, it would be helpful to have newer and ultimately better spermicide options available, she added.

Burke and her colleagues randomly assigned more than 1,500 young, sexually active women to use either a gel containing C31G or nonoxynol-9 for at least 6 months. Participants were not told which spermicide they were given and were asked to engage in sexual intercourse at least four times per month and use the study product as the primary means of contraception each time.

At six months, pregnancy rates were 12 percent in both groups, report the researchers in the journal Obstetrics & Gynecology.

Of course, not all women were perfect in their use of the spermicide, occasionally applying it incorrectly or not at all. When the researchers considered only correct and consistent use of the products, the pregnancy rates dropped to five percent in both groups.

The aim of the study was not to determine if C31G was better than nonoxonyl-9, noted Burke, but rather to see if it was "at least as good." Indeed, it was.

Moreover, participants reported fewer side effects with the new spermicide compared to the old standard. Among C31G users, 35 percent experienced at least one side effect -- such as irritation, vaginal or urinary tract infections, or menstrual changes -- over the course of the study compared to 41 percent of those using the nonoxynol-9 gel.

"There are concerns with nonoxynol-9, such as vaginal side effects and genital irritation for some users," she said. "It seems that C31G might offer improvements in those regards."

Exactly when new spermicidal products containing C31G might become available is unknown at this point, senior researcher Diana Blithe of the National Institute of Child Health and Human Development, in Rockville, Md., told Reuters Health in an e-mail.

One of the hopes among researchers developing new spermicides is that they might address not only the problems of unintended pregnancy but also sexually-transmitted infections such as HIV. As a result, C31G has already been extensively tested as a microbicide, however the current study was not designed to prove such an effect.

Despite showing C31G to be as effective at preventing pregnancy as existing spermicides, Burke cautioned that spermicides are still generally less effective than other contraceptive methods, such as birth control pills or condoms.

"For women who might prioritize effectiveness above all else," she said, "spermicides may not be the best choice."

SOURCE: http://link.reuters.com/kak96q Obstetrics & Gynecology, December 2010.
Reuters Health

(c) Copyright Thomson Reuters 2010. Check for restrictions at: http://about.reuters.com/fulllegal.asp
New spermicide may be as good as nonoxynol-9: MedlinePlus

Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial : The Lancet

Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial
Original Text
The Lancet, Volume 376, Issue 9751, Pages 1467 - 1475, 30 October 2010
Dr Edward J Gane MD a Corresponding AuthorEmail Address, Stuart K Roberts MD b, Catherine AM Stedman MD c, Prof Peter W Angus MD d, Brett Ritchie MD e, Rob Elston PhD f, David Ipe MS f, Peter N Morcos PharmD f, Linda Baher BS f, Isabel Najera PhD f, Tom Chu MD f, Uri Lopatin MD f, M Michelle Berrey MD g, William Bradford MD h, Mark Laughlin MD f, Nancy S Shulman MD f, Patrick F Smith PharmD f

Summary

Background

Present interferon-based standard of care treatment for chronic hepatitis C virus (HCV) infection is limited by both efficacy and tolerability. We assessed the safety, tolerability, and antiviral activity of an all-oral combination treatment with two experimental anti-HCV drugs—RG7128, a nucleoside polymerase inhibitor; and danoprevir, an NS3/4A protease inhibitor—in patients with chronic HCV infection.

Methods

Patients from six centres in New Zealand and Australia who were chronically infected with HCV genotype 1 received up to 13 days oral combination treatment with RG7128 (500 mg or 1000 mg twice daily) and danoprevir (100 mg or 200 mg every 8 h or 600 mg or 900 mg twice daily) or placebo. Eligible patients were sequentially enrolled into one of seven treatment cohorts and were randomly assigned by interactive voice or web response system to either active treatment or placebo. Patients were separately randomly assigned within each cohort with a block size that reflected the number of patients in the cohort and the ratio of treatment to placebo. The random allocation schedule was computer generated. Dose escalation was started in HCV treatment-naive patients; standard of care treatment-experienced patients, including previous null responders, were enrolled in higher-dose danoprevir cohorts. Investigators, personnel at the study centre, and patients were masked to treatment allocation. However, the pharmacist who prepared the doses, personnel involved in pharmacokinetic sample analyses, statisticians who prepared data summaries, and the clinical pharmacologists who reviewed the data before deciding to initiate dosing in the next cohort were not masked to treatment allocation. The primary outcome was change in HCV RNA concentration from baseline to day 14 in patients who received 13 days of combination treatment. All patients who completed treatment with the study drugs were included in the analyses. This study is registered with ClinicalTrials.gov, NCT00801255.

Findings

88 patients were randomly assigned to a study drug treatment regimen (n=74 over seven treatment groups; 73 received at least one dose of study drug) or to placebo (n=14, all of whom received at least one dose). The median change in HCV RNA concentration from baseline to day 14 ranged from −3·7 to −5·2 log10 IU/mL in the cohorts that received 13 days of combination treatment. At the highest combination doses tested (1000 mg RG7128 and 900 mg danoprevir twice daily), the median change in HCV RNA concentration from baseline to day 14 was −5·1 log10 IU/mL (IQR −5·6 to −4·7) in treatment-naive patients and −4·9 log10 IU/mL in previous standard of care null responders (−5·2 to −4·5) compared with an increase of 0·1 log10 IU/mL in the placebo group. The combination of RG7128 and danoprevir was well tolerated with no treatment-related serious or severe adverse events, no grade 3 or 4 changes in laboratory parameters, and no safety-related treatment discontinuations.

Interpretation

This oral combination of a nucleoside analogue polymerase inhibitor and protease inhibitor holds promise as an interferon-free treatment for chronic HCV.

Funding
Roche Palo Alto.
Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial : The Lancet



HEPATOLOGÍA
Una nueva combinación de fármacos para la hepatitis C podría revolucionar la terapéutica de la enfermedad
Actualidad Ultimas noticias - JANOes
JANO.es · 29 Noviembre 2010 09:30

Un estudio publicado en ‘The Lancet’ muestra que esta combinación es bien tolerada por los pacientes y prácticamente no provoca efectos secundarios.


Virus de la hepatitis C.

Un estudio preliminar ha probado la seguridad y eficacia de una nueva combinación de fármacos orales para la hepatitis C, que podría acabar con los problemas de los tratamientos que se aplican actualmente y revolucionar la terapéutica de esta patología.

El estudio, publicado recientemente en la revista The Lancet, concluye que los nuevos medicamentos son bien tolerados en general y no provocan más efectos secundarios que algún dolor de cabeza o náuseas, en pocos casos.

El equipo de investigadores, formado por especialistas de distintos centros de Australia y Nueva Zelanda, contó para el estudio con 88 pacientes que tenían hepatitis C crónica de genotipo 1 -la forma más común y difícil de tratar-. Algunos de estos pacientes nunca se habían medicado antes, y otros no habían respondido satisfactoriamente a la terapia con interferón. Los autores los asignaron a varios grupos: la mayoría recibió distintas dosis de los dos nuevos fármacos -RG7128 (un inhibidor de la polimerasa) y danoprevir (un inhibidor de la proteasa)- y el resto tomó placebo.

El resultado fue que aquéllos que nunca se habían tratado redujeron la presencia del virus en la sangre hasta niveles indetectables a los 13 días de iniciar el tratamiento, y aquellos que ya habían tomado antes alguno de los dos medicamentos, también mejoraron, aunque no con tanto éxito como los primeros. Por el contrario, quienes recibieron placebo, empeoraron.

Posibilidad de crear nuevos fármacos

Los autores del estudio reconocen que se trata de una investigación muy preliminar, ya que se encuentra en Fase 1, pero apuntan que “abre una puerta al desarrollo de nuevos fármacos para la hepatitis y supone una esperanza para los pacientes".

Aunque se desconoce, por el momento, la eficacia de la nueva terapia a largo plazo, los resultados del estudio son muy positivos ya que contribuyen en el objetivo de disponer de tratamientos plenamente eficaces para la hepatitis C a corto plazo. En cualquier caso, y aunque la llegada de nuevos fármacos, más fáciles de tomar y más seguros es una necesidad, también conviene extender las pruebas de diagnóstico y concienciar a la población sobre este problema de salud.

La hepatitis C afecta a más de 170 millones de personas en el mundo, de las cuales sólo una mínima parte se encuentra en terapia -en Europa, sólo un 16% de los pacientes lo está-. Se estima que la quinta parte de las personas que sufren esta enfermedad desarrollará cirrosis en algún momento de su vida.


The Lancet (2010), Volume 376, Issue 9751, Pages 1467 - 1475
Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial : The Lancet

Actualidad Ultimas noticias - JANOes - Una nueva combinacion de farmacos para la hepatitis C podria revolucionar la terapeutica de la enfermedad - JANO.es - ELSEVIER

Reemergence of Rabies, Bhutan, 2008 | CDC EID

EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Research
Reemergence of Rabies in Chhukha District, Bhutan, 2008

Tenzin, Basant Sharma, Navneet K. Dhand, Nilkanta Timsina, and Michael P. Ward1 Comments to Author
Author affiliations: The University of Sydney, Camden, New South Wales, Australia (Tenzin, N.K. Dhand, M.P. Ward); Regional Livestock Development Centre, Gelephu, Bhutan (Tenzin); and Regional Livestock Development Centre, Tshimasham, Bhutan (B. Sharma, N. Timsina)

Suggested citation for this article

Abstract
From January through July 2008, rabies reemerged in the Chhukha district of southwestern Bhutan. To clarify the distribution and direction of spread of this outbreak, we mapped reported cases and conducted directional tests (mean center and standard deviational ellipse). The outbreak resulted in the death of 97 animals (42 cattle, 52 dogs, and 3 horses). Antirabies vaccine was given free of charge to ≈674 persons suspected to have been exposed. The outbreak spread south to north and appeared to follow road networks, towns, and areas of high human density associated with a large, free-roaming, dog population. The outbreak was controlled by culling free-roaming dogs. To prevent spread into the interior of Bhutan, a well-coordinated national rabies control program should be implemented in disease-endemic areas.

Rabies is a fatal zoonosis caused by rabies virus or rabies-related viruses (genus Lyssavirus) and transmitted by the bite of a rabid animal (1). Domestic dogs are the main (>95%) source of human rabies infection. An estimated 55,000 persons die of rabies in Asia and Africa each year (2), >20,000 in India alone (3).

In Bhutan, rabies is endemic to the southern districts that border India (4,5). Domestic dogs are the main reservoir and are responsible for spillover infection of other domestic animals, especially cattle. Sporadic human deaths have also been reported in south-central and southwestern rabies-endemic areas of Bhutan (6,7).

On January 23, 2008, a clinical case of rabies in a cow in Dala, a subdistrict of the Chhukha district, was reported and later confirmed by fluorescent antibody test (8,9). The cow had reportedly been bitten ≈3 weeks earlier by a stray dog with suspected rabies. On the same day, another case was reported (and later confirmed by fluorescent antibody test) in a stray dog in the town of Tshimalakha, Bjachho subdistrict. A retrospective epidemiologic field investigation found that an unreported rabies outbreak in dogs had occurred in the southern villages of Dala subdistrict during November and December 2007.

We report a rabies outbreak in the 3 subdistricts of Chhukha district, Bhutan: Dala, Bongo, and Bjachho (Figure 1). To help develop future control programs, our objectives were to 1) describe the spatio–temporal patterns of the outbreak, 2) generate hypotheses about rabies introduction and spread, 3) assess the relationship between animal rabies and public health, and 4) estimate the cost of the outbreak.

full-text:
Reemergence of Rabies, Bhutan, 2008 | CDC EID

Suggested Citation for this Article

Tenzin, Sharma B, Dhand NK, Timsina N, Ward MP. Reemergence of rabies in Chhukha district, Bhutan, 2008. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1925.htm

DOI: 10.3201/eid1612.100958



1Current affiliation: The University of Sydney, Camden, New South Wales, Australia.

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Michael P. Ward, Faculty of Veterinary Science, The University of Sydney, 425 Werombi Rd, Camden, New South Wales 2570, Australia; email: michael.ward@sydney.edu.au

Yellow Fever Virus, Southern Brazil | CDC EID

EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Research
Yellow Fever Virus in Haemagogus leucocelaenus and Aedes serratus Mosquitoes, Southern Brazil, 2008

Jáder da C. Cardoso, Marco A.B. de Almeida, Edmilson dos Santos, Daltro F. da Fonseca, Maria A.M. Sallum, Carlos A. Noll, Hamilton A. de O. Monteiro, Ana C.R. Cruz, Valéria L. Carvalho, Eliana V. Pinto, Francisco C. Castro, Joaquim P. Nunes Neto, Maria N.O. Segura, and Pedro F.C. Vasconcelos Comments to Author
Author affiliations: Secretaria da Saúde do Estado do Rio Grande do Sul, Porto Alegre, Brazil (J. da C. Cardoso, M.A.B. de Almeida, E. dos Santos, D.F. da Fonseca, C.A. Noll); Universidade de São Paulo, São Paulo, Brazil (J. da C. Cardoso, M.A.M. Sallum); Instituto Evandro Chagas, Ananindeua, Brazil (H.A. de O. Monteiro, A.C.R. Cruz, V.L. Carvalho, E.V. Pinto, F.C. Castro, J.P. Nunes Neto, M.N.O. Seguara, P.F.C. Vasconcelos); and Universidade do Estado do Pará, Belém, Brazil (P.F.C. Vasconcelos)

Suggested citation for this article

Abstract
Yellow fever virus (YFV) was isolated from Haemagogus leucocelaenus mosquitoes during an epizootic in 2001 in the Rio Grande do Sul State in southern Brazil. In October 2008, a yellow fever outbreak was reported there, with nonhuman primate deaths and human cases. This latter outbreak led to intensification of surveillance measures for early detection of YFV and support for vaccination programs. We report entomologic surveillance in 2 municipalities that recorded nonhuman primate deaths. Mosquitoes were collected at ground level, identified, and processed for virus isolation and molecular analyses. Eight YFV strains were isolated (7 from pools of Hg. leucocelaenus mosquitoes and another from Aedes serratus mosquitoes); 6 were sequenced, and they grouped in the YFV South American genotype I. The results confirmed the role of Hg. leucocelaenus mosquitoes as the main YFV vector in southern Brazil and suggest that Ae. serratus mosquitoes may have a potential role as a secondary vector.

Yellow fever is an acute, often fulminant, disease caused by Yellow fever virus (YFV), the prototype member of the family Flaviviridae, genus Flavivirus. YFV is endemic to tropical regions of Africa and South America (1,2). The virus is transmitted through the bite of mosquitoes belonging to the family Culicidae to vertebrate hosts, especially nonhuman primates and humans.

In South America, the urban cycle involves the mosquito Aedes aegypti and humans, whereas in the jungle cycle, the virus is transmitted to nonhuman primates by mosquitoes in the genera Haemagogus and Sabethes, especially Hg. janthinomys, Hg. albomaculatus, Hg. leucocelaenus, Sa. chloropterus, Sa. glaucodaemon, Sa. soperi, and Sa. cyaneus (2,3).

Currently in Brazil, 2 yellow fever–endemic areas have been described. The area where vaccination is recommended or risk for yellow fever is recognized includes the northern and central regions, as well as Maranhão State and the eastern part of Bahia, Minas Gerais, São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul states. The area where vaccination has not been recommended includes the coastal region between Piauí and Rio Grande do Sul states (4). During 1989–2008, a total of 546 human cases of yellow fever and 241 deaths were recorded in Brazil (5).

In Rio Grande do Sul, the southernmost state in Brazil, the last cases of sylvatic yellow fever were recorded in the 1960s (6). After 40 years without detectable activity, the virus was isolated from mosquitoes (Hg. leucocelaenus) collected in 2001, during an epizootic involving free-living nonhuman primates of the species Alouatta caraya (black howler monkey) in the northwestern region of the state (7). These YFV hosts spend most of their time in the trees and only go down to the ground to feed during the day; they are extremly sensitive to YFV and die of the disease after they are infected naturally or experimentally even in lower doses.

The confirmation of YFV in nonhuman primates and in mosquitoes led to vaccination campaigns in 44 municipalities to prevent human cases and the initiation of a program of environmental surveillance for yellow fever and other arboviruses authorized by Brazil's state Ministry of Health. The goal of this program was to detect the early presence of YFV in mosquitoes and nonhuman primates (through the detection of specific antibodies). The monitoring program was improved and, in 2002, a new epizootic was recorded with virus circulation in the central region of the state, including 9 additional municipalities in the vaccination area. Subsequently, no YFV activity was recorded for 6 years.

In October 2008, the state health secretary reported an increase in the number of deaths of black howler monkeys in the northwestern region, and intensified surveillance began immediately, before the deaths from yellow fever were even confirmed (8). This study describes the results obtained in 2008 during entomologic surveillance in areas with records of yellow fever epizootics in 2 municipalities of the northwest region of Rio Grande do Sul State.

full-text:
Yellow Fever Virus, Southern Brazil | CDC EID

Suggested Citation for this Article

Cardoso JC, de Almeida MAB, dos Santos E, da Fonseca DF, Sallum MAM, Noll, CA, et al. Yellow fever virus in Haemagogus leucelaenus and Aedes serratus mosquitoes, southern Brazil, 2008. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1918.htm

10.3201/eid1612.100608

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Pedro F.C. Vasconcelos, Departamento de Arbovirologia e Febres Hemorrágicas. Instituto Evandro Chagas, SVS/MS, Rod. BR 316, Km 07, SNº, Bairro, Levilândia 66030-000, Belém, Brazil; email: pedrovasconcelos@iec.pa.gov.br

Pandemic (H1N1) 2009 and Hematologic Malignancy, CME Activity | CDC EID

EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
MEDSCAPE CME ACTIVITY
Pandemic (H1N1) 2009 Infection in Patients with Hematologic Malignancy

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscapecme.com/journal/eid; (4) view/print certificate.

Learning Objectives

Upon completion of this activity, participants will be able to:

* Distinguish the most common presenting symptom of pandemic (H1N1) 2009 infection in the current study
* Analyze the course of lower respiratory tract infection with pandemic (H1N1) 2009 among patients with hematologic malignancy
* Develop appropriate management strategies for pandemic (H1N1) 2009 infection for patients with hematologic malignancy

Medscape CME Editor

Karen L. Foster, MA, Technical Writer-Editor, Emerging Infectious Diseases. Disclosure: Karen L. Foster, MA, has disclosed no relevant financial relationships.
Medscape CME Author

Charles P. Vega, MD, Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.
Authors

Disclosures: Catherine Liu, MD; Brian S. Schwartz, MD; Snigdha Vallabhaneni, MD; Michael Nixon, NP; Peter V. Chin-Hong, MD Steven A. Miller, MD, PhD; and W. Lawrence Drew, MD, PhD, have disclosed no relevant financial relationships. Charles Chiu, MD, PhD, has disclosed the following relevant financial relationship: served as a speaker or a member of a speakers bureau for Cubist Pharmaceuticals, Inc. Lloyd Damon, MD, has disclosed the following relevant financial relationships: served as a speaker or a member of a speakers bureau for Celgene Corporation; Eisai Inc.; owns stock, stock options, or bonds from Genentech, Inc.

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Pandemic (H1N1) 2009 and Hematologic Malignancy, CME Activity | CDC EID



EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Research
Pandemic (H1N1) 2009 Infection in Patients with Hematologic Malignancy

Catherine Liu, Comments to Author Brian S. Schwartz, Snigdha Vallabhaneni, Michael Nixon, Peter V. Chin-Hong, Steven A. Miller, Charles Chiu, Lloyd Damon, and W. Lawrence Drew
Author affiliation: University of California, San Francisco, California, USA

Suggested citation for this article

Abstract
To assess outcomes of patients with hematologic malignancy and pandemic (H1N1) 2009 infection, we reviewed cases during June–December 2009 at the University of California San Francisco Medical Center. Seventeen (63%) and 10 (37%) patients had upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI), respectively. Cough (85%) and fever (70%) were the most common signs; 19% of patients had nausea, vomiting, or diarrhea. Sixty-five percent of URTI patients were outpatients; 35% recovered without antiviral therapy. All LRTI patients were hospitalized; half required intensive care unit admission. Complications included acute respiratory distress syndrome, pneumomediastinum, myocarditis, and development of oseltamivir-resistant virus; 3 patients died. Of the 3 patients with nosocomial pandemic (H1N1) 2009, 2 died. Pandemic (H1N1) 2009 may cause serious illness in patients with hematologic malignancy, primarily those with LRTI. Rigorous infection control, improved techniques for diagnosing respiratory disease, and early antiviral therapy can prevent nosocomial transmission and optimize patient care.

Influenza is a major cause of illness and death in patients with hematologic malignancy and in hematopoietic cell transplant (HCT) recipients. In up to 30% of HCT recipients, illness progressed to lower respiratory tract infection (LRTI); death rates were 28% for patients in whom pneumonia developed (1). During spring 2009, infection caused by pandemic (H1N1) 2009 virus emerged in Mexico and spread rapidly throughout the world (2–4). Although it does not appear to be associated with higher death rates than seasonal influenza (5), pandemic (H1N1) 2009 virus has caused severe disease and death, particularly in persons with preexisting illnesses (6,7). Little is known about the clinical features and outcomes of pandemic (H1N1) 2009 infection in patients with hematologic malignancy. One recently published study suggested that pandemic (H1N1) 2009 causes mild disease in most patients with hematologic malignancy (8), but several reports have been published about patients with severe infection and respiratory failure (9–11). Risk factors for progression to LRTI are unknown. To characterize the clinical spectra and outcomes of pandemic (H1N1) 2009 disease in patients with hematologic malignancy, we reviewed the first 27 cases of pandemic (H1N1) 2009 among these patients in the University of California San Francisco Medical Center during June 1–December 31, 2009.

Methods
Patients and Setting

The University of California San Francisco (UCSF) Medical Center (San Francisco, CA, USA) is a large, academic medical center with an active HCT program for children and adults and extensive experience treating children and adults with hematologic malignancy. In 2009, HCTs were performed for 171 adults and 50 children; a total of 1,020 adults and 782 children were admitted to the hospital's hematology/HCT service.

At UCSF, all nasal swabs performed to diagnose respiratory viral infection in inpatients and outpatients are routinely submitted for testing to the UCSF Virology Laboratory. For infection control surveillance during the pandemic (H1N1) 2009 outbreak, the UCSF Virology Laboratory generated a list of all laboratory-confirmed cases of influenza A during June–December 2009. HCT recipients and other patients with hematologic malignancy were identified through a retrospective chart review of all laboratory-confirmed cases of influenza A during this period. We used a standardized form to capture demographic data, clinical signs and symptoms, underlying hematologic disease and other medical conditions, transplant history, immunosuppressive medications, selected laboratory tests, radiographic findings, treatment course, and clinical outcomes. Dosing and duration of antiviral treatment with oseltamivir or zanamivir, use of concomitant antimicrobial therapy, and intravenous immunoglobulin was determined by the treating providers. The study protocol was approved by the UCSF Committee on Human Research.

Laboratory Confirmation of Infection

All diagnostic testing, including repeat serial testing, was performed at the discretion of the treating provider. The standard clinical practice for detecting respiratory viral infection, including influenza, was to obtain a nasopharyngeal wash, aspirate, or flocked swab for viral direct fluorescent antibody (DFA) testing (D3-DFA Respiratory Virus Screening and ID Kit, Diagnostics Hybrids, Athens, OH, USA) with same-day turnaround. Specimens from high-risk immunocompromised patients were submitted for multiplex PCR testing (xTAG RVP [Respiratory Viral Panel]; Luminex, Austin, TX, USA) if DFA results were negative. Results were considered consistent with pandemic (H1N1) 2009 infection when specimens were positive for influenza A by DFA or positive for influenza A matrix gene but negative for H1 and H3 hemagglutin gene subtypes by RVP. Pandemic (H1N1) 2009 infection was confirmed by using banked frozen specimens with at least 1 of 3 PCRs; the Xpert Flu A Panel (Cepheid Corp, Sunnyvale, CA, USA), the Centers for Disease Control and Prevention (CDC) real-time reverse transcription–PCR (rRT-PCR) swine influenza panel (performed at the San Francisco Department of Public Health), or a previously described PCR specific for pandemic (H1N1) 2009 performed in our laboratory (12). Patients were considered to have probable pandemic (H1N1) 2009 if laboratory-confirmed influenza A was detected during June–December 2009 and additional specimens were not available for confirmatory testing. CDC performed pyrosequencing to detect the H275Y mutation in the N1 neuraminidase gene associated with oseltamivir resistance.

Definitions

Upper respiratory tract infection (URTI) was defined as pandemic (H1N1) 2009 virus in nasopharyngeal specimen and compatible clinical symptoms without new pulmonary infiltrates on chest radiograph. Lower respiratory tract infection (LRTI) was defined as pandemic (H1N1) 2009 virus in a nasopharyngeal, endotracheal tube, or bronchoalveolar lavage specimen and compatible clinical symptoms with a new pulmonary infiltrate on chest radiograph or computed tomography (CT) imaging.

full-text (large):
Pandemic (H1N1) 2009 and Hematologic Malignancy | CDC EID


Suggested Citation for this Article

Liu C, Schwartz BS, Vallabhaneni S, Nixon M, Chin-Hong PV, Miller SA, et al. Pandemic (H1N1) 2009 infection in patients with hematologic malignancy. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited].
http://www.cdc.gov/EID/content/16/1/1910.htm

DOI: 10.3201/eid1612.100772

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Catherine Liu, University of California, San Francisco, Division of Infectious Diseases, 513 Parnassus Ave S-380, San Francisco, CA 94143-0654, USA; email: catherine.liu@ucsf.edu

Aquaculture and Zoonotic Trematodes, Vietnam | CDC EID

EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Research
Freshwater Aquaculture Nurseries and Infection of Fish with Zoonotic Trematodes, Vietnam

Van Thi Phan, Comments to Author Annette Kjær Ersbøll, Thanh Thi Nguyen, Khue Viet Nguyen, Ha Thi Nguyen, Darwin Murrell, and Anders Dalsgaard
Author affiliations: Research Institute for Aquaculture No.1, Bac Ninh, Vietnam (V.T. Phan, K.V. Nguyen, H.T. Nguyen); University of Southern Denmark, Odense, Denmark (A.K. Ersbøll); Vinh University, Vinh, Vietnam (T.T. Nguyen); and University of Copenhagen, Copenhagen, Denmark; (V.T. Phan, D. Murrell, A. Dalsgaard)

Suggested citation for this article

Abstract
Residents of the Red River Delta region of northern Vietnam have a long tradition of eating raw fish. Fish-borne zoonotic trematodes (FZTs) are estimated to infect ≈1 million persons in Vietnam. It remains uncertain at what stages in the aquaculture production cycle fish become infected with FZTs. Newly hatched fish (fry) from 8 hatcheries and juveniles from 27 nurseries were therefore examined for FZT infection. No FZTs were found in fry from hatcheries. In nurseries, FZT prevalence in juveniles was 14.1%, 48.6%, and 57.8% after 1 week, 4 weeks, and when overwintered in ponds, respectively. FZT prevalence was higher in grass carp (p<0.001) than in other carp species. Results show that nurseries are hot spots for FZT infections in fish. Thus, sustainable FZT prevention strategies must address aquaculture management practices, particularly in nurseries, to minimize the risk of distributing infected juveniles to grow-out ponds and, subsequently, to markets for human consumption. Liver and intestinal infections caused by fish-borne zoonotic trematodes (FZTs) are increasingly being recognized as serious public health problems and with FZTs incorporated among causes of neglected tropical diseases (1,2). FZTs are especially widespread in Southeast Asia, including Vietnam, Lao People's Democratic Republic, Thailand, Cambodia, People's Republic of China, and North and South Korea (3–9). Liver flukes are associated with high incidence of bile duct cancer (1,10), and intestinal flukes cause serious pathologic changes in the heart, brain, and spinal cord (1,2,11). The epidemiology of FZTs is complex because humans and reservoir hosts, such as dogs, cats, pigs, and fish-eating birds, harbor egg-shedding adult stages (12,13). These hosts are infected by consumption of raw, inadequately cooked, or pickled fish. For many inhabitants in the Red River Delta provinces of northern Vietnam, the consumption of such fish dishes is a traditional behavior that is difficult to alter (14–16). In the Nam Dinh and Ninh Binh provinces, the widespread habit of eating raw fish is associated with a high FZT prevalence of 30%–40% in humans (3,4). Aquaculture fish species commonly used to prepare raw fish dishes, such as carp, frequently also have high a prevalence of FZT metacercariae (12,17–19). The influence of FZTs on the food safety of aquaculture products can have a noticeable adverse economic and public health effect because fish farming in Asia is expanding rapidly. Farm-raised fish are a main protein source consumed domestically and an essential product for exporting to other countries (2,10,20). Therefore, the production of FZT-free fish for human consumption should be a key objective for the aquaculture industry. Achieving this goal is seriously hampered, however, because the present state of knowledge on FZT infection in the fish production chain is inadequate to devise practical and sustainable prevention strategies, especially for small-scale and integrated freshwater aquaculture. The available knowledge of FZT infection is mainly obtained from studies of fish in grow-out ponds, where fish are harvested for human consumption (12,17,19). Freshwater fish hatcheries in Nam Dinh, Ninh Binh, and Bac Ninh provinces include facilities such as a water reservoir, water storage facilities, breeding tanks, and incubators for hatching eggs. Depending on the hatchery, the water reservoirs are cement tanks or consist of earthen ponds from which the water is either pumped into cement breeding tanks or supplied from a tower to the breeding tanks and egg incubators. Water used for the breeding tanks and incubators is filtered through a net to remove different microbiota, e.g., zooplankton. Brood stock are moved from earthen ponds into cement breeding tanks for induced spawning. Fertilized eggs are then incubated in round cement incubators with running water for ≈5 days, depending on fish species and temperature. Newly hatched fish are termed fry. Fry are kept in tanks for 3–5 days, after which they are sold and subsequently stocked in earthen ponds in so-called nurseries. The fish raised in nursery ponds are called juveniles. The nursery ponds in Nam Dinh and Ninh Binh provinces are mainly backyard earthen ponds located close to households and premises housing livestock and poultry. Juveniles are nursed up to 4 weeks and then sold for further nursing to bigger size or to be stocked to reach market size in grow-out ponds. Juveniles may be kept in ponds during the winter months (overwintered juveniles) for sale in early spring. Management of nurseries in northern Vietnam often involves the application of livestock manure as fertilizer before stocking fish to increase the density of plankton that serves as a food source for juveniles. Additionally, farmers may also apply night soil (human manure) as fertilizers to the nursing ponds. We report an investigation that aimed to determine the FZT infection status in integrated small-scale hatcheries and nurseries in Nam Dinh, Ninh Binh, and Bac Ninh provinces, which are major areas endemic for FZTs in Vietnam. By assessing the FZT metacercariae prevalence in fish from the initial stages of production, namely the hatcheries and nurseries, the study provides knowledge needed for a comprehensive assessment of FZT infection during the entire fish production cycle. full-text: Aquaculture and Zoonotic Trematodes, Vietnam | CDC EID

Suggested Citation for this Article

Phan VT, Ersbøll AK, Nguyen TT, Nguyen KV, Nguyen HT, Murrell D, et al. Freshwater aquaculture nurseries and infection of fish with zoonotic trematodes, Vietnam. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1905.htm

DOI: 10.3201/eid1612.100422

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Van Thi Phan, Centre for Environment Disease Monitoring in Aquaculture–Research Institute for Aquaculture No. 1, Dinh Bang Tu Son, Bac Ninh 84, Vietnam; email: phanvan@ria1.org