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Lack of health insurance limits hepatitis C patients’ access to latest antiviral therapy

Infections • • Public HealthFeb 25 11

New research has determined that patients in the U.S. with hepatitis C virus (HCV) are twice as likely to not have health insurance coverage compared with those without the disease. In fact researchers found only a third of HCV infected Americans have access to antiviral therapy; the remaining are either uninsured or not candidates for therapy due to treatment contraindications. Details of this study are published in the March issue of Hepatology, a peer-reviewed journal of the American Association for the Study of Liver Diseases (AASLD).

HCV is the most common cause of chronic liver disease, hepatocellular (liver) cancer, and liver transplantation in the U.S., with up to 85% of HCV-positive individuals (3.5 million) developing chronic HCV infection. Symptoms of chronic HCV are non-specific which can inhibit diagnosis and as many as 75% of patients are unaware of their HCV infection (Hagan et al., 2006). Furthermore, the Centers for Disease Control and Prevention (CDC) estimates that HCV causes 12,000 deaths in the U.S. each year.

“Successful treatment with antiviral therapy improves health-related quality of life in patients with HCV and could potentially reduce morbidity and mortality in patients,” said Zobair Younossi, MD, MPH, from the Center of Liver Diseases at Inova Fairfax Hospital in Virginia and lead author of the study. “A significant number of HCV patients, however, may not even have access to antiviral therapy due to lack of adequate health insurance coverage.” It is estimated to cost up to $48,000 per year for monitoring and treatment of HCV.

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Can breastfeeding transmit yellow fever after maternal vaccination?

Children's Health • • InfectionsFeb 07 11

A five-week old infant most likely contracted a vaccine strain of yellow fever virus through breastfeeding, according to a case report published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only)

“Until recently, avoidance of vaccination of breastfeeding women with yellow fever vaccine had been based on theoretical grounds only,” writes Dr. Susan Kuhn, with coauthors. “We report the probable transmission of vaccine strain of yellow fever virus from a mother to her infant through breastfeeding,” which supports current recommendations for breastfeeding mothers to avoid the vaccine.

The yellow fever vaccine is a live-virus vaccine that has been used since the 1940s.

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New research examines how HIV infections occur on the molecular level

AIDS/HIV • • InfectionsJan 18 11

The UK’s National Physical Laboratory (NPL) with the University of Edinburgh and IBM’s TJ Watson Research Center have published new research about the structure of an HIV-1 protein that could help to develop new drugs to stop the virus infecting healthy cells.

The research provides a new insight into how the changes in structure of a small part of an HIV protein (a membrane proximal peptide) may alter the infection of the virus into healthy cells. The team was able to observe key changes in this part of the protein implicated in the early stages of the infection by using a combination of powerful experimental and computational tools. This is the first attempt to demonstrate that the inducible binding of the peptide with membrane-like surfaces can serve as a responsive molecular anchor underpinning HIV fusion to target cells.

This information is important as it gives us a better understanding of how HIV infections take hold at the molecular level. Drug designers could use this information to develop treatments that stop HIV from entering a healthy cell and infecting it.

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Researchers visualize herpes virus’ tactical maneuver

Infections • • Sexual HealthJan 07 11

For the first time, researchers have developed a 3D picture of a herpes virus protein interacting with a key part of the human cellular machinery, enhancing our understanding of how it hijacks human cells to spread infection and opening up new possibilities for stepping in to prevent or treat infection. This discovery uncovers one of the many tactical manoeuvres employed by the virus.

The Biotechnology and Biological Sciences Research Council (BBSRC)-funded team, led by The University of Manchester, have used NMR - a technique related to the one used in MRI body scanners and capable of visualising molecules at the smallest scales – to produce images of a herpes virus protein interacting with a mouse cellular protein. These images were then used to develop a 3D model of this herpes virus protein interacting with human protein. The research is published this evening (06 January) in PLoS Pathogens.

Lead researcher Dr Alexander Golovanov from Manchester’s Interdisciplinary Biocentre and Faculty of Life Sciences said “There are quite a few types of herpes viruses that cause problems as mild as cold sores through to some quite serious illnesses, such as shingles or even cancer. Viruses cannot survive or replicate on their own – they need the resources and apparatus within a human cell to do so. To prevent or treat diseases caused by viruses we need to know as much as possible about how they do this so that we can spot weak points or take out key tactical manoeuvres.”

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Hepatitis C: In 2011, a predictive marker for response to therapy

InfectionsJan 05 11

Scientists at Inserm and Institut Pasteur have performed biomarker discovery on patients being treated for chronic hepatitis C infection. Their work, published in The Journal of Clinical Investigation, demonstrates that the plasma levels of the protein IP-10 predict, prior to treatment initiation, the efficacy of treatment with pegylated-interferon and ribavirin. Based on these results, the scientists have developed a prognostic test. Commercialization is anticipated in 2011, and will help inform physicians of the chances that patients will respond to standard treatment or if instead they will require new therapeutic cocktails (e.g., inclusion of protease inhibitors).

Importantly, hepatitis C is the leading cause of primary liver cancer (hepatocellular carcinoma) and it remains an important cause of liver failure due to fibrosis and cirrhosis. This infectious disease represents a major public health problem, with greater than 170 million cases worldwide. The World Health Organization estimates 3 to 4 million new cases per year and considers the virus a ” viral time bomb” due to the long term sequella of infection.

Currently, there is no approved vaccine available and approximately 80% of individuals infected by the virus develop chronic disease, a risk factor for cirrhosis, liver failure, liver cancer as well as other medical complications (e.g., diabetes).

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New test announced for major killer of lung transplant patients

Infections • • Respiratory ProblemsJan 01 11

A lung transplant can mean a new chance at life. But many who receive one develop a debilitating, fatal condition that causes scar tissue to build up in the lungs and chokes off the ability to breathe.

University of Michigan researchers hope a new diagnostic tool they developed to predict bronchiolitis obliterans syndrome (BOS) will allow doctors to intervene earlier and, ultimately, to provide life-saving treatments.

BOS is the leading cause of death for those who survive one year after lung transplantation and more than half of recipients will develop BOS within five years. There is currently no cure.

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New Research Finds Delaying Surgical Procedures Increases Infection Risk and Health Care Cost

Infections • • SurgeryDec 15 10

Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs, according to the results of a new study in the December issue of the Journal of the American College of Surgeons.

The occurrence of infection following surgical procedures continues to be a major source of morbidity and expense despite extensive prevention efforts that have been implemented through educational programs, clinical guidelines, and hospital-based policies. The authors of the study queried a nationwide sample of 163,006 patients, 40 years of age and older, from 2003 to 2007. They evaluated patients who developed postoperative complications following one of three high-volume elective surgical procedures: 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections.

The infectious complications evaluated included pneumonia, urinary tract infections, postoperative sepsis and surgical site infections.

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Cholera fighting efforts restart in Haiti’s north

Infections • • Public HealthNov 22 10

Aid supplies to combat Haiti’s deadly cholera epidemic are flowing again into the country’s northern regions after protests by Haitians blaming U.N. troops for the outbreak, humanitarian groups said on Sunday.

Vehicles carrying equipment from some aid groups have begun to reach the northern city of Cap-Haitien, where aid efforts were disrupted last week by several days of protests that saw Haitians throw up road barricades and hurl stones at U.N. peacekeepers, said Imogen Wall of the U.N. humanitarian agency, OCHA.

“The security situation there has now stabilized,” Wall said. “We’re going to have to scramble to get back to where we were.”

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Studies examine costs, prospects of ending malaria

InfectionsOct 30 10

Eliminating malaria can be achieved only with repeated investment over the long term and will require a major shift in policy and funding now focused on control of the disease, experts said on Friday.

In a series of studies in the Lancet medical journal about the prospect of trying to eradicate the often deadly infectious disease, scientists said that for many countries, wiping it out would take many decades rather than be a quick victory.

Like routine immunizations against diseases such as smallpox or measles, it would require long-term investment to make sure the disease does not come back, even after the intensive elimination activity is over, they said.

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Oklahoma investigates salmonella outbreak

Infections • • Public HealthOct 05 10

Oklahoma health officials are investigating an outbreak of salmonella in several schoolchildren and some adults and say it may be connected to similar outbreaks in Iowa and Nebraska.

A total of 16 cases in three counties have been identified involving at least four elementary schools, according to Leslea Bennett-Webb, spokeswoman for the Oklahoma Department of Health.

No one has died, although one adult has been hospitalized due to the strain of Salmonella “Java” that can cause bloody diarrhea, abdominal cramps, fever and vomiting.

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Genetic signature may lead to better TB diagnosis

Infections • • TuberculosisAug 19 10

Scientists have found a “genetic signature” in the blood of patients with active tuberculosis (TB) and believe their discovery could help develop better diagnostic tests for the disease, as well as better treatments.

More than 2 billion people, or a third of the world’s population, are estimated to be infected with the organism Mycobacterium tuberculosis (MTB), which causes TB, but the vast majority have the infection in latent form and have no symptoms.

The British scientists said they had now found a pattern of genes in the blood that is specific to up to 10 percent of those 2 billion people who develop active TB in their lungs.

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Dogs may help collar Chagas disease

Infections • • Public HealthJul 12 10

Chagas disease, for example, is caused by a parasite that roams with only limited control among the rural poor in Latin America. The main vector for the parasite Trypanosoma cruzi is the triatomine insect, or “kissing bug,” which thrives in the nooks and crannies of mud-brick dwellings. The bug sucks the blood of mammals, helping T. cruzi move between wildlife, cats, dogs and humans.

“Dogs tend to lie on porches or other areas easily accessible to the bugs,” says disease ecologist Uriel Kitron, chair of environmental studies at Emory University. “And when a dog is malnourished and its immune system isn’t great, they are even more at risk.”

Kitron has been researching Chagas disease in remote communities of northern Argentina for the past 10 years. “One of our most significant findings is the importance of dogs in both the spread of the disease, and the potential to help control it,” he says, explaining that dogs can make good sentinels for health officials monitoring T. cruzi transmission.

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Early-Life Exposure to Polychlorinated Biphenyls Reduces Immune Response to Vaccination

Immunology • • InfectionsJun 21 10

Children exposed to polychlorinated biphenyls (PCBs) early in life later had a diminished immune response to diphtheria and tetanus vaccinations, according to a study published online June 20 ahead of print in the peer-reviewed journal Environmental Health Perspectives (EHP). This result suggests that PCB exposure during the first years of life, a critical period in immune system development, could undermine the effectiveness of childhood vaccinations and possibly impair immune system responses to infection.

PCBs are long-lived environmental contaminants that are suspected to be toxic to the immune system. The study included 587 children born between 1999 and 2001 who lived in the Faroe Islands. The residents of the Faroe Islands, which lie midway between Norway and Iceland in the North Atlantic, have widely varying PCB exposure due to differing consumption patterns of contaminated traditional foods such as pilot whale blubber. Routine childhood vaccinations, which feature standard antigen doses at set time points, provided an opportunity to examine immune responses in the Faroese children.

Mothers provided blood samples at 32 weeks of pregnancy and milk samples 4 to 5 days after birth.

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Russia registers first polio death in a decade

Infections • • Public HealthJun 14 10

Russia has confirmed its first death from polio in more than a decade, the country’s top public health official said on Sunday, Interfax news agency reported.

A citizen of the former-Soviet Central Asian country of Uzbekistan died of polio in the Urals Mountains city of Yekaterinburg in early June, Gennady Onishchenko was quoted as saying. “Tests have confirmed this,” he said.

Onishchenko’s spokeswoman was unavailable to comment on the report on Sunday.

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African mining may be driving TB epidemic: study

Infections • • TuberculosisJun 02 10

Poor living and working conditions for miners of gold, diamonds and other precious metals have contributed significantly to tuberculosis (TB) epidemics across Africa, scientists said on Tuesday.

Researchers from Britain and the United States said their study suggested that crowded living and working conditions, dust in mines, and the spread of HIV mean Africa’s mining industry may figure in up to 760,000 new cases of TB each year.

Men travelling from afar to work in mines, such as from Botswana to South Africa, are at the greatest risk of getting TB, the researchers wrote in a study published in the American Journal of Public Health.

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