Archive for March, 2016
March 25: CDC Issues Updated Zika Recommendations
Saturday, March 26th, 2016CDC Issues Updated Zika Recommendations: Timing of Pregnancy after Zika Exposure, Prevention of Sexual Transmission, Considerations for Reducing Unintended Pregnancy in Areas with Zika Transmission
For Immediate Release: Friday, March 25, 2016
Contact: Media Relations,
(404) 639-3286
CDC today issued new guidance and information to prevent Zika virus transmission and health effects:
- Updated interim guidance for healthcare professionals for counseling patients about pregnancy planning and the timing of pregnancy after possible exposure to Zika virus;
- Updated interim guidance for preventing sexual transmission with information about how long men and women should consider using condoms or not having sex; and
- Considerations and challenges, based on Puerto Rico’s experience, for reducing unintended pregnancy in areas with active Zika transmission.
CDC updates its interim guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. CDC will continue to update this guidance as new information becomes available.
Article 1: Updated interim guidance for pregnant and reproductive age women
Mounting evidence supports a link between Zika and microcephaly, a birth defect that is a sign of incomplete brain development, and possibly other problems such as miscarriage and stillbirth. The rate of these complications is not known but is being studied further. Importantly, even in places with active Zika transmission women are delivering apparently healthy infants. Healthcare providers need clear guidance to inform discussions with their patients about possible exposure to Zika virus, pregnancy planning, and timing of pregnancy. The updated CDC recommendations are these:
- For women and men who have been diagnosed with Zika virus or who have symptoms of Zika including fever, rash, joint pain or red eyes after possible exposure to Zika virus, CDC recommends healthcare providers advise:
- Women wait at least 8 weeks after their symptoms first appeared before trying to get pregnant.
- Men wait at least 6 months after their symptoms first appeared to have unprotected sex.
- In making these recommendations, we considered the longest known risk period for these categories. We then allowed for three times the known period of time.
- For men and women without symptoms of Zika virus but who had possible exposure to Zika from recent travel or sexual contact, CDC recommends healthcare providers advise their patients wait at least 8 weeks after their possible exposure before trying to get pregnant in order to minimize risk.
- For men and women without symptoms of Zika virus who live in an area with active Zika transmission, CDC recommends healthcare providers talk with their patients about their pregnancy plans during a Zika virus outbreak, the potential risks of Zika, and how they can prevent Zika virus infection. These are very complex, deeply personal decisions, and we are communicating the potential risks of Zika virus infection during pregnancy for people who live in areas with active transmission. We are encouraging health care providers to have conversations with women and their partners about pregnancy planning, their individual circumstances and strategies to prevent unintended pregnancies.
Men and women who reside in areas with active Zika virus transmission who are considering pregnancy need clear guidance to help inform the deeply personal and very complex decision about timing of pregnancy. Conversations about health risks of pregnancy can be very difficult, but are important to have. Healthcare providers should discuss the risks of Zika, emphasize ways to prevent Zika virus infection, and provide information about safe and effective contraceptive methods. As part of their pregnancy planning and counseling with their health care providers, some women and their partners residing in areas with active Zika virus transmission may decide to delay pregnancy.
Article 2: Updated interim guidance for preventing sexual transmission of Zika
The recommendations for men who live in or travel to an area with active Zika virus transmission who have a pregnant partner remain the same: CDC recommends that men with a pregnant partner should use condoms every time they have sex or not have sex for the duration of the pregnancy. To be effective, condoms must be used correctly from start to finish, every time during sex. This includes vaginal, anal or oral (mouth-to-penis) sex.
The updated guidance includes new timeframes for men and their non-pregnant partners based on the couple’s situation, including whether the man lives in or has traveled to an area with active Zika virus transmission and whether he develops symptoms of possible Zika infection. The guidance is based on available information about how long the virus remains in semen and the risks associated with Zika based on whether or not men had symptoms of infection:
- Couples with men who have confirmed Zika or symptoms of Zika should consider using condoms or not having sex for at least 6 months after symptoms begin. This includes men who live in and men who traveled to areas with Zika.
- Couples with men who traveled to an area with Zika but did not develop symptoms of Zika should consider using condoms or not having sex for at least 8 weeks after their return in order to minimize risk.
- Couples with men who live in an area with Zika but have not developed symptoms might consider using condoms or not having sex while there is active Zika transmission in the area.
Couples who do not want to get pregnant should use the most effective contraceptive methods that they can use consistently and correctly, and they should also use condoms to prevent the sexual transmission of Zika. Couples who are trying to get pregnant should consult with their healthcare provider.
Article 3: Increasing access to contraception in areas with active Zika transmission
Because of the potential for Zika virus to affect pregnant women and their fetuses, strategies to prevent unintended pregnancy are a critical part of current efforts to prevent Zika-related health effects. Based on Puerto Rico’s experience, CDC has identified considerations and challenges in reducing unintended pregnancies in areas with active Zika transmission.
Approximately two-thirds of pregnancies in Puerto Rico are unintended, indicating a potentially unmet need for access to birth control. In this report, researchers estimated that about 138,000 women in Puerto Rico may be at risk of unintended pregnancy and are not using one of the most effective or moderately effective forms of birth control. In areas with active Zika transmission, women and their partners who do not want to get pregnant now should be advised about the range of effective birth control methods and counseled that correct and consistent use of these methods is important if they do not want to become pregnant.
The Department of Health and Human Services (HHS) is working to leverage existing programs that currently provide resources for or access to contraception in Puerto Rico, including programs administrated by the Health Resources and Services Administration (HRSA), Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health (OASH), and Centers for Medicare & Medicaid Services (CMS). HHS is also coordinating with federal, local, and private partners to identify additional resources to support increased access to the most effective forms of contraception.
HRSA has 20 health center grantees that operate 84 sites in Puerto Rico, which serve over 330,000 people, including nearly 80,000 women ages 15 to 45. HHS is exploring possible expansion of services at these centers, which currently include prenatal care and other voluntary family planning services. OPA is working to provide additional funds for contraceptive services, as well as facilitate the training of providers in long-acting reversible contraception methods. OPA supports two Title X grantees that operate 15 clinics in Puerto Rico, which serve over 19,000 people. Family planning services are a mandatory benefit under Medicaid for women and men, and are exempt from cost-sharing requirements. CMS is working to provide additional guidance to states and territories on how their Medicaid programs can support the Zika response, including coverage for contraception.
CDC will continue to update its guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. For updates, visit: http://www.cdc.gov/zika/index.html.
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An Islamic State suicide bomber killed at least 24 people who had gathered to watch a soccer match south of Baghdad
Saturday, March 26th, 2016
https://www.youtube.com/watch?v=Oaod5vqOAEY
https://www.youtube.com/watch?v=wQKmlvwzBbg
** An additional 80 people were injured.
Brussels: How did a small country about the size of the state of Maryland spiral from a renowned architectural and cultural hub to a hotbed of violent jihadist ideology?
Saturday, March 26th, 2016
Kids with Dengue
Saturday, March 26th, 2016Symptomatic Dengue in Children in 10 Asian and Latin American Countries
N Engl J Med 2016; 374:1155-1166
March 24, 2016
DOI: 10.1056/NEJMoa1503877
“…..The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America……”
“… if A aegypti is the only competent Zika virus vector, then risk is geographically restricted; in North America to Florida, Louisiana, and Texas. Second, if A albopictus is a competent vector, then there is risk of autochthonous transmission cycles in Canada, Chile, much of western Europe, as well as south and east Asia. Third, for all these areas, the risk compounds that from flights originating in other areas historically endemic for Zika virus….”
Saturday, March 26th, 2016Global risk of Zika virus depends critically on vector status of Aedes albopictus
Published online: March 17, 2016
Lauren M Gardner, Nan Chen, Sahotra Sarkar
The Lancet Infectious Diseases
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00176-6/abstract
3/25/1911: The Triangle Shirtwaist Company factory in New York City burns down, killing 145 workers, mostly immigrants
Friday, March 25th, 2016WHO’s Zika situation report of 3/24/16
Friday, March 25th, 2016Zika situation report
24 March 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Summary
- From 1 January 2007 to 23 March 2016, Zika virus transmission was documented in a total of 61 countries and territories. Four of these countries and territories reported a Zika virus outbreak that is now over. Argentina and New Zealand are the latest countries to report sexual transmission of Zika virus. Thus, five countries have now reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission (Argentina, France, Italy, New Zealand and the United States of America).
- The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2014. Autochthonous Zika virus transmission has been reported in 34 countries and territories of this region.
- So far an increase in microcephaly and other fetal malformations has been reported in Brazil and French Polynesia. Two additional cases, linked to a stay in Brazil, were detected in the United States of America and Slovenia. Panama recently reported a newborn with microcephaly and occipital encephalocoele (neural tube defect) who died a few hours after birth and tested positive for Zika virus by RT-PCR.
- In the context of Zika virus circulation, 12 countries or territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.
- The mounting evidence from observational, cohort and case-control studies indicates that Zika virus is highly likely to be a cause of microcephaly, GBS and other neurological disorders. Among the tasks ahead are to further quantify the risk of neurological disorders following Zika virus infection, and to investigate the biological mechanisms that lead to neurological disorders.
- The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research, and this situation report is organized under those headings.
A “major arrest” in France: The suspect is a French national who was in an “advanced stage” of a terror plot.
Friday, March 25th, 2016Brussels: scenes of incredible carnage but also of heroism and love;
“…..The baggage security worker dove behind a machine to hide. When he got up a few minutes later he saw people on the ground, body parts and blood.
“The blood was everywhere,” said Youla, an immigrant from the Ivory Coast.
Youla said he sprung into action to help as many people as he could. Fear didn’t figure into the equation.
“I wasn’t afraid,” he explained. “If I was was going to die, I would’ve died.”
There were two police officers who’d lost their legs. A woman with shards of glass sticking out of her.
Youla put the basic first-aid skills he’d learned as a Boy Scout to work, tying tourniquets and applying bandages because “the blood was running, running.”
One woman was crying out “help me, help me,” he recalled. Youla said he picked her up and carried her out….”
March 24, 1882: When German microbiologist Robert Koch announced he had discovered Mycobacterium tuberculosis (Mtb), the bacterium that causes TB
Thursday, March 24th, 2016On World Tuberculosis (TB) Day 2016, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, reaffirms its commitment to researching ways to better understand, prevent, diagnose and treat TB. March 24 marks the day in 1882 when German microbiologist Robert Koch announced he had discovered Mycobacterium tuberculosis (Mtb), the bacterium that causes TB — an airborne disease that most often attacks the lungs. The 2016 World TB Day theme is Unite to End TB(link is external), and today NIAID joins the World Health Organization (WHO) and the global research community in highlighting some of our extensive efforts to help reduce TB deaths by 95 percent and to reduce the TB incidence rate by 90 percent by 2035.
Despite recent advances, TB remains one of the world’s deadliest diseases. TB incidence worldwide has declined 18 percent since 2000. However, in 2014 the disease still caused 9.6 million people across the globe to be sick, and killed 1.5 million people, mainly in developing countries, according to the WHO. TB is also a leading cause of death in people with HIV/AIDS: in 2015, one in three deaths among HIV-infected individuals worldwide was due to TB.
Although most TB is curable, certain forms of the bacterium that causes TB are becoming resistant to the drugs designed to kill them. Patient adherence to therapy was already difficult as most regimens require taking medicine daily for six months to two years. The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has caused significant setbacks in the effort to effectively treat and cure patients, and highlights the need for new medicines. According to WHO, among 480,000 total cases of MDR-TB in 2014, 190,000 people (40 percent) died. In keeping with the goals of the White House’s National Action Plan for Combating MDR-TB(link is external), NIAID’s research program supports the discovery of novel antibiotics and the conduct of clinical trials testing various drug regimens to lessen the burden of MDR-TB and XDR-TB.
NIAID supports various consortia and approaches that span all areas of TB drug discovery, from screening promising compounds in animal models to testing the safety and efficacy of candidate drugs in clinical trials. A key goal is to shorten the duration of standard treatment regimens for TB. In one NIAID-supported trial, investigators are testing a higher dose of the first-line drug rifampin over a shortened treatment period. In addition, NIAID researchers are collaborating with international investigators on studies of novel TB treatments. For example, NIAID and our collaborators conducted a trial among more than 1000 MDR-TB and XDR-TB patients in South Korea and China that demonstrated the efficacy of the drug linezolid for the treatment of XDR-TB.
New diagnostic tools are in development to detect early Mtb infection more accurately and to identify and track drug-resistant strains. Many countries still diagnose TB by examining sputum samples under a microscope to detect TB bacteria; this approach can take a day to complete and cannot diagnose drug-resistant strains. NIAID contributed to the development of the GeneXpert diagnostic test, which can detect TB and MDR-TB in two hours. The test is now used in numerous countries, and the NIAID-supported TB Clinical Diagnostic Research Consortium(link is external) — a group of researchers in the United States, South Africa, Uganda, Brazil and South Korea — is working to expand the capability of the test to accurately detect XDR-TB. NIAID is also funding a large-scale project at the Genomic Center for Infectious Diseases at the Broad Institute(link is external) to sequence the genomes of drug-resistant strains of Mtb. These data will aid the development of TB diagnostics and rapid drug susceptibility tests for MDR-TB and XDR-TB.
The WHO estimates that about one-third of the world’s population is latently infected with Mtb, meaning they do not exhibit symptoms of TB disease. A person with latent TB infection has a 5 to 10 percent risk of developing active, transmissible TB during his or her lifetime. NIAID’s Tuberculosis Research Units program has helped identify biomarkers that define the various stages of infection and is conducting animal and human studies to examine why most people with latent TB infection do not develop disease.
Safe and effective vaccines are critical to the effort to control TB globally. The Bacille Calmette-Guérin (BCG) vaccine developed in 1921 is currently the only available vaccine against TB. It provides some protection against severe forms of TB in children; however, it does not reliably protect adults. New vaccines to replace BCG or to boost the immunity conferred by BCG are urgently needed to protect against TB infection, disease, and recurrence of disease. NIAID supports basic, preclinical, and clinical research on candidate TB vaccines, including an investigational aerosol vaccine that induced potent immune responses in a small number of rhesus macaques and protected them against pulmonary infection with Mtb.
At least one-third of the 37 million people living with HIV worldwide are latently infected with Mtb and are 26 times more likely to develop active TB disease than those without HIV, according to the WHO. A 10-nation clinical trial(link is external) conducted by the NIAID-fundedAIDS Clinical Trials Group (ACTG)(link is external) recently demonstrated that isoniazid alone, compared with a standard four-drug empiric TB treatment regimen, was as effective for preventing TB and reducing death in adults with advanced HIV/AIDS in high-risk regions. Another ACTG trial is testing a novel regimen containing the drugs bedaquiline and delamanid to treat patients with MDR-TB. TB also accelerates the progression of HIV infection to AIDS, making it the leading cause of death associated with HIV infection globally. NIAID supports various studies examining optimized treatment regimens and improved diagnostic tests for people co-infected with TB and HIV.
An estimated 43 million lives were saved through appropriate TB diagnosis and treatment between 2000 and 2014, according to the WHO. However, we still have much work to do to end the global scourge of TB. NIAID is committed to the fight against TB and accelerating the comprehensive research needed to control and ultimately eliminate this ancient disease.
Anthony S. Fauci, M.D., is the director of NIAID. Richard Hafner, M.D., is chief of the TB Clinical Research Branch in the NIAID Division of AIDS; Christine F. Sizemore, Ph.D., is chief of the Tuberculosis and Other Mycobacterial Diseases Section in the NIAID Division of Microbiology and Infectious Diseases.
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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