Meat and germs: Cook meat properly as bacteria in meat growing drug resistance

Bacteria in meat show growing drug resistance, FDA says

By Robert Roos

Feb 7, 2013 (CIDRAP News) – An annual report released by the Food and Drug Administration (FDA) this week shows that antibiotic resistance in bacteria found in retail meat and poultry samples is continuing to increase, though not uniformly.

For example, almost 45% of Salmonella isolates found on retail chicken samples were resistant to multiple classes of antimicrobial classes, up slightly from the 2010 level, says the 2011 Retail Meat Report of the National Antimicrobial Monitoring System (NARMS). Also, close to half of Campylobacter isolates in chicken were resistant to tetracyclines.

The report also shows that Campylobacter contamination in general (both susceptible and resistant isolates) increased in chicken and ground turkey samples in 2011, while Salmonella detections were down slightly for both items.

The NARMS retail meat surveillance program is a joint effort of the FDA, the Centers for Disease Control and Prevention (CDC), and health departments in 11 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee, and Pennsylvania. Its goals include providing information to promote steps for reducing resistance in foodborne bacteria.

In 2011, each health department bought about 40 retail samples each month—10 each of chicken, ground turkey, ground beef, and pork chops. All the state labs cultured meat and poultry samples for Salmonella, but only poultry samples were cultured for Campylobacter. Four of the states also cultured samples for Enterococcus and Escherichia coli.

The states sent their bacterial isolates to the FDA Center for Veterinary Medicine for identification of serotypes, antimicrobial susceptibility testing, and genetic analysis, the report says.

Resistant Salmonella
The testing revealed that 44.9% of Salmonella isolates in chicken were resistant to at least three antimicrobial classes in 2011, compared with 43.3% in 2010. In ground turkey, 50.3% of isolates showed this level of resistance, up from 33.7% the year before. In addition, 27% of chicken isolates showed resistance to at least five drug classes, which was down from 29% in 2010.

The report also says the percentage of Salmonella isolates with no detected resistance declined in 2011.

The researchers found continuing increases in Salmonella resistance to two specific drug classes. Between 2002 and 2011, resistance to third-generation cephalosporins in chicken isolates climbed from 10% to 33.5%, while such resistance in ground turkey rose from 8.1% to 22.4%. Both increases were significant (P <.05).

Significant increases over that same period were seen for Salmonella resistance to ampicillin: chicken isolates, 16.7% to 40.5%; ground turkey isolates, 16.2% to 58.4%.

On the other hand, all Salmonella isolates were susceptible to nalidixic acid, a member of the quinolone class, the report says.

Campylobacter resistance
More than 90% of Campylobacter isolates come from chicken samples each year, with the rest from ground turkey, the report notes. It says macrolide and fluoroquinolone drugs are used to treat Campylobacterinfections. Fluoroquinolone use in poultry production was banned in 2005.

Macrolide resistance in chicken samples remained low in 2011, at 4.3% for Campylobacter coli and 0.5% for Campylobacter jejuni, the testing showed.

C coli resistance to ciprofloxacin, a fluoroquinolone, peaked at 29.1% in 2005 and has dropped since then, reaching 18.1% in 2011, the report says. However, C jejuni resistance to the drug has continued an upward trend, from 15.2% in 2002 to 22.4% in 2011.

In addition, tetracycline resistance in both Campylobacter species jumped from 2010 to 2011, from 36.3% to 48.4% for C jejuni and from 39.2% to 29.1% for C coli.

Further, gentamicin resistance in C coli reached 18.1% in 2011, a big increase from the 0.7% level seen in 2007 when it was first detected.

On the brighter side, the report says multidrug resistance is rare in Campylobacter: Only 9 of 634 isolates from poultry were resistant to three or more drug classes in 2011.

The report also profiles resistance in Enterococcus species and Escherichia coli found in meat and poultry samples. Among other things, it notes that no Enterococcus isolates were resistant to vancomycin or linezolid, two drug classes that "are critically important in human medicine but are not used in food animal production."

General prevalence
As for the overall prevalence of contamination (susceptible and resistant strains), the project showed that 45.7% of chicken samples in 2011 contained Campylobacter, up from 38.3% in 2010. For ground turkey, the 2011 figure was 2.3%, up from 1.0% in 2010.

For Salmonella, the general prevalence in chicken was 12.0%, down from 13.0% the year before, while the ground turkey figure was 12.3%, down from 15.3% a year earlier. Salmonella was found in less than 1% of ground beef samples both years. For pork chops, the 2011 number was 2.1%, up from 1.5% in 2010.

For E coli (most strains of which are nonpathogenic), prevalence numbers were lower in 2011 than 2010 but remained fairly high: chicken, 71.0%; ground turkey, 76.7%; ground beef, 44.8%; and pork chops, 30.4%.

Congress member reacts
Rep. Louise Slaughter, D-N.Y., a food safety advocate, called the FDA's findings on resistance in meat samples "alarming." In a statement, she cited the high level of ampicillin resistance found in bacteria in ground turkey and the tetracycline resistance seen in Campylobacter from poultry samples.

"The threat of antibiotic-resistant disease is real, it is growing and those most at risk are our seniors and children," Slaughter said. "We can help stop this threat by drastically reducing the overuse of antibiotics in our food supply, and Congress should act swiftly to do so today."

New guidelines for management of thyroid dysfunction in pregnancy launched by the Indian Thyroid Society

2013

Bangalore, Feb 18: The Indian Thyroid Society (ITS) today launched three guidelines for the Management of Thyroid Dysfunction in Pregnancy, Dyslipidemia and Depression at the 10th Annual Conference ‘ITSCON – 2013’. These guidelines are for managing thyroid dysfunction in Pregnancy to safeguard mother and child health, and for patients of Depression and Dyslipidemia to reduce the co-morbidities associated with thyroid disorders. Thyroid disorders in India are characterized by a high prevalence (approx. 11% of adult population), minimal diagnosis, low awareness and low involvement of doctors in treatment.

The guidelines were developed by Elsevier, a global provider of scientific, technical and medical information, and endorsed by the Indian Thyroid Society, Endocrine Society of India [ESI], Federation of Obstetric and Gynaecological Societies of India [FOGSI] and The Association of Physicians of India [API]. Abbott provided financial assistance for the development of these guidelines.

On the launch of the ITS Guidelines, Dr. R. V. Jayakumar, President, Indian Thyroid Society [ITS], Professor of Endocrinology, AIMS, Cochin said, “Conditions such as depression, cardiovascular disorders, high cholesterol, obesity, osteoporosis, infertility and miscarriages are linked to thyroid disorders and these are on the rise in India.. The three independent guidelines for the screening and management of Thyroid Dysfunction will support the medical fraternity in diagnosis and treatment. Timely diagnosis of thyroid disorders in pregnant women is important for a healthy pregnancy and a healthy child. In addition, the guidelines for dyslipidemia and depression offer recommendations to minimize the risk of arising complications.”
Dr. Rakesh Sahay Professor of Endocrinology, Osmania Medical College, Hyderabad said “Thyroid disorders are one of the most under-diagnosed medical conditions and often referred to as the hidden disease. The new guidelines for thyroid disorders associated with pregnancy, dyslipidemia and depression will aid doctors like us to educate the masses about the importance of undergoing a TSH test for the correct diagnosis. Timely treatment of thyroid disorders is the key to preventing health problems.”
The Thyroid Dysfunction and Pregnancy Guidelines recommend screening for hypothyroidism in pregnant women at the 1st antenatal visit by measuring TSH levels. In case overt hypothyroidism is diagnosed then expectant mothers should be treated with a full replacement dose of thyroxine to normalize thyroid function as rapidly as possible. It is also important to understand that; thyroid dysfunction by itself is not an indication for termination of pregnancy.

As per the Thyroid Dysfunction and Dyslipidemia Guidelines, overt hypothyroidism is associated with the risk of cardio vascular disease as it causes increased levels of LDL cholesterol and hypertension. It is therefore advised that doctors screen patients with dyslipidemia for abnormal thyroid levels and accordingly prescribe treatment.

According to theThyroid Dysfunction and Depression Guidelines one of the co-morbidities associated with thyroid disorders is depression. It is important for doctors who are treating patients for depression to refer them to undergo a TSH test to detect hypothyroidism. This will help in correct diagnosis and treatment to prevent further damage.
Thyroid disorder is a medical condition that impairs the normal functioning of the thyroid gland causing abnormal production of hormones leading to hyperthyroidism or hypothyroidism. Multiple factors such as hereditary, environment and diet can trigger thyroid dysfunction. Thyroid disorders are commonly diagnosed between 20 – 40 years and research has shown that women are more commonly detected with thyroid disorders than men.

Speaking of thyroid disorders in women during pregnancy, Dr. Hema Divakar, President - Federation of Obstetric and Gynaecological Societies of India [FOGSI], Bangalore said “Hypothyroidism is emerging as one of the most common endocrine problem during pregnancy and often goes undetected.

It increases the risk of miscarriage, stillbirth, premature birth and placental abnormalities that adversely affects the overall development of the foetus. In the best interest of the mother and baby, we encourage regular screening for thyroid disorders amongst pregnant women. The guidelines recommend screening at the 1st antenatal visit by measuring TSH levels.”

Often symptoms such as anxiety, mood swings and poor concentration are ignored as signs of stress. These could have been triggered due to abnormal levels of thyroid hormone which can push people into depression.

According to Dr Sarita Bajaj, President Endocrine Society of India (ESI), Allahabad, “Thyroid hormones have a tremendous effect on body processes and can even impact cognitive function. There is little awareness that depression is a co-morbidity associated with hypothyroidism. All patients with depression should preferably be screened for thyroid function tests and be appropriately treated with thyroxine as judged by the physician.”
Dr. Shashank Joshi, President Elect - The Association of Physicians of India [API], Mumbai says "Many hypothyroid patients have underlying lipid abnormalities which get controlled by simple thyroxine therapy. Hypothyroidism needs lifelong thyroxine therapy and if controlled well, the patients can lead a normal life."

Hypothyroidism also leads to a co-morbid condition called dyslipidemia indicated with an increase in serum total cholesterol, low-density lipoprotein (LDL), apolipoprotein B, lipoprotein (a) levels, and possibly triglyceride levels. Dyslipidemia puts a patient at an increased risk for developing cardiovascular diseases, atherosclerosis and coronary artery disease.

The Chairman Organising committee Dr. K. M. Prasanna Kumar confirmed that close to 500 eminent speakers and Key Opinion Leaders from across India were present at the ITSCON-2013 conference. The speakers highlighted various disorders arising from thyroid dysfunctions, the importance of timely screening and recommended treatment to prevent further complications. Till 2012, ITS had screened close to 12 lakh women for thyroid disorders at various diagnostic and education camps throughout India.

Campylobacter infections in Alaska linked to drinking of raw milk

Raw milk suspected in Campylobacter infections in Alaska

At least four people in Alaska's Kenai Peninsula recently suffered Campylobacter infections after drinking raw milk, the Alaska Division of Public Health (DPH) said in a Feb 15 health advisory.

The four people were infected with Campylobacter isolates that were matched by pulsed-field gel electrophoresis. In addition, at least one person with a probable infection also reported drinking raw milk, and an infant in close contact with a confirmed case-patient has a suspected case, the statement said.

The strain identified in the cases has not been seen in Alaska before, it said.
Feb 15 Alaska DPH notice

More about the breast pump and hygiene

Breast Pump Basics

• Breast shield: Cone-shaped cup that fits over the nipple and surrounding area.
• Pump: Creates the gentle vacuum that expresses milk. The pump may be attached to the breast-shield or have plastic tubing to connect the pump to the breast shield.
• Milk container: Detachable container that fits below the breast shield and collects milk as it is pumped.

These days, many new mothers return to the workplace with a briefcase in one hand—and a breast pump kit in the other.

For those moms working outside the home who are breastfeeding their babies (and those who travel or for other reasons can’t be with their child throughout the day), using a breast pump to “express” (extract) their milk is a must.

The Food and Drug Administration (FDA) oversees the safety and effectiveness of these medical devices.

New mothers may have a host of questions about choosing a breast pump. What type of breast pump should they get? How do they decide ahead of time which pump will fit in best with their daily routines? Are pumps sold “used” safe?
Choosing the Right Pump for You

Kathryn S. Daws-Kopp, an electrical engineer at FDA, explains that all breast pumps consist of a few basic parts: a breast shield that fits over the nipple, a pump that creates a vacuum to express the milk, and a detachable container for collecting the milk.

There are three basic kinds of pump: manual, battery-powered and electric. Mothers can opt for double pumps, which extract milk from both breasts at the same time, or single, which extract milk from one breast at a time.

Daws-Kopp, who reviews breast pumps and other devices for quality and safety, suggests that mothers talk to a lactation consultant, whose expertise is in breastfeeding, or other health care professional about the type of breast pump that will best fit their needs. Questions for new moms to keep in mind include:
How do I plan to use the pump? Will I pump in addition to breastfeeding? Or will I just pump and store the milk?
Where will I use the pump? At work? When I’m traveling?
Do I need a pump that’s easy to transport? If it’s electric, will I have access to an outlet?
Does the breast shield fit me? If not, will the manufacturer let me exchange it?


Should You Buy or Rent?

There’s also the decision of whether to buy or rent a breast pump. Many hospitals, lactation consultants and specialty medical supply stores rent breast pumps for use by multiple users, Daws-Kopp notes.

These pumps are designed to decrease the risk of spreading contamination from one user to the next, she says, and each renter needs to buy a new accessories kit that includes breast-shields and tubing.

“Sometimes these pumps are labeled “hospital grade,” says Daws-Kopp. “But that term is not one FDA recognizes, and there is no consistent definition. Consumers need to know it doesn’t mean the pump is safe or hygienic.”

Daws-Kopp adds that different companies may mean different things when they label a pump with this term, and that FDA encourages manufacturers to instead use the terms “multiple user” and “single user” in their labeling. “If you don’t know for sure whether a pump is meant for a single user or multiple users, it’s safer to just not get it,” she says.

The same precaution should be taken for “used” or second-hand pumps.

Even if a used pump looks really clean, says Michael Cummings, M.D., an obstetrician-gynecologist at FDA, potentially infectious particles may survive in the breast pump and/or its accessories for a surprisingly long time and cause disease in the next baby.
Keeping It Clean

According to FDA’s recently released website on breast pumps, the first place to look for information on keeping the pump clean is in the instructions for use. In general, though, the steps for cleaning include:
Rinse each piece that comes into contact with breast milk in cool water as soon as possible after pumping.
Wash each piece separately using liquid dishwashing soap and plenty of warm water.
Rinse each piece thoroughly with hot water for 10-15 seconds.
Place the pieces on a clean paper towel or in a clean drying rack and allow them to air dry.

If you are renting a multiple user device, ask the person providing the pump to make sure that all components, such as internal tubing, have been cleaned, disinfected, and sterilized according to the manufacturer’s specifications.

Cummings notes that there are many benefits to both child and mother from breastfeeding. “Human milk is recommended as the best and exclusive nutrient source for feeding infants for the first six months, and should be continued with the addition of solid foods after six months, ideally until the child is a year of age,” he says.

The benefits are both short- and long-term. In the short-term, babies can benefit from improved gastrointestinal function and development, and fewer respiratory and urinary tract infections. In the long-term, children who have been breast fed may be less obese and, as adults, have less cardiovascular disease, diabetes, inflammatory bowel disease, allergies, and even some cancers.

Cummings adds that moms and their families benefit by the bonding experience and economically as well, since a reduction in acute and chronic diseases in the baby saves money.

For women considering this option, FDA ‘s website offers resources and information on breast pumps and breastfeeding. These include information on the selection and care of the pumps, in addition to describing signs of an infection or injury related to their use.

(This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products. January 14, 2013)

Treating the influenza or flu

Flu and its management

 What should you do if you have the flu?

Follow these basic tips for treating the flu.

If you have been diagnosed with the flu, you should stay home and follow your health care provider’s recommendations.

You can treat the flu with or without medication. When treating without medication, be sure to get plenty of rest and fluids.

Talk to your health care provider or pharmacist about over-the-counter and prescription medications to ease flu symptoms and help you feel better faster. Over-the counter medications may relieve some flu symptoms, but they will not make you less contagious.

Your health care provider may prescribe antiviral medications to make your illness milder and prevent serious complications.

Antiviral medications are approved for adults and children one year and older. On December 21, 2012, the U.S. Food and Drug Administration expanded the approved use of Tamiflu to treat children as young as two weeks old who have shown symptoms of flu for no longer than two days.

All about pumpers: The harmful effects of Anabolic Steroids

Anabolic Steroids

Most anabolic steroids are synthetic substances similar to the male sex hormone testosterone. They are taken orally or are injected.

Some people, especially athletes, abuse anabolic steroids to build muscle and enhance performance. Abuse of anabolic steroids can lead to serious health problems, some of which are irreversible.

Street names

Juice, gym candy, pumpers, stackers

Effects

Major effects of steroid abuse can include liver damage; jaundice; fluid retention; high blood pressure; increases in "bad" cholesterol. Also, males risk shrinking of the testicles, baldness, breast development, and infertility.

Females risk growth of facial hair, menstrual changes, male-pattern baldness, and deepened voice. Teens risk permanently stunted height, accelerated puberty changes, and severe acne. All users, but particularly those who inject the drug, risk infectious diseases such as HIV/AIDS and hepatitis.

Statistics and Trends

The NIDA-funded 2010 Monitoring the Future Study showed that 0.5% of 8th graders, 1.0% of 10th graders, and 1.5% of 12th graders had abused anabolic steroids at least once in the year prior to being surveyed.

Loud music is dangerous to health

While loud noise can cause the collection of inaccurate data in experimentation, it can also lead to hearing loss in musicians. Even child musicians, aged eight to twelve, show signs of it, while most adult musicians suffer from it to some degree.
The relationship between hearing loss and musicians is due to their constant exposure to loud noise. Prolonged exposure to sounds above 85dB, the range of many musical instruments, can cause gradual hearing loss. Moreover, modern music genres, such as rock and hip hop, have a tendency to increase the decibel level until it crosses the ear's pain threshold.
To prevent or reduce loss of hearing, musicians are advised to keep their exposure to loud sounds to a minimum and wear soundproof earmuffs or noise cancelling headphones, when possible. Like Herzan'sacoustic enclosures and vibration cancellation technology, they both use the same principles to reduce the amount of noise to a tolerable level. Sound absorbing or deflecting materials muffle noise while the transmission of a noise cancelling signal eliminates sound or vibrations over a broad spectrum.

(courtesy: www.herzan.com)

Peanut allergy: New methods to treat allergy to peanuts

Peanut Therapy Shows Promise in Treating Peanut Allergy

NIH-Funded Clinical Study is One of the First to Evaluate Sublingual Immunotherapy as a Peanut Allergy Treatment

A new study supported by the National Institutes of Health (NIH) suggests that sublingual immunotherapy (SLIT) can reduce the allergic response to peanut in adolescents and adults. SLIT is a treatment approach in which, under medical supervision, people place a small amount of allergen under the tongue to decrease their sensitivity to the allergen. This is one of the first randomized, placebo-controlled studies to test the efficacy and safety of SLIT to treat peanut allergy and is one of several federally funded trials investigating immune-based approaches to preventing and treating food allergy. The results appear online in the January issue of the Journal of Allergy and Clinical Immunology.

The study enrolled 40 people aged 12 to 37 years with peanut allergy who were on a peanut-free diet. After an initial food challenge to measure how much peanut powder they could eat without having an allergic reaction, participants received 44 weeks of daily therapy, followed by a second food challenge. Fourteen of the 20 participants (70 percent) given peanut SLIT were able to consume at least 10 times more peanut powder than they could at the beginning of the study, compared with only 3 of the 20 participants (15 percent) given placebo. After 68 weeks on peanut SLIT, on average, participants could consume significantly more peanut powder without having an allergic reaction. Study investigators also observed that SLIT caused only minor side effects, such as itching in the mouth, suggesting that daily therapy is safe.

Although more work is needed, the investigators hope that SLIT could one day help protect people with peanut allergy from experiencing severe allergic reactions in cases of accidental exposure. The researchers caution that people should not try peanut SLIT on their own because any form of immunotherapy carries a significant risk for allergic reactions. The therapy should be administered only under the guidance of trained clinicians.

The multicenter study was supported by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and conducted by the Consortium of Food Allergy Research (CoFAR) at clinical sites in Baltimore; Chapel Hill, N.C.; Denver; Little Rock, Ark.; and New York City. CoFAR investigators David Fleischer, M.D., associate professor of pediatrics in the Division of Pediatric Allergy and Immunology at National Jewish Health in Denver, and A. Wesley Burks, M.D., chair of the Department of Pediatrics at the University of North Carolina, Chapel Hill, led the trial.

Sirturo (bedaquiline) for multidrug-resistant tuberculosis: The US Food and Drug Administration (FDA) approves Sirturo (bedaquiline), the first drug developed specifically to treat multidrug-resistant tuberculosis (MDR-TB), saying it must be used in combination with other TB medications

FDA approves first med for multidrug-resistant TB

Robert Roos News Editor

Dec 31, 2012 (CIDRAP News) – The US Food and Drug Administration (FDA) today announced its approval of Sirturo (bedaquiline), the first drug developed specifically to treat multidrug-resistant tuberculosis (MDR-TB), saying it must be used in combination with other TB medications.

The drug, developed by Jannsen Therapeutics, Titusville, N.J., inhibits an enzyme that Mycobacterium tuberculosis uses to replicate and spread, the FDA said in a news release. Janssen officials said it is the first TB drug in 40 years that has a new mechanism of action.

MDR-TB strains are those that resist isoniazid and rifampin, the two drugs most commonly used to treat TB patients, the FDA noted.

"Multi-drug resistant tuberculosis poses a serious health threat throughout the world, and Sirturo provides much-needed treatment for patients who don't have other therapeutic options available," said Edward Cox, MD, MPH, in the FDA release. He is director of the Office of Antimicrobial Products in the FDA's Center for Drug Evaluation and Research.

But he warned that the drug carries significant risks, including heart arrhythmias, and therefore must be used carefully and limited to patients who lack other treatment options.

About 310,000 cases of MDR-TB were identified among reported pulmonary TB patients in 2011, according to the World Health Organization. In the United States, MDR-TB is considered an orphan disease, with 98 patients reported in 2011, according to a Janssen press release.

The FDA said it endorsed Sirturo under its accelerated approval program, which allows the agency to approve a drug on the basis of a demonstrated effect on a surrogate end point that is reasonably likely to predict a clinical benefit to patients. The program speeds the availability of new drugs while requiring companies to conduct more studies of their benefits and safety.

The FDA also granted Sirturo fast-track status, priority review, and orphan-product designation. The drug showed the potential to fill an unmet medical need, has the potential to provide safe and effective treatment where no other satisfactory therapy exists, and is intended to treat a rare disease, the agency said.

Sirturo's safety and effectiveness were established in two phase 2 clinical trials involving 440 patients, the FDA reported. The surrogate end point used in the studies was the time it took for patients' sputum to be clear of M tuberculosis (sputum culture conversion).

Patients in the first trial were randomly assigned to be treated either with Sirturo plus other TB drugs or with a placebo and other TB drugs. Patients in the Sirturo group had a median sputum conversion time of 83 days, versus 125 days for the placebo group.

In the second trial, which is ongoing, all patients received Sirturo plus other TB drugs. Results so far have shown a median time to sputum conversion of 57 days, supporting the efficacy findings of the first trial, the FDA said.

Common side effects identified in the clinical trials include nausea, joint pain, and headache, the agency noted.

The FDA and Janssen said Sirturo carries a boxed warning that the drug can affect the heart's electrical activity by prolonging the QT interval, which could lead to an abnormal and potentially fatal heart rhythm.

The warning also says that in the placebo-controlled trial, 9 of 79 patients (11.4%) in the treatment group died, compared with 2 of 81 (2.5%) in the placebo group.

"Five of the deaths in the Sirturo group and all of the deaths in the placebo arm seemed to be related to tuberculosis, but no consistent reason for the deaths in the remaining Sirturo-treated patients could be identified," the FDA said.

The Janssen statement said Sirturo inhibits mycobacterial adenosine 5'-triphosphate, an essential enzyme for generating energy in M tuberculosis. The drug was discovered more than a decade ago, said Paul Stoffels, MD, chief scientific officer and worldwide pharmaceuticals chairman at Johnson & Johnson, Janssen's parent company.

Eid Al Adha and Orf virus infections: Take extra caution while selecting animals for sacrifice during Bakrid

Sheep-to-Human Transmission of Orf Virus during Eid al-Adha Religious Practices

Five persons in France were infected with Orf virus after skin wounds were exposed to infected sheep tissues during Eid al-Adha, the Muslim Feast of Sacrifice. Infections were confirmed by electron microscopy, PCR, and sequence analysis. Prevention and control of this underdiagnosed disease can be achieved by educating physicians, slaughterhouse workers, and persons participating in Eid al-Adha.

Although human Orf virus infections have typically been associated with occupational animal contact, they also have been linked to Muslim religious practices and, more globally, to household meat processing or animal slaughter, reports senior researcher Antoine Nougairede in Emerging Infectious Diseases of the CDC.

Our findings show that clinical microbiology laboratories (other than national reference centers) can accurately detect and identify poxviruses by using EM and broad-spectrum PCR. Our results also suggest that PCR is highly sensitive for detection of poxviruses, and they show that samples obtained by Virocult swab are well-suited for detection of Orf virus by EM or PCR and could replace more invasive methods (e.g., skin biopsy).

The finest, unblemished animals (e.g., cows, goats, sheep) were initially reserved for the ritual sacrifice during Eid al-Adha. Today, however, Muslims in developed countries (especially in cities) mostly buy lambs, which are cheaper and more plentiful but also highly susceptible to Orf virus infections. This change in buying practices has created a large market for possibly infected animals and an associated potential health risk for persons who butcher and prepare the animals.

The cases reported here stress the need for using appropriate measures to prevent animal-to-human transmission of pathogens. Public health officials should educate persons with occupational or household exposure to animals about the possibility for disease transmission and ways to avoid infection.

Persons at increased risk for exposure to Orf virus include livestock owners, slaughterhouse workers, and persons who prepare animals at home for religious practices. Persons who handle animals should wear nonpermeable gloves, avoid exposure of open wounds, and meticulously wash skin wounds with soap and water after handling animals.

In addition, slaughterhouses should verify that all animals to be sold or butchered are in good health; animals with Orf virus lesions should be disposed of in a safe manner. Physicians, including dermatologists, should be informed of the potential for Orf virus infection, a heretofore underdiagnosed disease, and suspected infections should be confirmed by microbiology laboratories. The first 3 cases presented here were rapidly diagnosed, and emergency department physicians were promptly advised of the cases, enabling rapid detection and confirmation of the subsequent cases.

Fighting human influenza through Oseltamivir: And now Tamiflu for small children approved

FDA expands Tamiflu’s use to treat children younger than 1 year

Parents, health care professionals

must ensure proper dosing

The U.S. Food and Drug Administration today expanded the approved use of Tamiflu (oseltamivir) to treat children as young as 2 weeks old who have shown symptoms of flu for no longer than two days.

The drug is not approved to prevent flu infection in this population. In addition, the safety and efficacy of Tamiflu to treat flu infection has not been established in children younger than 2 weeks old.

Tamiflu was approved in 1999 to treat adults infected with flu who have shown symptoms for no longer than two days. It has since been approved to treat flu in children ages 1 year and older who have shown symptoms of flu for no longer than two days, and to prevent flu in adults and children ages 1 year and older.

Although there is a fixed dosing regimen for patients 1 year and older according to weight categories, the dosing for children younger than 1 year must be calculated for each patient based on their exact weight. These children should receive 3 milligrams per kilogram twice daily for five days. These smaller doses will require a different dispenser than what is currently co-packaged with Tamiflu.

“Pharmacists must provide the proper dispenser when filling a prescription so parents can measure and administer the correct dose to their children,” said Edward Cox, M.D., M.P.H, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. “Parents and pediatricians must make sure children receive only the amount of Tamiflu appropriate for their weight.”

Tamiflu is the only product approved to treat flu infection in children younger than 1 year old, providing an important treatment option for a vulnerable population. According to the Centers for Disease Control and Prevention (CDC), children younger than 2 years are at higher risk for developing complications from the flu, with the highest rates of hospitalization in those less than 6 months of age.

The FDA expanded the approved use of Tamiflu in children younger than 1 year based on extrapolation of data from previous study results in adults and older children, and additional supporting safety and pharmacokinetic studies sponsored by both the National Institutes of Health and Roche Group, Tamiflu’s manufacturer.

Pediatric legislation permits efficacy to be extrapolated from previous study results in adults and older children if the illness being studied and the effects of the drug are sufficiently similar in adult and pediatric patients. Data on how the drug is metabolized in the body (pharmacokinetic data) indicated a dose of 3 mg/kg twice daily provided concentrations of Tamiflu similar to those observed in older children and adults, and is expected to provide similar efficacy in this very young age group.

Almost all of the 135 pediatric patients enrolled in the two safety studies had confirmed flu. Results from these studies showed the safety profile in children younger than 1 year was consistent with the established safety profile of adults and older children. The most common side effects reported with Tamiflu use in this age group include vomiting and diarrhea. Although not seen in the new studies, rare cases of severe rash, skin reactions, hallucinations, delirium, and abnormal behavior have been reported.

The FDA monitors drugs for side effects and believes reporting side effects is important. Health care professionals and patients should report any side effects associated with Tamiflu’s use to FDA’s MedWatch program.

Tamiflu is not a substitute for early, annual flu vaccination, as recommended by the CDC’s Advisory Committee on Immunization Practices. CDC recommends all persons aged 6 months and older receive an annual flu vaccine.

Tamiflu is distributed in the United States by South San Francisco-based Genentech, a member of the Roche Group.

Not all dietary substances are healthy: Dexamethasone, a corticosteroid, causes severe damage to liver

Dangerous Supplement Now Sold as 'WOW'

The Food and Drug Administration (FDA) is warning the public that a product distributed and sold under the name 'WOW' is really just another product in disguise, one that can cause serious harm.
Earlier in 2012, FDA twice warned the public about taking Reumofan Plus—marketed as a "natural" dietary supplement for the treatment of many conditions, including arthritis and bone cancer—because, in reality, it contains undeclared active ingredients found in prescription drugs that should only be used under the supervision of a health care professional.
Brad Pace, regulatory counsel at FDA's Health Fraud and Consumer Outreach Branch, says some distributors have deliberately put a new label and a new name, WOW, on bottles of Reumofan Plus to deceptively sell remaining supplies. Pace says WOW has been distributed to online retailers and other distributors, as well as directly to consumers.
FDA is concerned that other distributors will also put different labels on Reumofan Plus and sell it under other names.

The agency offers this advice to consumers:

Immediately consult a health care professional if you are now taking Reumofan Plus or WOW.
Do not use any products with "Riger Naturals S.A." printed on the bottom of the bottle. Reumofan Plus is manufactured in Mexico by Riger Naturals.
Report any health problems related to these products to FDA's MedWatch Safety Information and Adverse 

Serious Health Risks

Since June, FDA has received dozens of reports from consumers who used Reumofan Plus of serious, and sometimes fatal, outcomes. The reports include liver injury, severe bleeding, corticosteroid withdrawal syndrome, adrenal suppression and stroke.
FDA laboratory analysis confirmed that WOW contains the same undeclared prescription drug ingredients that are in Reumofan Plus:
dexamethasone—a corticosteroid used to treat inflammatory conditions such as asthma and rheumatoid arthritis, that can increase the risk of infection, and cause increased blood sugar levels, changes in blood pressure, damage to bones, psychiatric problems. When taken for a prolonged period at high doses, it can cause adrenal suppression.
diclofenac sodium—a non-steroidal anti-inflammatory drug (NSAID) that may cause increased risk of cardiovascular events, such as heart attack, as well as serious gastrointestinal problems.
methocarbamol—a muscle relaxant that can cause sedation, dizziness and low blood pressure, and impair mental or physical abilities to perform tasks such as driving a motor vehicle or operating machinery.In addition to causing injury on their own, the hidden drugs found in these products could interact with other medications, resulting in serious health consequences.

Medical Advice Needed

Because one of the hidden ingredients—dexamethasone—is a corticosteroid, people taking these supplements must work with their health care professional to safely stop taking the drug. A person who abruptly stops taking corticosteroids after long-term use or after taking high doses runs the risk of suffering from a withdrawal syndrome and life-threatening adrenal suppression.
The withdrawal syndrome may include nausea, low blood pressure, low blood sugar levels, fever, muscle and joint pain, dizziness and fainting. Adrenal suppression of cortisol production can be life-threatening because, among its many important roles in the body, cortisol is needed to maintain normal blood pressure and supply glucose to vital tissues, such as the brain and red blood cells, in response to stressors such as trauma, surgery, and infection.
FDA notes that there may be other harmful hidden ingredients in these products. Ingredients may vary from lot to lot, and products found to have hidden drug ingredients are generally not manufactured in a way that would ensure their quality and safety.
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
December 21, 2012

Beat the stress to fight chronic health conditions in later stages of life

Reacting to Stress

We all experience stress at some point. There are interpersonal stressors, like arguments. There are overloads. I have too much to do and no time!

And there are network stressors that happen around you. Researchers reviewed the US National Study of Daily Experiences to see how people react to stress, and how that affected long-term health.

David Almeida is a professor of human development at Penn State.

“People who reported being emotionally reactive were 30 perc ent more likely to report chronic health conditions 10 years later.”

People were more reactive to interpersonal stress that involved their family. If you’re feeling stressed… “Get away from the situation. Try to take a break. And, if possible, engage in some sort of physical activity.”

The study in the Annals of Behavioral Medicine was supported by the National Institutes of Health.

Exercise reduces the symptoms of depression

December 2012

Exercise may help reduce depression for those with heart failure. Researchers at Duke University gave heart failure patients a questionnaire, measuring depressive symptoms like sadness, irritability, and disturbed sleep. They were then randomly assigned into one of two groups for usual care, and usual care with an exercise routine.

Patients who exercised for 90 minutes a week reduced their symptoms of depression compared to those who just received usual care. Beyond those 90 minutes, exercise did nothing more.

Dr. James Blumenthal led the study.

“We do recommend exercise for heart failure patients. It improves cardiovascular fitness and it also reduces depressive symptoms.”

The study in the journal of the American Medical Association was supported by the National Institutes of Health, says a CDC report.

Gonorrhoea gets new treatment: United States changes guidelines on Gororrhoea treatment: No longer oral drugs recommended

CDC No Longer Recommends Oral Drug for Gonorrhea Treatment

Change is critical to preserve last effective treatment option

The Centers for Disease Control and Prevention no longer recommends the oral antibiotic cefixime as a first-line treatment option for gonorrhea in the United States because of the possibility that the bacteria which causes gonorrhea is becoming resistant to the drug. The change was prompted by recent trends in laboratory data showing that cefixime, marketed under the brand name Suprax, is becoming less effective in treating the sexually transmitted disease, says a CDC report.

This change leaves only one recommended drug proven effective for treating gonorrhea, the injectable antibiotic ceftriaxone.

According to the revised guidelines, published on August 9, 2012 in CDC’s Morbidity and Mortality Weekly Report, the most effective treatment for gonorrhea is a combination therapy: the injectable antibiotic ceftriaxone along with one of two other oral antibiotics, either azithromycin or doxycycline.

In the past, gonorrhea has developed resistance to every antibiotic recommended for treatment, leaving the cephalosporins, which include cefixime and ceftriaxone, as the final recommended class of drugs. In light of this history and the recent lab data, CDC researchers are concerned that continued use of cefixime may prompt gonorrhea to develop resistance to all cephalosporins. Limiting the use of cefixime now may help preserve ceftriaxone as a treatment option for a little longer.

“As cefixime is losing its effectiveness as a treatment for gonorrhea infections, this change is a critical pre-emptive strike to preserve ceftriaxone, our last proven treatment option,” said Kevin Fenton, M.D., director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Changing how we treat infections now may buy the time needed to develop new treatment options.”

To guard against the threat of drug resistance, the guidelines outline additional follow-up steps providers should take to closely monitor for ceftriaxone treatment failure. According to the new recommendations, patients who have persistent symptoms should be retested with a culture-based gonorrhea test, which can identify antibiotic-resistant infections. The patient should return one week after re-treatment for another culture test – called a test-of-cure – to ensure the infection is fully cured.

In some instances, cefixime may be needed as an alternative treatment option. If ceftriaxone is not readily available, providers may prescribe a dual therapy of cefixime plus either azithromycin or doxycycline. Azithromycin may be given alone if a patient has a severe allergy to cephalosporins. However, to closely monitor for resistance, if either of these alternative regimens is prescribed, providers should perform a test-of-cure one week after treatment.

These revised guidelines are one aspect of CDC’s response to the threat of untreatable gonorrhea. Today CDC published a public health response plan, offering guidance on steps state and local health departments can take to keep a watchful eye on the emergence of drug resistance. In addition to closely monitoring for resistance nationally, CDC is working with the World Health Organization to monitor for emerging resistance on the global level. The agency is also collaborating with the National Institutes of Health to test new combinations of existing drugs.

Gail Bolan, M.D., director of CDC’s Division of STD Prevention, says that additional measures will be needed to stay ahead of untreatable gonorrhea. “It is imperative that researchers and pharmaceutical companies prioritize research to identify or develop new, effective drugs or drug combinations,” Bolan said. “Health departments and labs can help CDC monitor for emerging resistance by enhancing or re-building their ability to do culture testing.”

It is critical for individuals to take steps to protect themselves from infection. The surest way to prevent infection is not having sex. For those who are sexually active, consistent and correct condom use and limiting the number of sex partners are effective strategies for reducing the risk of infection.

Gonorrhea is one of the most common STDs in the United States; more than 700,000 infections are estimated to occur in this country each year. Although some men and women may have symptoms (such as burning when urinating or discharge), most people do not. As a result, many infections go undetected and untreated. Left untreated, gonorrhea can cause serious health problems, particularly for women, including chronic pelvic pain, life-threatening ectopic pregnancy, and even infertility. Infection also increases the risk of contracting and transmitting HIV.

New insights into epidemiology of HIV: 50 per cent of infected people do not know they are carrying the HIV

More than half of young HIV-infected Americans are not aware of their status

Too many young people continue to become infected and few are tested for HIV

Young people between the ages of 13 and 24 represent more than a quarter of new HIV infections each year (26 percent) and most of these youth living with HIV (60 percent) are unaware they are infected, according to a Vital Signs report from the Centers for Disease Control and Prevention. The most-affected young people are young gay and bisexual men and African-Americans, the report says.

The analysis looks at the latest data on HIV infections, testing, and risk behaviors among young people and was published in advance of World AIDS Day, Dec. 1.

Overall, an estimated 12,200 new HIV infections occurred in 2010 among young people aged 13-24, with young gay and bisexual men and African-Americans hit harder by HIV than their peers. In 2010, 72 percent of estimated new HIV infections in young people occurred in young men who have sex with men (MSM). By race/ethnicity, 57 percent of estimated new infections in this age group were in African-Americans.

“That so many young people become infected with HIV each year is a preventable tragedy,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “All young people can protect their health, avoid contracting and transmitting the virus, and learn their HIV status.”

According to CDC experts, a number of factors contribute to the high levels of HIV in young people and vary by population. HIV prevalence is higher in some communities than in others, which can increase the likelihood that a person will be exposed to infection with each sexual encounter. Previous research has also found that other factors can increase risk of infection, such as higher levels of unrecognized and untreated infection, as well as social and economic factors, such as poverty, lack of access to health care, stigma, and discrimination.

Despite recommendations from CDC and the American Academy of Pediatrics that call for routine HIV testing of youth in medical settings, the analysis shows that 35 percent of 18-24 year olds have been tested for HIV, while only 13 percent of high school students (and 22 percent of sexually experienced students) have ever been tested.

Partially as a result of lower testing levels, HIV-infected people under the age of 25 are significantly less likely than those who are older to get and stay in HIV care, and to have their virus controlled at a level that helps them stay healthy and reduce their risk of transmitting HIV to partners, reports CDC.

CDC also examined risk behaviors among high school students in 12 states and nine large urban school districts, and found that young MSM reported engaging in substantially higher levels of risk behavior than their heterosexual male peers:
Young MSM were more likely to report having had sex with four or more partners or ever injecting illegal drugs.
Among students who were currently sexually active, young MSM were more likely to have used alcohol or drugs before their last sexual experience, and were less likely to have used a condom.
Young MSM were also less likely to report having been taught about HIV or AIDS in school.

“We can and must achieve a generation that is free from HIV and AIDS,” said Kevin Fenton, M.D., director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. “It will take a concerted effort at all levels across our nation to empower all young people, especially young gay and bisexual youth, with the tools and resources they need to protect themselves from HIV infection.” These efforts are underway as part of the National HIV/AIDS Strategy.

CDC works with partners across the country to help prevent HIV and other STDs among young people. These efforts include encouraging HIV education and testing, funding the delivery of targeted testing and prevention services for youth at greatest risk, and working to address the social and environmental factors that can place some youth at increased risk. CDC also provides data and support to help communities develop effective school- and community-based HIV and STD prevention efforts.

The truth about vitamins and heart health: Taking a multivitamin does not appear to have a role in preventing cardiovascular disease

December 2012

Hearts and multivitamins

Taking a multivitamin does not appear to have a role in preventing cardiovascular disease. A clinical trial lasting about11 years on nearly 15,000 male doctors who were 50 years of age or older tested whether multivitamin use could lower the risk of heart disease, stroke and death from cardiovascular causes.

Howard Sesso of Harvard-affiliated Brigham and Women’s Hospital:

“Taking a daily multivitamin over the long term appeared to have no risk or benefit on major cardiovascular outcomes.”

Sesso says that to prevent cardiovascular disease, eating right, such as eating more whole grains, fruits, and vegetables, does work.

The study, presented at an American Heart Association meeting and published in the Journal of the American Medical Association, was supported by the National Institutes of Health.

Sports and longevity: Olympics medal winners live longer than others

Olympians Live Longer Than the Rest of Us

by Sarah C. P. Williams

When medal-winning athletes return home from the Olympic Games, their fame may be short-lived, but they can look forward to a long life, reports Science.

A new study has found that Olympic medalists live an average of 2.8 years longer than the rest of us, whether they're a gymnast, golfer, runner, or athlete in any other event.

The study used data on 15,174 male and female athletes who won medals in Olympic Games since 1896 and found that 30 years after any given Olympics, 8% more medalists were alive than others from their country and birth year.

The effect, a second study concluded, wasn't just seen in Olympic athletes who participated in high-endurance or high-intensity events. Researchers found no difference in mortality, for example, between cyclists, rowers, tennis stars, and cricket players.

But the factor that did make a difference: whether a sport had high levels of physical contact and collisions. Olympians in sports with higher bodily collision, such as boxing, had an 11% higher mortality risk than those in sports with minimal collisions. Both studies were published online today in BMJ.

The researchers hypothesize that medalists could live longer because of their intensive training, exercise levels throughout life, or because their success leads to increased wealth or education levels, but more research will be needed to determine what is at play.

Beware! World Health Organisation is watching over motorists who drive in drunken state

WHO launches road safety campaign in Hyderabad

Focus on drive against drunken driving and saving lives

Hyderabad, 12th December 2012: The World Health Organization (WHO) Country Office for India and the Ministry of Health, Government of India today launched a multi-media campaign against drunken driving in Hyderabad and Cyberabad with support from the city’s local departments of police, health and transport.

In her message at the launch of the campaign, Dr Nata Menabde, WHO Representative to India, said, “We call for greater action towards prompting a culture of responsible driving in our society to save lives on the roads.”

Kick-starting the month long multi-media awareness generation campaign, DCP (traffic) Mr Ramakrishna, flagged off a specially designed vehicle aimed at sensitizing the general public about ills of drunken driving. The vehicle - a car, which has been in an accident - was wrapped in a way to give the effect of a newspaper having messages/news clips communicating the adverse effects of drunken driving. Moving across the city, it will stop at vantage points including wine shops and distribute pamphlets based on the design of this vehicle to reiterate the key message of the campaign.

As part of the awareness campaign, the internationally renowned 48 Hour Film Project is inviting filmmakers from Hyderabad to make short films on the theme, “Do Not Drink and Drive.” The participants have to complete the films in just two days, and they will be used to create greater awareness through social media forums as well as on-ground activities like screenings. The competition will be held on the weekend of 21-23 December and is open to all, amateurs and professional filmmakers. 

Targeting the young drivers, the campaign encourages responsible driving. Speaking about the project  Mr Ramakrishna said, “The Police Department has been very active with the enforcement drive against drunken driving and we are delighted to support this initiative. It will bring about greater awareness about road safety and the risks of drunken driving, and thereby save lives.”

“I am happy that the mass media campaign will be accompanied by on-ground activities, and outdoor exposure through hoardings, bus panels and cinemas. This will make the campaign more effective,” he further added.

The pilot project is part of RS 10, a road safety initiative in ten countries. In India, the RS 10 project started in April 2010, and the first phase was completed in December 2011 in the cities of Hyderabad and Jalandar (Punjab).

The RS 10 project is an important initiative launched under the Decade of Action for Road Safety 2011-2020, which covers more than 100 countries, with one goal: to prevent five million road traffic deaths globally by 2020. The campaign against drunken driving is being carried out in coordination with the consortium partners Global Road Safety Partnership and Johns Hopkins University.

Infectious diseases are causing fewer deaths and illnesses worldwide than two decades ago, with fewer kids dying, but younger and middle-aged adults are bearing more of the overall medical burden

Global study notes progress against infectious diseases

Dec 13, 2012 (CIDRAP News) – Infectious diseases are causing fewer deaths and illnesses worldwide than two decades ago, with fewer kids dying, but younger and middle-aged adults are bearing more of the overall medical burden, according to a massive multipart study published today in The Lancet.

Titled the Global Burden of Disease Study 2010 (GBD 2010), the report represents the biggest systematic effort to portray the world's distribution and causes of a wide range of major diseases, injuries, and health risk factors, and the first since a 1990 GBD study was commissioned by the World Bank, according to a Lancet press release.

The latest effort took 5 years and involved 486 authors in 50 different countries. The Lancet today released an online issue containing the study's seven main articles plus eight related commentaries from experts.

The study was led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, with main collaborators at the University of Queensland, Harvard School of Public Health, Johns Hopkins Bloomberg School of Public Health, University of Tokyo, Imperial College London, and World Health Organization (WHO).

This is the first time The Lancet has ever dedicated an entire issue to a single study, which journal editors will officially launch tomorrow at The Royal Society in London.

Christopher Murray, MD, DPhil, director of IHME, said in the press release e-mailed to reporters that study findings enable policymakers, health leaders, and informed citizens to see the big picture and weigh different factors such as specific diseases, risk factors, and demographics to understand the most important drivers of health loss.

Unlike the 1990 GBD study, the new study includes data generated from different points in time, allowing researchers to track how health indictors have changed over the last two decades. Another of the study's main findings is that since 1970 men and women across the world have gained slightly more than 10 years of life expectancy, though they spend more years livings with injury and illness.

Despite the global gain in life expectancy, some countries have seen declines, according to the first of the seven study articles. The authors reported that between 1970 and 2010 the AIDS epidemic in southern sub-Saharan Africa dropped the life expectancy for men by 1.3 years for women by 0.9 years.

In the second paper, which addressed the leading causes of death, researchers reported that deaths attributed to communicable, maternal, neonatal, and nutritional causes dropped by around 17% between 1990 and 2010. A substantial part of the decrease was driven by reductions in deaths caused by diarrheal disease, lower respiratory tract infections, neonatal conditions, measles, and tetanus.

However, despite the overall global decrease, communicable, maternal, and neonatal causes still accounted for half of all premature deaths in sub-Saharan Africa in 2010, the group reported. "The burden of HIV and malaria remain high, despite concerted efforts to tackle these communicable diseases in recent years," they wrote.

In articles that addressed healthy life expectancy and living with disability, researchers noted that over the years, Millennium Development Goals have been crafted to reduce the burden of specific diseases such as HIV, tuberculosis, and malaria, with varying results. Overall, however, disability has changed little, they note. They wrote that the findings are a reminder that health is about more than just avoiding death.

In the commentaries, Richard Horton, MD, editor-in-chief of The Lancet, wrote that infectious diseases are being controlled, but big gaps remain in some of the world's regions where, for example, tuberculosis and malaria each were estimated to have killed 1.2 million people in 2010.

He emphasized that the most affected area remains Africa. "Here, maternal, newborn, and child mortality, along with a broad array of vaccine-preventable and other communicable diseases, remain urgent concerns," Horton wrote.

Margaret Chan, MD, director-general of the WHO, wrote in a commentary that the WHO warmly welcomes the study and that accurate assessments of global health trends is essential for setting health policies. She said in many instances the findings are similar to recent WHO estimates, but some differ substantially.

The world needs common standards for sharing and documenting data, she said, adding that as a next step she will convene an expert group in 2013 to review work on global health estimates and discuss ways to improve estimates.

Chan reminded health officials that the real need is to close data gaps, especially in low- and middle-income countries so that global health groups don't need to rely on statistical modeling for gauging disease burden.