Clean your home and business.

Keep mold from harming you, your family, or your employees.

Use SteriLight to purify the indoor air.

Use Germ Free 60 to clean surfaces and skin.

------------

From:                     DoD News [dlnews_sender@DTIC.MIL]

Sent:                      Wednesday, June 30, 2004 10:16 AM

To:                         DODNEWS-L@DTIC.MIL

Subject:                 Anthrax, Smallpox Protection Policies Updated

NEWS RELEASE from the United States Department of Defense

No. 624-04

IMMEDIATE RELEASE

Jun 30, 2004

Media Contact: (703)697-5131

Public/Industry Contact: (703)428-0711

Anthrax, Smallpox Protection Policies Updated

          William Winkenwerder, Jr., MD, assistant secretary of defense for health affairs, today announced that the anthrax and smallpox vaccination programs would include selected units within the U. S. Pacific Command, additional personnel now serving with the U.S. Central Command and selected other groups of individuals.

          “The decision to protect additional personnel with these vaccines reflects our concern for their health and safety as well as the continuity of essential operations,” said Winkenwerder. “When we began these vaccination programs we stated that we would periodically review them, evaluating the threats to our forces and vaccine availability. We recently completed such an evaluation and determined that the threat continues. In light of our successful implementation of these programs and the increased quantities of vaccine, we will include additional forces in the vaccination programs,” he offered.

          Vaccination offers an extra layer of protection, in addition to antibiotics and other measures, that is needed for members of the armed forces, emergency-essential DoD civilians and contractor personnel carrying out mission-essential services.

          The program update will continue to include personnel assigned or deployed to the selected units for 15 or more consecutive days.  DoD will offer the vaccinations to family members in these geographic areas on a voluntary basis.  We will pursue vaccination, subject to appropriate Personnel and Contractor procedures, of emergency essential civilian employees and comparable contractor personnel in these geographic areas.

         DoD continues to reserve a portion of the vaccine supply for contingency use by other federal agencies.  The Office of Homeland Security heads the planning effort among federal agencies for use of the vaccine.

         Anthrax remains one of the top biological warfare threats to U.S. troops.  Vaccination is the safest and most reliable way to protect U. S. Forces from a potential threat that is highly lethal, even with early treatment.  Since June 2002, DoD has vaccinated more than 750,000 service members with more than 2.2 million doses of anthrax vaccine.  Refusals among service members leading to separations from the service have been extremely rare since 2002, only four per 100,000 persons vaccinated.

           Because of its contagiousness, smallpox is also considered a top biological warfare threat.  It can cause a severe rash covering the whole body that can leave permanent scars, high fever, severe headaches or backaches.  Smallpox infection kills about three out of ten people infected.  This disease, as a bioweapon, can generate significant consequences and critically interrupt military operations.  Since December 2002, DoD has vaccinated more than 625,000 service members.

The Department continues to work aggressively with the Department of Health and Human Services, using a new federal coordinating committee and the Bioshield Legislation to prioritize and develop new and better vaccines and other medical countermeasures for biological threats to civilians and the military.

  More information about the Anthrax Vaccine Immunization Program is at *http://www.anthrax.mil/ [http://www.anthrax.osd.mil/] ;* and about the Smallpox Vaccination Program at *http://www.smallpox.mil [http://www.smallpox.mil/] *.

[Web Version: http://www.defenselink.mil/releases/2004/nr20040630-0955.html]

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-- U.S. Department of Defense News About the War on Terrorism -

http://www.defendamerica.mil

Clean your home and business.

Keep mold from harming you, your family, or your employees.

Use SteriLight to purify the indoor air.

Use Germ Free 60 to clean surfaces and skin.

From: owner-promed-ahead-edr@promed.isid.harvard.edu on behalf of ProMED

[promed@promed.isid.harvard.edu]

Sent: Friday, June 11, 2004 7:24 PM

To: promed-ahead-edr@promedmail.org

Subject: PRO/AH/EDR> Anthrax, laboratory error - USA (CA)

ANTHRAX, LABORATORY ERROR - USA (CALIFORNIA)

*******************************************

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases <http://www.isid.org>

Date: Fri, 11 Jun 2004 13:40:13 -0500

From: Richard Wilsnack<rwilsnac@medicine.nodak.edu>

Source: Oakland [California] Tribune [edited]

Workers exposed to anthrax; Live samples sent to Children's Hospital Oakland by mistake

-----------------------------------------------

At least 6 researchers working on an anthrax vaccine at Children's Hospital Oakland Research Institute were exposed to the dangerous live agent, possibly due to a shipping mix-up, officials said Thursday. The workers -- including a lead researcher, 2 lab technicians and an animal handler -- handled the live anthrax bacterium. Several other researchers were also present. None has shown signs of illness, and 7 are now on the antibiotic Cipro as a precautionary measure. The incident poses no risk to any other staff, the surrounding community or Children's Hospital, which is about one mile from the research facility, state health officials said.

"All the proper procedures are being followed here," said Dr. Richard Jackson, public health officer for the state Department of Health Services, which is investigating. [I am sure that the DHS follows proper procedures. - Mod.MHJ]

The institute's researchers believed they were working with a dead sample of the anthrax bacterium, but were inadvertently shipped live anthrax by their supplier, Southern Research Institute of Frederick, MD, hospital officials said. Children's Hospital Oakland Research Institute is not authorized to handle live anthrax. The sealed liquid agent was shipped via FedEx, double-boxed, about 3 months ago to Oakland, officials said.

Researchers began injecting what they thought was dead anthrax [bacilli or spores; 'anthrax' is the disease - Mod.MHJ] into mice 28 May 2004. Over that weekend, 10 mice died in separate cages, and animal handlers placed the mice in a freezer. It was not brought to the immediate attention of lead researchers that all the mice in the 1st experiment had died.

Last Friday, another batch of mice was inoculated with the deadly agent. On Monday, those mice, too, were dead, and the lead researcher obtained cultures from the cavity of a dead mouse. By Wednesday, the researchers discovered the anthrax organism growing [in] the abdominal cavity of the dead mouse.

"From there, the investigations continued at a rapid pace," said Dr. Ann Petru, a pediatric infectious disease expert at the institution. The institute contacted the state Department of Health Services and the federal Centers for Disease Control and Prevention, which launched their own investigations. Agents from the Federal Bureau of Investigation's bioterror unit transported the infected dead mice to the state's laboratory in Richmond on Wednesday afternoon, where evidence of the live bacterium was confirmed.

Samples have been sent to the CDC in Atlanta for further testing, Jackson said. Nasal samples from the lab workers are also being evaluated, with results expected next week, Petru said.  CDC spokeswoman Rhonda Smith said how the live agent was accidentally sent to Children's Hospital is under investigation. "We're working with the California Department of Health Services, the shipping and receiving institutions and the FBI to determine what happened and how we can prevent it from happening again," Smith said.

Southern Research Institute's Thomas Voss, who is in charge of the institute's emerging infectious disease program, said the company is investigating what happened. He said it's unclear whether the institute did ship live anthrax to Oakland. Voss said the institute's hot labs in Frederick and Birmingham, Ala., handle most "select agents" listed with the CDC, and that they are one of 350 entities registered to handle live anthrax. He said the institute rarely ships out the agents. "We receive agents on a routine basis," Voss said.

"But on our end, we ship very infrequently. I can't even recall shipping live agents."

Dr. Frederick Murphy, a microbiologist at University of California, Davis, said such mixups are extremely rare. "It's much more serious than it used to be," Murphy said. "There's all kinds of protocols in place to prevent these mistakes." Namely, deadly live bacteria require extensive permits to ship and are typically handled by couriers. The agents would be encased in a safe-like container to prevent tampering or any exposure.

Edward Hammond, director of the Sunshine Project, a watchdog group on biological weapons research, said with so many federal funds pouring into biodefense research, there should be more controls in place. "This hospital clearly did not have the ambition [sic -- ability? capacity?] to handle such agents," Hammond said.

Neighbors of the institute, located on Martin Luther King Jr. Drive, are wondering the same thing. "When (the institute) opened, they told us they would be researching meningitis, but they never talked about anthrax," said Bob Brokyl, a North Oakland activist. Brokyl noted that a senior center is housed in the same building as the institute, which is surrounded by a working-class neighborhood. "I'm really angry and nervous because ... {T]hey said they would never have anything dangerous there. The great children's hospitals of our country are where a lot of the most incredible research is done -- major research in infectious disease," he said.

[Byline: Rebecca Vesely, Robert Gammon, Jill Tucker & Associated Press]

--

Richard W. Wilsnack, Ph.D.

Department of Neuroscience

University of North Dakota School of Medicine & Health Sciences Grand Forks, ND  58202-9037 <rwilsnac@medicine.nodak.edu>

[We need reports like this on a Friday afternoon to lighten the week. It is hard to work out what they were trying to do by injecting mice with a dead product. My one suspicion, if they knew what they were up to, would be to develop antibodies to the spore exosporium. Michelle Mock at the Pasteur Institute, Paris, has nicely shown that if you mix dead spores with PA [protective antigen] you get enhanced immunity. Sterne vaccine is pathogenic for mice at certain doses but can be used safely at lower doses. Plus it is available and certainly cheaper than whatever they got from SRI, which might well have been intended to be dead Sterne anyway. From their nasal swabbing to the pointless prescription of Cipro, institutional spin, and the certainty of official visits from CDC, there is enough to satisfy anyone's need for schadenfreude and superiority. With the unbelievable sums of money flowing around the US in response to the perceived BT threats, it is a wonder that we have not had more reports of institutional embarrassment like this. Before the letters of 2001 there were probably only about a dozen US institutes working with _B. anthracis_; now apparently there are 350. Are we better off?

Enjoy your weekend. Thanks also to Philip Henika and Paul Cheek for sending reports on this event. - Mod.MHJ] ...................................jw/mhj/pg/jw

*#####*

ProMED-mail makes every effort to  verify  the reports  that are  posted,  but  the  accuracy  and  completeness  of  the information,   and  of  any  statements  or  opinions  based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by  ProMED-mail.   ISID and  its  associated  service  providers  shall not be  held responsible for errors or omissions or  held liable for  any damages incurred as a result of use or reliance upon  posted or archived material.

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#######

A landscape of laboratories

10/13/2004 - Updated 10:37 PM ET

In the aftermath of the terrorist and anthrax attacks in 2001, biodefense laboratories are springing up across the country. Critics worry that the lack of adequate safeguards could make these labs a danger to public safety, particularly in urban areas, if deadly materials escape. The most dangerous of these pathogens are in biosafety-4 labs.

Classifications:

States that either have, plan or are considering BSL-4 labs:

Biodefense aerosol facilities

Open-Air Testing facilities

Operational BSL-4 facilities

Planned BSL-4 facilities

Considering BSL-4 labs

Operational BSL-3 facilities

 (Major) planned BSL-3 facilities

Classified or secretive research

Source: The Sunshine Project

Posted 10/13/2004 10:29 PM     Updated 10/14/2004 3:21 AM

Anthrax slip-ups raise fears about planned biolabs

By Dan Vergano and Steve Sternberg, USA TODAY

Bruce Ivins was troubled by the dust, dirt and clutter on his officemate's desk, and not just because it looked messy. He suspected the dust was laced with anthrax.

  In 2001, a scientist opens a letter addressed to Sen. Patrick Leahy that contained anthrax.   AP file photo

And he was in a position to know. Ivins, a biodefense expert, and his officemate were deeply involved in Operation Noble Eagle — the government's response to the Sept. 11, 2001, attacks that killed almost 3,000 Americans and the anthrax attacks that killed five more less than a month later.

It was December 2001. Ivins, an authority on anthrax, was one of the handful of researchers at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Md., who prepared spores of the deadly bacteria to test anthrax vaccines in animals. He knew enough to grow alarmed when his officemate complained, as she had frequently of late, about sloppy handling of samples coming into the lab that could be tainted with anthrax.

"I swabbed approximately 20 areas of (her) desk, including the telephone computer and desktop," Ivins later reported to Army investigators. Half of the samples, he found, "were suspicious for anthrax," betraying the clumpy brown appearance of anthrax colonies under a microscope.

Rather than reporting contamination to his superiors, Ivins said, he disinfected the desk. "I had no desire to cry wolf," he later told an Army investigator.

Months later, Army investigators would see Ivins' desk cleanup as the first sign of an alarming anthrax contamination at the nation's most renowned biodefense laboratory. A 361-page U.S. Army report on the events of that winter and the following spring, recently obtained through a Freedom of Information Act request, opens a rare window into the government's guarded biodefense establishment. (Related: Where labs are located or planned)

Today, the view from that window frightens critics of the government's plans to establish similar labs in urban centers throughout the country. They say it's too dangerous to bring deadly microbes into populated areas. In July, hundreds of Boston-area scientists and activists marched to oppose plans to construct a biodefense lab at Boston University. Supporters say such facilities are needed to fight bioterrorism.

But the new safety concerns echo fears expressed in late 2001 and early 2002 after anthrax spores, too small for the naked eye to see, escaped from a supposedly secure lab suite and into the scientists' offices. Within USAMRIID, 88 people were eventually tested for exposure to anthrax. The incident also raised fears that anthrax had leaked into nearby Frederick, Md.

Researchers express relief that no one was hurt or killed in the episode, but Stephanie Loranger of the Federation of American Scientists asks, "Fort Detrick is one of the premier biodefense labs, and if they have problems, what does it mean for all the others?"

A time of turmoil

December 2001 was almost two months after the inhalation-anthrax death of tabloid photo editor Bob Stevens in Atlantis, Fla. Stevens' death was the first from five anthrax-laced letters that infected 22 people, hobbled the U.S. postal system and shut down the Hart Senate Office Building in Washington after Sen. Tom Daschle, D-S.D., received one of the letters. The person who sent the deadly envelopes has never been caught.

It was a frantic time at the biodefense lab. The criminal investigation, dubbed Amerithrax by the FBI, was in full swing and USAMRIID was the only national laboratory giving authorities round-the-clock biodefense analysis, spokeswoman Caree Vander-Linden says.

The six-member team that worked in the lab equipped to handle anthrax had swollen to a staff of 85. Most had to learn how to handle the bacteria "on the fly," says USAMRIID's commander Col. Erik Henchal, who headed the forensic effort. As many as 70 researchers slept in cars or on cots as they scrambled to keep up with a deluge of specimens flooding the lab.

Over roughly eight months, USAMRIID researchers ran tests on 30,000 suspect envelopes, packages and other items that arrived at the lab.

They also tested about 320,000 environmental samples from such places as the Hart Senate Office Building and Washington, D.C.'s Brentwood postal center, which lost two employees exposed to the lethal letters. (In addition to the Florida victim and the postal workers, an elderly woman from Oxford, Conn., and a Vietnamese immigrant from New York City were killed.)

"They were running just fantastic numbers of (anthrax) samples," says biodefense expert D.A. Henderson of the University of Pittsburgh. "I'm not sure what they have accomplished is appreciated."

In April 2002, four months after Ivin's initial suspicions, the contamination resurfaced. A microbiologist spotted the liquid slurry in which anthrax is grown leaking from flasks inside a secure lab suite. He reported the episode up the chain of command, which set off alarms throughout the lab. Ivins did more tests.

This time he found that three strains of anthrax had escaped the supposedly secure "Biosafety Level 3," or BL-3, laboratory, which is designed to enable scientists to safely work with deadly microbes. Two of the strains were used in biodefense work. One of them may have come from the envelope sent the previous October to Daschle's office.

Powdered anthrax from the Daschle envelope so readily surfed currents of air that it frightened USAMRIID experts who opened the envelope.

"The good news is nobody got the disease," says Alan Zelicoff, a biodefense expert who is now a consultant at ARES Corp., a risk analysis firm. "The bad news is that nobody got the disease because just about everybody near the BL-3 suite had been vaccinated."

It was during that period, as the anthrax investigation gained momentum, that Ivins' officemate "repeatedly expressed concern to (Ivins) that she may have been exposed to anthrax spores when handling powder," according to the Army's report.

The leak inside the BL-3 lab was found on April 8. Over the next two weeks, Ivins and other researchers tested lab surfaces to confirm the extent of the contamination. Eighteen lab workers were tested for anthrax exposure. Nasal swabs from one of them tested positive for anthrax. Army officials acknowledged the incident in an April 19 press release.

Anthrax was found in three places outside the containment lab. Colonies of two anthrax strains were found in the "clean change room" where male scientists disrobe before showering and donning sterile suits to enter the secure lab suite. The strains were Sterne, a benign form used in inoculations, and Vollum 1B, once Fort Detrick's signature bioweapons strain. Vollum 1B was grown from the blood of lab microbiologist William Boyle, who died after inhaling anthrax in a 1951 lab accident, hence the B in the name.

Further away from the lab suite, researchers found three strains of anthrax in the office called B-19 that Ivins and his colleague shared: Sterne, Vollum 1B and Ames. Ames is now the preferred strain for biodefense research and was the strain found in the Daschle letter.

Their tests also found more than 200 colonies of Ames strain on the lab's "passbox." The passbox is a 2-foot-square ultraviolet-bathed portal — a blue glow emanating around the edges of its door — used for safely passing potentially contaminated material into and out of the laboratory suite.

Fears in the community

As the investigation continued, word was leaking out. On April 20, USAMRIID officials got irate calls from Frederick's mayor and a visit from local U.S. Rep. Roscoe Bartlett, R-Md., who told Army investigators that he thought the incident was being "blown out of proportion" and "gives the terrorists an advantage."

Bartlett also wanted his nearby horse farm tested for anthrax. One day later he showed up at the lab, bearing a soil sample from his farm, which turned out to be negative for anthrax. He now says the public was never at risk and the lessons learned from the episode have made USAMRIID's safety standards stronger.

Fear that spores had escaped into the community in USAMRIID's dirty laundry prompted officials to dispatch technicians to the base's laundry at the Jeanne Bussard Center, a rehabilitation center for the developmentally disabled in Frederick.

One laundry worker's doctor had already called the base to query about the exposure risk. On April 20, the team collected 32 samples to test for possible anthrax contamination. Nothing was found.

The formal probe of how the contamination occurred began April 24, led by an Army investigator from Walter Reed Army Institute of Research. In 20 interviews over two weeks, investigators learned that some lab workers had been concerned about possible exposure for months, beginning with the botched handling of the Daschle letter that sent 16 people to the infirmary for preventive antibiotics.

By the time the investigation drew to a close, about 1,120 sites in the lab, the off-site laundry and the laundry's delivery vans had been tested. About 90 people had been evaluated for exposure, and many of them treated with preventive antibiotics. No one became ill and no other traces of anthrax were found.

Military investigators concluded that the Sterne and Vollum 1B colonies had probably persisted in Building 1425 for years, perhaps as far back as the U.S. offensive biowarfare program ended by President Richard Nixon in 1969. The Ames strain likely escaped the lab because workers didn't thoroughly decontaminate shipping containers with fresh bleach. USAMRIID's Henchal suspects that a researcher who handled a poorly decontaminated container may have spread the Ames spores outside of the containment area.

A question the report leaves unanswered is whether that Ames strain came from the Daschle letter, which would elevate the episode to a higher level of concern. "It is a little ambiguous," says C.J. Peters, of the University of Texas Medical Branch at Galveston, formerly one of USAMRIID's experts on deadly microbes. "If this is from the (Daschle) powder, it could be re-aerosolized and somebody could get hurt really bad. If it's from ordinary culture, it's not that dangerous."

Lt. Col. Jeffrey Adamovicz, who was then deputy chief of bacteriology at USAMRIID, says it's unlikely that the contamination stemmed from aerosolized spores, noting that spores would have been found in air filters throughout the building. They were not.

Henchal insists that the contaminating anthrax never posed an airborne threat to anyone. Despite acknowledging that the FBI has genetically typed the Ames strain found outside the containment lab, as well as the Daschle letter anthrax, Henchal declined to say whether the two were the same. "I'm not convinced I know the source of the contamination," he says.

No one was disciplined for the contamination. Ivins couldn't be reached for comment. USAMRIID declined to permit interviews with staff mentioned in the report. Henchal says lessons from the incident have been used in a revamped biosecurity program. "We're not going to take any shortcuts on safety," he says.

Broader safety concerns

That such a slip-up occurred in the research center that pioneered safety procedures now used worldwide to deal with lethal microbes raises broader questions, experts say.

"The message here from a scientific and policy standpoint is profound," Zelicoff says. "Facilities that are medical and microbiological may not be suitably equipped for dealing with aerosolized versions of the organisms that they otherwise deal with in great safety. ... These facilities probably ought not be located in a heavily populated area. How do you contain smoke?"

About 50 maximum-containment labs nationwide harbor the deadliest of bacteria, viruses and toxins. Forty more biodefense research labs are planned in cities such as Atlanta and Boston. In addition to the furor over the plans in Boston, opponents have also taken aim at a lab to be built at the University of Texas Medical Branch in Galveston, citing concerns about excessive secrecy and biosafety.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is building its own facility at Fort Detrick, notes that accidents are rare and that planned labs are unlikely to be as deluged with the flood of samples that arrived at USAMRIID as part of the anthrax investigation.

"Most scientists do things in a very careful way," Fauci says. "The chance that they'll be working in the same rushed atmosphere they faced at Fort Detrick is very small."

Ultimately, the unsolved 2001 anthrax killings still shadow Fort Detrick. The Ames strain of anthrax used in the letters, and found in the contamination incident, was first used in biodefense studies there.

For that reason, the FBI briefly shut down parts of the lab this July to look for more clues, searching for stray spores that might match those used in the attack. In August, FBI investigators carted away more lab equipment for analysis, looking for clues that may reveal a link of some kind between the lab and the attacks that can be presented to a grand jury.

Army investigators concluded that years of sloppy practices at the lab resulted from neglect of safety procedures, compounded by the pressure of a high-profile criminal case. One researcher described a common room in the lab area as a "rats' nest." And experts say the "sloppiness" documented in the report may complicate prosecution if the anthrax killer is ever caught, especially if defense lawyers can cast doubt on USAMRIID'S reliability.

"Any defense lawyer should read this report carefully and keep it in mind when DNA results are being quoted against his (or) her client," says Martin Hugh-Jones of Louisiana State University, a leading expert on anthrax. "I now understand why the FBI (anthrax) letter team is so fascinated by USAMRIID."

Contributing: Robert Barbrow and Susan O'Brian

Source: http://www.usatoday.com/news/nation/2004-10-13-anthrax-labs_x.htm (October 15, 2004)

How to Find Your State's Insurance Regulators

Arkansas

Commissioner
Arkansas Department of Insurance
1200 West 3rd St.
Little Rock AR 72201-1904
501-371-2640
Toll free in AR only: 1-800-282-9134
Toll free nationwide: 1-800-282-5494
Fax: 501-371-2749
E-mail: insurance.consumers@mail.state.ar.us
Web site: www.state.ar.us/insurance

Illinois

Office Manager and Staff Attorney
Department of Insurance
100 West Randolph St., Suite 15-100
Chicago IL 60601
312-814-2420
Fax: 312-814-5435
Web site: www.state.il.us/ins

Director
Department of Insurance
320 West Washington St.
Springfield IL 62767
217-782-4515
Toll free: 1-877-527-9431 (Office of Consumer Health Insurance)
TDD: 217-524-4872
Fax: 217-782-5020
E-mail: director@ins.state.il.us
Web site: www.state.il.us/ins/

Iowa

Commissioner
State of Iowa
Division of Insurance
330 Maple St.
Des Moines IA 50319
515-281-5705
Fax: 515-281-3059
Web site: www.state.ia.us/government/com/ins/ins.htm

Kentucky

Commissioner
Department of Insurance
215 West Main St.
Frankfort KY 40601
502-564-3630
Toll free: 1-800-595-6053
Fax: 502-564-1650
Web site: http://http://www.doi.state.ky.us/

Missouri

Director
Missouri Department of Insurance
PO Box 690
301 West High Street, Room 630
Jefferson City MO 65102
573-751-4126
573-751-2640
Toll free in MO: 1-800-726-7390
TTD/TTY: 573-526-4536
Fax: 573-751-1165
E-mail: dsprings@mail.state.mo.us
Web site: http://www.insurance.state.mo.us/

Source: HSH Associates, Financial Publishers

This listing is extracted from the Consumer Action Handbook, one of the most popular books published by the Federal government. This handy guide also includes lists of other State regulatory agencies. We highly recommend this as a source of consumer information!

We also offer the Handbook's list of State Banking Regulators.

HEALTH 

Indoor Mold Linked to Problems Such as Asthma and Coughing

By SARA SCHAEFER MUÑOZ

Staff Reporter of THE WALL STREET JOURNAL

May 26, 2004; Page D3

WASHINGTON -- Otherwise-healthy people are more likely to experience coughing, wheezing and respiratory illness if their homes are damp, new research on indoor mold and moisture has found.

The report, by the Institute of Medicine, part of the National Academies -- which includes the National Academy of Sciences -- also found that people with asthma are more likely to experience symptoms if they are exposed to indoor mold.

The report didn't find evidence that mold causes other health trouble, such as sinusitis, skin disorders, gastrointestinal problems, fatigue and difficulty concentrating. However, it didn't rule out such a relationship.

"It can be hard to tease apart the health effects from mold from all other factors that may be influencing health in the indoor environment," said Noreen Clark, dean of the School of Public Health at the University of Michigan at Ann Arbor, who helped compile the report.

The report is the first comprehensive review of existing data on mold and dampness in indoor environments, authors said. It was requested by the Centers for Disease Control and Prevention to determine whether mold growing indoors can cause health problems. It urges people who notice a mold or moisture problem in their home to address it immediately, even if they are healthy and have experienced no respiratory symptoms.

In recent years, claims that mold growth has led to health problems have touched off a flurry of litigation around the country. In 2001, a Texas couple was awarded $32 million after they claimed their insurance company botched a flood cleanup and the dampness resulted in mold and health problems. The award later was reduced by a state appellate court, and the couple settled out of court for an undisclosed amount. Last year, activist Bianca Jagger filed a $20 million suit against the owner of her New York apartment over mold growth.

Researchers said they lack the precise data on how widespread mold problems are, but "it is clear that building dampness is an extensive problem and is found around the country," Ms. Clark said. More studies must be done to determine what levels of mold are considered unhealthy.

Mold, a growth of minute fungi, is part of the natural outdoor environment. It reproduces through tiny spores that float through the air. Forming a downy or fur-like coat, mold can begin to grow indoors if the spores land on an area that is wet. A house or building is susceptible to mold growth if it has problems such as leaking pipes or flooding.

Cleanup of mold isn't cheap. Remediation of a small mold problem caused by water from leaking a pipe, for example, could cost between $800 and $1,000, said Glenn Fellman, executive director of the Indoor Air Quality Association, an industry-standards group in Rockville, Md. A large cleanup after a flood can cost tens of thousands of dollars.

For information on mold growth and remediation, visit the group's Web site, www.iaqa.org, or the Centers for Disease Control and Prevention, at www.cdc.gov.

Write to Sara Schaefer Muñoz at sara.schaefer@wsj.com

Source: WSJ (May 26, 2004)

Clean your home and business.

Keep mold from harming you, your family, or your employees.

Use SteriLight to purify the indoor air.

Use Germ Free 60 to clean surfaces and skin.

Regulatory Status Regarding Mold

There are currently no state or federal regulations addressing mold in buildings. The New York City Department of Health’s Guidelines on Assessment and Remediation of Fungi in Indoor Environments, and the EPA’s March 2001 document entitled Mold Remediation in Schools and Commercial Buildings are the two most frequently referenced documents providing guidance regarding the health effects, assessment and remediation of mold in indoor environments. Both of these documents are available at the following website addresses: www.ci.nyc.us and www.epa.gov/iaq/molds, respectively. These documents provide some commonsense guidelines regarding the assessment and remediation of molds in buildings:

nn“The key to mold control is moisture control. Identify and address sources of moisture in buildings, otherwise, a mold problem will reoccur.”

nn“Maintain low indoor humidity, below 60 percent relative humidity (RH), ideally 30-50 percent if possible.”

nnUse experienced professionals when conducting an assessment for the potential presence of mold. The Indoor Air Quality Association has lists of Certified Mold Remediators, and the National Air Duct Cleaners Association may also be able to provide lists of qualified professionals.

nnIn the event that remediation is indicated, and it is determined that professional oversight is required, do not use the same firm for remediation that conducted the assessment. This prevents obvious conflicts of interest.

nnIf the mold remediation is comprised of an area less than 30 square feet, remediation may be conducted by building maintenance personnel. These persons should receive proper training and equipment. (See guidance documents reference previously).

nnIf the remediation area is greater than 30 square feet, then cleanup should be supervised by an experienced health and safety professional

nnWater damage should be addressed within 24-48 hours of the incident to prevent the buildup and growth of mold

nnNon-porous surfaces such as plastics or metal may be cleaned by vacuuming or damp wiping.

nnPorous surfaces are handled differently depending upon the amount of water damage: ceiling tiles and cellulose insulation should be removed and replaced; carpet and backing should be dried within 24-48 hours with a water extraction vacuum and ambient humidity levels should be reduced; wallboard may be dried in place if there is no obvious swelling and the seams are intact.

nnPrevention of the growth of mold through inspections and proper building maintenance is the most cost-effective way to address the concerns of both tenants and building managers.

Additional detailed guidelines and recommendations are found in the two documents previously referenced, and should be consulted in the event a mold problem is encountered.

Source: http://www.ppmco.com/resources/upload/cre_novdec_2002.pdf (April 12, 2004)

Examples follow of just a few mycotoxins, the molds that produce them, and their role in the history of human disease.

Aspergillus

Aflatoxins are classic mycotoxins produced by Aspergillus flavus, A. niger, and A. parasiticus.

Foods that can be contaminated include peanuts, pecans, peas, bread, cheese, rice, corn, barley, grain, sorghum, wheat, and cotton seed.  Aflatoxins are also found in milk, eggs, and livers of animals that have consumed contaminated feed.

Aflatoxins by the oral route can be teratogenic or carcinogenic in animals, with rats and trout being more sensitive than mice and monkeys. 

Animal studies indicate that inhaled aflatoxins are immunosuppressive and may also be carcinogenic by the inhalation route in animals.

The disease outbreak that caused aflatoxins to be identified in the 1960s was “Turkey X disease.” Hundreds of thousands of turkeys died after eating aflatoxins-containing peanut meal.

Ingestion of Aflatoxins has been implicated in human liver cancer, with hepatitis B as a co-risk factor.

Aflatoxins have also been indirectly associated with liver cirrhosis and Reye’s syndrome.

Case reports of inhalation exposure to laboratory workers have associated lung disease and cancer with aflatoxin exposure, and epidemiological studies suggest higher cancer rates in workers involved in peanut processing.

Read more …Health Effects of Mycotoxins in Indoor Air

Cladosporium

High levels of Cladosporium in wintertime household dust approximately tripled the risk of allergic sensitization in children

Read more …Cladosporium

Read these PDF:

MOLD: HEALTH RISK OR HYSTERIA AND MEDIA-HYPE?

Mold Guide

Mold Remediation in Schools and Commercial Buildings

A Guide for Building Owners and Facility Managers

Clean your home and business.

Keep mold from harming you, your family, or your employees.

Use SteriLight to purify the indoor air.

Use Germ Free 60 to clean surfaces and skin.

SteriLight kills Aspergillus mold

Thursday, October 28, 2004 · Last updated 2:28 a.m. PT

Hungary bans sale of paprika

THE ASSOCIATED PRESS

BUDAPEST, Hungary -- Hungary banned the sale of its signature spice, paprika, and told people not to use whatever supplies they had at home after more than a pinch of moldy toxin was found in products sold by three large companies.

The ban takes effect Thursday and will last until tests determine how much paprika has been affected by aflatoxin, which is produced by mold, Health Minister Jeno Racz said.

Health officials found that products distributed by three of the country's largest paprika companies contained more aflatoxin than permitted by law.

Aflatoxin could be dangerous to people if they consumed more than 1 pound of paprika a week, Racz said. The average Hungarian consumes about that much in a year. Paprika is traditionally the main spice used in Hungarian cuisine.

Racz said the mold that produces the toxin does not survive in the Hungarian climate. That has led the Health Ministry to suspect that distributors may have mixed South American paprika with Hungarian paprika and sold it as Hungarian.

The government said any paprika with an expiration date of April 15, 2005, or later was safe.

Hungary exports about 5,500 tons of paprika a year, but it was unclear whether any of the affected paprika was sent abroad.

Source: Seattle Post Intellegence (October 28, 2004)

U.S. OKs booster shot for whooping cough

By THE ASSOCIATED PRESS

05/04/2005

Injection is for adolescents

WASHINGTON - The first booster shot to protect adolescents against whooping cough won government approval Tuesday, offering a new tool to battle the return of a dangerous illness that leaves sufferers gasping for air.

Whooping cough, a bacterial infection, was once thought to be history thanks to effective vaccination of babies and toddlers, but it turns out that protection from those early shots wears off.

Outbreaks among preteens, teenagers and even adults have increased dramatically. The cough is so strong it can break a rib, and it can cause weeks of misery, sometimes living up to its nickname of the 100-day cough. While older patients usually recover, they can easily spread the illness to not-yet-vaccinated infants - and whooping cough can kill babies.

Specialists say GlaxoSmithKline's Boostrix is a first step toward ending that cycle. The Food and Drug Administration on Tuesday approved its use as a one-time booster dose of vaccine for people from ages 10 to 18.

It won't require an extra shot. Children already are supposed to get a booster shot against two other diseases - tetanus and diphtheria - sometime during those years. Boostrix merely adds protection against pertussis, whooping cough's formal name, to that existing shot.

FDA approval allows Glaxo to begin selling the shots. The company expects Boostrix to be in physicians' offices by next month, but it wouldn't release a price.

Eventually, adults will be asked to roll up their sleeves, too. Glaxo competitor Sanofi Pasteur is awaiting FDA approval of its own pertussis booster, called Adacel, for both adolescents and adults. Already, a committee of the Centers for Disease Control and Prevention is debating how often adults will need a booster, and whom to target first - day-care providers, health care workers or parents of infants, perhaps.

About 250,000 Americans a year got pertussis before vaccinations began in the 1940s.

The most common side effects of Boostrix were pain, redness and swelling at the injection site; headaches, fever and fatigue for a short period after the shot also were reported.

Source: St. Louis Post-Dispatch 4 May 2005 Page A3 (May 4, 2005)

The following pathogens are too small to be removed by typical household filters.

Use SteriLight to purify the indoor air.

------------

From:                    owner-promed-edr@promed.isid.harvard.edu on behalf of ProMED-mail [promed@promed.isid.harvard.edu]

Sent:                     Thursday, September 23, 2004 2:56 PM

To:                        promed-edr@promedmail.org

Subject:                 PRO/EDR> Pertussis - USA (multistate)

PERTUSSIS - USA (MULTISTATE)

****************************

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases

<http://www.isid.org>

[1] Illinois

Date: Mon, 20 Sep 2004

From: ProMED-mail <promed@promedmail.org>

Source: Chicago Sun-Times [edited]

<http://www.suntimes.com/output/health/20whoop.html>

Whooping cough cases on upswing

-------------------------------

There's been a significant rise in the number of cases of whooping cough in the Chicago area in 2004, public health administrators said on 20 Sep 2004, urging people to use precautions to help stem the spread of the contagious disease. The outbreak has been concentrated in children 10 to 15 years old, ages when immunity from the childhood vaccine wanes. While Chicago has confirmed an increase in whooping cough cases in 2004 compared with previous years, the biggest jump in numbers appears to be happening in suburban Cook and the collar [surrounding - Mod.LL] counties. McHenry County, for example, averages about 8 cases annually. In 2004, it's already up to 143.

Health officials couldn't explain what's driving the increase. "Part of it may be increased surveillance," said Dr Julie Morita, medical director of the Chicago Department of Public Health's immunization program.

Also known as pertussis, whooping cough is a bacterial infection that spread easily through coughing or sneezing. It's called whooping cough because those who get it -- especially children -- sometimes make a "whooping" sound when inhaling. The first symptoms usually appear about a week after someone is exposed. They can mimic the symptoms of a cold: runny nose, sneezing, a low fever and a mild cough. Whooping cough symptoms can progress, though, to severe coughing fits, particularly at night, and

coughing attacks are sometimes followed by vomiting.

The potentially fatal disease tends to be most serious in infants and people who have compromised immune systems. The last whooping cough death in Illinois was that of a 2 month old baby in 2001.

Each child should get the pertussis vaccine at 2, 4, 6, and 15 months, followed by a booster between ages 4 and 6 years, experts say. The vaccine isn't recommended for anyone over 7, but a booster shot for older people is in development and could be available in a year, said Dr Eric Whitaker, director of the Illinois Department of Public Health.

He urged parents to get their children vaccinated and to practice "plain old good hygiene," including frequent hand washing and covering your mouth and nose while coughing or sneezing. People exposed to someone with pertussis should see a doctor and begin antibiotic treatment immediately.

[byline: Lori Rackl]

******

[2] New York

Date: Wed, 22 Sep 2004

From: ProMED-mail <promed@promedmail.org>

Source: NY Newsday.com [edited]

<http://www.newsday.com/news/local/wire/ny-bc-ny--whoopingcough0922sep22,0,6987317.story?coll=ny-ap-regional-wire>

Whooping cough on the rise in New York

--------------------------------------

After several years under the public health radar, whooping cough is making a comeback in New York. The number of New Yorkers affected by the highly contagious respiratory illness passed the 1000 mark for the 2nd straight year, prompting health officials to step up efforts to stave off the disease.

Earlier in 2004, the state Health Department posted a bulletin to community health departments and health care providers about the recent trend. A similar alert was sent in Jun 2004 to directors and nurses at summer camps, where whooping cough outbreaks are not uncommon since children live together in tight quarters and often have direct contact with one another, making the disease easier to spread.

Now with the fall school year underway, the focus is shifting to school nurses and teachers to be on the alert. New York is among 7 states that currently do not require school-age children to be vaccinated against whooping cough, although most received the shot as infants as part of a combination vaccine. Starting in 2005, babies born after 1 Jan would be required to be vaccinated against whooping cough before they enter school or day care, under a new law.

"We are taking some unusual and strong measures here to try to deal with this problem," said Dr Gus Birkhead, the director of the Center for Community Health at the state Health Department. So far in 2004, there were 1448 confirmed cases of whooping cough, up from 388 in 2000. The average is 300 cases annually.

Health experts say a number of factors may be responsible for the spike in whooping cough cases in recent years, a trend that is mirrored nationwide, although they have been unable to pinpoint an exact cause. In 2003, 229 people, in the newborn to age 14 category, were hospitalized with pertussis. Hospitalization data for 2004 were incomplete.

"Public health officials are somewhat exasperated by not being able to get this quickly under control," said Dr Lloyd Novick, the commissioner of the Onondaga County Health Department in central New York, whose county is considered a whooping cough hotspot. Onondaga County, which includes the city of Syracuse, normally has 10 cases of pertussis annually. So far this year, the county is leading the state with the highest number of cases at 128, according to state Health Department figures.

Historically, the incidence of whooping cough has fluctuated, peaking every 3 to 5 years, and health officials say it's possible that the past 2 years are part of the natural peak cycle. Health officials also point out there's increased awareness in the medical community and doctors now have more advanced technology to detect the disease than in previous years.

The federal government is debating whether it should allow booster shots against the cough, since protection begins to drop 5 to 10 years after the last shot.

[byline: Alicia Chang]

******

[3] Kansas

Date: Thu, 23 Sep 2004

From: ProMED-mail <promed@promedmail.org> Source: Johnson County Sun [edited]

<http://www.zwire.com/site/news.cfm?newsid=12984252&BRD=1459&PAG=461>

Whooping cough is cyclical in Kansas

------------------------------------

The upsurge in whooping cough or pertussis cases in Kansas in 2004, particularly in the northeast part of the state, may be cyclical, said Sharon Watson, spokeswoman for the Kansas Department of Health and Environment.

The department said that, from May through Sep 2004, there were 31 confirmed cases reported in the state, compared with an average of 9 cases in the previous 3 years for the same months.

In Johnson County, there have been 8 confirmed cases since 1 May 2004. In 2003, 10 cases total were reported, said Nancy Tausz, director of disease containment for the county health department. No cases have been reported in the Shawnee Mission School District, according to Debbie Sokoloff, health services and safety resource specialist. "I do not know of any cases," she said Wed, 22 Sep 2004. Loralee Baker, director of community relations for the Olathe School District, said the district had reported 1 suspected case of whooping cough to the Johnson County Health Department but that it had not been confirmed.

"It seems to go in cycles," Watson said. "In 1999, we had an upsurge in cases with a total of 49. Children either don't have the vaccinations at all or haven't completed them. This leads to some adults getting pertussis from children." More than half of the 31 (Kansas) cases involved children under age 5, Watson said. "In the cases reported since May 2004, a number of children were not vaccinated or had not completed the vaccinations they needed to be protected."

A majority of the Kansas cases so far in 2004 have been reported by 6 north east Kansas counties, including Douglas, Franklin, Leavenworth, Johnson, Miami and Wyandotte, according to Watson. KDHE hopes that, by reporting the increasing incidence of the disease this year, parents will be encouraged to check their children's records and complete their vaccinations if they have not already done so.

[byline: Elaine Bessier]

--

ProMED-mail

<promed@promedmail.org>

[Even in developed countries such as the USA, pertussis clusters continue to occur. The demographics of the cases in such clusters are nonvaccination of children, incomplete vaccination of children, primary vaccine failure, waning immunity in adolescence and adults, improved reporting of cases, or, most likely, a combination of factors. The change in DTP vaccine (which contained killed, whole-cell pertussis organisms and was quite reactogenic) to DTaP (which contains several toxoids of _Bordetella pertussis_) has decreased the reactogenicity but does not appear to greatly increase immunogenicity. In addition to a higher percentage of infants receiving a full primary series of vaccination against pertussis, the addition of aP to the Td booster (which should be given to adults every decade) can assist in diminishing cases. Unlike the whole-cell product, acellular pertussis vaccine is well-tolerated in adults. - Mod.LL]

[see also:

2003

---

Pertussis - USA (South Carolina)                          20030716.1750

Pertussis - USA (WA, NY)                                  20030624.1554

Pertussis, adults - USA (Ill) (02):chemoprophylaxis       20030112.0102

Pertussis, adults - USA (Illinois)                        20030109.0073

2002

---

Pertussis - USA (Texas) (02)                              20020926.5404

Pertussis - USA (Texas)                                   20020925.5396

Pertussis, worldwide increase, change in epidemology (04) 20020506.4119

Pertussis, worldwide increase, change in epidemiology     20020503.4084

1998

---

Pertussis in adults, current trends - USA (02)            19980828.1709

Pertussis in adults, current trends - USA                 19980827.1699

Pertussis - USA: Review, case study & comment             19980706.1270]

.....................lm/ll/pg/sh

ProMED-mail makes every effort to  verify  the reports  that are  posted,  but  the  accuracy  and  completeness  of  the information,   and  of  any  statements  or  opinions  based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by  ProMED-mail.   ISID and  its  associated  service  providers  shall not be  held responsible for errors or omissions or  held liable for  any damages incurred as a result of use or reliance upon  posted or archived material.

*********

Visit ProMED-mail's web site at <http://www.promedmail.org>.  Send  all  items  for   posting  to:   promed@promedmail.org (NOT to  an  individual moderator).  If you do not give your full name and  affiliation, it  may  not  be  posted.   Send commands  to  subscribe/unsubscribe,   get  archives,  help, etc. to: majordomo@promedmail.org.    For assistance  from a human  being  send  mail  to:   owner-promed@promedmail.org.

####

####

------------

From:                     owner-promed@promed.isid.harvard.edu on behalf of ProMED-mail [promed@promed.isid.harvard.edu]

Sent:                      Friday, June 25, 2004 10:50 AM

To:                         promed-edr@promedmail.org

Subject:                 PRO/EDR> Measles, adoptees - USA ex China (03)

MEASLES, ADOPTEES - USA EX CHINA (03)

*************************************

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases

<http://www.isid.org>

Date: Thu 24 Jun 2004

From: ProMED-mail <promed@promedmail.org>

Source: CDC Health Alert Network, Tue 22 Jun 2004 [edited]

Measles in an Adopted Child from China leading to Potential Airline

Exposure - Missouri, June 2004

-------------------------------------------------

On 18 Jun 2004, the Missouri Department of Health and Senior Services (DHSS) contacted the Centers for Disease Control and Prevention (CDC) to report a laboratory-confirmed case of measles in a recently adopted child from China. The child was part of a group of 35 families from 16 states and the United Kingdom who traveled from China to the United States with their adopted children.  The investigation is ongoing to determine whether any of the other adopted children or family members in this group may have developed measles. CDC has also contacted Chinese officials to obtain more information.

The 14-month-old child with confirmed measles had onset of rash on 10 Jun 2004 and was likely infectious while traveling from China to the United States on the following flights: China Southern Airlines flight CZ327 arriving in Los Angeles (LAX) from Guangzhou, China on 8 Jun 2004 and Southwest Airlines flight 1979 from Los Angeles (LAX) to Kansas City, Missouri on 9 Jun 2004.  Due to challenges in obtaining timely and accurate passenger contact information, CDC is providing the flight information in lieu of individual passenger notifications.

Although measles transmission is known to have occurred on commercial aircraft, available data suggest the risk of transmission to other passengers is low. Passengers seated adjacent to a measles-infected person appear to have an increased risk of infection.

In general, measles is a highly infectious disease that can have severe complications. The incubation period from exposure to rash onset for measles is approximately 10 days (range 7-18 days); on rare occasions the incubation period can be as long as 19-21 days. Persons on these flights who develop fever and/or rash on or before 30 Jun 2004 should be evaluated by a healthcare provider for measles. Persons with these symptoms should notify their healthcare provider of the possible exposure to measles before visiting a health care facility so that preparations can be made to avoid exposing other susceptible persons to measles. Possible cases of measles should be reported to state health departments.  State health departments are asked to report any possible cases under investigation to CDC (404-639-8763 or 770-488-7100). Adoptive parents should ensure that they and their families are appropriately immunized before traveling abroad for adoption and should be aware of the potential for communicable diseases in children adopted from international regions.

For more information on imported measles in the United States see:

Amornkul PN, Takahashi H, Bogard AK, Nakata M, Harpaz R, Effler PV. Low

risk of measles transmission after exposure on an international airline

flight. JID 2004;189:81-85.

Centers for Disease Control and Prevention.  Multistate investigation of

measles among adoptees from China -- April 9, 2004. MMWR 2004;53:309-310.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5314a5.htm>

Centers for Disease Control and Prevention.  Measles among adoptees from

China -- April 14, 2004. MMWR 2004;53:309.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5314a4.htm>

Centers for Disease Control and Prevention.  Imported Measles Case

Associated with Nonmedical Vaccine Exemption -- Iowa, March 2004. MMWR

2004;53:244-246. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5311a6.htm>

Centers for Disease Control and Prevention. Measles Outbreak Among

Internationally Adopted Children Arriving in the United States, February --

March 2001. MMWR 2002;51:1115-1116.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a3.htm>

Oster NV, Harpaz R, Redd SB, Papania MJ.  International importation of

measles virus -- United States, 1993-2001. JID 2004; 189:48-53.

--

ProMED-mail

<promed@promedmail.org>

[see also:

Measles, adoptees - USA ex China  20040411.0985

Measles, adoptees - USA ex China (02)  20040416.1050]

....................cp/pg/mpp

*#####*

ProMED-mail makes every effort to  verify  the reports  that are  posted,  but  the  accuracy  and  completeness  of  the information,   and  of  any  statements  or  opinions  based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by  ProMED-mail.   ISID and  its  associated  service  providers  shall not be  held responsible for errors or omissions or  held liable for  any damages incurred as a result of use or reliance upon  posted or archived material.

**********

Visit ProMED-mail's web site at <http://www.promedmail.org>.  Send  all  items  for   posting  to:   promed@promedmail.org (NOT to  an  individual moderator).  If you do not give your full name and  affiliation, it  may  not  be  posted.   Send commands  to  subscribe/unsubscribe,   get  archives,  help, etc. to: majordomo@promedmail.org.    For assistance  from a human  being  send  mail  to:   owner-promed@promedmail.org.

#######

#######

ST. LOUIS COUNTY

10/28/2004

LOCAL BRIEFS

Two elderly people catch first cases of flu

Two elderly St. Louis County residents are recovering from the first cases of influenza reported in the St. Louis area this year.

Shortage of the flu vaccine doesn't appear to factor in the cases, as both people received flu shots this year, said Mac Scott, St. Louis County spokesman.

"I guess they didn't get them (flu shots) far enough in advance to keep them from getting the flu," Scott said.

Scott identified the patients as a 95-year-old man and an 85-year-old woman, both from mid-St. Louis County. Their illnesses were confirmed by a swab test at an area hospital, Scott said. A spokeswoman for the Missouri Department of Health and Senior Services said she didn't know whether the state had received the specimens for further testing.

Source: St. Louis Post-Dispatch

Cover Your Cough

Cover your mouth and nose with a tissue when you cough or sneeze

Or Cough or sneeze into your upper sleeve, not your hands.

Put your used tissue in the waste basket.

You may be asked to put on a surgical mask to protect others.

Wash with soap and water long enough to sing “Happy Birthday” song twice.

Or Clean with alcohol-based hand cleaner.

------------

From:                    owner-promed-edr@promed.isid.harvard.edu on behalf of ProMED-mail [promed@promed.isid.harvard.edu]

Sent:                     Sunday, October 24, 2004 5:54 PM

To:                        promed-edr@promedmail.org

Subject:                 PRO/EDR> Influenza A (H3N2), variant strain

INFLUENZA A (H3N2), VARIANT STRAIN

******

A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

Date: Sun 24 Oct 2004

From: Jonathan Nash <jnash@qis.net>

Source: San Francisco Chronicle, Sun 24 Oct 2004 [edited]

<http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/10/24/FLU.TMP>

Northern hemisphere: risk of A/Wellington/1/2004(H3N2)-like virus

------------

As Americans scramble for scarce doses of flu vaccine in hopes of warding off the respiratory bug this winter [2004-2005], the wily influenza virus may have other plans. Through a natural process known as antigenic drift, a new strain of influenza that can diminish the effectiveness of today's vaccine is already emerging on the far side of the world. The emergent strain raising questions now is known as A/Wellington, named after the New Zealand city where it was 1st detected. "The flu season has been late this year [2004], and it seems some people who have been vaccinated have been hit by this changing strain," said New Zealand Health Ministry flu chief Dr. Lance Jennings.

Like weather forecasters watching tropical storms, epidemiologists for the World Health Organization track the ever-evolving strains of influenza. The predominant flu virus around the globe right now is one called A/Fujian, and the vaccine Americans are seeking today is a perfect match for it. But, A/Wellington is gaining ground. Tests suggest that 43 percent of recent New Zealand flu cases spring from the new strain, or variants of it.  A/Wellington has even turned up about as far from the South Pacific as is geographically possible: in Norway.

The late season surge of A/Wellington was so worrying that the WHO, on 8 Oct 2004, recommended that next year's [2005] flu vaccine for the Southern Hemisphere, which is shipped in March, be reformulated to protect against it. Dr. Nancy Cox, director of the Influenza Branch at the Centers for Disease Control and Prevention, said there is no way of knowing whether the A/Wellington strain will establish a beachhead in the United States this winter. "Influenza viruses are inherently unpredictable," she said in a telephone interview.

One reason for concern is that laboratory animal tests suggest that the current vaccine -- which targets A/Fujian -- is about 2/3rds less effective in stirring antibodies against A/Wellington than it is against the targeted strain. That does not mean, Cox emphasized, that the current flu shot would be 2/3rds less effective in actual use, should the A/Wellington strain turn up in the United States. People who regularly receive flu shots, she said, may have higher levels of antibody protection against influenza than the laboratory animals. "We would not anticipate that the Wellington strain will cause an enormous problem," she said.

Doris Bucher, a flu vaccine expert at New York Medical College in Valhalla, N.Y., said the animal tests on A/Wellington are actually encouraging, because they show that antibodies stirred up by today's vaccine will inhibit the new strain. "If Wellington rushed in and took over, people would have good protection with the current vaccine," she said. Bucher's lab specializes in developing strains of influenza that grow well in eggs and hence serve as the basis for each year's flu vaccine made from eggs.  The current flu vaccine is made from a strain developed by her laboratory, and she is working right now on an A/Wellington-like strain for manufacturers who will make next year's [2005] vaccines.

When flu vaccines are well-matched to the prevailing flu strains, the shots can prevent flu in 70 to 90 percent of vaccinated adults, according to the CDC. Well-matched shots may prevent flu in only 30 to 40 percent of nursing home residents, but they can reduce the death rate from influenza and pneumonia in that population by 80 percent. American manufacturers need a 9-month lead to produce flu vaccine. That requires flu forecasters to predict in February what the prevailing flu strain will be November.

In February 2003, the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee selected a strain called A/Panama as the target. Another strain, known as A/Fujian, was starting to emerge on the World Health Organization's flu radar, but planners feared there was not enough time to develop a vaccine for it. Influenza struck the United States early and hard last year [2003]. The 1st cases turned up in early October 2003 in Texas, and soon anxious Americans were clamoring for vaccine, a foreshadowing of this year's [2004] flu shot frenzy.

A near-record 83 million eventually had a flu shot last fall [2003]. But, the predominant flu strain was not A/Panama but A/Fujian, and the vaccine was only partially effective. A Colorado study for the CDC concluded last year's flu shots were 52 percent effective in protecting healthy adults against flu and 38 percent effective in preventing flu among those with health conditions putting them at higher risk.

Bucher said it is reassuring that tests are showing there is less of a mismatch between the current flu vaccine and A/Wellington than there was last year [2003] between A/Panama and A/Fujian. "It's nothing like the situation we had last year,'' she said. The issue, of course, will be academic if the A/Fujian strain predominates again this year, as it did in the Southern Hemisphere during most of the winter season that has now ended there. Those 61 million Americans who find the vaccine will be protected.

There is also some evidence that the A/Fujian strain, having swept across the globe last year [2003], may have lost its punch. Despite the late emergence of the new flu strain, influenza was unusually mild throughout the Southern Hemisphere from May through October 2004. One reason may be that the human population, vaccinated or not, developed its own natural resistance to A/Fujian when it came through last winter [2003]. "There are a number of factors that determine whether you will have a good, medium, or bad flu year, and clearly a major factor is whether the predominant strain happens to be the same as the one the previous year,'' said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. So far, there have been only isolated cases of flu detected in the United States at the start of this year's flu season, and all have turned out to be A/Fujian. "Things are looking pretty good, in that regard,'' Fauci said. "But, that doesn't mean we won't get into trouble in November or December [2004]."

[Byline: Sabin Russell]

--

Jonathan Nash

<jnash@qis.net>

[The WHO Recommendations for Influenza Vaccine Composition for the Northern hemisphere for 2004-2005 (the current vaccine) are the following:

(1) an A/New Caledonia/20/99(H1N1)-like virus

(2) an A/Fujian/411/2002(H3N2)-like virus a

(3) a B/Shanghai/361/2002-like virus b

a: The currently used vaccine virus is A/Wyoming/3/2003. A /Kumamoto/102/2002 is also available as a vaccine virus.

b: Candidate vaccine viruses include B/Shanghai/361/2002 and B/Jilin/20/2003 which is a B/Shanghai/361/2002-like virus.

For more detailed information, please see: Recommended composition of influenza virus vaccines for use in the 2004-2005 influenza season, Weekly Epidemiological Record, 27 Feb 2004.

<http://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/index1.

html>

The WHO Recommendations for Influenza Vaccine Composition for the southern hemisphere for 2005 (southern hemisphere winter) are the following:

(1) an A/New Caledonia/20/99(H1N1)-like virus;

(2) an A/Wellington/1/2004(H3N2)-like virus;

(3) a B/Shanghai/361/2002-like virus a

a: Currently used vaccine viruses include B/Shanghai/361/2002, B/Jilin/20/2003 and B/Jiangsu/10/2003

For more detailed information, please see: Recommended composition of influenza virus vaccines for use in the 2005 influenza season, Weekly Epidemiological Record, 8 Oct 2004.<http://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/index.h

tml>.

  - Mod.CP]

[see also:

Influenza activity update 2003/2004 - worldwide 20040703.1776

Influenza A virus, virulence, 1918 pandemic strain 20041007.2754

Influenza update - Northern Hemisphere (01) 20040108.0088

Influenza update - Northern Hemisphere (02) 20040114.0150

Influenza update - Northern Hemisphere (03) 20040121.0242

Influenza update - Northern Hemisphere (04) 20040312.0688

Influenza update - Northern Hemisphere (05) 20040322.0799

Influenza vaccine 2004/2005 - N. hemisphere 20040220.0552

Influenza vaccine 2004/2005 - N. hemisphere (02): ... 20041005.2742

Influenza vaccine 2004/2005 - N. hemisphere (03) 20041006.2745

Influenza vaccine 2004/2005 - N. hemisphere (04) 20041014.2798]

.......................cp/msp/dk

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