Sunday, July 19, 2009

News Clipping Archives

 

 

Maryland / Regional

Summer camps deal with swine flu (Washington Times)

Meals on Wheels benefits from Eppel retirement (Baltimore Sun)

 

National / International

Food-Safety Bill Spurs Backlash (Wall Street Journal)

A family battles MRSA after losing a child (Baltimore Sun)

Standards Might Rise on Monitors for Diabetics (New York Times)

 

Opinion

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Maryland / Regional

Summer camps deal with swine flu

 

By Karen Goldberg Goff

Washington Times

Sunday, July 19, 2009

 

At summer camp in 2009, hand-sanitizing, temperature-taking and a triage for who might need Tamiflu are part of daily activities, right along with swimming, basketball and crafts.

 

Fears of an H1N1 - or swine flu - pandemic have abated somewhat since spring. But that doesn't mean people, particularly young people, aren't getting sick. Part of the hallmark of the H1N1 virus - which for most people turns out to be a mild case of the flu - is that it is sweeping through the United States during the summer months, traditionally the "off-season" for most flu strains.

 

This has meant extra vigilance on the part of public health officials, camp directors, parents and campers.

 

"It is very real, and it is not going away," said Joe Quimby, spokesman for the Centers for Disease Control and Prevention.

 

Through Friday, CDC statistics show Maryland has had 732 confirmed cases of H1N1. The District has reported 45, with 319 in Virginia. Nationally, 40,617 cases and 263 deaths have been verified.

 

However, Mr. Quimby says those numbers "are just the tip of the iceberg." He estimates the real number of H1N1 cases is more like 1 million to 1.5 million, as the vast majority of people falling ill this summer do not go through formal testing.

 

Six camps in Maryland have reported outbreaks and "have all acted appropriately to address the health and safety of the children," said Fran Phillips, deputy secretary for public health services for the Maryland Department of Health and Mental Hygiene.

 

"There is no reason that parents should be concerned about sending a child away to camp," she said. "The flu is everywhere. Camps are monitoring kids' behaviors a bit better, but there is not an increased number of incidents at camp."

 

Still, some camps have been hit hard. At Sandy Hill Camp in Cecil County, Md., 25 campers were sent home from their two-week session in late June because of flu. The camp eventually cut short that session and sent remaining campers home, the camp's director, Greg Joseph, said in an e-mail.

 

"Nearly everyone was very understanding of the decision and many have expressed their appreciation for our proactive response as the situation developed," Mr. Joseph said. "The decision to shorten the first two-week session was a difficult one, but we continue to put the health and safety of our campers as the highest priority."

 

Sandy Hill is now running smoothly with no more than the typical visits to the health center, he said. Hand sanitizer is kept on the tables in the dining hall, and shared surfaces such as doorknobs are disinfected daily. On the camp's Web site, parents can read a daily health update about the status of campwide temperature checks and whether anyone has fallen ill.

 

"For the last 2 1/2 weeks, we have been taking the temperatures of all campers and staff twice each day," said Mr. Joseph. "Campers or staff that develop elevated temperatures or flulike symptoms at any time during the camp session are evaluated by the camp medical staff. Campers' parents are notified, and any unhealthy campers are sent home. Any unhealthy staff members either go home [if home is nearby] or are isolated here at camp for seven days from the onset of their symptoms or until they have been fever-free for 24 hours, whichever is longer, as recommended by the CDC."

 

Adam Levine, 14, of Reston, was similarly quarantined when flu affected his camp, Camp Harlam in Kunkletown, Pa., in early July.

 

At drop-off day in late June, staff members took campers' temperatures, and parents were asked to sign a release form authorizing the dispensing of antiviral drugs such as Tamiflu should their child be exposed to the flu, said Adam's mother, Laurie.

 

Shortly after, Mrs. Levine got an e-mail saying her son had a slight fever and headache and was being given Tamiflu. He later spent five nights in the infirmary, as it is camp protocol to isolate suspected sick children.

 

"I was impressed with the way the camp handled it," said Mrs. Levine, whose son has since recovered and has rejoined his fellow campers.

 

A spokesman for the Union of Reform Judaism, which sponsors the camp, said that 57 children at Camp Harlam were infected with the flu as of Friday. Most have recovered, and the camp never had to close. Meanwhile, URJ camps in Georgia and California have delayed opening or have ended a session early because of the flu.

 

The flu outbreak has definitely had an effect on camps and campers with special medical needs. The Muscular Dystrophy Association has canceled plans for 45 camps in 35 states, including Camp Maria in Leonardtown, Md.

 

The American Lung Association has advised closing camps for children with asthma.

 

"Due to the immediate threat of H1N1, the national headquarters of the American Lung Association has recommended to all of our affiliate organizations [that sponsor asthma camps] to cancel asthma camps planned for the remainder of the summer," association spokeswoman Heather Grzelka said. "While seasonal influenza is typically not common during the summer months, the H1N1 influenza strain has been more widespread this summer. Influenza poses a special health risk to children with asthma, so an abundance of caution must be exercised to best protect the health and welfare of these more vulnerable kids."

 

The American Camp Association, the professional group that provides health and safety accreditation for more than 2,400 camps, has been working with the CDC and individual camps to provide monitoring strategies and prevent spread of the illness, CEO Peg Smith said.

 

"The camps affected are fewer than those not affected," she said. "Most kids are going to camp and having a normal camp experience. But all of us have heightened precautions, and due diligence is being taken, as it should be. Most camps are screening kids the minute they arrive."

 

Ms. Smith said camps have been flexible about delayed arrivals, advising if a child is running a fever they should remain out of camp until they are well. Camps have also been sharing strategies to quell the spread of germs, such as staggering beds or placing them head to foot so campers are not breathing on one another all night.

 

Copyright 2009 Washington Times.

 

Meals on Wheels benefits from Eppel retirement

 

By Mary Gail Hare

Baltimore Sun

Sunday, July 19, 2009

 

When Arnold Eppel retired as director of Baltimore County's Department of Aging in May, he wanted no celebrations or personal gifts. But he did ask for charitable donations to Meals on Wheels of Central Maryland. He invited friends and co-workers to participate in an online virtual retirement party that raised $8,000 for the nonprofit organization. Eppel, now director of Atrium Village Retirement Community in Owings Mills, did have a celebration Friday. He and County Executive James T. Smith Jr. presented the donation to A. Thomas Grazio, executive director of the organization whose staff and 2,000 volunteers prepare and deliver meals to thousands of clients each day.

 

Copyright © 2009, The Baltimore Sun.

 

National / International

Food-Safety Bill Spurs Backlash

 

By Jane Zhang

Wall Street Journal

Sunday, July 19, 2009

 

WASHINGTON -- Legislation to overhaul the nation's food-safety system has spurred a backlash from livestock and grain farmers who don't want the Food and Drug Administration inspecting farms.

 

The legislation, approved by the House Energy and Commerce Committee last month, aims to give the FDA more money and authority to police food safety, and technically doesn't apply to foods the agency doesn't regulate: meat, poultry and some egg products, which are regulated by the Department of Agriculture.

 

But livestock and grain farmers say the legislation isn't written clearly enough, and they gave lawmakers and regulators an earful Thursday at a House Agriculture Committee hearing.

 

"Live animals are not 'food' until the point of processing, which is why this bill needs to clarify that the FDA does not have regulatory authority on our farms, ranches and feedlots," said Sam Ives, a veterinarian who spoke for the National Cattlemen's Beef Association.

 

The bill appears to have touched off a dispute, as well, between two powerful lawmakers: Agriculture Committee Chairman Collin Peterson (D., Minn.) and Rep. John Dingell (D., Mich.), a main sponsor of the FDA food-safety bill. While Mr. Peterson said that he has been assured by Mr. Dingell that the bill doesn't seek to include livestock and other farms, Mr. Peterson said he will meet again with Mr. Dingell and Commerce Committee Chairman Henry Waxman (D., Calif.) to press for further clarification. If he's not satisfied, Mr. Peterson said, he threatened to stop the legislation.

 

"We are a little skeptical of FDA," Mr. Peterson said outside the hearing room Thursday. "We are very concerned about them getting involved in grain farms, livestock farms."

 

Dingell spokesman Adam Benson said that "Mr. Dingell has had numerous conversations with Chairmen Waxman and Peterson in an effort to identify and address any concerns Chairman Peterson and the members of the Agriculture Committee may have with the legislation" and that staff members have also met "on a number of occasions." Mr. Benson said Mr. Dingell wants to see passage of the food-safety legislation in coming weeks.

 

The dispute over legislation to address gaps in the nation's food-safety system shows farmers' apprehension about new regulatory requirements and the FDA. The agency has been under fire for a string of foodborne-illnesses involving products such as spinach, peanut butter and hot peppers.

 

The USDA, however, hasn't come under as much criticism, even though it has been involved in several recent beef recalls. The agency, which inspects meat and poultry, operates under a different law and is better funded than FDA. Its inspection rules are generally considered more stringent than the FDA's.

 

At Thursday's hearing, both FDA and USDA officials tried to ease farmers' concerns, saying the legislation won't change the their jurisdictions. Mike Taylor, the FDA's new senior adviser on food safety, said the agency already goes to farms as part of its responsibility to oversee the safety of animal feed, vegetables, eggs and other products. The two agencies also cooperated on the investigations of mad-cow disease and others emergencies, he said. If lawmakers exclude grain and livestock farmers from the legislation, they should be careful not to take away current FDA authority.

 

Mr. Jerold Mande, deputy undersecretary for food safety at the USDA, said both agencies have seen "unprecedented cooperation" through the White House's cabinet-level panel on food safety.

 

Some farmers - mostly those producing fresh fruits and vegetables, which have been hit with several large-scale outbreaks -- support the legislation.

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

A family battles MRSA after losing a child

 

Chicago Tribune

By Judith Graham

Baltimore Sun

Sunday, July 19, 2009

 

No matter what doctors did, the baby's oxygen levels kept dropping.

 

Drug-resistant bacteria were eating holes in the lungs of 7-week-old Madeline Reimer of Batavia. The most powerful antibiotics available could not stop them.

 

The baby died four years ago this week, succumbing to an infection that flared at home after birth. Angry and grieving, Beth Reimer called publicly for better efforts to control the bacterium that killed her daughter: methicillin-resistant Staphylococcus aureus, or MRSA.

 

It was a threat the 37-year-old woman would meet again, with horror and disbelief.

 

Longing for another child, Reimer eventually set aside her anxiety and gave birth to a girl in April. But days after Emma was born, hospital staff discovered the infant carried MRSA on her body, putting her at a much higher risk of infection.

 

"What are the odds of this happening twice, in the same family?" Reimer said recently in her kitchen as a healthy Emma napped quietly in her lap.

 

"We had the whole fear we were going to bury another child," said her husband, Ken Reimer.

 

The Reimers' story is highly unusual; MRSA doesn't strike newborns very often. But it underscores the continuing spread of this potentially dangerous bacterium in hospitals and the community -- and the difficulty of keeping it at bay.

 

The methicillin-resistant form of the bacterium commonly known as staph was identified in the 1970s, in hospitals. By the 1980s, it had surfaced across the world. A decade later, University of Chicago researchers identified a community form of the germ that is now circulating widely in day-care centers, gyms and schools.

 

Up to 1.2 million MRSA infections occur in hospitals each year in the U.S., and invasive MRSA infections kill more than 19,000 people each year, according to estimates. Reliable data about trends aren't available because MRSA isn't tracked nationally, unlike mumps or HIV/AIDS.

 

The bacterium sometimes causes life-threatening infections, but people often are "colonized" without becoming ill and carry it for years in or on their body. To avoid transmission in the community, experts urge people not to share towels or clothing in gyms, to clean wounds and keep them covered, and to wash hands frequently. Active infections can be treated with vancomycin, a top-of-the-line antibiotic.

 

In the past several years, hospitals across the country have mounted aggressive campaigns against MRSA, stressing hand-washing by staff and thorough cleaning of rooms and equipment with disinfectants. Yet many U.S. hospitals are cutting infection control budgets amid the current economic downturn, according to a survey released last month by the Association for Professionals in Infection Control and Epidemiology.

 

Two years ago, Illinois became the first state to mandate that hospitals screen all at-risk patients for MRSA and take measures to stop the bacterium's spread. People considered at risk include frail seniors transferred from nursing homes and all patients in intensive care. This fall, Illinois will begin reporting data about MRSA infections in hospitals.

 

Nationally, legislation introduced last month in Congress would require hospitals to screen patients for MRSA and report the number of infections publicly.

 

Where the bacteria that entered Emma's body came from remains a mystery that haunts the Reimers.

 

"The hospital had Emma in isolation. How does a newborn get something like this?" Ken Reimer asked.

 

Not from her mother, apparently: Beth Reimer also had a MRSA test after giving birth in April and the results were negative.

 

Dr. Jeffrey Loughead, director of neonatal intensive care at Central DuPage Hospital in Winfield, where Emma was born, said, "It's highly unlikely" she contracted the germ from a health-care worker.

 

"We don't have MRSA in labor and delivery, the [neonatal intensive care], the [pediatric intensive care] or the nursery," Loughead said.

 

Some neonatal intensive care units and nurseries at area hospitals have persistent problems with MRSA, but Central DuPage is not among them, he said.

 

Among pregnant women, 2.1 percent to 3.5 percent are colonized with MRSA, according to several small research studies cited by Dr. Laura Riley, an expert on the subject and director of labor and delivery at Massachusetts General Hospital in Boston. Transmission from mother to baby during childbirth is not common, she said, but MRSA can be passed through breast milk. Riley and other physicians report increasing numbers of mothers with breast infections involving the bacterium.

 

When MRSA was discovered on Emma, prompt diagnosis and treatment eliminated it from her body. Today, at 3 months old, she is fine, but her mother lives with anxiety and dread.

 

Every time Emma coughs, Reimer remembers the dry cough that was the first symptom Madeline was ill. Every person who comes into the house represents another opportunity for MRSA to be carried in on Reimer's hands or clothes.

 

At home, she sterilizes toys regularly for Emma and Luke, Madeline's twin brother, age 4. Hand-washing is mandatory, several times a day. When anyone in the family becomes sick, everyone uses paper towels. The couple also have an 18-year-old son from Ken Reimer's first marriage.

 

Beth Reimer's persistent fear is that her baby will become infected and she will learn too late. That is what happened with Madeline.

 

At 4 pounds 10 ounces, Madeline was the smaller of the twins born at 32 weeks in June 2005 after Reimer had an emergency Caesarean section at Edward Hospital in Naperville.

 

"She seemed to be healthier; she never needed oxygen," Reimer said. In all, Madeline spent 2½ weeks in the neonatal intensive care unit.

 

Edward Hospital spokesman Keith Hartenberger said the medical center investigated the case in 2005 and determined the baby's MRSA was acquired outside the hospital.

 

Madeline was a sweet baby with petite features and big blue eyes that seemed to look right through whoever was holding her, her mother remembers. Two days after Madeline started coughing and a doctor diagnosed a likely viral infection, Reimer found her limp and blue in the middle of the night when she went to pick her up for a feeding.

 

An ambulance rushed Madeline to Rush-Copley Medical Center in Aurora with suspected meningitis. After several tests, she was airlifted to Loyola University Medical Center in Maywood in critical condition. Doctors there put Madeline on a ventilator and diagnosed sepsis and a virulent pneumonia that was destroying her lungs. Cultures showed the culprit was MRSA.

 

Dr. Kathleen Webster, a pediatric critical care physician at Loyola, cared for Madeline for 11 days before the baby died. She described a roller coaster course of illness: a touch-and-go situation in the first 24 hours, growing optimism as the infant's condition appeared to stabilize, then acute crisis as her lungs collapsed.

 

Often, Madeline's grandfather sat beside her, urging her not to give up, the doctor remembered. Every night, Beth Reimer slept at her daughter's side -- except once, the night before Madeline died, when Reimer went to the Ronald McDonald House near Loyola. The next morning, Webster recalled, Reimer walked into the hospital and said: "She's not going to get better."

 

"She knew before we did," Webster said.

 

All day, nothing the doctors tried prevented the baby's oxygen from dropping. Madeline died that night, surrounded by family and the physicians who had cared for her, including Webster, who had come in on her day off, Ken Reimer said.

 

"You spend the next weeks and months thinking, 'Is there something I could have done?' " Webster said.

 

After the funeral, the Reimers learned the entire family had some form of MRSA. Beth Reimer was colonized with the bacterium and was crushed by guilt, thinking she might have passed MRSA to Madeline. Luke, who was admitted to neonatal intensive care the day after Madeline died, also was carrying MRSA. A boil on Ken Reimer's hip was lanced and tested positive for the bacterium. The family was treated until the bacterium disappeared.

 

The Reimers' experience highlights the unpredictability of MRSA.

 

"Why do some people exposed to MRSA get severe infections -- like Madeline -- and others have no or mild infections, like Luke?" Webster asked. "That's the million-dollar question and we don't have an answer."

 

Copyright 2009 Baltimore Sun.

 

Standards Might Rise on Monitors for Diabetics

 

By Gardiner Harris

New York Times

Sunday, July 19, 2009

 

Federal officials may soon require improvements for the glucose monitors used by more than 11 million diabetics in the United States.

 

The rise in the use of home glucose monitors, even by hospitals, is pushing the action by the Food and Drug Administration, which for decades has followed international standards that allow the devices to be wrong by as much as 20 percent. Such a wide error rate can leave patients vulnerable to severe problems, including seizures, unconsciousness and coma.

 

In June, the agency pressed the international group that sets the standards to tighten them. If the group refuses to act, the agency “may instead recognize other (higher) performance standards” on its own, according to a June letter from Dr. Margaret A. Hamburg, the agency commissioner.

 

A change in the international standards is the easiest and best option, officials said. The International Organization for Standardization, which sets the standards, can act quickly and broadly. But the F.D.A. can change the rules itself through a more time-consuming and cumbersome process.

 

Officials said they would keep pushing until monitor accuracy improves, a promise that diabetes doctors cheered. In a May letter, the American Association of Clinical Endocrinologists formally asked that the agency act on the issue.

 

“Because of the highly variable quality of the meters and the glucose testing strips in widespread use, the safety of our patients who depend upon those meters is threatened,” the letter said.

 

Khatereh Calleja, a spokeswoman for the Advanced Medical Technology Association, which represents monitor manufacturers, responded, “We think the present standard is working.”

 

Diabetes has been diagnosed in 18 million people in the United States, and another 6 million are estimated to have the disease without knowing it. It is the seventh leading cause of death and costs the United States an estimated $174 billion a year, with the federal Medicare program spending $1 billion on diabetes test strips alone.

 

Of particular concern to federal officials is the increasing use of home glucose monitors in hospitals. A landmark 2001 study published in The New England Journal of Medicine found that using insulin to maintain low blood sugar levels in critically ill patients, even those without diabetes, reduced hospital deaths by 34 percent — a result so astonishing that hospitals around the world soon adopted the practice.

 

But instead of buying the highly accurate and expensive glucose monitors used in the study, many hospitals bought cheaper home models never approved for hospital use. More recent studies have shown that critically ill hospital patients whose glucose levels were kept low suffered more problems — the opposite result from 2001.

 

The difference, F.D.A. officials said, may have resulted because many patients in the second study were checked with home monitors.

 

“We think this technology is not up to par for some of the protocols we see out there” like hospital treatment of critically ill patients, said Dr. Alberto Gutierrez, deputy director of the agency’s in vitro diagnostics office. “We feel passionately that this is an important issue.”

 

Besides having a wide error rate, many home monitors give the wrong result if patients are taking certain drugs like Tylenol or even vitamin C. The Accu-Chek monitors made by Roche can be confounded by drugs commonly used in dialysis. Julie A. Vincent, a Roche spokeswoman, said, “Every blood glucose monitor on the market has some limitation or interferences.”

 

The F.D.A. issued warnings about the drug-related problems, but doctors complain that they have a hard time keeping straight which drugs conflict with which monitors.

 

“In the hospital setting, you really don’t know how many deaths are due to things that may be related to meter accuracy,” said Dr. Richard Hellman, a former president of the endocrinology group. “I don’t know how common it is, but I don’t think it’s rare.”

 

A study by government researchers found that when comparing tests from five different popular monitors, results varied by as much as 32 percent. For a class science project recently, Morgan DiSanto-Ranney, 16, of Bishop O’Connell High School in Arlington, Va., bought seven different glucose monitors and had her father, a diabetic, use all of them.

 

“What I found was that almost all of the meters were off from one another by 60 to 75 points,” Morgan said in an interview. Two of the meters — Ascensia Breeze and Ascensia Breeze II, both made by Bayer — differed by an average of 62 points, she said.

 

Staci Gouveia, a Bayer spokeswoman, said her company’s monitors meet federal requirements. “If the F.D.A. standards change, Bayer will work with the F.D.A. to meet their requirements and assure the accuracy and effectiveness of our meter,” Ms. Gouveia said.

 

Morgan’s mother is Emilia DiSanto, a staff investigator for Senator Charles E. Grassley, Republican of Iowa. Briefed on Morgan’s test and other studies, Mr. Grassley sent a letter to the F.D.A. in June asking officials to review the problem.

 

As a result of her project, Morgan’s father lost faith in glucose monitors. “He doesn’t use them as much anymore,” she said.

 

That reaction is exactly what federal officials are hoping to avoid by quietly pressing manufacturers to improve accuracy. Multiple studies make clear that diabetics who routinely use monitors are healthier and suffer fewer serious complications than those who do not.

 

Manufacturers have long complained that any requirement to improve accuracy would lead them to raise prices, which would discourage use.

 

“If we decrease the use of meters, you will have some fairly dire consequences to health,” Dr. Gutierrez said, but requiring stricter accuracy standards “seems a reasonable and safe practice to do.”

 

Every year, the F.D.A. receives reports of several deaths and thousands of injuries related to glucose monitor failures, but the reports represent only a fraction of the actual toll. Insulin-dependent diabetics slip into unconsciousness once a year on average, and 40 percent suffer seizures or coma in their lifetimes because of low blood sugar levels, according to the American Diabetes Association, which has long advocated stricter accuracy standards for monitors.

 

“Insulin is a dangerous drug, and if someone makes the wrong decision about its use because of a bad test, they could die,” said Dr. David Sacks, an associate professor of pathology at Harvard Medical School.

 

Copyright 2009 The New York Times Company.

 

Opinion

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