Last Flu Season Was Mild, But Child Deaths Worrying

Although the 2006-07 flu season was comparatively mild in the United States, it still claimed the lives of 68 children, and experts say more must be done to reduce the death toll. They're especially concerned about the steady rise in a potentially lethal combination of infection with flu and drug-resistant staphylococcus, or "staph."

"While waiting to see what this year will bring, we should all plan to roll our sleeves up and get vaccinated and in no way let our guard down," said Dr. David Katz, director of Yale University School of Medicine's Prevention Research Center. In a report released Thursday by the U.S. Centers for Disease Control and Prevention, experts said the 2006-07 flu season peaked in mid-February. And there were actually fewer pediatric deaths and fewer children hospitalized with influenza than in the past three flu seasons, according to the CDC.

But, among the 68 children whose deaths were associated with flu from Oct. 1, 2006, to May 19, 2007, 21 had influenza plus Stapholococcus aureus ("staph") that was resistant to a leading antibiotic, methicillin, according to the report in the Aug. 10 issue of the CDC's Morbidity and Mortality Weekly Report.

In comparison, only one child died from flu coupled with S. aureus infection in 2004 through 2005, and three died during the 2005-06 season, the CDC said.

"We are looking into the number of deaths of children combined with staff bacterial infection," said Dr. Joe Bresee, CDC's chief of the Epidemiology and Prevention Branch in the Influenza Division. "From our perspective, it looks like it has increased."

Bresee said the CDC isn't sure if the number of deaths is actually rising, or the increase is due to better reporting. "The actual risk to kids from this is not known, but it is concerning," he said.

Bresee thinks that increasing the number of young children who get flu shots is key to reducing the problem. "They would be less likely to get influenza and, therefore, less likely to get co-infections with S. aureus," he said.

Despite the troubling news that such dual infections may be on the rise, the past season's flu statistics were relatively positive, Katz said.

"Data from the last flu season provide mostly good news," he said. "The number of cases was never unusually high. The strains were mostly of the expected varieties, and vaccine composition was just right. The death toll from complications of influenza was a bit lower than average."

The reasons for the milder flu season aren't clear, said Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine. "It could be increased surveillance and improved care and more awareness of what influenza can do," he said. "It may also be a less virulent strain of the virus."

Katz noted that, even in a good year, the average number of deaths from flu in the United States totals about 30,000, mostly among the elderly.

During the 2006-07 flu season, the influenza A (H1) virus was most common in the United States, but the A (H3) virus was found to be more common late in the season, according to the CDC.

For the 2007-08 vaccine, the U.S. Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee has recommended that the trivalent flu vaccine contain A/Solomon Islands/3/2006-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses, the CDC reported.

The influenza A (H3N2) and influenza B components remain the same for the new vaccine. These recommendations were based on antigenic analyses of recently isolated influenza viruses, epidemiologic data, vaccination studies in humans, and the availability of vaccine strains and reagents, the CDC said.

Last season, around the world, influenza A (H1), A (H3), and B viruses were most common. In Africa, small amounts of influenza A and B were seen. In Europe and Asia, influenza A (H3) virus was most common, but low levels of A (H1) were seen. Influenza B viruses were seen at lower levels in Asia and Europe but were most common in some countries, according to the CDC.

The best way to protect yourself from flu is to get vaccinated, experts said. "We had a good flu year. But that was last year," Katz noted.

In terms of the H5N1 bird flu virus, from December 2003 to mid-July 2007, 319 cases of bird flu in humans were reported to the World Health Organization. Among these cases, 60 percent (192) were fatal. To date, no human cases of bird flu have been reported in the United States.

All human cases were reported from Asia (Azerbaijan, Cambodia, China, Indonesia, Iraq, Laos, Thailand, Turkey, and Vietnam) and Africa (Djibouti, Egypt, and Nigeria).

But, "the threat of an avian flu pandemic still looms," Katz said. "To date, deaths from avian flu have been few, and limited to Asia. But no one knows for sure when that might change."

Siegel, author of Bird Flu: Everything You Need to Know About the Next Pandemic, noted that although H5N1 has a high mortality rate, "we see year after year that it is confined to birds. There is no indication that it is about to become a massive human problem. There is no indication that it is on the verge of transforming."

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Check-ups, immunizations urged for pre-teens

By scheduling a well-child visit for their 11- or 12-year-old, parents can help protect their pre-teen's health into the turbulent teen years and beyond, according to the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). At this visit, kids can be immunized or re-vaccinated against whooping cough, meningitis and other serious infectious diseases. It's also an opportunity for parent, child and doctor to discuss health concerns that become increasingly important in adolescence, such as growth, nutrition and obesity; peer pressure, substance use and sex; and more, Dr. Anne Schuchat, the director of the CDC's National Center for Immunization and Respiratory Diseases, told Reuters Health.

Currently, just 9 percent of pediatrician visits by 11- to 12-year-olds are for preventive care, Schuchat notes; the rest are for illness and injury. This means many parents and their pre-teens are missing an opportunity to update immunizations and address key health issues.

With this in mind, the CDC and the AAP have launched their first-ever Preteen Vaccine campaign to increase awareness of three new vaccines now routinely recommended for 11- and 12-year olds. They include Tdap, a tetanus, diphtheria and pertussis (whooping cough) booster, and MCV4, which helps prevent meningitis, both introduced in 2005; and the cervical cancer-preventing human papilloma virus (HPV) vaccine for girls, which became available last year.

"Most parents know about vaccines for babies," Schuchat noted. "A lot of parents think that immunization ends at the beginning of elementary school, but that's just not true."

Immunity to some infectious diseases, such as whooping cough, begins to fade in the pre-teen years, she explained, making boosters particularly important. Moreover, in adolescence, kids become increasingly vulnerable to meningococcal meningitis, an infection of the membranes surrounding the brain and spinal cord that can lead to permanent disability or even death. "It's a very tragic disease and now it can be prevented through the vaccine," Schuchat said.

While some parents may question giving girls a vaccine against a sexually transmitted virus at such a young age, this is actually the best time for them to be immunized against HPV, she added. Preteens have a stronger antibody response to the shot than young adults, Schuchat explained, and giving the vaccine -- which requires a series of three injections -- so early ensures that a girl is well protected years before sexual activity begins.

The cost of the shots shouldn't worry, Schuchat noted. Health insurers typically cover immunizations recommended by the CDC, and the CDC's Vaccinations for Children program will pay for immunizations for uninsured kids, she added, as long as a child's pediatrician is participating in the program, and most do.

Another key issue for pre-teens is obesity, Schuchat noted. At this age, boys and girls are growing so quickly that they, and their parents, may not know if they are overweight or obese, and checking in with their pediatrician will give them a chance to talk about nutrition and exercise.

Finally, the pre-teen well-child visit is generally the first time that a pediatrician will speak to the child privately, which can help build a relationship that makes it possible for the child to address sensitive issues with his or her doctor down the road.

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Calcium supplements ward of pregnancy complication

Pregnant women who take calcium supplements reduce their risk of developing preeclampsia, sometimes called toxemia of pregnancy, according to a new study. However, calcium supplementation has no effect on the risk of preterm birth or stillbirth. Dr. G. J. Hofmeyr, of the University of the Witwatersrand/University of Fort Hare, East London, South Africa, and colleagues conducted a systematic review of 12 clinical trials, involving over 15,500 women, that compared at least 1 gram of calcium daily during pregnancy with an inactive "placebo" supplement.

Most of the women were at low risk for pregnancy complications, but they had low levels of calcium in their diet. Compared with placebo, calcium supplementation was associated with less high blood pressure and less preeclampsia, the investigators report in the British Journal of Obstetrics and Gynecology.No overall effect was seen on the risk of preterm birth or stillbirth or infant death before hospital discharge.

"Calcium supplementation during pregnancy for women with deficient dietary calcium intake offers modest benefit for individual women," Hofmeyr's team concludes.

"However, a public health policy of calcium supplementation during pregnancy is unlikely to have a major impact on the incidence of pre-eclampsia," they continue, because in those communities where dietary calcium is inadequate, high-risk women "often attend antenatal clinics late in pregnancy or not at all and so would not benefit from strategies directed at those attending for antenatal care."

The researchers therefore suggest "that future research be directed towards evaluation of improving calcium intake at a population level, for example by food fortification, rather than at an individual level."

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Some children shut out from vaccines

For children whose health insurance doesn't cover newly recommended shots, it's better to have no insurance at all, a new study suggests. Free vaccines are available to children who are uninsured or qualify for public insurance. But many states can't afford to help children with inadequate private insurance that doesn't cover new, expensive shots and even some older shots, the study found. That puts more than a million children at risk, researchers said.

Illinois, for example, doesn't provide vaccines against chickenpox, pneumonia, hepatitis A, human papillomavirus and rotavirus to children with insufficient private insurance. Parents would have to pay $400 out of pocket for those vaccines. "Health insurance plans are not necessarily keeping up with the new vaccines, posing significant ethical dilemmas to public health clinics," said the study's lead author Dr. Grace Lee of Harvard Medical School.

The study of the nation's patchwork system of paying for immunizations appears in Wednesday's Journal of the American Medical Association.

Childhood shots have become a $1 billion-a-year endeavor for government since the discovery of polio vaccine 55 years ago. The per-child cost grew more than sevenfold from $155 in 1995 to $900 for boys and $1,200 for girls this year. Costs in the private sector are higher.

Lee and her colleagues surveyed states to find out which shots they provide and to whom. Program managers from 48 states responded. Lee wouldn't say which states participated because researchers promised anonymity.

Sixteen of the states require health insurers to cover all recommended vaccines.

About 55 million employees and their dependents get coverage through self-insured companies that are exempt from state mandates. Those people are the most likely to be underinsured for vaccines, said vaccine policy expert Dr. Matthew Davis of the University of Michigan.

According to the research, 17 states reported they were unable to give a vaccine for meningitis to children with inadequate private insurance, even if they were seen in public health clinics. And eight states don't give pneumococcal shots to underinsured infants and toddlers.

A handful of states don't provide shots for chickenpox and hepatitis A to the underinsured. Two states don't provide Tdap, the combined booster shot for tetanus, diphtheria and pertussis (whooping cough) for 11- to 12-year-olds.

More than 1 million insured children are unable to get the meningococcal vaccine leaving them vulnerable to potentially deadly infection, the researchers estimated.

The survey did not ask about two vaccines recommended last year: an oral vaccine for infants against rotavirus, a common cause of childhood diarrhea and vomiting, and a vaccine for girls against human papillomavirus, which can cause cervical cancer.

Workers covered by plans marketed by Aetna and other insurance companies generally are covered for childhood vaccines, although they may have to pay co-payments or satisfy deductibles, said Mohit Ghose, a spokesman for America's Health Insurance Plans.

As costs rise, it may be necessary to decide at a national level which vaccines are most important, Davis said. He was not involved in the new study, but wrote an accompanying editorial in the journal.

Officials at the U.S. Centers for Disease Control and Prevention oppose prioritizing vaccines and instead favor better coverage by insurers and more government funding as a safety net, said CDC immunizations director Dr. Lance Rodewald.

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Energy drinks' caffeine in line with coffee

Despite such speedy-sounding names as "Full Throttle," "Amp" and "Rush," energy drinks pack a punch that is generally no stronger than coffee, according to a report released on Monday. A comparison of 12 popular energy drinks, published in the September issue of Consumer Reports, found that the caffeine in 8 ounces of various brands ranged from 50-145 milligrams (mg), though most were in the 75- to 80-mg range.

Results were rounded to the nearest 5 mg. By comparison, the caffeine in an 8-oz cup of brewed coffee can range from 65-120 mg, with an average of 85 mg, according to the National Coffee Association. The least-caffeinated energy drink Consumer Reports tested was the fruit punch-flavored offering by Target Corp.'s private label Archer Farms, with 50 mg. At the high end was the lemon-lime flavored Celsius with 145 mg.

Market-leading Red Bull had 80 mg of caffeine. Sobe No Fear, owned by PepsiCo Inc., had 85 mg of caffeine. Amp had 75 mg of caffeine, while Rush and Coca-Cola Co.'s Full Throttle both had 80 mg.

Jamie Kopf Hirsh, associate editor at Consumer Reports and the report's author, said it was "good news" that energy drinks were not much more caffeinated than coffee, but said consumers should still be cautious.

Even though 8 ounces is the standard serving size for measuring, most containers have more than that, and most consumers drink more than that.

"You don't have to be alarmed by this, you just have to account for it in your daily caffeine intake," Hirsh said, adding that energy drinks, with their graphic video-game-like logos that appeal to young men, could be "coffee for the new generation."

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Coffee may slow memory declines in women

Drinking more than three cups of coffee a day helped protect older women against some age-related memory decline, French researchers said on Monday, giving women more reason to love the world's most popular stimulant. Men did not enjoy the same benefit, they said. "The more coffee one drank, the better the effects seemed to be on (women's) memory functioning in particular," said Karen Ritchie at the French National Institute of Medical Research, whose work appears in the journal Neurology.

The researchers followed more than 7,000 men and women in three French cities, checking their health and mental function and asking them about their current and past eating and drinking habits, their friends, and their daily activities. They used this information to sort out the specific role caffeine played in these women's lives.

They found that women who drank more than three cups of coffee per day, or its caffeine equivalent in tea, retained more of their verbal and -- to a lesser extent -- visual memories over four years.

These women had a 33 percent lower odds of having verbal memory declines and 18 percent lower odds of having visual and spatial memory declines, compared to women who drank one cup or fewer per day.

The effect also depended on age, with women over 80 reaping more benefits from these beverages than those who were 10 to 15 years younger, Ritchie's team wrote. It was unclear whether current or former coffee consumption made the difference.

Some studies in mice have suggested that caffeine might block the buildup of proteins that lead to mental decline.

Ritchie is not sure why only women benefited in her study.

"Our best guess is that women don't metabolize coffee in the same way (as men)," she said in a telephone interview.

Ritchie plans to follow the women longer to see if caffeine delays the onset of dementia -- the mental confusion that signals Alzheimer's disease and other brain disorders.

She said people should weigh any brain gains derived from caffeine against other effects of the stimulant, including raised blood pressure.

The average American drinks one to two cups of coffee a day, according to the National Coffee Association.

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New treatment boosts survival chances for child leukaemia

A prototype method of treating infants with a form of leukaemia boosts their chances of survival compared with the standard drug regimen, according to a paper published in next Saturday's Lancet.

In general, children with acute lymphoblastic leukaemia have a good chance of survival -- about 80 percent today, compared with only 10 percent 40 years ago.

But this success rate drops significantly in infants aged under 12 months, where it falls to a range of 17-45 percent.

Dutch doctors carried out a study of 482 infants from 22 countries who were aged under one year and had been diagnosed with the disease.

In addition to the standard drug for acute lymphoblastic leukaemia -- a treatment called Prednisone -- the children were given tiny doses of drugs usually designed for treating a related form of cancer, acute myeloid leukaemia.

The key ingredient was Cytabarine, which in lab-dish tests have been shown to be highly effective against lymphoblasts, as immature lymphocyte cells are called.

At the 38-month followup mark, 260 (58 percent) of the patients who received this "hybrid" treatment were in complete remission.

Meanwhile, a separate study, also published in The Lancet, highlights new combination chemotherapy for chronic lymphyocytic leukaemia, the commonest form of leukaemia in the developed world.

Institute of Cancer Research doctors in Britain found that fludarabine (marketed as Fludara) and chlorambucil (Leukeran), when used together, were no better than fludarabine alone or chorambucil alone in boosting a patient's chance of survival five years after treatment.

However, the combination more than tripled the chance that the disease had not progressed by the time of the five-year checkup.

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