newsymail archive 2003

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A new vaccine combination was approved by the FDA on December 16, 2002 for GlaxoSmithKline by the name of Pediarix™. It contians Diphtheria, Tetanus, Pertussis, Hepatitis B, Polio Vaccines. and can be given to infants at 2, 4 and 6 months of age. It will be months before it is manufactured and distributed to our offices but it will cut down the number of pokes for the babies. It still hurts us more than it does them. Like our Dad said "This spanking is going to hurt me more than you." and now that we have children we understand what he was saying.

Because dietary supplements can vary in their contents and quality, supplement manufacturers will begin distributing products bearing the United States Pharmacopeia's Dietary Supplement Verification Program mark, a guarantee that the bottle contains exactly the ingredients that the label claims. Not that it does what it says .... but just that it contains that amount of the material. USP’s program is voluntary. Supplements meeting these standards will be labeled with the DSVP-certification mark and the following statement: "USP has tested and verified the ingredients, product and manufacturing process. USP sets official standards for dietary supplements." Northridge, Calif.-based Pharmavite Corp.'s Nature Made Vitamin E will be the first product with the DSVP-certification seal to hit shelves.

The U.S. Pharmacopeia (USP) plans to formally launch a national certification program for dietary supplements. All U.S. dietary supplement manufacturers are invited to participate. The USP program includes:

Quality control and manufacturing data review
Laboratory evaluation of product samples
Evaluation of manufacturers’ quality systems through GMP audits
Granting of a USP verification mark Surveillance of products bearing the USP verification mark

The USP verification mark will indicate that the product will:
Contain the declared ingredients on the product label
Contain the amount or strength of ingredients declared on the product label
Meet requirements for limits on contaminants Comply with the United States Pharmacopeia.

U.S. Pharmacopeia’s (USP) new Dietary Supplement Verification Program (DSVP) is confusing and could be misleading. The USP certification mark means that it vouches for the presence, quantity, and purity of a supplement’s ingredients—and not the supplement’s safety or possible benefits. The concern is that some consumers will assume that the USP mark means the product is safe and beneficial. It does not mean that it has been shown to do what it claims to do. If you are going to trust your body and health to these dietary supplements, at least get quality stuff with this seal.

The cream to numb up the skin for blood drawing and such is called EMLA in the doctors office. You can get it over the counter in ELA-Max which is just as effective and safer. You can get the "glue" with which the doctor puts minor cuts together now over the counter. So we are gradually trying to get things over the counter that you can do safely so you can avoid a trip to the doctor or ER. You might consider taking the skin glue on camping trips in case of minor little cuts.

CNN Reports:

http://www.cnn.com/2003/HEALTH/04/10/sars.child.reut

GUANGZHOU, China (Reuters) -- A new and often deadly virus which is sweeping the globe has infected thousands, with no apparent regard for race, gender or nationality. But one group has so far come through virtually untouched -- children.

Doctors are trying to explain why a virus that moves with relative ease through the adult population, so far infecting 3,000 worldwide with more than 100 dead, has come up against something of an immunological wall when it comes to youngsters.

In the south China city of Guangzhou, just miles from where the outbreak began, Guangzhou Children's Hospital has yet to see its first patient with Severe Acute Respiratory Syndrome (SARS), officials said this week.

"We haven't had any cases of SARS," said Yu Minghua, chief of paediatrics at south China's largest hospital for children.

Viral illnesses are usually worse in adults and less severe in children. Children are not immune to SARS (in my opinion) but they only have a mild cough and not much fever. They never get diagnosed. Mild cases in adults does not get diagnosed. The incidence of SARS is probably much higher (I bet more likely 30,000 rather than 3,000.) but the true total amount of cases just never gets known. SARS is a nasty chest “flu” but may not be any deadlier than the flu every winter. As you can see for this report from the CDC:

In the United States, influenza epidemics occur nearly every winter and are responsible for substantial morbidity and mortality, including an average of approximately 114,000 hospitalizations and 20,000 deaths/year. During influenza epidemics, hospitalization rates among older adults and persons with underlying chronic health problems can increase twofold to fivefold above rates in nonepidemic periods. From 1972--73 through 1994--95, >20,000 influenza-associated deaths/year were estimated to occur during 11 U.S. epidemics, with >40,000 influenza-associated deaths estimated for 6 of these 11 epidemics (unpublished data, National Center for Infectious Diseases, CDC, 1998). In each of the 3 influenza seasons from 1997--98 through 1999--00, P&I mortality exceeded epidemic threshold values for >10 consecutive weeks. The peak proportion of P&I deaths was 9.7% during 1997--98, 9.8% during 1998--99, and 11.2% during the 1999--00 season.

We worry about a new strain of flu going through and killing many people … mostly adults, elderly, and rarely small babies. The flu however is not as severe in children.

To compare, think about Hepatitis A. It is such a mild illness in children that they hardly ever even get jaundiced. They have a 7 day stomach flu and the main reason I want to diagnose them is so that I can give the family shots to prevent it in them. Hepatitis in adults is bad and 100 every year die, which equals 1/500 cases. In children it is not severe and most parents do not know that their child had Hepatitis and usually do not even bring them to the doctor. Also if we compare the child with chicken pox and the adult with chicken pox. It is more severe in adults. We give the chicken pox vaccine since rarely these viruses can kill a child, therefore we recommend the chicken pox vaccine and the Flu shot.

The flu can kill just as bad as SARS:

The 1918 Spanish Flu Pandemic, and the Hong Kong Incident

Mankind’s most devastating recorded global epidemic and its latest close call

By Leonard Crane, author of Ninth Day of Creation.

As their lungs filled … the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business.

--Isaac Starr, 3rd year medical student, University of Pennsylvania, 1918.

By the fall of 1918 a strain of influenza seemingly no different from that of previous years suddenly turned so deadly, and engendered such a state of panic and chaos in communities across the globe, that many people believed the world was coming to an end. It struck with amazing speed, often killing its victims within just hours of the first signs of infection. So fast did the 1918 strain overwhelm the body's natural defenses, that the usual cause of death in influenza patients---a secondary infection of lethal pneumonia---oftentimes never had a chance to establish itself. Instead, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients would drown in their own body fluids.

Not only was the Spanish Flu strikingly virulent, but it displayed an unusual preference in its choice of victims---tending to select young healthy adults over those with weakened immune systems, as in the very young, the very old, and the infirm. The normal age distribution for flu mortality was completely reversed, and had the effect of gouging from society's infrastructure the bulk of those responsible for its day to day maintenance. No wonder people thought the social order was breaking down. It very nearly did.

But at the close of the First World War, when Spanish Flu appeared, the world was a very different place. Since then, outstanding advances in our knowledge of the germ world have been made, adding dramatically to our repertoire of medical wizardry. Surely what happened back then couldn't happen again.

Or could it?

During the 1918-1919 fall period the number of Americans who died from influenza is estimated at 675,000. Of those, almost 200,000 deaths were recorded in the month of October 1918 alone. Worldwide, the mortality figure for the full pandemic is believed to stand somewhere between 30 to 40 million. So, with the world population today having more than tripled in the intervening years, what is to stop a modern flu pandemic from claiming upwards of 100 million lives? The answer, it seems, is nothing at all.

Today, of course, we have vaccines and antiviral drugs. But in the Third World, at least, these combatants are in very short supply. In India, where the Spanish Flu is thought to have culled more than 10 million from the population, public health care is still notoriously deficient. In China, with a population one third larger again, the situation is not much better. Even for developed countries, where vaccines are readily available, the fraction of the population that routinely subjects itself to inoculation generally hovers around 10 percent. In the event that the public were to receive adequate warnings of an impending pandemic, it's likely of course that this number could be significantly increased. But even then, it may not matter. By their nature pandemics tend to take us by surprise. The next influenza strain that ravages the human population will probably not be the one we were planning to encounter.

If all this seems a little alarmist in nature, consider for a moment the recent controversy surrounding what Robert Webster, chairman of the Department of Virology and Molecular Biology at Saint Jude Children's Research Hospital in Memphis, Tennessee, has called The Hong Kong Incident.

In 1997 epidemiologists and public health officials from around the world got their first glimpse¹ of an entirely new variety of human influenza. Known as subtype H5N1 for the surface proteins which the virus carries, the new strain had only ever previously been observed in birds. Ominously, the effect of H5N1 on poultry had earned it the evocative title of "Chicken Ebola." And when it surfaced in the human population of Hong Kong last year it proved to be almost as deadly.

How deadly? Even with the advantages of intensive-care treatment, fully one third of the first 18 confirmed cases never recovered. They died. The numbers are suggestive of the death tolls suffered by immunologically-isolated Alaskan villages in 1918, where, in some cases, half the population was lost to the disease. In Hong Kong, bird-to-human contact is believed to have been the transmission route. Fearing a public health crisis, city officials in December of 1997 ordered the slaughter of Hong Kong's entire poultry population. All ducks, geese, and chickens in the city were killed. Fortunately it appears the H5N1 subtype lacks the ability to transmit itself through the air from one human host to the next potential victim.

On the surface, HK97 shows the hallmarks of what might be described as a "near miss" for our species. In other words, a biological catastrophe. Or it could be a false alarm. It's too early to say. Either way, it's hard to argue that we didn't just receive a wake-up call of sorts. Maybe what happened in 1918 has today merely the substance of a tenuous memory, but it also marks a lesson that clearly would be dangerous to forget. On the scale of a human life span, pandemic influenza is a rarity, but no-one seriously doubts that it will be back.

As Webster reminds² us, "All the genes of all influenza viruses in the world are being maintained in aquatic birds, and periodically they transmit to other species... The 1918 viruses are still being maintained in the bird reservoir. So even though these viruses are very ancient, they still have the capacity to evolve, to acquire new genes, new hosts. The potential is still there for the catastrophe of 1918 to happen again."

So what I am saying is that SARS is a new strain of the “cold” virus called coronavirus and we will need to get a vaccine for it. Soon the majority of people will become immune to it since most cases will not be severe enough to diagnose and will not get it the next year. This illness will come to the USA like most diseases and I worry about you adults out there. I am not concerned for your children and I suggest you not loose sleep either. Actually they are better off getting immune now when their body can fight it off better. I would not go to the orient now as an adult. Hopefully since they now have the DNA mapped out for the virus that a vaccine can be rushed quickly.

The World Health Organization is appropriately trying to identify it and quarantine it until more is known and a vaccine produced. The news media has of course taken this and used the good old fear and scare tactic to get viewers as usual. Stay calm about the SARS but don’t travel to Hong Kong this year.

I guess I am allowed to get tacky here: Those parents who are paranoid about vaccines and how they are terrible for our children and they do not get their children vaccinated against the common childhood diseases …… please continue your ignorant ways and don’t get vaccinated against SARS either.

Sorry this is so long.

Dr. Knapp

www.rogerknapp.com

Helicobacter pylori infection is common worldwide. The age at which the acquisition rate of H pylori infection is highest was examined, and the effects of race and sex on the acquisition of the infection were determined. 224 children were followed up from 1975 when they were 1 to 3 years of age, to 1995. Eight percent of the children had H pylori antibodies at 1 to 3 years of age. By 18 to 23 years of age, the prevalence of the infection was 24.5% overall. Nineteen percent of the 206 participants uninfected at baseline became infected by 21 to 23 years of age. Overall, the crude incidence rate per year was 1.4%, ranging from 2.1 % at 4 years of age and 1.5% at the ages of 7years.

The Stool Antigen Test for Detection of Helicobacter pylori After Eradication Therapy

Patients underwent endoscopy with histologic assessment, rapid urease test and culture, urea breath test, and a stool antigen test at baseline and on day 35 after completing triple eradication treatment. In addition, the stool antigen test was done on days 3, 7, 15, 21, 28, and.35 after treatment completion. A positive result on stool antigen testing 7 days after treatment completion identifies patients in whom H pylori eradication was unsuccessful. Current guidelines therefore recommend the use of the urea breath test 4 weeks after completion of therapy to determine whether the organism has truly been eradicated. The fecal antigen test is a relatively new noninvasive test for detection of H pylori. The test detects the presence of infection by measuring the fecal excretion of H pylori antigens.

Many researchers have documented an association between Helicobacter pylori infection and the development of gastric cancer. A prospective study included 1526 Japanese patients with duodenal ulcers, gastric ulcers, gastric hyperplasia, or non‑ulcer‑related dyspepsia. Of these patients, 1246 had H pylori infection; 280 did not. Patients were followed up for a mean 7.8 years. Endoscopy with biopsy was performed at enrollment and 1 to 3 years later. Gastric cancer developed in 2.9% of infected patients and in none of the uninfected patients. Worldwide, gastric cancer is the second most frequent cancer, and is also the second leading cause of death from cancer. Since the discovery of Hpylori just 20 years ago, an association between this bacterium and gastric cancer has been suspected. Whether better anti‑H pylori therapy will reduce the long‑term risk for gastric cancer remains unknown. Many of these doubts about the link between Hpylori and gastric cancer can now be put to rest. The question of who should actually undergo complete H pylori eradication still remains largely unresolved. Most patients with chronic H pylori infection have no symptoms. Previous studies have indicated that screening for and treating Hpylori infection to prevent gastric cancer is potentially cost‑effective if it prevents at least 30% of cancers attributable to H pylori. Evidence is rapidly accumulating that anti‑H pylori therapy is effective, and gastric cancer may in the future be viewed, like colon cancer, as largely preventable.

Also be aware that H pylori infection can trigger apparently unrelated problems. For example, some think that H pylori is a causal factor in various dermatologic disorders. Wedi et al have shown that Helicobacter infection can be a causal factor for such diverse dermatologic disorders as rosacea, urticaria, angioneurotic edema, and atopic dermatitiS.2 Recently, investigators in Budapest studied 65 patients with hereditary angioneurotic edema and found that approximately one‑third had H pylori infection. When this was eradicated, the episodes of periodic edema were virtually eliminated in the majority of treated subjects. This is an interesting link between the gastrointestinal tract and the skin. You may recall that President Clinton had rosacea, which somewhat miraculous disappeared during his presidency. One wonders if someone slipped him a little ampicillin and Pepto‑Bismol.

"Medical books espoused the curative powers of tobacco for everything from flatulence to rabies, as an antiseptic, and as a cure for headaches. Pity the poor asthmatics of the time‑doctors recommended tobacco smoke as the cure. For pearly whites, rub teeth with tobacco ashes, A bad memory? Sixteenth‑century physicians suggested tobacco smoke because it 'rose to the brain, the seat of recollection.' The plague? Smoking, the medical establishment believed, would keep it at bay, prompting widespread smoking during the Great Plague of 1665. During the plague years, boys at England's Eton College were whipped if they tried to skip their daily smoke."

"In the 1950s, the first news reports that smoking might cause health problems began to appear. But the bad news seemed to enhance, rather than diminish, the cigarette's role in popular culture. The fact that there was growing unease about cigarettes affirmed the cigarette's role as seductive right of passage for rebellious teenagers. The leather‑clad, cigarette‑smoking outsider, immortalized by James Dean in Rebel Without a Cause, appealed to a generation that had grown disillusioned with cookie‑cutter suburbs and the Ozzie and Harriet lifestyle."

Smokers are more likely to take risks, act defiantly, and rebel against cultural norms than are nonsmokers. Smokers, for instance, are less likely to wear seat belts and more likely to be divorced. They are even said to have higher sex drives. So while government health warnings and growing antitobacco sentiments certainly scared many smokers off the habit, those very prohibitions also served to solidify many smokers' loyalties, partly because the more smoking was vilified, the more rebellious and appealing it seemed. 'Smoking has always been somewhat daring and has become much more so since the 1960s/ writes David Krogh in Smoking: The Artificial Passion (repr. 1992). 'There's a commercially approved way of being daring, and it's called smoking cigarettes."'

"This state‑controlled tobacco monopoly caters to more smokers than any other cigarette company in the world. One of every 3 cigarettes is smoked in China. But the CNTC is more of a government agency than a business. It controls virtually every aspect of China's tobacco market, from the buying of tobacco leaf to the licensing of cigarette retailers. CNTC sells more than 900 cigarette brands, the biggest of which is Hong Ta Shan, which accounts for just 4% of sales. Although China accounts for one third of the world's cigarette consumption by volume, it represents only 8% of world tobacco sales because of the low price of cigarettes sold there."