From WebMD Health News
Jennifer Warner
February 4, 2010 — Missing genes may be behind at least some cases of morbid or extreme obesity, according to a new study.
Researchers found that a small but significant portion of morbidly obese people are missing a section of their DNA that may contribute to their obesity.
The results suggest around seven in every 1,000 morbidly obese people are missing this section of their DNA, which contains about 30 genes. This genetic variation was not found in any people of normal weight.
"Although the recent rise in obesity in the developed world is down to an unhealthy environment, with an abundance of unhealthy food and many people taking very little exercise, the difference in the way people respond to this environment is often genetic," says researcher Philippe Froguel, of the School of Public Health at Imperial College London, in a news release.
Overall, researchers say about one in 20 cases of morbidly obese people is caused by genetics, including previously identified genetic mutations and these missing genes. But many more genetic mutations linked to obesity are yet to be found.
The researchers hope that identifying genetic variations that cause people to be morbidly obese will lead to the development of genetic tests that can help determine the best treatment.
"If we can identify these individuals through genetic testing, we can then offer them appropriate support and medical interventions, such as the option of weight loss surgery, to improve their long-term health," says Froguel.
In the study, published in Nature, researchers first identified the missing genes in teenagers and adults who had learning difficulties or delayed development.
The results showed 31 people had nearly identical deletions in one copy of their DNA. All of the adults with this genetic variation had a BMI of over 30, which means they were obese.
People inherit two copies of their DNA, one copy from their mother and one from their father. Sometimes one copy of one or more genes is missing and can affect a person’s development, as shown by this study.
In the second part of the study, researchers examined the genomes or genetic maps of 16,053 European people who were either obese or normal weight. They found 19 more people with the same set of missing genes. All of these individuals were morbidly obese.
The study showed people with the genetic deletion tended to be normal-weight toddlers who became overweight during childhood and morbidly obese as adults.
Researchers did not find the genetic deletion in any normal-weight people. Although they do not know the function of the missing genes, previous studies suggest some of them may be involved with delayed development, autism, and schizophrenia.
SOURCES:
Walters, R. Nature, Feb. 3, 2010, online advance edition.
News release, Imperial College London.
Saturday, February 6, 2010
Tuesday, February 2, 2010
Blood Test May Predict Rheumatoid Arthritis
From WebMD Health News
Jennifer Warner
January 29, 2010 - Elevated levels of inflammatory proteins called cytokines and related factors in the blood may be an early warning sign of impending rheumatoid arthritis (RA), according to a new study.
Researchers have found that levels of certain cytokines and related factors in the blood increase significantly prior to the development of rheumatoid arthritis, long before symptoms emerge. They say the finding paves the way for developing a blood test for early diagnosis of the mysterious disease.
"Our findings present an opportunity for better predicting the risk of developing RA and possibly preventing disease progression," says researcher Solbritt Rantapää-Dahlqvist, MD, of University Hospital in Umea, Sweden, in a news release.
Rheumatoid arthritis is a painful, progressive condition that can be difficult to diagnose in the early stages because it often begins with only subtle symptoms, such as achy joints or early morning stiffness. Other conditions, such as lupus, osteoarthritis, and fibromyalgia may also mimic the early symptoms of rheumatoid arthritis, which makes a definitive diagnosis difficult.
But studies have shown that early diagnosis and treatment of rheumatoid arthritis can help sufferers live a more active life and potentially avoid the type of joint damage that leads to disability.
Early Signs of RA
The cause of rheumatoid arthritis is not understood, but various components of the immune system and synovial tissue, which lubricates the joints, are thought to be involved.
Cytokines are pro-inflammatory proteins that are often found in the synovial tissue after rheumatoid arthritis has developed.
In the study, published in Arthritis & Rheumatism, researchers examined whether particular cytokines and related factors are elevated prior to the emergence of rheumatoid arthritis symptoms.
They analyzed blood samples from 86 people in Sweden without symptoms of rheumatoid arthritis at the time of donation who later developed RA and compared them with samples from 256 healthy individuals.
The results showed levels of several cytokines and related factors were elevated up to years before diagnosis with rheumatoid arthritis.
Researchers say the findings support the idea that the immune system was already stimulated and rheumatoid arthritis was developing. If further studies confirm these results, a blood test to screen for these elevated cytokines may help diagnose RA before symptoms emerge.
SOURCES:
Kokkonen, H. Arthritis & Rheumatism, Feb. 2, 2010; vol 62: pp 383-391.
News release, Wiley-Blackwell.
Jennifer Warner
January 29, 2010 - Elevated levels of inflammatory proteins called cytokines and related factors in the blood may be an early warning sign of impending rheumatoid arthritis (RA), according to a new study.
Researchers have found that levels of certain cytokines and related factors in the blood increase significantly prior to the development of rheumatoid arthritis, long before symptoms emerge. They say the finding paves the way for developing a blood test for early diagnosis of the mysterious disease.
"Our findings present an opportunity for better predicting the risk of developing RA and possibly preventing disease progression," says researcher Solbritt Rantapää-Dahlqvist, MD, of University Hospital in Umea, Sweden, in a news release.
Rheumatoid arthritis is a painful, progressive condition that can be difficult to diagnose in the early stages because it often begins with only subtle symptoms, such as achy joints or early morning stiffness. Other conditions, such as lupus, osteoarthritis, and fibromyalgia may also mimic the early symptoms of rheumatoid arthritis, which makes a definitive diagnosis difficult.
But studies have shown that early diagnosis and treatment of rheumatoid arthritis can help sufferers live a more active life and potentially avoid the type of joint damage that leads to disability.
Early Signs of RA
The cause of rheumatoid arthritis is not understood, but various components of the immune system and synovial tissue, which lubricates the joints, are thought to be involved.
Cytokines are pro-inflammatory proteins that are often found in the synovial tissue after rheumatoid arthritis has developed.
In the study, published in Arthritis & Rheumatism, researchers examined whether particular cytokines and related factors are elevated prior to the emergence of rheumatoid arthritis symptoms.
They analyzed blood samples from 86 people in Sweden without symptoms of rheumatoid arthritis at the time of donation who later developed RA and compared them with samples from 256 healthy individuals.
The results showed levels of several cytokines and related factors were elevated up to years before diagnosis with rheumatoid arthritis.
Researchers say the findings support the idea that the immune system was already stimulated and rheumatoid arthritis was developing. If further studies confirm these results, a blood test to screen for these elevated cytokines may help diagnose RA before symptoms emerge.
SOURCES:
Kokkonen, H. Arthritis & Rheumatism, Feb. 2, 2010; vol 62: pp 383-391.
News release, Wiley-Blackwell.
Thursday, January 28, 2010
Blood Test for Schizophrenia May Be on the Horizon
From Medscape Medical News
Caroline Cassels
January 26, 2010 — A blood test to aid in the diagnosis of schizophrenia may be available within the year.
An article in the January 18 issue of Chemical & Engineering News, the American Chemical Society's weekly news magazine, highlights the groundbreaking work led by Sabine Bahn, MD, PhD, MRCPsych, director of the Cambridge Institute of Psychiatric Research at the University of Cambridge in the United Kingdom, which reveals that up to 40% of changes that occur in the brains of schizophrenic patients also occur in other body parts.
Reporter Celia Henry Arnaud writes that the scientists are studying these biomarkers in the skin, immune cells, and serum to find samples that give a real-time picture of the disease. In contrast, she notes, most previous studies of schizophrenia have focused on examining potential biomarkers in brain tissue harvested at autopsy.
In the article, Dr. Bahn is quoted as saying, "We were pleased that some of our previous findings could be reproduced in the fibroblast system. It was reassuring that we can trace central nervous system abnormalities in the peripheral system."
Although the investigators initially studied fibroblasts, they are now using immune cells in schizophrenia studies because they have an added advantage of being involved in more signaling pathways, Ms. Arnaud reports.
The researchers are reportedly working with the company Rules-Based Medicine, located in Austin, Texas, and Lake Placid, New York, on the development of a diagnostic blood test. The hope is that the test will help clinicians confirm schizophrenia diagnoses and facilitate earlier treatment of the disease, which affects approximately 2 million Americans.
"The customary window is often a delay of several years until someone is confirmed and diagnosed. We know very well that if patients are treated early in the disease process, we improve outcome," said Dr. Bahn.
Chemical & Engineering News. 2010;88:26.
Caroline Cassels
January 26, 2010 — A blood test to aid in the diagnosis of schizophrenia may be available within the year.
An article in the January 18 issue of Chemical & Engineering News, the American Chemical Society's weekly news magazine, highlights the groundbreaking work led by Sabine Bahn, MD, PhD, MRCPsych, director of the Cambridge Institute of Psychiatric Research at the University of Cambridge in the United Kingdom, which reveals that up to 40% of changes that occur in the brains of schizophrenic patients also occur in other body parts.
Reporter Celia Henry Arnaud writes that the scientists are studying these biomarkers in the skin, immune cells, and serum to find samples that give a real-time picture of the disease. In contrast, she notes, most previous studies of schizophrenia have focused on examining potential biomarkers in brain tissue harvested at autopsy.
In the article, Dr. Bahn is quoted as saying, "We were pleased that some of our previous findings could be reproduced in the fibroblast system. It was reassuring that we can trace central nervous system abnormalities in the peripheral system."
Although the investigators initially studied fibroblasts, they are now using immune cells in schizophrenia studies because they have an added advantage of being involved in more signaling pathways, Ms. Arnaud reports.
The researchers are reportedly working with the company Rules-Based Medicine, located in Austin, Texas, and Lake Placid, New York, on the development of a diagnostic blood test. The hope is that the test will help clinicians confirm schizophrenia diagnoses and facilitate earlier treatment of the disease, which affects approximately 2 million Americans.
"The customary window is often a delay of several years until someone is confirmed and diagnosed. We know very well that if patients are treated early in the disease process, we improve outcome," said Dr. Bahn.
Chemical & Engineering News. 2010;88:26.
Vitamin D May Lower Colon Cancer Risk
From WebMD Health News
Kelli Miller Stacy
January 25, 2010 — Soaking in more sunlight and drinking more dairy may help you ward off colon cancer.
Researchers in Europe have found that people with abundant levels of vitamin D -- the so-called sunshine vitamin -- have a much lower risk of colon cancer. The findings add to a growing body of evidence that suggest vitamin D may have the power to help prevent colon cancer and possibly even improve survival in those who have the disease.
The body makes vitamin D after the skin absorbs some of the sun's rays.
You can also get vitamin D by consuming certain foods and beverages, such as milk and cereal, which have been fortified with the vitamin, but few foods naturally contain it.
For the current study, researchers looked at the link between blood levels of vitamin D as well as dietary vitamin D and calcium, and who was at risk for colorectal cancer. They based their findings on information from the European Prospective Investigation into Cancer Study (EPIC), a study of more than 520,000 people from 10 Western European countries. The study participants gave blood samples and completed detailed diet and lifestyle questionnaires between 1992 and 1998.
During the follow-up period, 1,248 patients were diagnosed with colorectal cancer. Researchers compared their lifestyle and diet backgrounds to the same number of healthy patients. They discovered that those with the highest blood levels of vitamin D had a nearly 40% decrease in colorectal cancer risk than those with the lowest levels.
However, the best way to boost your vitamin D level may be a matter of debate. As vitamin D's potential health benefits become more widely advertised, more people may advocate supplementation. However, the researchers say it's unclear if supplements are better at increasing blood levels of vitamin D than a balanced diet and moderate exposure to outdoor sunlight. They caution that the long-term effects of taking large doses of vitamin D supplements have not been well studied.
"Our findings suggest that the potential cancer risk benefits of higher vitamin D levels should be balanced with caution for the toxic potential," they write in today's online version of BMJ. "Before any public health recommendations can be made for vitamin D supplementation, new randomized trials are needed to test the hypothesis that increases in [blood levels of vitamin D] are effective in reducing colorectal cancer risk without inducing serious adverse events."
Colorectal cancer is the third most common cancer in men and women in the U.S., according to the American Cancer Society.
SOURCES:
News release, BMJ.
Jenab, M. BMJ, Jan. 20, 2010; vol 340.
American Cancer Society web site: "How Many People Get Colorectal Cancer."
National Institutes of Health web site: "Dietary Supplements: Vitamin D."
Kelli Miller Stacy
January 25, 2010 — Soaking in more sunlight and drinking more dairy may help you ward off colon cancer.
Researchers in Europe have found that people with abundant levels of vitamin D -- the so-called sunshine vitamin -- have a much lower risk of colon cancer. The findings add to a growing body of evidence that suggest vitamin D may have the power to help prevent colon cancer and possibly even improve survival in those who have the disease.
The body makes vitamin D after the skin absorbs some of the sun's rays.
You can also get vitamin D by consuming certain foods and beverages, such as milk and cereal, which have been fortified with the vitamin, but few foods naturally contain it.
For the current study, researchers looked at the link between blood levels of vitamin D as well as dietary vitamin D and calcium, and who was at risk for colorectal cancer. They based their findings on information from the European Prospective Investigation into Cancer Study (EPIC), a study of more than 520,000 people from 10 Western European countries. The study participants gave blood samples and completed detailed diet and lifestyle questionnaires between 1992 and 1998.
During the follow-up period, 1,248 patients were diagnosed with colorectal cancer. Researchers compared their lifestyle and diet backgrounds to the same number of healthy patients. They discovered that those with the highest blood levels of vitamin D had a nearly 40% decrease in colorectal cancer risk than those with the lowest levels.
However, the best way to boost your vitamin D level may be a matter of debate. As vitamin D's potential health benefits become more widely advertised, more people may advocate supplementation. However, the researchers say it's unclear if supplements are better at increasing blood levels of vitamin D than a balanced diet and moderate exposure to outdoor sunlight. They caution that the long-term effects of taking large doses of vitamin D supplements have not been well studied.
"Our findings suggest that the potential cancer risk benefits of higher vitamin D levels should be balanced with caution for the toxic potential," they write in today's online version of BMJ. "Before any public health recommendations can be made for vitamin D supplementation, new randomized trials are needed to test the hypothesis that increases in [blood levels of vitamin D] are effective in reducing colorectal cancer risk without inducing serious adverse events."
Colorectal cancer is the third most common cancer in men and women in the U.S., according to the American Cancer Society.
SOURCES:
News release, BMJ.
Jenab, M. BMJ, Jan. 20, 2010; vol 340.
American Cancer Society web site: "How Many People Get Colorectal Cancer."
National Institutes of Health web site: "Dietary Supplements: Vitamin D."
Consensus Guidelines for Psoriasis-Related Disease
From Medscape Rheumatology > Viewpoints
Kevin Deane, MD
Review data Treatment Recommendations for Psoriatic Arthritis
Ritchlin CT, Kavanaugh A, Gladman DD, et al; Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)
Ann Rheum Dis. 2009;68:1387-1394
Study Summary
Treating the "heartbreak"* and "joint-ache" of psoriasis has become easier with the introduction of effective disease-modifying drugs such as methotrexate and leflunomide, and especially with the introduction of biological therapy such as anti-tumor necrosis factor (TNF)-alpha agents. However, given the wide range of literature on the diagnosis and treatment of psoriatic-associated conditions, it may be difficult for an individual clinician to know which treatments are best studied. These study authors reviewed the literature on the treatment of psoriatic conditions and made recommendations regarding the use of available therapies.
Members of the multinational Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) (including rheumatologists, dermatologists, and patients) reviewed the psoriasis literature and graded it according to criteria established by the Agency for Health Care Policy Research (AHCPR), with scores ranging from 1a and 1b (meta-analysis of randomized controlled trials [RCTs]) through 4 (expert committee/clinical experience). Next, on the basis of this literature review, subcommittees of GRAPPA members graded treatment recommendations regarding the 6 conditions related to psoriasis: peripheral arthritis, nail disease, spinal disease, skin disease, dactylitis, and enthesitis.
Grade A recommendations were based on evel 1a-1b evidence, with grade B recommendations based on 2a-2b evidence (1 or more controlled trials, no randomization, or other well-designed study). Finally, diagnostic and treatment recommendations were formed and sent in survey form to all members of GRAPPA, 70 of whom responded, and the level of agreement with the treatment recommendations was calculated.
Treatment options scored by GRAPPA as grade A for moderate-severe peripheral arthritis (with approximately 90% agreement) included: sulfasalazine, leflunomide, and TNF-alpha inhibitors. Of note, methotrexate was scored as grade B.
For psoriatic skin disease, phototherapy, methotrexate, TNF-alpha inhibitors, efalizumab, cyclosporine, leflunomide, and sulfasalazine were graded as A (approximately 69% agreement).
For spinal disease, nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, analgesia, sacroiliac joint injections, and TNF inhibitors were all grade A (approximately 86% agreement).
For enthesitis, TNF-alpha antagonists were graded A, with others, including NSAIDs and oral disease-modifying antirheumatic drugs, given a grade D (approximately 88% agreement).
Viewpoint
Consensus statements such as the one discussed here allow for an individual clinician to quickly review the available data and make diagnostic or treatment decisions based on expert review of the literature. These reviews are dependent on many factors, including: (1) the quality of literature review and expert panel evaluation; (2) the availability of good RCTs; and (3) timely updates. However, for a disease such as psoriasis, in which clinical manifestations are protean, and multiple types of physicians may care for patients, consensus statements such as this may be the best way to summarize large amounts of data for clinically useful recommendations.
*The term "heartbreak of psoriasis" originated with a 1960s advertising campaign for the coal-tar treatment Tegrin.
Abstract
Kevin Deane, MD
Review data Treatment Recommendations for Psoriatic Arthritis
Ritchlin CT, Kavanaugh A, Gladman DD, et al; Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)
Ann Rheum Dis. 2009;68:1387-1394
Study Summary
Treating the "heartbreak"* and "joint-ache" of psoriasis has become easier with the introduction of effective disease-modifying drugs such as methotrexate and leflunomide, and especially with the introduction of biological therapy such as anti-tumor necrosis factor (TNF)-alpha agents. However, given the wide range of literature on the diagnosis and treatment of psoriatic-associated conditions, it may be difficult for an individual clinician to know which treatments are best studied. These study authors reviewed the literature on the treatment of psoriatic conditions and made recommendations regarding the use of available therapies.
Members of the multinational Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) (including rheumatologists, dermatologists, and patients) reviewed the psoriasis literature and graded it according to criteria established by the Agency for Health Care Policy Research (AHCPR), with scores ranging from 1a and 1b (meta-analysis of randomized controlled trials [RCTs]) through 4 (expert committee/clinical experience). Next, on the basis of this literature review, subcommittees of GRAPPA members graded treatment recommendations regarding the 6 conditions related to psoriasis: peripheral arthritis, nail disease, spinal disease, skin disease, dactylitis, and enthesitis.
Grade A recommendations were based on evel 1a-1b evidence, with grade B recommendations based on 2a-2b evidence (1 or more controlled trials, no randomization, or other well-designed study). Finally, diagnostic and treatment recommendations were formed and sent in survey form to all members of GRAPPA, 70 of whom responded, and the level of agreement with the treatment recommendations was calculated.
Treatment options scored by GRAPPA as grade A for moderate-severe peripheral arthritis (with approximately 90% agreement) included: sulfasalazine, leflunomide, and TNF-alpha inhibitors. Of note, methotrexate was scored as grade B.
For psoriatic skin disease, phototherapy, methotrexate, TNF-alpha inhibitors, efalizumab, cyclosporine, leflunomide, and sulfasalazine were graded as A (approximately 69% agreement).
For spinal disease, nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, analgesia, sacroiliac joint injections, and TNF inhibitors were all grade A (approximately 86% agreement).
For enthesitis, TNF-alpha antagonists were graded A, with others, including NSAIDs and oral disease-modifying antirheumatic drugs, given a grade D (approximately 88% agreement).
Viewpoint
Consensus statements such as the one discussed here allow for an individual clinician to quickly review the available data and make diagnostic or treatment decisions based on expert review of the literature. These reviews are dependent on many factors, including: (1) the quality of literature review and expert panel evaluation; (2) the availability of good RCTs; and (3) timely updates. However, for a disease such as psoriasis, in which clinical manifestations are protean, and multiple types of physicians may care for patients, consensus statements such as this may be the best way to summarize large amounts of data for clinically useful recommendations.
*The term "heartbreak of psoriasis" originated with a 1960s advertising campaign for the coal-tar treatment Tegrin.
Abstract
Guidance for Relief Workers and Others Traveling to Haiti for Earthquake Response
US Centers for Disease Control and Prevention
Posted: 01/20/2010
Editor's Note:
The following guidelines are provided by the US Centers for Disease Control and Prevention. They were last updated on January 16, 2010.
This notice is to advise relief workers and other personnel traveling to Haiti to assist with the humanitarian response following the January 12th earthquake near Port-au-Prince. Conditions in the area remain hazardous, including extensive damage to buildings, roads, and other infrastructure.
Before You Depart for Haiti
Recommended Vaccines
A number of vaccines are recommended for travelers to Haiti. See your doctor before you travel to make sure you have had all necessary vaccines.
Routine. Be sure that you are up to date on vaccines such as measles/mumps/rubella (MMR), diphtheria/pertussis/tetanus (DPT), polio, seasonal and H1N1 flu, and varicella. It is especially important to have a current tetanus shot.
Hepatitis A or immune globulin (IG). Even if your departure is imminent, one dose of hepatitis A vaccine provides adequate short-term protection for healthy people. For long-term protection, a second dose is required 6-18 months after the first dose, depending on the brand of vaccine used.
Typhoid. There are 2 vaccines available for typhoid prevention. The injectable vaccine may be preferable to the oral vaccine in cases where travel is imminent. The oral vaccine requires refrigeration and 4 tablets taken every other day over one week.
Hepatitis B. If your departure is imminent, the first in a 3-dose series (day 0, 1 month and 6 months) may provide some protection. An accelerated dosing schedule may be used (doses at days 0, 7, and at 21-30 days with a booster at 12 months).
Insect-borne Diseases
Malaria
Malaria occurs in all parts of Haiti. Ways to prevent malaria include the following:
Taking a prescription antimalarial drug
Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
Sleeping in air-conditioned or well-screened rooms or using bed nets.
No antimalarial drug is 100% protective, so it is important to use all three ways to prevent malaria.
All of the following antimalarial drugs are equal options for preventing malaria in Haiti: atovaquone/proguanil (Malarone®), chloroquine, doxycycline, or mefloquine. Each drug has its own side effects, contraindications, and precautions. You will need to talk to your doctor to decide which of these drugs would be best for you, depending on your current health, medical history, drug allergies, and specific needs. Additional information can be found on the Drugs to Prevent Malaria page.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while in Haiti or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the doctor that you have recently been in Haiti.
Dengue
Dengue is a common infection in Haiti. Dengue is a disease caused by a virus transmitted to people by the bite of an infected mosquito. Some important information to know about dengue as you travel to Haiti:
No vaccine or medications are available to prevent dengue.
The best way to reduce your risk of dengue is to protect yourself from mosquito bites (see the section below called "Protection Against Insects and Animals").
The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day.
Symptoms and signs are high fever, chills, headache and muscle pain. Additionally, a faint rash on the trunk and upper arms may appear on the second to third day of illness.
There are no specific medicines to treat dengue, so treatment is supportive with fever-reducing medicines and fluids.
You can help control mosquito populations by draining all standing water that you find in open containers left outdoors.
If you are in the Dominican Republic awaiting entry into Haiti, be aware that dengue is also common there.
Other Infectious Diseases
HIV
Haiti has a high prevalence of HIV infection. To reduce the risk of HIV and other sexually transmitted diseases, always use latex condoms. Healthcare workers should also take the following additional precautions:
Wear gloves for touching blood and body fluids, mucous membranes, or broken skin and for handling items or surfaces soiled with blood or body fluids.
Use masks and protective eyewear or face shields to prevent exposure of the mouth, nose, and eyes during procedures that are likely to generate droplets of blood or body fluids.
Wear gowns or aprons during procedures that are likely to generate splashes of blood
Tuberculosis (TB)
Rates of tuberculosis are very high in Haiti.
If you anticipate giving medical care or working closely with ill or injured victims, a tuberculin skin test (ideally, a two-step test) is recommended prior to travel and then 6-8 weeks after return.
If exposure to known TB patients will occur, traveling with personal respiratory protective devices (e.g., N-95 respirators), along with training, is recommended.
Anthrax
Anthrax occurs in Haiti and is primarily transmitted by direct contact with infected animals or with contaminated products from infected animals. Cases of cutaneous and inhalation anthrax have been reported among the local population.
Symptoms of anthrax can occur within 7 days of infection. Symptoms include: fever (>100° F) and chills or night sweats; cough; chest discomfort; shortness of breath; fatigue; muscle aches; sore throat followed by difficulty swallowing; enlarged lymph nodes; headache; nausea; loss of appetite; abdominal discomfort, vomiting, or diarrhea; a sore, especially on your face, arms, or hands that starts as a raised bump and develops into a painless ulcer with a black area in the center.
If you develop any of these symptoms, see a healthcare provider immediately.
Key Items to Bring
There will be almost no infrastructure support available in Haiti for the immediate future. Relief workers, volunteers, and other travelers will need to be self-sufficient.
Pack basic supplies, including:
Food and water sufficient for the length of your stay.
Insect protection: insect repellent and a bed net.
Medications: antimalarial pills, medications for the treatment of travelers' diarrhea (e.g., loperamide and an antibiotic), personal prescriptions (including extras), any preferred over-the-counter medications, and copies of all your prescriptions.
An extra set of prescription eyeglasses and/or contacts.
Water purification tablets (iodine or chlorine), bleach, or a water purifier.
Persons with pre-existing health conditions should consider wearing an alert-bracelet and make sure this information is on a contact card in their wallet or travel documents. A contact card should include the following information:
Name and contact information of U.S. family member or close contact.
Name and contact information of U.S. health-care provider.
Pre-existing health conditions and treatment.
Personal protective equipment (PPE): safety glasses or goggles, work boots, leather gloves for physical labor, rubber gloves for handling blood or body fluids, surgical masks, hard hat, ear plugs, N-95 respirators for those who are fit-tested.
Due to severe damage to health facilities and shortages of medical supplies, carry a first aid kit for your own protection. Minimum suggested contents:
Bandages (roller, adhesive, triangular)
Sterile gauze pads
Disposable gloves
Scissors
Tweezers
Cold compress
Antiseptic wipes
Antibiotic ointment
Hydrocortisone ointment
Commercial suture/syringe kits to be used by a local health-care provider. These items will require a letter from the prescribing physician on letterhead stationery. Pack these items in checked baggage, since they may be considered sharp objects and confiscated by airport or airline security if packed in carry-on bags.
While in Haiti
Wash your hands often with soap and clean water or use an alcohol-based hand cleaner (with at least 60% alcohol). Clean your hands especially before you eat or prepare food.
Safe Food and Drinks
Eat foods that are packaged or that are freshly cooked and served hot.
Do not eat raw and undercooked meats and seafood or unpeeled fruits and vegetables.
Drink only bottled, boiled, or chemically treated water and bottled or canned carbonated beverages. When using bottled drinks, make sure that the seal has not been broken.
Avoid tap water, fountain drinks, and ice cubes.
To disinfect your own water: boil for 1 minute or filter the water and add 2 drops of household bleach or 1/2 an iodine tablet per liter of water.
Use bottled, boiled, or chemically treated water to wash dishes, brush your teeth, wash and prepare food, or make ice.
Protection Against Insects and Animals
Insects. Insect-borne diseases such as malaria and dengue are risks in Haiti. Prevent insect bites by:
Using insect repellent (bug spray) that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of the active ingredient. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.
Wearing lightweight long-sleeved shirts, long pants, and a hat outdoors. For greater protection, clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent. (Remember: don't use permethrin on skin.)
Remaining indoors in a screened area or using insect repellent frequently on uncovered skin during the peak biting period for malaria (dusk and dawn) and dengue (any time of day).
Sleeping in beds covered by a bed net (preferably treated with permethrin), if not sleeping in an air-conditioned or well-screened room.
Spraying rooms with products effective against flying insects, such as those containing pyrethroid.
For detailed information about insect repellent use, see Insect and Arthropod Protection.
Animals. Direct contact with animals can spread diseases like rabies or cause serious injury or illness. Displaced animals may revert to the wild and go about in packs. They will also be hungry and may be searching for food and may be more likely to bite. It is important to prevent animal bites and scratches:
Stay away from all animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
If you are bitten or scratched, wash the wound well with soap and clean water and seek medical care right away. If you have a povidone-iodine solution (such as Betadine®), use that to clean the wound after washing it.
Resist the urge to rescue animals with the intent to bring them home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
After you return from Haiti, be sure to tell your doctor or state health department if you were bitten or scratched during travel.
For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards. To learn more about rabies see CDC's Rabies homepage.
Injury
The risk of injury after an earthquake is high. Hazards such as electrocution from downed power lines and structural damage to buildings and roads all pose a risk. Accidents and violence are documented risks for humanitarian workers and cause more deaths than disease and natural causes.
The majority of the road network in Haiti is not paved. Haiti is predominately mountainous and has extensive deforestation and soil erosion, making travel over roadways especially hazardous. Exercise extreme care when traveling on roads particularly in rural areas.
There has been extensive structural damage to buildings in Haiti. Avoid unstable structures if possible.
Other potential hazards to be aware of in collapsed buildings include standing water from water system breaks, natural gas leaks, airborne smoke and dusk, hazardous materials such as ammonia or leaking fuels, exposure to germs from sewer line breaks, and exposed wiring.
Use personal protection equipment, such as hard hats and steel-toed boots, if in areas with damaged buildings.
Exposure to Human Remains
Human remains may contain blood-borne viruses and diarrhea-causing bacteria. Relief workers who are handling remains should take precautions to avoid being exposed to these organisms:
Protect your face from splashes of body fluids and fecal material by using a plastic face shield or a combination of eye protection and surgical mask. In extreme situations, a cloth tied over the nose and mouth can be used to block splashes.
Protect your hands from direct contact with body fluids and from injuries that break the skin by using a combination of a cut-proof inner layer glove and a latex (or similar) outer layer.
Wash your hands with soap and water or with an alcohol-based hand cleaner immediately after you remove the gloves.
Protect your feet and ankles against sharp debris by wearing foot wear that covers the entire foot and has thick soles.
Give prompt care -- including immediate cleansing with soap and water, and a tetanus booster if indicated -- to anyone who is injured during work with human remains.
For more extensive information about working with human remains after a disaster, see the Interim Health Recommendations for Workers who Handle Human Remains After a Disaster fact sheet.
Posted: 01/20/2010
Editor's Note:
The following guidelines are provided by the US Centers for Disease Control and Prevention. They were last updated on January 16, 2010.
This notice is to advise relief workers and other personnel traveling to Haiti to assist with the humanitarian response following the January 12th earthquake near Port-au-Prince. Conditions in the area remain hazardous, including extensive damage to buildings, roads, and other infrastructure.
Before You Depart for Haiti
Recommended Vaccines
A number of vaccines are recommended for travelers to Haiti. See your doctor before you travel to make sure you have had all necessary vaccines.
Routine. Be sure that you are up to date on vaccines such as measles/mumps/rubella (MMR), diphtheria/pertussis/tetanus (DPT), polio, seasonal and H1N1 flu, and varicella. It is especially important to have a current tetanus shot.
Hepatitis A or immune globulin (IG). Even if your departure is imminent, one dose of hepatitis A vaccine provides adequate short-term protection for healthy people. For long-term protection, a second dose is required 6-18 months after the first dose, depending on the brand of vaccine used.
Typhoid. There are 2 vaccines available for typhoid prevention. The injectable vaccine may be preferable to the oral vaccine in cases where travel is imminent. The oral vaccine requires refrigeration and 4 tablets taken every other day over one week.
Hepatitis B. If your departure is imminent, the first in a 3-dose series (day 0, 1 month and 6 months) may provide some protection. An accelerated dosing schedule may be used (doses at days 0, 7, and at 21-30 days with a booster at 12 months).
Insect-borne Diseases
Malaria
Malaria occurs in all parts of Haiti. Ways to prevent malaria include the following:
Taking a prescription antimalarial drug
Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
Sleeping in air-conditioned or well-screened rooms or using bed nets.
No antimalarial drug is 100% protective, so it is important to use all three ways to prevent malaria.
All of the following antimalarial drugs are equal options for preventing malaria in Haiti: atovaquone/proguanil (Malarone®), chloroquine, doxycycline, or mefloquine. Each drug has its own side effects, contraindications, and precautions. You will need to talk to your doctor to decide which of these drugs would be best for you, depending on your current health, medical history, drug allergies, and specific needs. Additional information can be found on the Drugs to Prevent Malaria page.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while in Haiti or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the doctor that you have recently been in Haiti.
Dengue
Dengue is a common infection in Haiti. Dengue is a disease caused by a virus transmitted to people by the bite of an infected mosquito. Some important information to know about dengue as you travel to Haiti:
No vaccine or medications are available to prevent dengue.
The best way to reduce your risk of dengue is to protect yourself from mosquito bites (see the section below called "Protection Against Insects and Animals").
The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day.
Symptoms and signs are high fever, chills, headache and muscle pain. Additionally, a faint rash on the trunk and upper arms may appear on the second to third day of illness.
There are no specific medicines to treat dengue, so treatment is supportive with fever-reducing medicines and fluids.
You can help control mosquito populations by draining all standing water that you find in open containers left outdoors.
If you are in the Dominican Republic awaiting entry into Haiti, be aware that dengue is also common there.
Other Infectious Diseases
HIV
Haiti has a high prevalence of HIV infection. To reduce the risk of HIV and other sexually transmitted diseases, always use latex condoms. Healthcare workers should also take the following additional precautions:
Wear gloves for touching blood and body fluids, mucous membranes, or broken skin and for handling items or surfaces soiled with blood or body fluids.
Use masks and protective eyewear or face shields to prevent exposure of the mouth, nose, and eyes during procedures that are likely to generate droplets of blood or body fluids.
Wear gowns or aprons during procedures that are likely to generate splashes of blood
Tuberculosis (TB)
Rates of tuberculosis are very high in Haiti.
If you anticipate giving medical care or working closely with ill or injured victims, a tuberculin skin test (ideally, a two-step test) is recommended prior to travel and then 6-8 weeks after return.
If exposure to known TB patients will occur, traveling with personal respiratory protective devices (e.g., N-95 respirators), along with training, is recommended.
Anthrax
Anthrax occurs in Haiti and is primarily transmitted by direct contact with infected animals or with contaminated products from infected animals. Cases of cutaneous and inhalation anthrax have been reported among the local population.
Symptoms of anthrax can occur within 7 days of infection. Symptoms include: fever (>100° F) and chills or night sweats; cough; chest discomfort; shortness of breath; fatigue; muscle aches; sore throat followed by difficulty swallowing; enlarged lymph nodes; headache; nausea; loss of appetite; abdominal discomfort, vomiting, or diarrhea; a sore, especially on your face, arms, or hands that starts as a raised bump and develops into a painless ulcer with a black area in the center.
If you develop any of these symptoms, see a healthcare provider immediately.
Key Items to Bring
There will be almost no infrastructure support available in Haiti for the immediate future. Relief workers, volunteers, and other travelers will need to be self-sufficient.
Pack basic supplies, including:
Food and water sufficient for the length of your stay.
Insect protection: insect repellent and a bed net.
Medications: antimalarial pills, medications for the treatment of travelers' diarrhea (e.g., loperamide and an antibiotic), personal prescriptions (including extras), any preferred over-the-counter medications, and copies of all your prescriptions.
An extra set of prescription eyeglasses and/or contacts.
Water purification tablets (iodine or chlorine), bleach, or a water purifier.
Persons with pre-existing health conditions should consider wearing an alert-bracelet and make sure this information is on a contact card in their wallet or travel documents. A contact card should include the following information:
Name and contact information of U.S. family member or close contact.
Name and contact information of U.S. health-care provider.
Pre-existing health conditions and treatment.
Personal protective equipment (PPE): safety glasses or goggles, work boots, leather gloves for physical labor, rubber gloves for handling blood or body fluids, surgical masks, hard hat, ear plugs, N-95 respirators for those who are fit-tested.
Due to severe damage to health facilities and shortages of medical supplies, carry a first aid kit for your own protection. Minimum suggested contents:
Bandages (roller, adhesive, triangular)
Sterile gauze pads
Disposable gloves
Scissors
Tweezers
Cold compress
Antiseptic wipes
Antibiotic ointment
Hydrocortisone ointment
Commercial suture/syringe kits to be used by a local health-care provider. These items will require a letter from the prescribing physician on letterhead stationery. Pack these items in checked baggage, since they may be considered sharp objects and confiscated by airport or airline security if packed in carry-on bags.
While in Haiti
Wash your hands often with soap and clean water or use an alcohol-based hand cleaner (with at least 60% alcohol). Clean your hands especially before you eat or prepare food.
Safe Food and Drinks
Eat foods that are packaged or that are freshly cooked and served hot.
Do not eat raw and undercooked meats and seafood or unpeeled fruits and vegetables.
Drink only bottled, boiled, or chemically treated water and bottled or canned carbonated beverages. When using bottled drinks, make sure that the seal has not been broken.
Avoid tap water, fountain drinks, and ice cubes.
To disinfect your own water: boil for 1 minute or filter the water and add 2 drops of household bleach or 1/2 an iodine tablet per liter of water.
Use bottled, boiled, or chemically treated water to wash dishes, brush your teeth, wash and prepare food, or make ice.
Protection Against Insects and Animals
Insects. Insect-borne diseases such as malaria and dengue are risks in Haiti. Prevent insect bites by:
Using insect repellent (bug spray) that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of the active ingredient. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.
Wearing lightweight long-sleeved shirts, long pants, and a hat outdoors. For greater protection, clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent. (Remember: don't use permethrin on skin.)
Remaining indoors in a screened area or using insect repellent frequently on uncovered skin during the peak biting period for malaria (dusk and dawn) and dengue (any time of day).
Sleeping in beds covered by a bed net (preferably treated with permethrin), if not sleeping in an air-conditioned or well-screened room.
Spraying rooms with products effective against flying insects, such as those containing pyrethroid.
For detailed information about insect repellent use, see Insect and Arthropod Protection.
Animals. Direct contact with animals can spread diseases like rabies or cause serious injury or illness. Displaced animals may revert to the wild and go about in packs. They will also be hungry and may be searching for food and may be more likely to bite. It is important to prevent animal bites and scratches:
Stay away from all animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
If you are bitten or scratched, wash the wound well with soap and clean water and seek medical care right away. If you have a povidone-iodine solution (such as Betadine®), use that to clean the wound after washing it.
Resist the urge to rescue animals with the intent to bring them home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
After you return from Haiti, be sure to tell your doctor or state health department if you were bitten or scratched during travel.
For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards. To learn more about rabies see CDC's Rabies homepage.
Injury
The risk of injury after an earthquake is high. Hazards such as electrocution from downed power lines and structural damage to buildings and roads all pose a risk. Accidents and violence are documented risks for humanitarian workers and cause more deaths than disease and natural causes.
The majority of the road network in Haiti is not paved. Haiti is predominately mountainous and has extensive deforestation and soil erosion, making travel over roadways especially hazardous. Exercise extreme care when traveling on roads particularly in rural areas.
There has been extensive structural damage to buildings in Haiti. Avoid unstable structures if possible.
Other potential hazards to be aware of in collapsed buildings include standing water from water system breaks, natural gas leaks, airborne smoke and dusk, hazardous materials such as ammonia or leaking fuels, exposure to germs from sewer line breaks, and exposed wiring.
Use personal protection equipment, such as hard hats and steel-toed boots, if in areas with damaged buildings.
Exposure to Human Remains
Human remains may contain blood-borne viruses and diarrhea-causing bacteria. Relief workers who are handling remains should take precautions to avoid being exposed to these organisms:
Protect your face from splashes of body fluids and fecal material by using a plastic face shield or a combination of eye protection and surgical mask. In extreme situations, a cloth tied over the nose and mouth can be used to block splashes.
Protect your hands from direct contact with body fluids and from injuries that break the skin by using a combination of a cut-proof inner layer glove and a latex (or similar) outer layer.
Wash your hands with soap and water or with an alcohol-based hand cleaner immediately after you remove the gloves.
Protect your feet and ankles against sharp debris by wearing foot wear that covers the entire foot and has thick soles.
Give prompt care -- including immediate cleansing with soap and water, and a tetanus booster if indicated -- to anyone who is injured during work with human remains.
For more extensive information about working with human remains after a disaster, see the Interim Health Recommendations for Workers who Handle Human Remains After a Disaster fact sheet.
Sunday, January 24, 2010
Flu Pandemic Remains Moderate, Easing in Areas: WHO
From Reuters Health Information
GENEVA (Reuters) Jan 18 - The H1N1 flu pandemic remains moderate and its effects are probably closer to those of 1957 and 1968 than the far more deadly 1918 version, the World Health Organisation (WHO) said on Monday.
Margaret Chan, WHO director-general, also said the H1N1 pandemic appeared to be easing in the northern hemisphere but could still cause infections until winter ends in April. It was too soon to say what would happen once the southern hemisphere enters winter and the virus becomes more infectious.
"An event similar to the 1918 pandemic was feared when what happened was probably closer to the 1957 or 1968 pandemics," Chan said in a speech opening a week-long meeting of the WHO's executive board.
The 1918 pandemic, known as the Spanish flu, swept around the world at the end of World War One, killing some 40-50 million people.
Governments have taken appropriate steps this time to protect their populations and will ultimately earn "the highest marks", said Chan, a former health director of Hong Kong. "Though the burden on emergency rooms and intensive care units has been heavy, nearly all health systems have coped well."
Populations should continue to be vaccinated, she added, reiterating that the vaccine was safe and effective.
In public health crises, it was better to "err on the side of caution", Chan said. "I believe we would all rather see a moderate pandemic with ample supplies of vaccine than a severe pandemic with inadequate vaccine."
Nearly 14,000 official deaths have been reported by more than 200 countries since the virus emerged in North America last April, but it will take at least 1-2 years after the pandemic ends to establish the true toll, she said.
WHO experts say the actual death rate could be much higher than the number of laboratory-confirmed cases so far.
Data on H1N1 outbreaks in Africa was scarce, she warned.
"We are concerned that some countries in the western part of the continent remain susceptible to intense waves of transmission," Chan said.
GENEVA (Reuters) Jan 18 - The H1N1 flu pandemic remains moderate and its effects are probably closer to those of 1957 and 1968 than the far more deadly 1918 version, the World Health Organisation (WHO) said on Monday.
Margaret Chan, WHO director-general, also said the H1N1 pandemic appeared to be easing in the northern hemisphere but could still cause infections until winter ends in April. It was too soon to say what would happen once the southern hemisphere enters winter and the virus becomes more infectious.
"An event similar to the 1918 pandemic was feared when what happened was probably closer to the 1957 or 1968 pandemics," Chan said in a speech opening a week-long meeting of the WHO's executive board.
The 1918 pandemic, known as the Spanish flu, swept around the world at the end of World War One, killing some 40-50 million people.
Governments have taken appropriate steps this time to protect their populations and will ultimately earn "the highest marks", said Chan, a former health director of Hong Kong. "Though the burden on emergency rooms and intensive care units has been heavy, nearly all health systems have coped well."
Populations should continue to be vaccinated, she added, reiterating that the vaccine was safe and effective.
In public health crises, it was better to "err on the side of caution", Chan said. "I believe we would all rather see a moderate pandemic with ample supplies of vaccine than a severe pandemic with inadequate vaccine."
Nearly 14,000 official deaths have been reported by more than 200 countries since the virus emerged in North America last April, but it will take at least 1-2 years after the pandemic ends to establish the true toll, she said.
WHO experts say the actual death rate could be much higher than the number of laboratory-confirmed cases so far.
Data on H1N1 outbreaks in Africa was scarce, she warned.
"We are concerned that some countries in the western part of the continent remain susceptible to intense waves of transmission," Chan said.
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