Angolan Men Hide Their HIV Status From Their Spouses

Maria Antónia* began to wonder about her husband's frequent trips to neighbouring South Africa, especially when he was away for 15 days without contacting her on one occasion.

She decided to investigate whether he was going to South Africa to see another woman, but discovered that he was going to get antiretroviral (ARV) medication because he was HIV positive.

Miguel André's wife died in 2001, officially from typhoid fever, but before she died she told her child's godmother that she had AIDS. She never found the courage to tell her husband, but the news spread and soon everyone in Benguela, a coastal town in central Angola, was talking about it. André was the last to find out that his wife had been HIV positive.

Stories like these are repeated time and again in Angola, but fear of a partner's reaction, fear of being abandoned, fear of discrimination, even fear of shame, are just some of the reasons that prevent people living with HIV from telling those dear to them.

Many only discover the HIV status of their partners after they have died, and then learn that they are also infected, but it is often hard to know who infected whom, or how. An estimated 2.5 percent of Angola's 16 million people are living with HIV/AIDS.

To tell or not to tell?

The debate in Angola about the role of healthcare workers in disclosing the HIV status of their patients has been heated. On the one hand there are those who believe that health workers should do their utmost to find the spouses of patients living with HIV, as was once the case with syphilis, and there should be compulsory notification. Others say doctor-patient confidentiality should be preserved at all costs.

António Coelho, executive secretary of the Network of AIDS Service Organisations (known by the Portuguese acronym Anaso), feels there should not be mandatory notification of spouses, but rather awareness-raising to enable HIV-positive patients to tell their partners.

He stressed that by law "infected persons have the duty to inform those people with whom they have or intend to have sexual relations about their serological status."

But Catarina Saldanha, executive secretary of Mwenho, an association of HIV-positive women, believes that doctors should inform their patients' spouses.

Saldanha, who is HIV positive, told IRIN/PlusNews this was to protect the partners of people living with HIV, because the network of sexual relations is often not restricted to spouses, but extends to previous partners and extra-spousal relations.

She said some doctors in Angola were already doing this: they told patients that they could continue treatment only if their spouse or partner also came to the next appointment.

The country's network of people living with HIV/AIDS is calling for a compromise. "First, the doctor should exhaust every possibility of changing the infected person's behaviour. If this doesn't work, the doctor should make his position clear regarding intentional infection - that it is a crime punishable by law," said Noé Mateus, the network's executive secretary.

"But confidentiality can and should be discarded as soon as the physician realises that the infected person's behaviour places his or her spouse or others at risk of becoming infected."

The mysterious cassette tape

UNAIDS official Roberto Campos said confidentiality should be maintained in all instances, without exception. "People have to have the sovereignty to reveal their serological status to whomever they wish. They and they alone have this right, under any and all circumstances."

Campos stressed that because of the extremely high levels of stigma still associated with HIV/AIDS, doctors could place patients at risk of being publicly condemned by revealing their seropositivity. "Health professionals must be competent enough to give patients all the information they need to make the decision," he added.

António Feijó, the director of Hospital Esperança ("Hope" in Portuguese), a healthcare facility for HIV patients in the capital, Luanda, said doctors should encourage their patients to tell. "Notifying a patient's spouse about his or her serological status cannot be decided in an arbitrary manner ... It's immoral to treat one of them and leave the other's life at risk."

When she was 17, Suzana* married her first boyfriend. After 25 years of marriage her husband died in her arms, but she only learned that he had died of an AIDS-related illness when, during the funeral, she heard a cassette tape on which he confessed to being HIV-positive.

Her husband had given the cassette to a nephew, who thought it contained his wishes regarding his estate and it would therefore be appropriate to play the tape at the funeral.

With clearer rules covering confidentiality and HIV, the final message left by Suzana's husband could have been a message of love, or even about his estate, rather than a painful confession of his positive status.

* Not their real names

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Drink to Stupor And Still Feel Good The Next Day

The root cause of all hangovers is, of course, drinking alcohol. If you drink enough and end up with a hangover, it means you've ingested more alcohol than your body can metabolize efficiently. The toxins in alcohol build up in your body and make you feel sick. A chief culprit is a chemical called acetaldehyde. This is an alcohol by-product that research suggests may cause the worst of your hangover symptoms.

Admittedly, I binge drink two or three times per month (the version where one drinks 5+ drinks in one evening). I know this isn’t especially good for my physical well-being, but being a 28 year old male in New York City it’s a common or even conservative amount. I am not proud of this fact, but know I do it and admit that it’s not healthy. I try to drink in a way where it affects me the least. I try to not ruining the following day, by avoiding a hangover. Below are a few ways to help you do this if you don’t already have your own method.

Hangover1. My Method. An old colleague once gave me his method of hangover prevention. It always worked for him, so I tried it, and I’m a fan. You must do this before you go to sleep, but it’s easy to do. After you finish drinking alcohol, drink a sports drink or a liquid with mostly water and electrolytes. Any drink with glucose will do. My colleague always liked Gatorade. I like Glacéau Vitamin Water. Drink as much as you can without feeling too water logged. With this drink, take a pair of ibuprofen pills.

2. Eating. Eating before you drink will help slow the absorption of the alcohol. Starchy foods like bread and pasta are best for this. Drinking also causes loss of essential minerals like vitamins B & C. Eat foods to get these back. Fruit is a great solution.

3. Water. Drink lots of water before, during, and after drinking. This will prevent dehydration.

4. Know what to drink. Don’t drink drinks that hide the taste of alcohol too much. You will drink fast and too much. The exception here is fruit drinks have the vitamins you lose through alcohol. If you must drink hard liquor, get cranberry with it once to get those vitamins back.

Avoid beverages that have given you hangovers before. Pay attention to which alocohol triggers a hangover, as results vary from person to person. Red wine has a exceeding negative effect for many people.

Some says additives make a hangover worse. I’m not sure about this, but I would be willing to bet artificial added chemicals and ingredients don’t help the situation.

Side tip: Have any chemistry ambitions inside you? Start to brew your own beer! In college, I joined a beer brewing club. It’s a great way to meet people, have fun, and learn to make and drink great beer! You can save money this way too. But I bring this up because of another great reason to brew, the lower hangover effect. Homemade beer has most of the vitamins you lose when drinking! Yeast is filtered out in most macrobrews, but usually not in homebrews. This yeast is rich in B vitamins. I never had a hangover from our homebrews.Hangover

5. Pills and Medicine. Though I prefer eating because you also get the sugars and water you need from food, you can directly ingest the vitamins you are losing by drinking with supplements. Some companies also have cocktail type pills with everything you need supposedly. I tried Chasers a few times. They worked, but am not really sure if it was the pills or the fact I also took the measures I always take.

Another point worth mentioning is the choice of pain killers before or after going to bed. Although acetaminophen is one of the most popular pain killers, alcohol metabolism increases the toxic effect acetaminophen has on the liver. Go with Asprin.

I know this may sound like a public safety announcement, but I also have to mention it because of so many people I know have been affected by it in one way or another, including myself. Don’t drink and drive!

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The Ugly Side Of Coffee

There are hundreds, if not thousands, of books which discuss the wide-range of views concerning the mass use of caffeine in our culture.

From my own research, it does not seem to be much of a debate- nutritionists and scientists have repeatedly shown, in a myriad of ways, that the caffeine chemical is not very healthy for the human body.

In his book Caffeine Blues Stephen Cherniske, M.S goes so far to propose that if caffeine were introduced today as a new food additive, the FDA would never approve it.

He explains that any substance that causes such extreme reactions—heart palpitations, anxiety, panic, insomnia, and even birth defects—would be treated as a new drug and denied status as a food additive.

This is an interesting perspective, and if you are a big coffee drinker I urge you to consider the sentiment. The purpose of this article is to expound on Mr. Cherniske’s insights and explore some unique and interesting characteristics of caffeine that you may not have known.

Before I get to these points, let me say that although I will paint a pretty negative picture of coffee and caffeine, my goal is NOT to scold you and suggest that you stop drinking coffee immediately.

I hope some of the things I explain opens your eyes to the elemental effects of caffeine, but I also understand, and believe, there is a very real enjoyment for many people in a nice, hot cup of Java (for me too, sometimes)!

With that said, here are a few interesting things I bet you didn’t know about coffee and caffeine:

Its a Pesticide

By definition, caffeine is a naturally occurring compound found in the beans, leaves, and fruit of over 60 plants where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants. If you drink a lot of coffee and caffeinated drinks, I urge you to read that sentence again and start seeing caffeine in this light—as a substance produced with the sole purpose to harm creatures that ingest it.

Its Highly Acidic

To date, over 700 volatile substances have been found in coffee, including more than 200 acids and an incredible array of alcohols, aromatic compounds and carbonyl compounds.

It Erodes Your Ability to Metabolize Blood Sugar

Caffeine stimulates the fight or flight stress response in humans and plays a major role in hypoglycemia (a condition where blood sugar levels fall below normal). As part of this response, the liver rapidly raises blood sugar levels. This is felt as a “lift” to the person consuming caffeine, but the body must then deal with the metabolic emergency of hyperglycemia, or elevated blood sugar.

This is accomplished by the pancreas, which secretes insulin, driving the blood sugar down. Over time, this “wear and tear” of our blood sugar metabolism causes the system to become ineffective and can result in hypoglycemia and even diabetes.

There is NO Positive Science

According to Mr. Cherniske: “No scientific study has ever shown that coffee is good for you. The discussion only concerns the degree to which it will harm you”. Interesting.

It Causes Chronic Digestive Problems

Caffeine lowers the stress threshold of our bodies so that the events we would normally handle suddenly become insurmountable. Because of this, coffee consumption is a major contributor to bloating, pain and gas that roughly 50% of Americans adults experience after they eat.

It Leads to “Caffeinism” Which Is Very Serious

In large amounts, and especially over extended periods of time, caffeine can lead to a condition known as caffeinism. Caffeinism is defined on Wikipedia as: “combining caffeine dependency with a wide range of unpleasant physical and mental conditions including nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia, headaches, respiratory alkalosis and heart palpitations”.

Furthermore, because caffeine increases the production of stomach acid, high usage over time can lead to peptic ulcers, erosive esophagitis, and gastroesophageal reflux disease.

With all this said, nearly 100 million American adults drink three or more cups of coffee a day. But does that make it right? Consider that sometimes we make decisions in our lives based NOT upon what is real, but upon habit, or upon what other people want us to think.

“If five million people do a foolish thing, it is still a foolish thing” –Ancient Chinese Proverb

Here are a few more myths about caffeine, effectively debunked:

Caffeine Gives You Energy

* Caffeine does not provide energy, only chemical stimulation. The perceived “energy” comes from the body’s struggle to adapt to increased blood levels to stress hormones.

Caffeine Gives You a Lift

* Using coffee for mood enhancement is a short-term blessing and a long-term curse. While the initial adrenal stimulation may provide a transient antifatigue “lift”, caffeine’s ultimate mood effect is a letdown, either subtle or profound.

Caffeine Sharpens Your Mind

* While caffeine users may feel more alert, the experience is simply one of increased sensory and motor activity (dilated pupils, increased heart rate, and higher blood pressure). The quality of thought and recall is improved no more than the quality of music is improved when played at a higher volume or speed!

In all, caffeine is substance that purports to give you energy by stimulating your nervous system. But it really isn’t giving you anything, and is in fact harming you! That’s because caffeine creates tension, and the ultimate result of tension is always fatigue.

So how can you start “getting off” caffeine? There are a million and one ways to do this, and I plan on writing a follow-up article on this subject within the next week. Here are some basic suggestions you can start with right away:

SUGGESTIONS

- Brew your coffee with 50% decaf

- Switch to an herbal tea, herbal coffee or another caffeine alternative

- Get a smaller coffee mug

- Spill half of your favorite Starbucks concoction out, before you start drinking it

- Make your coffee weaker by adding more milk

- If you must drink coffee, have it after eating a big meal (preferably after lunch)

- Start eating foods high in minerals

- Try Gingko Biloba

- Drink more water

- Do not drink coffee first thing in the morning

- Do not drink coffee before you go to bed

- Try coffee substitutes

- Drink less potent caffeinated drink

I hope this article was informative, and opened your eyes to some of the very real dangers of continuous caffeine consumption. Look for a second article next week which goes into some more detail about how to weed yourself off caffeine, or better yet, please share your thoughts and experiences in the comment field below!

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Key Facts You Need To Know About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus

This is a fact sheet by Centers for Disease Control and Prevention, dated January 18, 2006, provided for general information about bird flu and information about one type of bird flu, called avian influenza A (H5N1) that is infecting birds in Asia and has infected some humans.

What is avian influenza (bird flu)?

Bird flu is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the “highly pathogenic” form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100%, often within 48 hours.

How does avian influenza spread among birds?

Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or with surfaces that are contaminated with excretions or secretions. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Do bird flu viruses infect humans?

Bird flu viruses do not usually infect humans, but more than 100 confirmed cases of human infection with bird flu viruses have occurred since 1997. The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1). Please visit these and previous WHO situation updates and cumulative reports for additional information.

How do people become infected with avian influenza viruses?

Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions and excretions from infected birds. The spread of avian influenza viruses from an ill person to another person has been reported very rarely, and transmission has not been observed to continue beyond one person. During an outbreak of avian influenza among poultry, there is a possible risk to people who have direct or close contact with infected birds or with surfaces that have been contaminated with secretions and excretions from infected birds.

What are the symptoms of avian influenza in humans?

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

How is avian influenza detected in humans?

A laboratory test is needed to confirm avian influenza in humans.

What are the implications of avian influenza to human health?

Two main risks for human health from avian influenza are 1) the risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease; and 2) the risk that the virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person.

How is avian influenza in humans treated?

Studies done in laboratories suggest that the prescription medicines approved for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to determine the effectiveness of these medicines.

Does the current seasonal influenza vaccine protect me from avian influenza?

No. Influenza vaccine for the 2005-06 season does not provide protection against avian influenza.

Should I wear a surgical mask to prevent exposure to avian influenza?

Currently, wearing a mask is not recommended for routine use (e.g., in public) for preventing influenza exposure. In the United States, disposable surgical and procedure masks have been widely used in health-care settings to prevent exposure to respiratory infections, but the masks have not been used commonly in community settings, such as schools, businesses, and public gatherings.

Is there a risk for becoming infected with avian influenza by eating poultry?

There is no evidence that properly cooked poultry or eggs can be a source of infection for avian influenza viruses. For more information about avian influenza and food safety issues, visit the World Health Organization website .

The U.S. government carefully controls domestic and imported food products, and in 2004 issued a ban on importation of poultry from countries affected by avian influenza viruses, including the H5N1 strain. This ban still is in place. For more information, see Embargo of Birds, http://www.cdc.gov/flu/avian/outbreaks/embargo.htm .

We have a small flock of chickens. Is it safe to keep them?

Yes. In the United States there is no need at present to remove a flock of chickens because of concerns regarding avian influenza. The U.S. Department of Agriculture monitors potential infection of poultry and poultry products by avian influenza viruses and other infectious disease agents.

What precautions can be taken to reduce the risk for infection from wild birds in the United States?

As a general rule, the public should observe wildlife, including wild birds, from a distance. This protects you from possible exposure to pathogens and minimizes disturbance to the animal. Avoid touching wildlife. If there is contact with wildlife do not rub eyes, eat, drink, or smoke before washing hands with soap and water. Do not pick up diseased or dead wildlife. Contact your state, tribal, or federal natural resource agency if a sick or dead animal is found.

What precautions can hunters take to reduce the risk for infection when hunting birds in the United States?

Hunters should follow routine precautions when handling game, including wild birds. The National Wildlife Health Center recommends that hunters:

* Do not handle or eat sick game.
* Wear rubber or disposable latex gloves while handling and cleaning game, wash hands with soap and water (or with alcohol-based hand products if the hands are not visibly soiled), and thoroughly clean knives, equipment and surfaces that come in contact with game.
* Do not eat, drink, or smoke while handling animals.
* Cook all game thoroughly.

Avian Influenza A (H5N1)

What is the avian influenza A (H5N1) virus that has been reported in Asia and Europe?

Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia , China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control.

Since late June 2004, however, new outbreaks of influenza H5N1 among poultry have been reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey and Romania and among wild migratory birds in Croatia .

Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, Turkey, and Vietnam. For the most current information about avian influenza and cumulative case numbers, see the World Health Organization website at http://www.who.int/csr/disease/avian_influenza/en/.

What are the risks to humans from the current H5N1 outbreak in Asia and Europe?

H5N1 virus does not usually infect people, but more than 140 human cases have been reported. Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 virus have occurred.

So far, spread of H5N1 virus from person to person has been rare and has not continued beyond one person. Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population.

If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.

How does H5N1 virus differ from seasonal influenza viruses that infect humans?

Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 virus has caused the largest number of reported cases of severe disease and death in humans. In the current situation in Asia, more than half of the people infected with the virus have died. Most cases have occurred in previously healthy children and young adults. However, it is possible that the only cases currently being reported are those in the most severely ill people and that the full range of illness caused by the H5N1 virus has not yet been defined.

Unlike seasonal influenza, in which infection usually causes only mild respiratory symptoms in most people, H5N1 infection may follow an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure have been common among people who have become ill with H5N1 influenza.

How is infection with H5N1 virus in humans treated?

Most H5N1 viruses that have caused human illness and death appear to be resistant to amantadine and rimantadine, two antiviral medications commonly used for treatment of patients with influenza. Two other antiviral medications, oseltamivir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies are needed to demonstrate their current and ongoing effectiveness.

Is there a vaccine to protect humans from H5N1 virus?

There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being detected in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine that will protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way. For more information about the H5N1 vaccine development process, visit the National Institutes of Health website .

What does CDC recommend regarding H5N1 virus?

In February 2004, CDC provided U.S. public health departments with recommendations for enhanced surveillance (“detection”) of H5N1 influenza in the country. Follow-up messages, distributed via the Health Alert Network, were sent to the health departments on August 12, 2004, and February 4, 2005; both alerts reminded public health departments about recommendations for detecting (domestic surveillance), diagnosing, and preventing the spread of H5N1 virus. The alerts also recommended measures for laboratory testing for H5N1 virus. To read the alerts, visit Health Updates on Avian Influenza .

Does CDC recommend travel restrictions to areas with known H5N1 outbreaks?

CDC does not recommend any travel restrictions to affected countries at this time. However, CDC currently advises that travelers to countries with known outbreaks of H5N1 influenza avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. For more information, visit Travelers' Health update.

Is there a risk in handling feather products that come from countries experiencing outbreaks of avian influenza A (H5N1)?

The U.S. government has determined that there is a risk to handling feather products from countries experiencing outbreaks of H5N1 influenza.

There is currently a ban on the importation of birds and bird products from H5N1-affected countries in Asia and Europe. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Cambodia, Indonesia, Japan, Laos, Kazakhstan, Malaysia, People's Republic of China, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, and Vietnam (current as of December 29, 2005). This prohibition does not apply to any person who imports or attempts to import products derived from birds if, as determined by federal officials, such products have been properly processed to render them noninfectious so that they pose no risk of transmitting or carrying H5Nl and which comply with the U.S. Department of Agriculture (USDA) requirements. Therefore, feathers from these countries are banned unless they have been processed to render them noninfectious. Additional information about the import ban is available on the USDA website.

Is there a risk to importing pet birds that come from countries experiencing outbreaks of avian influenza A (H5N1)?

The U.S. government has determined that there is a risk to importing pet birds from countries experiencing outbreaks of H5N1 influenza. CDC and USDA have both taken action to ban the importation of birds from areas where H5N1 has been documented. There is currently a ban on the importation of birds and bird products from H5N1-affected countries in Asia. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Cambodia, Indonesia, Japan, Laos, Kazakhstan, Malaysia, Peoples' Republic of China, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, and Vietnam. (current as of December 29, 2005) .

Can a person become infected with avian influenza A (H5N1) virus by cleaning a bird feeder?

There is no evidence of H5N1 having caused disease in birds or people in the United States . At the present time, the risk of becoming infected with H5N1 virus from bird feeders is low. Generally, perching birds (Passeriformes) are the predominate type of birds at feeders. While there are documented cases of H5N1 causing death in some Passeriformes (e.g., house sparrow, Eurasian tree-sparrow, house finch), in both free-ranging and experimental settings, most of the wild birds that are traditionally associated with avian influenza viruses are waterfowl and shore birds.

Influenza Pandemic Preparedness

What changes are needed for H5N1 or another avian influenza virus to cause a pandemic?

Three conditions must be met for a pandemic to start: 1) a new influenza virus subtype must emerge; 2) it must infect humans and causes serious illness; and 3) it must spread easily and sustainedly (continue without interruption) among humans. The H5N1 virus in Asia and Europe meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them.

However, the third condition, the establishment of efficient and sustained human-to-human transmission of the virus, has not occurred. For this to take place, the H5N1 virus would need to improve its transmissibility among humans. This could occur either by “reassortment” or adaptive mutation.

Reassortment occurs when genetic material is exchanged between human and avian viruses during co-infection (infection with both viruses at the same time) of a human or pig. The result could be a fully transmissible pandemic virus—that is, a virus that can spread easily and directly to humans. A more gradual process is adaptive mutation, where the capability of a virus to bind to human cells increases during infections of humans.

What is CDC doing to prepare for a possible H5N1 flu pandemic?

CDC is taking part in a number of pandemic prevention and preparedness activities, including:

* Providing leadership to the National Pandemic Influenza Preparedness and Response Task Force, created in May 2005 by the Secretary of the U.S. Department of Health and Human Services.
* Working with the Association of Public Health Laboratories on training workshops for state laboratories on the use of special laboratory (molecular) techniques to identify H5 viruses.
* Working with the Council of State and Territorial Epidemiologists and others to help states with their pandemic planning efforts.
* Working with other agencies such as the Department of Defense and the Veterans Administration on antiviral stockpile issues.
* Working with the World Health Organization (WHO) and Vietnamese Ministry of Health to investigate influenza H5N1 in Vietnam and to provide help in laboratory diagnostics and training to local authorities.
* Performing laboratory testing of H5N1 viruses.
* Starting a $5.5 million initiative to improve influenza surveillance in Asia .
* Holding or taking part in training sessions to improve local capacities to conduct surveillance for possible human cases of H5N1 and to detect influenza A H5 viruses by using laboratory techniques.
* Developing and distributing reagents kits to detect the currently circulating influenza A H5N1 viruses.

CDC also is working closely with WHO and the National Institutes of Health on safety testing of vaccine candidates and development of additional vaccine virus seed candidates for influenza A (H5N1) and other subtypes of influenza A viruses.

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Qualitative Alternatives To Blood Transfusion

You might feel, 'Transfusions are hazardous, but are there any high-quality alternatives?' A good question, and note the word "quality."

Everyone, including Jehovah's Witnesses, wants effective medical care of high quality. Dr. Grant E. Steffen noted two key elements: "Quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals." (The Journal of the American Medical Association, July 1, 1988) "Nonmedical goals" would include not violating the ethics or Bible-based conscience of the patient. —Acts 15:28, 29.

Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the answer is yes.

Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that "one of the few benefits of the epidemic" was that it "resulted in various strategies on the part of patients and physicians to avoid blood transfusion." A blood-bank official explains: "What has changed is the intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration of alternatives." —Transfusion Medicine Reviews, October 1989.

Note, there are alternatives! This becomes understandable when we review why blood is transfused.

The hemoglobin in the red cells carries oxygen needed for good health and life. So if a person has lost a lot of blood, it might seem logical just to replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood. (Another measure of the concentration is hematocrit, which is commonly about 45 percent.) The accepted "rule" was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30 percent hematocrit). The Swiss journal Vox Sanguinis (March 1987) reported that "65% of [anesthesiologists] required patients to have a preoperative hemoglobin of 10 gm/dl for elective surgery."

But at a 1988 conference on blood transfusion, Professor Howard L. Zauder asked, "How Did We Get a 'Magic Number'?" He stated clearly: "The etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in obscurity, and unsubstantiated by clinical or experimental evidence." Imagine the many thousands of patients whose transfusions were triggered by an 'obscure, unsubstantiated' requirement!

Some might wonder, 'Why is a hemoglobin level of 14 normal if you can get by on much less?' Well, you thus have considerable reserve oxygen-carrying capacity so that you are ready for exercise or heavy work. Studies of anemic patients even reveal that "it is difficult to detect a deficit in work capacity with hemoglobin concentrations as low as 7 g/dl. Others have found evidence of only moderately impaired function." —Contemporary Transfusion Practice, 1987.

While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says: "With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three months . . . The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration with no apparent clinical difficulties." —Pediatric Clinics of North America, February 1986.

Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery. If the loss is rapid and great, a person's blood pressure drops, and he may go into shock. What is primarily needed is that the bleeding be stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.

Volume replacement can be accomplished without using whole blood or blood plasma.* Various nonblood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989) Such fluids have definite advantages. "Crystalloid solutions [such as normal saline and lactated Ringer's solution], Dextran and HES are relatively nontoxic and inexpensive, readily available, can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease." —Blood Transfusion Therapy —A Physician's Handbook, 1989.

You may ask, though, 'Why do nonblood replacement fluids work well, since I need red cells to get oxygen throughout my body?' As mentioned, you have oxygen-carrying reserves. If you lose blood, marvelous compensatory mechanisms start up. Your heart pumps more blood with each beat. Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more oxygen is released to the tissues. These adaptations are so effective that if only half of your red cells remain, oxygen delivery may be about 75 percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. And most general anesthetics reduce the body's need for oxygen.

HOW CAN DOCTORS HELP?

Skilled physicians can help one who has lost blood and so has fewer red cells. Once volume is restored, doctors can administer oxygen at high concentration. This makes more of it available for the body and has often had remarkable results. British doctors used this with a woman who had lost so much blood that "her haemoglobin fell to 1.8 g/dlitre. She was successfully treated . . . [with] high inspired oxygen concentrations and transfusions of large volumes of gelatin solution [Haemaccel]." (Anaesthesia, January 1987) The report also says that others with acute blood loss have been successfully treated in hyperbaric oxygen chambers.

Physicians can also help their patients to form more red cells. How? By giving them iron-containing preparations (into muscles or veins), which can aid the body in making red cells three to four times faster than normal. Recently another help has become available. Your kidneys produce a hormone called erythropoietin (EPO), which stimulates bone marrow to form red cells. Now synthetic (recombinant) EPO is available. Doctors may give this to some anemic patients, thus helping them to form replacement red cells very quickly.

Even during surgery, skilled and conscientious surgeons and anesthesiologists can help by employing advanced blood-conservation methods. Meticulous operative technique, such as electrocautery to minimize bleeding, cannot be overstressed. Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation.#

Patients on a heart-lung machine primed with a nonblood fluid may benefit from the resulting hemodilution, fewer red cells being lost.

And there are other ways to help. Cooling a patient to lessen his oxygen needs during surgery. Hypotensive anesthesia. Therapy to improve coagulation. Desmopressin (DDAVP) to shorten bleeding time. Laser "scalpels." You will see the list grow as physicians and concerned patients seek to avoid blood transfusions. We hope that you never lose a great amount of blood. But if you did, it is very likely that skilled doctors could manage your care without using blood transfusions, which have so many risks.

SURGERY, YES —BUT WITHOUT TRANSFUSIONS

Many people today will not accept blood. For health reasons, they are requesting what Witnesses seek primarily on religious grounds: quality medical care employing alternative nonblood management. As we have noted, major surgery is still possible. If you have any lingering doubts, some other evidence from medical literature may dispel them.

The article "Quadruple Major Joint Replacement in Member of Jehovah's Witnesses" (Orthopaedic Review, August 1986) told of an anemic patient with "advanced destruction in both knees and hips." Iron dextran was employed before and after the staged surgery, which was successful. The British Journal of Anaesthesia (1982) reported on a 52-year-old Witness with a hemoglobin level under 10. With the use of hypotensive anesthesia to minimize blood loss, she had a total hip and shoulder replacement. A surgical team at the University of Arkansas (U.S.A.) also used this method in a hundred hip replacements on Witnesses, and all the patients recovered. The professor heading the department comments: "What we have learned from those (Witness) patients, we now apply to all our patients that we do total hips on."

The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded: "The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah's Witnesses." (Transplantation, June 1988) Likewise, refusal of blood has not stood in the way even of successful heart transplants.

'What about bloodless surgery of other types?' you may wonder. Medical Hotline (April/May 1983) told of surgery on "Jehovah's Witnesses who underwent major gynecological and obstetric operations [at Wayne State University, U.S.A.] without blood transfusions." The newsletter reported: "There were no more deaths and complications than in women who had undergone similar operations with blood transfusions." The newsletter then commented: "The results of this study may warrant a fresh look at the use of blood for all women undergoing obstetric and gynecological operations."

At the hospital of Göttingen University (Germany), 30 patients who declined blood underwent general surgery. "No complications arose that could not also have arisen with patients who accept blood transfusions. . . . That recourse to a transfusion is not possible should not be overrated, and thus should not lead to refraining from an operation that is necessary and surgically justifiable." —Risiko in der Chirurgie, 1987.

Even brain surgery without using blood has been done on numerous adults and children, for instance, at New York University Medical Center. In 1989 Dr. Joseph Ransohoff, head of neurosurgery, wrote: "It is very clear that in most instances avoidance of blood products can be achieved with minimal risk in patients who have religious tenets against the use of these products, particularly if surgery can be carried out expeditiously and with a relatively short operative period. Of considerable interest is the fact that I often forget that the patient is a Witness until at the time of discharge when they thank me for having respected their religious beliefs."

Finally, can intricate heart and vascular surgery without blood be performed on adults and children? Dr. Denton A. Cooley was a pioneer in doing just that. As you can see in the medical article reprinted in the Appendix, on pages 27-9, based on an earlier analysis, Dr. Cooley's conclusion was "that the risk of surgery in patients of the Jehovah's Witness group has not been substantially higher than for others." Now, after performing 1,106 of these operations, he writes: "In every instance my agreement or contract with the patient is maintained," that is, to use no blood.

Surgeons have observed that good attitude is another factor with Jehovah's Witnesses. "The attitude of these patients has been exemplary," wrote Dr. Cooley in October 1989. "They do not have the fear of complications or even death that most patients have. They have a deep and abiding faith in their belief and in their God."

This does not mean that they assert a right to die. They actively pursue quality care because they want to get well. They are convinced that obeying God's law on blood is wise, which view has a positive influence in nonblood surgery.

Professor Dr. V. Schlosser, of the surgical hospital at the University of Freiburg (Germany), noted: "Among this group of patients, the incidence of bleeding during the perioperative period was not higher; the complications were, if anything, fewer. The special view of illness, typical of Jehovah's Witnesses, had a positive influence in the perioperative process." —Herz Kreislauf, August 1987.

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Doripenem Injection (Doribax) Gets FDA Approval For Treating Complicated Urinary Tract and Intra-Abdominal Infections

The U.S. Food and Drug Administration has approved doripenem injection, 500 mg intravenous infusion, for the treatment of complicated urinary tract and intra-abdominal infections. Doripenem injection, sold under the trade name Doribax, has been shown to be active against several strains of bacteria.

“This is a significant new drug in the treatment of hospitalized patients with serious bacterial infections,” said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer and acting director, Center for Drug Evaluation and Research.

In several multi-center, multinational studies, doripenem was shown to have a cure rate comparable to the currently prescribed medications levofloxacin, for complicated urinary tract infections, and meropenem, for complicated intra-abdominal infections.

The most common adverse reactions reported were headache, nausea, diarrhea, rash, and phlebitis. In addition, allergic reactions have occurred and some may require immediate treatment.

The safety and effectiveness of doripenem injection in pediatric patients have not been established. Doripenem has not been studied in pregnant women, and the drug should be used during pregnancy only if clearly needed.

Doripenem injection is manufactured by Johnson and Johnson Pharmaceutical Research and Development, LLC, Raritan, N.J.

However it is beneficial to know symptoms of Urinary Tract infections before they become complicated or if one has a clean slate prevent it.

UTI-bladder-Urinary tract infection symptoms:

* Burning sensation when urinating
* Persistent strong urge to urinate
* Going frequently on bathroom passing small amounts of urine
* Strong smelling urine , blood in the urine or cloudy
Prevention of urinary tract infection:
You can take action to prevent urinary tract infection:

* Drink a lot of liquid Cranberry juice(not if you are taking the blood-thinning medication warfarin) and especially water. Cranberry juice is known as good natural remedy for urinary tract infection.
* Urinate promptly, when urge arises. Don't retain urine for a long time after you feel urge to urinate.
* Wipe from front to back after urinating and after bowel movement. It helps bacteria in the anal region from spreading to the vagina and urethra.
* Clean your genital area before sex intercourse
* Empty your bladder as soon as possible after sex intercourse
* Avoid using feminine products that could be potentially irritable, such as deodorant sprays for genital areas.
* Take showers instead of tub baths

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FDA,s Approved Source Of Puffer Fish

The Food and Drug Administration (FDA) is advising consumers only to eat puffer fish (also known as fugu, bok, blowfish, globefish, swellfish, balloonfish, or sea squab) from two known safe sources. The safe sources are 1) imported puffer fish that have been processed and prepared by specially trained and certified fish cutters in the city of Shimonoseki, Japan, and 2) puffer fish caught in the mid-Atlantic coastal waters of the United States, typically between Virginia and New York. Puffer fish from all other sources potentially contain deadly toxins and therefore are not considered safe.

The liver, gonads (ovaries and testes), intestines, and skin of some puffer fish contain the toxins tetrodotoxin and/or saxitoxin. These toxins are 1,200 times more deadly than the poison cyanide and can affect a person's central nervous system. There are no known antidotes for these toxins. Puffer fish must be cleaned and prepared properly so the organs containing the toxins are carefully removed and do not cross-contaminate the flesh of the fish. These toxins cannot be destroyed by cooking or freezing.

Symptoms resulting from ingesting either of the toxins include tingling of the lips and mouth, followed by dizziness, tingling in the extremities, problems with speaking, balance, muscle weakness and paralysis, vomiting, and diarrhea. These symptoms can begin anywhere from 20 minutes to 2 hours after eating the toxic fish. In extreme cases death can result from respiratory paralysis.

The Japanese government licenses specially trained fish cutters to process and prepare puffer fish. These fish are imported into the United States two to three times per year for special occasions, by only one approved New York importer, Wako International, under an FDA/Japanese government agreement. This is the only acceptable source of imported puffer fish. They are sold only to restaurants and dishes containing the fish are often very expensive, sometimes costing hundreds of dollars for a full meal.

Puffer fish caught from the mid-Atlantic coastal waters of the United States do not contain these deadly toxins and are considered safe to eat. They are less expensive than imported puffer fish and may be found in markets or restaurants. However, puffer fish caught off the east coast of Florida should not be eaten because the entire fish is potentially toxic.

Before ordering or buying puffer fish, consumers should ask where it came from to ensure it is from a known safe source. Consumers who are unsure of the source should not eat puffer fish.

To Spanish Readers

Coma pez globo sólo de fuentes seguras conocidas

La Administración de Medicamentos y Alimentos (FDA, Food and Drug Administration) recomienda a los consumidores que coman pez globo (también conocido como, fugu, bok, botete diana, pez inflado o pez rechoncho) sólo de fuentes seguras conocidas. Las fuentes seguras son: 1) pez globo importado que se ha procesado y preparado por cortadores de pescado certificados y especialmente capacitados en la ciudad de Shimonoseki, Japón, y 2) pez globo que se pesca en las aguas costeras del Atlántico medio de los Estados Unidos, normalmente entre Virginia y Nueva York. Los peces globo de todas las demás fuentes pueden contener toxinas mortales, por lo que no se consideran seguros.

El hígado, las gónadas (ovarios y testículos), los intestinos y la piel de algunos peces globo contienen las toxinas tetrodotoxina o saxitoxina. Estas toxinas son 1,200 veces más mortales que el cianuro y pueden afectar el sistema nervioso central de una persona. No se conocen antídotos para estas toxinas. El pez globo se debe limpiar y preparar de manera adecuada para que los órganos que contienen las toxinas se retiren cuidadosamente y no se produzca la contaminación cruzada de la carne del pescado. Estas toxinas no se pueden destruir con la cocción o congelación.

Los síntomas que aparecen al ingerir cualquiera de las toxinas incluyen hormigueo en los labios y la boca, seguido de mareos, hormigueo en las extremidades, problemas para hablar, con el equilibrio, debilidad muscular y parálisis, vómitos y diarrea. Estos síntomas pueden comenzar desde 20 minutos hasta 2 horas después de comer el pescado tóxico. En casos extremos, se puede producir la muerte debido a una parálisis respiratoria.

El gobierno japonés autoriza a cortadores de pescado especialmente capacitados para procesar y preparar pez globo. Estados Unidos importa estos pescados dos a tres veces al año para ocasiones especiales, y lo hace a través de un sólo importador aprobado de Nueva York, Wako International, en virtud de un acuerdo entre la FDA y el gobierno japonés. Ésta es la única fuente aceptable de pez globo importado. Se vende sólo a restaurantes y los platos que contienen el pescado a menudo son muy costosos, en ocasiones llegando a costar cientos de dólares una comida completa.

El pez globo que se pesca en las aguas costeras del Atlántico medio de los Estados Unidos no contiene estas toxinas mortales y se considera seguro para comer. Cuesta menos que el importado y se puede encontrar en mercados o restaurantes. Sin embargo, el pez globo que se pesca en la costa este de Florida no se debe comer porque el pescado completo puede ser tóxico.

Antes de pedir o comprar pez globo, los consumidores deben preguntar por su origen para asegurarse de que proviene de una fuente segura conocida. Los consumidores que no están seguros de la fuente no deben comer pez globo.

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The U.S. FDA Approves Raltegravir Tablets As New HIV Drug

The U.S. Food and Drug Administration (FDA) has approved raltegravir tablets for treatment of Human Immunodeficiency Virus (HIV)-1 infection in combination with other antiretroviral agents in treatment-experienced adult patients who have evidence of viral replication and HIV-1 strains resistant to multiple antiretroviral agents.

Raltegravir is the first agent of the pharmacological class known as HIV integrase strand transfer inhibitors, designed to interfere with the enzyme that HIV-1 needs to multiply. Raltegravir, sold under the trade name Isentress, received a priority review by the FDA.

“This is an important new product for many HIV-infected patients whose infections are not being controlled by currently available medications,” said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer and acting director, Center for Drug Evaluation and Research.

When used with other anti-HIV medicines, raltegravir may reduce the amount of HIV in the blood and may increase white blood cells, called CD4+ (T) cells, that help fight off other infections.

FDA’s approval of raltegravir is based on data from two double-blind, placebo-controlled studies in 699 HIV-1 infected adult patients with histories of extensive antiretroviral use. A greater proportion of the patients who received raltegravir in combination with other anti-HIV drugs experienced reductions in the amount of HIV in the blood, compared with patients who received placebo in combination with other anti-HIV drugs.

The most common adverse events reported with raltegravir were diarrhea, nausea, and headache. Blood tests also showed abnormal elevated levels of a muscle enzyme in some patients receiving raltegravir. Caution is advised when using raltegravir in patients at increased risk for certain types of muscle problems, including those who use other medications that can cause muscle problems.

Patients taking raltegravir may still develop infections, including opportunistic infections or other conditions that may develop in patients living with HIV-1 infection. The long-term effects of raltegravir are not known, and its safety and effectiveness in children less than 16 years of age has not been studied.

Raltegravir also has not been studied in pregnant women. Women who are taking HIV medications when they get pregnant are advised to talk with their physician or other health care professional about use of this drug during pregnancy, and about registering with the Antiviral Pregnancy Registry if they use raltegravir.

Raltegravir is distributed by New Jersey-based Merck & Co., Inc.

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OTC Cough and Cold Oral infant Medicines Voluntarily Withdrawn Due To Abuse

The Consumer Healthcare Products Association (CHPA) on behalf of the leading makers of over-the-counter cough and cold medicines today announced voluntary market withdrawals of oral cough and cold medicines that refer to "infants." The voluntary withdrawal affects only these "infant" oral medicines, not those intended and labeled for use in children age two and older.

"It’s important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately," said Linda A. Suydam, D.P.A, president of CHPA. "The reason the makers of over-the-counter, oral cough and cold medicines for infants are voluntarily withdrawing these medicines is that there have been rare patterns of misuse leading to overdose recently identified, particularly in infants, and safety is our top priority."

The branded cough and cold medicines that are being voluntarily withdrawn are:

* Dimetapp® Decongestant Plus Cough Infant Drops
* Dimetapp® Decongestant Infant Drops
* Little Colds® Decongestant Plus Cough
* Little Colds® Multi-Symptom Cold Formula
* PEDIACARE® Infant Drops Decongestant (containing pseudoephedrine)
* PEDIACARE® Infant Drops Decongestant & Cough (containing pseudoephedrine)
* PEDIACARE® Infant Dropper Decongestant (containing phenylephrine)
* PEDIACARE® Infant Dropper Long-Acting Cough
* PEDIACARE® Infant Dropper Decongestant & Cough (containing phenylephrine)
* Robitussin® Infant Cough DM Drops
* Triaminic® Infant & Toddler Thin Strips® Decongestant
* Triaminic® Infant & Toddler Thin Strips® Decongestant Plus Cough
* TYLENOL® Concentrated Infants' Drops Plus Cold
* TYLENOL® Concentrated Infants' Drops Plus Cold & Cough

This voluntary withdrawal does not affect medicines intended for children age two and older. CHPA and its member companies have put forth recommendations to the U.S. Food and Drug Administration (FDA) to strengthen the labels on all oral OTC children’s cough and cold medicines from "ask a doctor" before using to "do not use" in children under two years.

CHPA made these recommendations to the FDA in preparation for a joint FDA advisory committee meeting on October 18 and 19. These recommendations, as well as several additional recommendations, including those proposed by FDA review staff, will be explored further at this meeting.

"These medicines are—and always have been—safe at recommended doses," Suydam said.

"These voluntary actions are being taken out of an abundance of caution. The vast majority of parents and caregivers safely use these medicines to help relieve their children’s symptoms. But as with all medicines, it’s important that parents read over-the-counter medicine labels carefully, use these medicines only as directed, and store them safely out of the reach of children."

CHPA will be launching a major, multi-year national campaign to educate parents and healthcare providers about the safe use of over-the-counter medicines in children, partnering with major physician, nurse, and pharmacist organizations.

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Controversial Vaccine Drops Cases Of Meningococcal B In Rotorua And Taupo In News Zealand

Alison Brown

A drop in the number of cases of meningococcal B in Rotorua and Taupo is proof a controversial vaccine is working, health experts say.

There have been no cases of meningococcal B in Rotorua or Taupo this year. Nationally, 76 people have contracted the potentially deadly illness.

The figures are well down on the hundreds of cases reported at the height of the epidemic, which has swept the country for 16 years.

Bay of Plenty medical officer of health Phil Shoemack says there's no doubt the immunisation campaign has been effective.

"The vaccine has accelerated the natural decrease in the epidemic. When you look at how much of an impact it's had, we wish we could have had it earlier so fewer kids would have got the disease."

Since 1991 about 6000 New Zealanders - half of them under 6 - have been struck down by the disease and 245 people have died. At the height of the epidemic, Bay of Plenty was among the worst regions affected, recording double the rate of cases as the rest of the country.

In the two years before the vaccine became available in the Bay of Plenty, 107 cases were reported - 29 in 2004 and 78 in 2003. Two people died.

Meningococcal B is an infection of the fluid of the spinal cord and fluid surrounding the brain. It is caused by bacterium and can kill within 24 hours. Other strains of the disease are caused by a virus. Symptoms can be mistaken for influenza and include fever, severe headaches, vomiting, drowsiness, muscular aches and a stiff neck.

In an attempt to control the epidemic, the Ministry of Health launched a massive $220 million vaccination programme targeting babies and teenagers in 2004. Free but not mandatory, it became available in Rotorua and Taupo in February 2005. About 32,100 people under 20 in the Lakes district have been eligible for the vaccine - 82 per cent or 26,400 have completed the programme.

The figures are slightly less for Maori, with 78 per cent of eligible Maori receiving all their doses.

About 5800 out of 7629 preschoolers (76 per cent) have been immunised. Of the 4139 Maori under fives eligible for the vaccine, 2730 (66 per cent) have completed the programme.

Vaccination rates for school-aged children are higher. Of the 24,540 eligible for the vaccine, about 20,600 (84 per cent) have completed the programme. About 9600 out of 11,740 Maori school children and teenagers (82 per cent) have received their three doses.

The school-age immunisation campaign has finished but the health ministry has indicated vaccinations will continue to be available for under-5s until 2009.

Health Rotorua chief executive and Maori health manager Eugene Berryman-Kamp said Lakes has had more success reaching Maori in all age groups than other regions.

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Massage Hurts, But Hurts So Good

Jo McCarroll

I am a bit of sadist when it comes to having a massage, which might sound like a non-sequitur but it isn't really. Because while there is a wide variety of massages on offer, in the end there are only really two - hard massage and soft massage.

Some people like those fluffy soft massages, all tinkling music and feathery stroking.

Me, I'd rather chew glass. If I'm having a massage, I like a bruising deep tissue massage right on that edge of pain.

I am already a fan of Thai massage, which is usually, in my experience, quite exquisitely agonising (don't be fooled by the often tiny therapist - they often have superhuman upper body strength). However, I had never tried a Thai herbal hot compress ($200 for 90 minutes), an ancient form of massage and one of the signature treatments at Senses Spa at the Westin Hotel.

It uses a "massage ball", a poultice stuffed with lemon grass, plai, soap pod, turmeric and kaffir lime (among other things), soaked in hot oil and then rubbed onto your skin, followed by a full body massage.

The massage ball looks exactly like a larger version of one of those money balls you get as part of a mixed entree platter at a Thai restaurant - in fact, the waft of lemon grass that pervades the room is quite reminiscent of Thai restaurants as well (in the most pleasant way, I hasten to add).

Lemongrass, apparently, helps you relax - and the herbs that make up the compress all have healing or soothing properties. Plai, which is from the same plant family as ginger, combats joint and muscle problems; soap pod, a Thai herb similar to tamarind, improves the texture of the skin; turmeric is good for skin problems; and Kaffir lime works on skin tone.

The essential oils in the plants are released into the heated massage oil - devotees of this treatment claim it has a number of health benefits, in particular relieving muscle sprains and joint stiffness.

But the health benefits, for me, are not the point of having a massage, what I want is to de-stress and relax. And, my God, after an hour-and-a-half of being rubbed with this hot massage ball (and be warned it is hot, almost to the point where it's uncomfortable) I felt like I was practically liquid.

Having (rather swaggeringly) told the therapist I liked my massages fairly hard, she more than took me at my word: ow, ow, ow, ooo, ooo, ooo God yes.

At the end my arms barely had the strength to lift my cleansing ginger tea. Those of you who like your light ticklings and barely-there back rub, steer clear.

But for the rest of us it's best summed up in just three words: hurts so good.

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Gordon McEwen, A Veteran Chef Allergic To Fish

Julie Jacobson

Gordon McEwen could be forgiven for wanting to cry into his kilt at times. The veteran chef, who has cooked for some of the diplomatic community's most powerful members, is acutely allergic to fish.

But the former Wellington restaurateur hasn't let what many would consider to be a major handicap get in the way of a stellar 40-year career in the kitchen.

Now at the Tauranga Club in the Bay of Plenty, McEwen spent the past 19 years as chef to five US ambassadors. During that time he catered for several world leaders and dozens of visiting dignitaries.

It was while working at the ambassador's Lower Hutt residence he had his first reaction to seafood.

"I'd been cooking fish for 25 years. I'd just had a meal when my eyes started falling out of my head and my lips began swelling up. It was not very pleasant."

Since then, he has used gloves to prepare the fish and shellfish meals for which he has become renowned.

At the same time, he "cooks" in his head - "I imagine the dish and the taste in my mind".

McEwen's wife, Elizabeth, and other kitchen staff are called on to check seasoning and taste any new dish he develops.

He says the allergy has had unexpected results - he believes his kitchen has some of the highest hygiene standards in the business.

"I take huge care in the kitchen not to cross-contaminate anything. I've had to become very aware of the implements I use, which means everyone else in the kitchen picks up on that."

While it doesn't hamper what goes on the menu - calamari in a soy-lime dressing; chilli, garlic and ginger prawns; and fresh fish with an Asian mustard sauce and balsamic vinegar drizzle are some of his dishes - it has occasionally put a dampener on McEwen's social life.

He has learned not to kiss his wife immediately after she has eaten seafood, and there have been several times when he's especially chosen steak at a restaurant only to suffer a reaction. "I've known straight away that whoever cooked that steak had been handling fish."

Despite that, McEwen still loves fish. He waxes lyrical when describing the preparation that goes into his dishes, and says he remembers distinctly what fish tastes like; "the texture on my tongue, Akaroa smoked salmon ... it sometimes drives me insane that I can't taste it".

He admits to being so tempted by a nice piece of fresh fish that he ate several small pieces "just in case I'd got over it.

"Unfortunately, I learned the hard way that I hadn't."

Ironically, Thai fish sauce, tinned salmon and tuna, and marinated mussels, are four things that don't trigger a reaction.

Nor does smelling seafood. "Like any- one else, I can tell what's fresh and what isn't," he laughs.

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Tattoo Removal Surgeries Now Gaining Grounds

Diamonds, cockroaches, and tattoos are forever. But wait a minute - that's no longer true of the latter. These days, a tattoo can be here today and gone over the course of several painful tomorrows.

For many regretful men and women, what used to be a permanent reminder of a passing fad is now written in erasable ink. Tattoo removal surgeries, involving multiple laser treatments that destroy the pigments beneath the skin, have become increasingly common.

Over the past twenty years, tattoos have exploded in popularity. The explosion is thanks to better health and safety standards, including single-use needles, protective gloves, and sterilisation, as well as a surge of ink in popular culture. Together, these factors have encouraged a generation who otherwise could have lived without the Chinese symbol for Mouthwash etched in its skin. A newly tattooed tribe was born, and it thrives to this day.

While the techniques had become safer and more common, the classic dangerous appeal of the tattoo remained. Regardless of their relative safety, tattoos were no less painful or permanent. Somehow, even the promise of individuality persevered. But with more and more skin going under the needle, more and more people began to realise that forever is a long, long time.

The most comment argument against the tattoo is regret, and that regret falls into three basic categories. One, your sensibilities may change: You may eventually decide that you do not feel as strongly about Megadeth, or the Tasmanian Devil, or Jason, Sharon or Steve. Two, your circumstances may change: You may find it difficult to acquire gainful employment with exposed tattoos, even if they include WORD and EXCL across the knuckles.

All the more common is reason three: you, physically, will change. Thousands of years ago, before the first tattoo was performed on an early Eurasian ancestor, his ancient Eurasian mother asked him how it was going to look when he was old and wrinkly. This, however, is the easiest argument to refute. After all, nobody's modelling swimsuits when they're old and wrinkly.

The common theme of these arguments is time. Time passes, things change, yet (with occasional retouching) tattoos stay the same. For many, committing to a tattoo used to mean coming to terms with and accepting your regret. That, strangely, was yet another part of the appeal.

But today, for a few thousand dollars and a few weeks of appointments, that permanence and regret is no more.

Soon, a new type of tattoo ink will be available that is designed for laser surgery. Only one treatment will be necessary to remove the ink from the skin, making this the tattoo equivalent of non-alcoholic beer.

Meanwhile, the fringe will continue to get - and keep - their tattoos, even while the tribe who sought their tattooed individuality together seeks removal together as well. Like any other youthful fad, ink is now readily tossed aside for family, career, and adulthood.

Tattoos aren't forever, but some things never change.

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Some One Million Crib Recall Underway In The United States

The largest crib recall in history is underway following findings showing that a couple of kids have been killed by their cribs. Some one million cribs with older drop-side hardware were recalled following an announcement by the Consumer Product Safety Commission (CPSC) and Simplicity for Children Inc., asking consumers with such cribs to return them.

The agency and the company are concerned with failure in the "drop-side" of the crib when it is incorrectly assembled. According to the CPSC, the drop-side failures result from both the hardware and crib design. These two faulty elements all too easily trick consumers into unintentionally installing the drop-side upside down. Thus installed, the hardware can weaken and cause the drop-side to detach from the crib, creating a gap in which infants can become entrapped and, there, suffocate. Thus far this failure has led to three infant deaths.

"According to First Candle, a leading promoter of infant health, infants who sleep in an adult bed with their parents are up to 40 times more likely to die through suffocation or other means than infants who sleep in a crib. Parents need to know that babies are
safest in a separate sleeping space designed for them," said Simplicity President Ken Waldman.

This is the largest recall of cribs in United States history. The cribs were made in China.

All of the cribs in question were manufactured by the first part of 2006, and none of the cribs that Simplicity is presently distributing to stores have this design problem.

Once again, a controversy is surrounding products made in China and sold for children in the United States.

However, the last time such a thing happened, which was with the recent recall of supposedly lead paint toxic toys made in China for the giant Mattell toy manufacturer, it ended up being a red herring. Today, Mattell issued a company apology to the entire nation of China when it became clear that the amounts of lead paint that were in the recalled toys did not exceed CPSC limits. Instead, the problem lay tiny magnets in the toys that children could swallow and get sick from - which was a design problem on Mattell's end, not China's.

Critics are concerned that the real motive behind at least a lot of the "China bashing" lies in the frustration that many American consumers feel over the outsourcing of so many formerly American jobs to the Asian nation, where the workers demand only a fraction of the salary that their American counterparts would, as well as with the United States' steep trade deficit with China which American officials blame largely on China's artificially depreciated currency.

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E. Coli Found In US Lettuce Brand, Triggers Dole Lettuce Recall

A bag of Dole's Hearts Delight salad mix sold at a store in Canada, tested positive for E. coli triggering a recall in at least nine states. Neither Canadian health officials nor Dole Food Co. have received reports of anyone getting sick from the product, despite speculations that the product, which is suspected of being contaminated with E. coli O157:H7 has been distributed all over Canada.

The affected packages contain romaine and green leaf lettuce and butter lettuce hearts.

“Don’t play Russian roulette,” said Rene Cardinal, national manager of the fresh fruit and vegetable program at the Canadian Food Inspection Agency. “If you have it in your home, destroy it.”

Cardinal added that not all bags are necessarily contaminated, “but don’t take any chances.”

The food safety agency discovered that a sample of Dole’s Hearts Delight mixed lettuce salad was tainted with bacteria as part of random testing completed over the weekend. It’s possible the recall could be expanded as the agency begins an investigation to determine the origin of the bagged salad and where it was distributed.

However, he noted it will take time for the government to determine where the produce was grown because it is a blend of different lettuce types.

“If it had been one single type of lettuce it would be easier,” he said. “It’s too premature at this point in time (to say) what caused the contamination.”

Last year, E. coli-tainted spinach was linked to the deaths of several people in the U.S. Hundreds more were made ill. The spinach scare, as well as subsequent recalls involving items such as carrot juice and lettuce, prompted governments and the food industry to find new ways to improve produce safety.

But this most recent recall shows there is still a long way to go before problems involving food safety are eliminated, said Mansel Griffiths, director of the Canadian Research Institute for Food Safety at the University of Guelph, Ont.

“Hopefully as we identify these issues and put things in place — the correct production practices for the fruit and vegetable industry — then we can reduce the problems that we have.”

The traceability of food, which refers to the ability of authorities to determine where food came from and how it was distributed, is a major factor affecting how quickly possible sources of contamination can be pinpointed and dangerous foods pulled off shelves, Griffiths said.

“Certainly it would help if you could trace the sources of this lettuce as quickly as possible so remedial measures could be taken,” he said.

Despite these latest safety scares, the industry has been making major gains to improve the safety and quality of food, said Heather Holland, senior technical manager of food safety and government relations at the Canadian Produce Marketing Association.

“In actual fact, we’ve been working on food safety for a number of years,” she said.

The fact that this week’s recall is focused on a specific type of Dole brand lettuce shows that the industry’s focus on improving safety and production is working, Holland said.

“What we’re seeing here is the benefits of good practices,” she said. “We’re able here to have the scope of the product narrowed down to a lot number and a best-before date.”

The affected Dole brand lettuce blend is sold in 227-gram packages, coded UPC 0 71430 01038 9 and lot code A24924B, with a best-before date of Sept. 19. It may have been distributed nationally.

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Long-Term Breastfeeding Does Not Reduce Children's Risk Of Suffering Asthma

Long-term breastfeeding, while famously rich in nutrients for baby, does nothing to reduce the risk of developing childhood asthma and allergies, a new study suggests.

Canadian and Belarusian doctors recruited 17,046 breastfeeding women who were attending maternity clinics in Belarus in the late 1990s.

The volunteers were split into two groups.

In one group, the women (and the healthworkers at the maternity clinics) carried out their normal practices and policies of breastfeeding.

In the other, breastfeeding was promoted and supported, with the result that more infants of women in this group were breastfed exclusively for their first three months of life, and for longer periods, at up to 12 months.

When the children reached the age of six and a half, they were tested for any symptoms of asthma and their parents were asked to detail any symptoms of wheezing, chest tightness, hay fever and eczema.

In addition, the children were given allergy pricks to test for any response to house dust mites, cats, birch pollen, mould and grass pollen.


A total of 13,889 youngsters were followed up this way.

There was no difference between the groups on the questions of asthma, hay fever or eczema - and the results from the allergy pricks showed that in the "pro-breastfeeding" group, the youngsters were more sensitive to dust mites and grass pollen than their counterparts.

"These results do not support a protective effect of prolonged and exclusive breastfeeding on asthma or allergy," say the investigators, led by Michael Kramer of The Montreal Children's Hospital, Canada.

They note that asthma and allergies have surged in incidence in the past few decades while breastfeeding has enjoyed a renaissance.

This "strong suggests that breast feeding does not have a potent protective effect (against these disease) at population level."

In 2002, a smaller study, conducted among 1,037 New Zealand infants, found that babies who had been breastfed for more than four weeks rank almost double the risk of contracting asthma and allergies in their childhood compared with counterparts who had been fed on infant formula.

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Oesophagus Cancer Linked To Obesity In Australia

A rapid rise in cases of a deadly oesophagus cancer has been linked to Australia's obesity crisis, with doctors investigating whether fat tissue is feeding the tumours.

The incidence of adenocarcinoma of the oesophagus — one of the most lethal cancers — has increased fivefold in the past 25 years in Australia, according to David Whiteman, senior research fellow at the Queensland Institute of Medical Research.

"It's a real increase in cancer which you just don't see in epidemiological lifetimes," he said. "It's unprecedented to see a cancer come up so quickly."

Those at greatest risk appear to be obese people, especially men, who suffer from reflux and have smoked at some time.

Dr Whiteman has recently completed a study aiming to identify factors that might affect a person's risk of oesophageal cancer, with a particular focus on whether fat may be feeding certain cancers.

"There really is no question that this is an obesity-related cancer but the question is how and why?" he said.

"Could it be that the fat tissue itself is acting like a fertiliser? Is it producing an environment where if you have an early change that could turn into a cancer in someone with more body fat, that it is more likely to flourish, take root and grow than it would in a lean person who doesn't have the same amount of proteins flitting around the body?"

Dr Whiteman's study has been accepted for publication in the medical journal Gut, published by the British Medical Journal publishing group. His research team compared more than 1000 Australians diagnosed with oesophagus cancers with healthy people.


The participants were asked a number of questions including the nature of their symptoms prior to diagnosis.

"People often don't realise they have any problem until they get their food stuck when they swallow and when that happens usually the cancer is of a large size, which means it's resistant to treatment," Dr Whiteman said.

"It has a survival rate that's as bad as any of the bad cancers like pancreatic cancer."

According to Cancer Council Victoria, there were an average of 133 new cases of the cancer per year in Victorian men and women in 2002-04. Men are five to eight times more likely to get it than women.

One of the big risk factors associated with the cancer is reflux (heartburn) from the stomach, a condition more often suffered by overweight people.

Smoking is also a risk factor, even for people who have only smoked for a short time.

The director of Cancer Council Victoria, Professor David Hill, said the rise in adenocarcinoma of the oesophagus was concerning.

The Cancer Council has conducted a 20-year study of more than 40,000 Victorians, which looked at how lifestyle factors, including diet and exercise, affected a person's risk of developing certain cancers.

It was estimated that obesity contributed to 500 cancer deaths in Victoria each year.

The study, developed by Professor Graham Giles, found men and women who were considered overweight — with a body mass index over 25 — had an increased risk of adenocarcinoma of the oesophagus. Of the patients with the cancer, 45 per cent had the disease because they were overweight.

Professor Hill said certain cancers were associated with being overweight including cancer of the colon, endometrium, postmenopausal breast, kidney and myeloid leukaemia.

"This study shows how much impact you could make in reducing the burden of cancer by in fact changing the prevalence of the risk factor, in this case, overweight/obesity," Professor Hill said.

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Mattel Makes A Third Toy Recall

Mattel, Inc. announced today that, as a result of the company's ongoing investigation of its toys manufactured by vendors in China, the company has voluntarily recalled 11 toys globally, including eight pet and furniture playsets sold under the Barbie® brand and three Fisher-Price® toys, due to impermissible levels of lead. No Barbie® dolls are included within the recall. In total, there are 530,000 affected toys in the U.S., and 318,000 affected toys outside of the U.S. Mattel has completed the testing program for the majority of its toys, including all of its toys currently sourced from vendors.


The voluntary recall results from Mattel's thorough investigation of vendor-sourced toys. Mattel has also globally implemented a strengthened, three-point check system to test toys throughout the manufacturing process.

"In August we promised that we'd continue to focus on ensuring the safety and quality of our toys through extensive testing of finished products, thorough investigation of our vendors and the implementation of a strengthened three-point check system. As a result of our ongoing investigation we discovered additional affected products. Consequently, several subcontractors are no longer manufacturing Mattel toys. We apologize again to everyone affected and promise that we will continue to focus on ensuring the safety and quality of our toys," said Robert A. Eckert, chairman and chief executive officer, Mattel.

In the U.S., there are seven recalled Barbie®-branded toys. The specific affected parts include:

* Dream Puppy House™– orange on miniature dog
* Dream Kitty Condo™– brown on miniature cat
* Table & Chairs Kitchen Playset – yellow food on two dinner plates, brown on miniature dog, yellow and orange on potato chip bowl, orange on salad bowl
* Bathtub & Toilet Playset – brown on miniature cat
* Desk & Chair Bedroom Playset – brown on miniature dog
* Living Room Playset (deluxe) – brown on miniature cat
* Living Room Playset (premium) – yellow flower on purse



The playsets affected by the recall were produced by Holder Plastic Company (Holder), a Mattel contract vendor, which subcontracted the painting of miniature toy pets and small furniture pieces to Dong Lian Fa (DLF) and Yip Sing (YS). DLF and YS used uncertified paint and are no longer producing toys for Mattel.

Mattel's investigation revealed that the subcontractors painted the affected toys between March 2007 and August 2007. However Mattel is being cautious and recalling the entire production of the seven toys painted by the subcontractors. Therefore, toys manufactured beginning in October 2006 are included within the recall. The toys being recalled were sold at retail between November 2006 and August 2007.

Among the three Fisher-Price® toys recalled are two Fisher-Price® GEOTRAX™ toys and one "It's a Big Big World" toy. Fisher-Price® toys with specific parts affected include:

* GEOTRAX™ Rail & Road System Freightway Transport™– yellow headlights on train car and miniature ladder
* GEOTRAX™ Special Track Pack™ – yellow headlights on train car and miniature ladder
* "It's a Big Big World" 6-in-1 Bongo Band – painted decal on top of clear plastic on drum



The two GEOTRAX™ toys were manufactured by Apex Manufacturing Company Ltd. (Apex), one of Mattel's contract vendors, which outsourced paint work to a subcontractor, Boyi Plastic Products Factory (Boyi). Apex supplied Boyi with certified paint; however, the toys were manufactured with uncertified paint. Boyi is no longer in business. The two GEOTRAX™ toys that tested for impermissible levels of lead were manufactured between July 31, 2006, and September 4, 2006; however, the painted parts were stored and incorporated into toy production throughout the year. Mattel is being cautious and recalling toys shipped between August 3, 2006, and July 31, 2007.

The Fisher-Price® "It's a Big Big World" 6-in-1 Bongo Band toy was manufactured by Shun On Factory, one of Mattel's contract vendors, which outsourced the molding and painting of one plastic piece. A subcontractor, Jingying Tampo Printing Processing Factory, used uncertified paint on the affected piece. The "It's a Big Big World" 6-in-1 Bongo Band was manufactured between May 19, 2007, and August 1, 2007.

Mattel is working in cooperation with the U.S. Consumer Product Safety Commission and other regulatory agencies worldwide. Mattel is also working with retailers worldwide to identify and remove affected products from retail shelves.

For additional information regarding this recall, including a full list of affected products, please contact Mattel at (888) 496-8330, or visit the company's Web site at www.service.mattel.com. A full list of products is also published by the Consumer Products Safety Commission.

How to Return Affected Toys/Parts:

1) The first step is for consumers to determine if they have a toy that has been affected by the recall. To do so, they can visit www.service.mattel.com where they will find a complete list of each toy recalled, including color photos, toy model numbers and affected date codes. Consumers can locate toy model numbers on the bottom of most recalled toys.

For consumers without a computer, or for those preferring phone support, they may call (888) 496-8330

2) Once consumers determine that they think they own a Mattel toy affected by the recall, they are prompted to fill out a form (online) or provide their postal address (via phone), and Mattel will send to consumers (via email or to a postal address) a color brochure with photos, toy numbers and date code ranges of every affected toy, as well as a pre-paid mailing label for return of the affected part(s).

3) After receiving consumers' returned, affected part(s), Mattel will send consumers replacement parts for each affected product, as well as bonus pieces/parts.

Mattel recommends that consumers do not return toys to retailers for three reasons:

1) Mattel can help consumers determine if a toy has been affected by the recall (vs. returning an unaffected toy)

2) Mattel will provide consumers with a replacement part for each toy part affected by the recall

3) Mattel will handle affected products in an environmentally friendly way

Consumers do not need to have the toy's original packaging or a receipt to return affected products to Mattel.

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