A hospital in New York state is notifying about 2,800 patients of possible exposure to hepatitis C after learning that a former employee is suspected of exposing nearly 6,000 patients in Colorado to the disease.
The New York State Health Department said Wednesday that it's working with Northern Westchester Hospital in Mount Kisco after learning that Kristen Diane Parker, 26, worked there between Oct. 8, 2007, Feb. 28, 2008. The agency is recommending that patients who had surgery then should be tested.
Colorado health officials believe Parker, who is facing federal charges, may have exposed patients to hepatitis C while working as a surgery technician at Denver's Rose Medical Center and Audubon Ambulatory Surgery Center in Colorado Springs. She's accused of injecting herself with painkillers meant for patients, then filling the used syringes with saline solution, even though she knew she was infected.
Ten cases of hepatitis C have been linked to Rose Medical Center, where Parker worked until April. Health officials are conducting tests to determine if the cases are definitively linked to her.
Parker was arrested earlier this month and faces federal charges of tampering with a consumer product, creating a counterfeit controlled substance, and obtaining a controlled substance by deception or subterfuge. She is being held without bond. Her next court hearing is Oct. 6.
Hepatitis C is a blood-borne disease that can cause serious liver problems, including cirrhosis or liver cancer. The illness is treatable, but there is no cure.
Rose Medical officials said Parker was advised that she tested positive for hepatitis C before starting her job there. She has said hospital officials didn't make it clear she tested positive.
People with hepatitis C are not barred from working in health services, so long as standard precautions are taken, according to the federal Centers for Disease Control.
Thousands of former surgery patients have contacted Denver's Rose Medical Center and Audubon Ambulatory Surgery Center in Colorado Springs for free blood tests being offered by both facilities.
Parker went to work for the Audubon surgery center in Colorado Springs shortly after being fired by Rose. She worked there from May 4.
Claire Pospisil of the New York State Department of Health said it's not known whether Parker had hepatitis C while working at Northern Westchester Hospital.
"The State Health Department is working closely with the hospital to ensure that any patients who underwent surgery at the hospital while Parker worked there are contacted and offered free testing," Pospisil told KMGH-TV in Denver.
The hospital has set up a patient help line at 914-666-1902 for information.
July 16, 2009
Fight for swine flu vaccine could get ugly
An ugly scramble is brewing over the swine flu vaccine — and when it becomes available, Britain, the United States and other nations could find that the contracts they signed with pharmaceutical companies are easily broken.
Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country.
That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad.
"This isn't rocket science," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "If there is severe disease, countries will want to hang onto the vaccine for their own citizens."
Experts say politicians would not be able to withstand the pressure.
"The consequences of shipping vaccine to another country when your own people don't have it would be devastating," added David Fedson, a retired vaccine industry executive.
About 70 percent of the world's flu vaccines are made in Europe, and only a handful of countries are self-sufficient in vaccines. The U.S. has limited flu vaccine facilities, and because factories can't be built overnight, there is no quick fix to boost vaccine supplies.
Last week, the World Health Organization reported nearly 95,000 cases of swine flu including 429 deaths worldwide. If swine flu turns deadlier in the winter, the main flu season in the Northern Hemisphere, countries will likely be clamoring for any available vaccines.
"Pandemic vaccine will be a valuable and scarce resource, like oil or food during a famine," said David Fidler, a professor of law at Indiana University who has consulted for WHO. "We've seen how countries behave in those situations, and it's not encouraging."
Britain claims it will start vaccinating people in August, Italy says it will begin by the end of the year, and many other countries have similar strategies. Those mass vaccination plans could be derailed by problems making the vaccine and by other countries' refusal to ship it abroad.
If the virus remains mild, this could all be moot. Experts estimate swine flu to be about as dangerous as seasonal flu, and there usually isn't a high demand for those vaccines. Still, regular flu kills up to 500,000 people a year.
In past pandemics, or global epidemics, vaccines were never exported before the country that produced them got enough for its own population first.
Unlike the last two pandemics in 1957 and 1968, however, many more countries this time around have struck deals with companies which they say guarantees them first access to vaccine. Yet in a global health emergency, those contracts may ultimately be meaningless.
Countries with flu vaccine plants might decide to seize all vaccines and ban their export, thus breaking the pharmaceutical contracts promising other countries vaccine supplies. These private contracts are not binding international law between two countries, according to Fidler.
He said most vaccine contracts include a clause allowing them to be broken under extraordinary circumstances, such as a health emergency. That would leave the countries who had brokered such deals not only without vaccine, but without legal recourse.
"There's nothing in international law that helps you resolve this, it's just a political nightmare happening in the midst of an epidemiological nightmare," Fidler said.
Britain has ordered 60 million doses, enough to cover its entire population. But those doses are being manufactured by GlaxoSmithKline PLC and Baxter International Inc., whose production plants are in Germany, Austria and the Czech Republic. Neither Britain's department of health or the vaccine manufacturers would comment on delivery plans.
Osterholm said about 80 percent of the United States' pandemic vaccine supply will be coming from abroad and he is very concerned about when it might arrive. Timing could be everything to avoid a vaccine spat.
"It's easy to move vaccine around if the disease is relatively mild. But if it is more severe, countries may not be willing to let it go," he said.
So far, swine flu remains a relatively mild disease, and most people don't need medical treatment to get better. But experts fear the virus could mutate into a more dangerous form. And during the flu season, when the virus spreads more easily, more people will probably fall sick and die.
Public health officials are aware that so-called "vaccine wars" might break out if the swine flu outbreak worsens, but are loathe to even discuss the topic.
The European Centre for Disease Prevention and Control, an agency of the European Union, said it had no mandate to advise countries in such circumstances. WHO said it was not aware of any countries planning to block the shipment of vaccines and said they would work to ensure all countries get enough doses to protect their health workers.
Questions also remain about when a swine flu vaccine will even be available, as WHO reported this week that a fully licensed vaccine might not be ready until the end of the year.
With little or no safety data about a swine flu vaccine, governments that are planning to roll out mass campaigns are taking a gamble, since any rare side effects won't show up until millions of people start getting the shots.
Experts say government promises about when vaccines will arrive should be taken with a huge grain of salt.
"Many pieces of the puzzle are missing," Osterholm said. "Anyone who pretends to have a well-defined schedule of vaccine delivery is obviously very poorly informed."
Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country.
That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad.
"This isn't rocket science," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "If there is severe disease, countries will want to hang onto the vaccine for their own citizens."
Experts say politicians would not be able to withstand the pressure.
"The consequences of shipping vaccine to another country when your own people don't have it would be devastating," added David Fedson, a retired vaccine industry executive.
About 70 percent of the world's flu vaccines are made in Europe, and only a handful of countries are self-sufficient in vaccines. The U.S. has limited flu vaccine facilities, and because factories can't be built overnight, there is no quick fix to boost vaccine supplies.
Last week, the World Health Organization reported nearly 95,000 cases of swine flu including 429 deaths worldwide. If swine flu turns deadlier in the winter, the main flu season in the Northern Hemisphere, countries will likely be clamoring for any available vaccines.
"Pandemic vaccine will be a valuable and scarce resource, like oil or food during a famine," said David Fidler, a professor of law at Indiana University who has consulted for WHO. "We've seen how countries behave in those situations, and it's not encouraging."
Britain claims it will start vaccinating people in August, Italy says it will begin by the end of the year, and many other countries have similar strategies. Those mass vaccination plans could be derailed by problems making the vaccine and by other countries' refusal to ship it abroad.
If the virus remains mild, this could all be moot. Experts estimate swine flu to be about as dangerous as seasonal flu, and there usually isn't a high demand for those vaccines. Still, regular flu kills up to 500,000 people a year.
In past pandemics, or global epidemics, vaccines were never exported before the country that produced them got enough for its own population first.
Unlike the last two pandemics in 1957 and 1968, however, many more countries this time around have struck deals with companies which they say guarantees them first access to vaccine. Yet in a global health emergency, those contracts may ultimately be meaningless.
Countries with flu vaccine plants might decide to seize all vaccines and ban their export, thus breaking the pharmaceutical contracts promising other countries vaccine supplies. These private contracts are not binding international law between two countries, according to Fidler.
He said most vaccine contracts include a clause allowing them to be broken under extraordinary circumstances, such as a health emergency. That would leave the countries who had brokered such deals not only without vaccine, but without legal recourse.
"There's nothing in international law that helps you resolve this, it's just a political nightmare happening in the midst of an epidemiological nightmare," Fidler said.
Britain has ordered 60 million doses, enough to cover its entire population. But those doses are being manufactured by GlaxoSmithKline PLC and Baxter International Inc., whose production plants are in Germany, Austria and the Czech Republic. Neither Britain's department of health or the vaccine manufacturers would comment on delivery plans.
Osterholm said about 80 percent of the United States' pandemic vaccine supply will be coming from abroad and he is very concerned about when it might arrive. Timing could be everything to avoid a vaccine spat.
"It's easy to move vaccine around if the disease is relatively mild. But if it is more severe, countries may not be willing to let it go," he said.
So far, swine flu remains a relatively mild disease, and most people don't need medical treatment to get better. But experts fear the virus could mutate into a more dangerous form. And during the flu season, when the virus spreads more easily, more people will probably fall sick and die.
Public health officials are aware that so-called "vaccine wars" might break out if the swine flu outbreak worsens, but are loathe to even discuss the topic.
The European Centre for Disease Prevention and Control, an agency of the European Union, said it had no mandate to advise countries in such circumstances. WHO said it was not aware of any countries planning to block the shipment of vaccines and said they would work to ensure all countries get enough doses to protect their health workers.
Questions also remain about when a swine flu vaccine will even be available, as WHO reported this week that a fully licensed vaccine might not be ready until the end of the year.
With little or no safety data about a swine flu vaccine, governments that are planning to roll out mass campaigns are taking a gamble, since any rare side effects won't show up until millions of people start getting the shots.
Experts say government promises about when vaccines will arrive should be taken with a huge grain of salt.
"Many pieces of the puzzle are missing," Osterholm said. "Anyone who pretends to have a well-defined schedule of vaccine delivery is obviously very poorly informed."
House Democrats set to vote on health care bill
House Democrats on Thursday pushed ahead with legislation that would deliver on President Barack Obama's promise to remake the health care system and cover some 50 million uninsured, despite concerns from their own party's moderate and conservative lawmakers that the $1.5 trillion plan costs too much.Congressional Budget Office Director Douglas Elmendorf warned lawmakers the legislation that he has seen so far would raise costs, not lower them. Elmendorf was asked by Senate Budget Committee Chairman Kent Conrad, D-N.S., if the bills Congress is considering would "bend the cost curve." The budget director responded: "The curve is being raised."
Subsidies to help uninsured people would raise federal health care spending, which is already growing at an unsustainable rate, Elmendorf explained at a hearing. The Medicare and Medicaid cuts that lawmakers have offered to pay for the coverage expansion aren't big enough to offset the cost trend, particularly in the long term, he said.
Congress is moving forward nonetheless. On the heels of the Senate health committee's approval Wednesday of a plan to revamp U.S. health care, three House committees with jurisdiction over the issue were shifting into action.
Votes were planned Thursday in the Education and Labor and Ways and Means committees on a $1.5 trillion plan that majority House Democrats presented this week. The legislation seeks to provide coverage to nearly all Americans by subsidizing the poor and penalizing individuals and employers who don't purchase health insurance.
A third House committee, Energy and Commerce, also was considering the measure Thursday, but the road was expected to be rougher there. A group of fiscally conservative House Democrats called the Blue Dogs holds more than a half dozen seats on the committee — enough to block approval — and is opposing the bill over costs and other issues.
Rep. Mike Ross, D-Ark., who chairs the Blue Dogs' health care task force, said the group would need to see significant changes to protect small businesses and rural providers and contain costs before it could sign on. "We cannot support the current bill," he said.
The Energy and Commerce Committee's Blue Dogs met Wednesday to consider what amendments they would offer, and the panel scheduled vote sessions daily through next Wednesday in what promised to be an arduous process to reach consensus.
Obama was doing all he could to encourage Congress to act. He scheduled White House meetings for Thursday morning with two potential Senate swing votes, Sens. Ben Nelson, D-Neb., and Olympia Snowe, R-Maine. On Wednesday he met with a group of Senate Republicans in the White House in search of a bipartisan compromise and appeared in the Rose Garden for the latest in a daily series of public appeals to Congress to move legislation this summer.
Obama also pushed his message in network television interviews, and his political organization launched a series of 30-second television ads on health care.
Wednesday's Senate health committee vote "should make us hopeful — but it can't make us complacent," Obama said. "It should instead provide the urgency for both the House and the Senate to finish their critical work on health reform before the August (congressional) recess."
The Senate health panel's $615 billion measure would require individuals to get health insurance and employers to contribute to the cost. The bill calls for the government to provide financial assistance with premiums for individuals and families making up to four times the federal poverty level, or about $88,000 for a family of four, a broad cross-section of the middle class.
But the 13-10 party-line vote on the bill signaled a rift in Congress — including between Democrats. Some liberal-leaning Senate Democrats are eager to move forward with or without Republican support, while some moderates want to hold out for a bipartisan deal.
But a core group on the Senate Finance Committee — which, unlike the health committee, must come up with a payment mechanism for the bill — continued to labor toward bipartisan agreement. Because it might be difficult to secure support from all Democrats, Finance Chairman Max Baucus, D-Mont., insisted after daylong meetings Wednesday that a bipartisan bill was needed.
Obama has made clear that he wants the Finance Committee to produce legislation by week's end but Baucus couldn't say whether that would happen.
Finance Committee members are considering a new proposal from Sen. Charles Schumer, D-N.Y., that would raise $100 billion over 10 years by imposing new fees on health insurance companies.
July 15, 2009
Rare Cells Linked to Pediatric Cancers
Certain types of circulating blood cells appear to be important predictors of the spread of cancer in children, say French researchers.
They measured levels of circulating endothelial cells and endothelial progenitor cells in 23 children with localized cancer, 22 children with metastatic cancer and 20 healthy children. Circulating endothelial cells are rare cells shed from the lining of blood vessels after vascular damage. Endothelial progenitor cells are precursors of circulating endothelial cells.
"Not only were these cells found in higher levels in [cancer] patients compared to healthy volunteers, but endothelial progenitor cells were found in strikingly higher amounts in patients with metastatic disease," Francoise Farace, director of the department of biology of circulating cells at the Gustave Roussy Cancer Institute, said in a news release from the American Association for Cancer Research.
The finding that children with metastatic cancer had much higher levels of these cells than healthy children was a surprise, the researchers indicated.
"This implies that these endothelial cells most likely play a role in the development of cancer in children," Farace said. "We also observed a large range of cell levels in patients with various tumor types. In some cases, very high levels were observed, which means their role may be very important."
The study appears July 15 in Clinical Cancer Research.
Further research is needed to confirm whether these cells play a role in metastasis. If so, the researchers suggested, testing levels of the cells could improve early detection of metastatic cancer, and the cells could be targeted by new drugs to prevent the spread of cancer.
They measured levels of circulating endothelial cells and endothelial progenitor cells in 23 children with localized cancer, 22 children with metastatic cancer and 20 healthy children. Circulating endothelial cells are rare cells shed from the lining of blood vessels after vascular damage. Endothelial progenitor cells are precursors of circulating endothelial cells.
"Not only were these cells found in higher levels in [cancer] patients compared to healthy volunteers, but endothelial progenitor cells were found in strikingly higher amounts in patients with metastatic disease," Francoise Farace, director of the department of biology of circulating cells at the Gustave Roussy Cancer Institute, said in a news release from the American Association for Cancer Research.
The finding that children with metastatic cancer had much higher levels of these cells than healthy children was a surprise, the researchers indicated.
"This implies that these endothelial cells most likely play a role in the development of cancer in children," Farace said. "We also observed a large range of cell levels in patients with various tumor types. In some cases, very high levels were observed, which means their role may be very important."
The study appears July 15 in Clinical Cancer Research.
Further research is needed to confirm whether these cells play a role in metastasis. If so, the researchers suggested, testing levels of the cells could improve early detection of metastatic cancer, and the cells could be targeted by new drugs to prevent the spread of cancer.
Senate health committee clears insurance overhaul
The Senate health committee cast a milestone vote Wednesday to approve legislation expanding insurance coverage to nearly all Americans, becoming the first congressional panel to act on President Barack Obama's top domestic priority.The 13-10 party line vote advanced a $600 billion measure that would require individuals to get health insurance and employers to contribute to the cost. The government would provide financial assistance with premiums for individuals and families making up to four times the federal poverty level, or about $88,000 for a family of four. The health committee legislation is but one piece of broader Senate legislation that's still under development.
"This time we've produced legislation that by and large I think the American people want," said Sen. Chris Dodd, D-Conn., who stood in for committee chairman Sen. Edward M. Kennedy of Massachusetts. Kennedy, who's made health care legislation a lifelong priority, is being treated for brain cancer.
But ranking Republican Sen. Mike Enzi of Wyoming argued that the bill would break Obama's promises by adding to the deficit.
Obama himself was driving the action, scheduling a Rose Garden statement to reiterate that a bill will get done and focus on the role of nurses in any overhaul. It marked the third straight day the president has kept up a full-court press on health care. The drive included a television ad blitz by Obama's political operation, targeting moderate lawmakers of both parties.
On Tuesday, House Democratic leaders pledged to meet the president's goal of health care legislation before their August break, offering a $1.5 trillion plan that for the first time would make health care a right and a responsibility for all Americans. Left to pick up most of the tab were medical providers, employers and the wealthy.
"We cannot allow this issue to be delayed. We cannot put it off again," Rep. Henry Waxman, D-Calif., the chairman of the House Energy and Commerce committee, said Tuesday. "We, quite frankly, cannot go home for a recess unless the House and the Senate both pass bills to reform and restructure our health care system."
In the Senate, Majority Leader Harry Reid said he wanted floor debate to begin a week from Monday. With the Senate Finance Committee still struggling to reach consensus, that timetable could slip. Even so, it underscored a renewed sense of urgency.
"There's going to be a major debate over the next three weeks," Obama said Tuesday in Warren, Mich., deviating from his prepared text on new spending for community colleges. "And don't be fooled by folks trying to scare you saying we can't change the health care system. We have no choice but to change the health care system because right now it's broken for too many Americans."
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