Reducing Flu in Pre-school Children

Impact of Requiring Influenza Vaccination for Children Attending Licensed Childcare or Preschool Programs — Connecticut, 2012–13 Influenza Season

Preschool-aged children are at high risk for serious consequences of influenza and should be vaccinated against influenza, especially those in settings where transmission is common such as child care facilities.

Effective January 2011, preschool-aged children in Connecticut were required to be vaccinated against influenza to attend licensed child care. Investigators from the Yale School of Public Health and the Connecticut Department of Public Health evaluated the effect of this requirement on vaccination rates and on hospitalizations of young children during the 2012-2013 influenza season. Vaccination rates in Connecticut rose more quickly and were higher than children in the rest of the United States. After the requirement was implemented, hospitalization rates for influenza in young children in Connecticut were lower compared with 10 other sites in the United States with similar monitoring.

Requiring influenza vaccination in children attending child care facilities appears to have contributed to lower hospitalization rates from influenza among young children in Connecticut.

Australia: Organic Sprouts Recalled Due to Salmonella

Energetic Greens—Organic Sprouts Salad

Organic Sprouts Salad (broccoli, sunflower and radish) packaged in a 50g plastic punnet.

The Sprouts are marked - Best before: 08.03.14

The recall is due to Salmonella contamination and may cause illness if consumed.

These Sprouts were sold from 28th February 2014 to 6th March 2014 in New South Wales. They were sold by Local green grocers, IGA stores and Mullumbimby, Bangalow and Glorious Organic Farmers Markets

Any consumers concerned about their health should seek medical advice. Customers should return the product to the place of purchase for a full cash refund.

New Zealand: Cheese Recalled Due to Listeria Contamination

Whitestone cheese Ltd recalled Windsor Blue retail ready and wholesale cheese products due to listeria contamination.

Package Description & Size:	These products are sold in 220g and 110g wedges or in varying quantities specified by the customer or repacked by the retailer
NZ Distribution:	These products are sold from some supermarkets, delicatessens & food retail outlets throughout New Zealand
Overseas Distribution:	Yes
Reason for Recall:	Whitestone Cheese Ltd are initiating a recall of the Windsor Blue retail ready and wholesale products listed above after discovering that these products may be contaminated with Listeria.
Comments:	If you have purchased any Whitestone Cheese Windsor Blue wholesale product between February 2014 and March 2014 and/or retail ready product listed above please do not consume. If you have consumed any of these products and have any concerns about illness, please contact your doctor or seek medical advice. Customers should return the product to their retailer for a full refund or phone 0800 892 43373 with any queries. This recall does not affect any other Whitestone Cheese products.

Army Studies Suicide in the Military

The largest study of mental health risk and resilience ever conducted among U.S. military personnel today released its first findings related to suicide attempts and deaths in a series of three JAMA Psychiatry articles. Findings from The Army Study to Assess Risk and Resilience in Service members include: the rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed; nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment; and soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.

“These studies provide knowledge on suicide risk and potentially protective factors in a military population that can also help us better understand how to prevent suicide in the public at large,” said National Institute of Mental Health (NIMH) Director Thomas R. Insel, M.D.

Although historically, the suicide death rates in the U.S. Army have been below the civilian rate, the suicide rate in the U.S. Army began climbing in the early 2000s, and by 2008, it exceeded the demographically matched civilian rate (20.2 suicide deaths per 100,000 vs. 19.2)

The articles reflect different strategies to evaluate information on suicide risk and potentially protective factors. An article by lead author Michael Schoenbaum of NIMH examined the suicide and accident death rates in relation to basic socio-demographic and Army experience factors in the 975,057 regular Army soldiers who served between Jan. 1, 2004 and Dec. 31, 2009. This study found that the suicide rates increased during this time period, even among those who had never deployed, and also found that being deployed increased suicide risk for women more than it did for men. However, suicide risk still remained lower for deployed women than for deployed men. Additionally, the study identified a correlation between demotion and suicide risk: soldiers who had been demoted in the past two years experienced increased suicide risk, compared to those without such demotions. There was also increased risk in soldiers without at least a high school diploma or a GED certificate, compared to soldiers with similar or higher degrees. The data suggest that being male, white, or a junior enlisted rank put individuals at the highest risk of suicide.

The second article, by lead author Matthew Nock, Ph.D., at Harvard University, Cambridge, Mass., explains the findings from a survey of more than 5,000 non-deployed soldiers, designed to shed light on suicidal thoughts, plans, and attempts before and after entering the Army. Recruitment interviews revealed that 13.9 percent of soldiers considered suicide at some point in their lifetime, 5.3 percent made a suicide plan, and 2.4 percent attempted suicide, with between 47 to 60 percent of these outcomes first occurring prior to joining the Army. Researchers found that soldiers attempting suicide appeared to be lower-ranking, enlisted, female, and to have been previously deployed. Certain pre-enlistment mental disorders, including panic disorder and post-traumatic stress disorder, linked to increased rates of suicide attempts after joining the Army. In fact, approximately one-third of post-enlistment suicide attempts tied back to pre-enlistment mental disorders. Pre- and post-enlistment mental disorders accounted for 60 percent of first suicide attempts in the Army. The soldiers’ pre-enlistment patterns of suicidal thoughts and behaviors remained lower than suicidal thoughts and behaviors reported by a demographically matched civilian group. However, once in the Army, the onset of suicidal thoughts and planning became more common than among comparable civilians. Both groups had similar rates of suicide attempts.

The last article, by lead author Ronald C. Kessler, Ph.D., at Harvard Medical School, Boston, Mass., describes a comparison of the same set of non-deployed soldiers and a group of similarly aged civilians. Rates of common mental disorders in the U.S. Army are compared with a demographically-matched civilian population from the National Comorbidity Survey Replication, a national household study that assesses mental disorders. The Kessler study estimated how common certain mental health disorders are among Army soldiers, and whether the disorders developed prior to entering the Army. The most common disorders in soldiers included ADHD and intermittent explosive disorder. Almost 85 percent of those who self-identified as having had a mental health disorder reported that the problem began prior to joining the Army. For some of the disorders — including ADHD, intermittent explosive disorder, and substance use disorder — an early age of onset occurred more among soldiers than in civilians. The study also looked at role impairment, which is whether the disorders seriously affected the soldiers’ home life, work performance, social life, or close relationships. Severe role impairment was found to be substantially more common among soldiers with a mental disorder, than those without.

Although the root causes for the rise in Army suicides still remain unknown, these three studies point to risk factors, which may help identify potential protective factors, focus existing prevention programs, and foster the development of novel efforts to reduce suicide and suicidal thoughts and actions among service members at higher risk.

Prevalence of Allergies the Same Regardless of Where You Live

In the largest, most comprehensive, nationwide study to examine the prevalence of allergies from early childhood to old age, scientists from the National Institutes of Health report that allergy prevalence is the same across different regions of the United States, except in children 5 years and younger.

“Before this study, if you would have asked 10 allergy specialists if allergy prevalence varied depending on where people live, all 10 of them would have said yes, because allergen exposures tend to be more common in certain regions of the U.S.,” said Darryl Zeldin, M.D., scientific director of the National Institute of Environmental Health Sciences (NIEHS), part of NIH. “This study suggests that people prone to developing allergies are going to develop an allergy to whatever is in their environment. It’s what people become allergic to that differs.

The research appeared online in February in the Journal of Allergy and Clinical Immunology, and is the result of analyses performed on blood serum data compiled from approximately 10,000 Americans in the National Health and Nutrition Examination Survey (NHANES) 2005-2006.

Although the study found that the overall prevalence of allergies did not differ between regions, researchers discovered that one group of participants did exhibit a regional response to allergens. Among children aged 1-5, those from the southern U.S. displayed a higher prevalence of allergies than their peers living in other U.S. regions. These southern states included Texas, Oklahoma, Louisiana, Arkansas, Tennessee, Kentucky, Mississippi, Alabama, Georgia, West Virginia, Virginia, North Carolina, South Carolina, and Florida.

“The higher allergy prevalence among the youngest children in southern states seemed to be attributable to dust mites and cockroaches,” explained Paivi Salo, Ph.D., an epidemiologist in Zeldin’s research group and lead author on the paper. “As children get older, both indoor and outdoor allergies become more common, and the difference in the overall prevalence of allergies fades away.”

The NHANES 2005-2006 not only tested a greater number of allergens across a wider age range than prior NHANES studies, but also provided quantitative information on the extent of allergic sensitization. The survey analyzed serum for nine different antibodies in children aged 1-5, and nineteen different antibodies in subjects 6 years and older. Previous NHANES studies used skin prick tests to test for allergies.

The scientists determined risk factors that made a person more likely to be allergic. The study found that in the 6 years and older group, males, non-Hispanic blacks, and those who avoided pets had an increased chance of having allergen-specific IgE antibodies, the common hallmark of allergies.

Socioeconomic status (SES) did not predict allergies, but people in higher SES groups were more commonly allergic to dogs and cats, whereas those in lower SES groups were more commonly allergic to shrimp and cockroaches.

By generating a more complete picture of U.S. allergen sensitivity, the team uncovered regional differences in the prevalence of specific types of allergies. Sensitization to indoor allergens was more prevalent in the South, while sensitivity to outdoor allergens was more common in the West. Food allergies among those 6 years and older were also highest in the South.

The researchers anticipate using more NHANES 2005-2006 data to examine questions allergists have been asking for decades. For example, using dust samples obtained from subjects’ homes, the group plans to examine the link between allergen exposure and disease outcomes in a large representative sample of the U.S. population.

Antibiotic Prescribing Putting Patients at Risk

Antibiotics can be lifesaving, but poor prescribing practices put hospital patients at risk for preventable allergic reactions, super-resistant infections, and deadly diarrhea caused by Clostridium difficile.  These practices also drive antibiotic resistance, further endangering the future of these miracle drugs and the patients who need them.  For some hospital patients, it is already too late.  We must change prescribing practices now.

According to a new CDC Vital Signs report:

• About one-third of the time, prescribing practices to treat urinary tract infections and prescriptions for the critical and common drug vancomycin included a potential error. This means that many patients are given drugs without proper testing or evaluation, or were given drugs for too long.
• Clinicians in some hospitals prescribed three times as many antibiotics as clinicians in other hospitals, even though patients were receiving care in similar areas of each hospital. This difference suggests the need to improve prescribing practices.
• A 30 percent reduction in the antibiotics most likely to cause C. difficile infections can reduce these deadly infections by more than 25 percent.

C. difficile infection is a growing problem in healthcare facilities. Outbreaks occur when humans accidentally ingest spores in a medical facility. The infection kills 14,000 people a year in America aloneWhen the bacteria are in a colon in which normal gut flora has been destroyed (usually after a broad-spectrum antibiotic such as clindamycin has been used), the gut becomes overrun with C. difficile. The bacteria release toxins that can cause bloating and diarrhea, with abdominal pain, which may become severe.

Latent symptoms of C. difficile infection often mimic some flu-like symptoms and can mimic disease flare in patients with inflammatory bowel disease-associated colitis. Mild cases of C. difficile infection can often be cured by discontinuing the antibiotics. In more serious cases, oral administration of, first, oral metronidazole and—if that fails—then, second, vancomycin and if unsuccessful again, intravenous metronidazole can be used. Relapses of C. difficile have been reported in up to 20% of cases]

High Plasticizer Levels and BPA Linked to Delayed Pregnancy

Women whose male partners have high concentrations of three common forms of phthalates, chemicals found in a wide range of consumer products, take longer to become pregnant than women in couples in which the male does not have high concentrations of the chemicals, according to researchers at the National Institutes of Health and other institutions.

The researchers assessed the concentrations of phthalates and Bisphenol A (BPA) in couples trying to achieve pregnancy. Phthalates, sometimes known as plasticizers, are used in the manufacture of plastics, to make them more flexible. BPA is also used in plastics, including in some food and drink packaging.

According to the U.S. Centers for Disease Control and Prevention, pthalates are used in hundreds of products , such as fragrances, shampoos, nail polish, plastic film and sheets. For the most part, people are exposed to phthalates by eating and drinking foods that have been in contact with containers and products containing the compounds. BPA is used to make some types of plastic containers, in the protective lining of food cans, and other products.

The study authors measured urine concentrations of BPA and 14 phthalate compounds in couples trying to achieve pregnancy. The study authors explained that many phthalates are often broken down and chemically changed before they are excreted from the body.

Pregnancy took the most time to achieve in couples in which the males had high concentrations of monomethyl phthalate, mono-butyl phthalate, and monobenzyl phthalate. Neither male nor female exposure to BPA was associated with pregnancy rates.

Because the researchers examined only the time it took to achieve pregnancy, the study could not determine precisely how the compounds might affect fertility. Future studies, the authors wrote, would be needed to determine if the compounds affected particular aspects of reproductive health, such as hormone levels.

“Our study shows that exposure to certain phthalates can reduce the chance of conception for otherwise healthy couples,” said the study’s first author, Germaine M. Buck Louis, Ph.D., Director of the Division of Intramural Population Health Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Many people have been exposed to these compounds, so it’s important to continue to investigate whether they have any health effects.

The study was published online in the journal Fertility and Sterility. In addition to Dr. Buck Louis and her colleagues from the NICHD, the study also included researchers from the Texas A&M School of Public Health in College Station, the New York state Department of Health, and the University at Albany of the State University of New York.

In their article, the authors cited previous studies by other researchers who found high concentrations of BPA and other phthalates among couples seeking treatment for infertility. One study found that men with a high BPA level had decreased testosterone levels. Another found that men with a high BPA concentration had a reversal in the ratio of testosterone to estradiol, an estrogen-related hormone. Numerous studies found that, compared to infertility patients without high BPA levels, women seeking treatment for infertility had lower estradiol levels, fewer egg cells, lower rates for the implantation of the fertilized egg, and lower pregnancy rates. Similarly, the authors wrote, studies in lab animals suggest that BPA and other phthalates can hinder the maturation of egg cells, impair the production of reproductive hormones, and alter the development of reproductive organs.

For the current analysis, the researchers studied couples who were not being treated for infertility, but who were trying to conceive a child. The researchers enrolled 501 couples from four counties in Michigan and 12 counties in Texas from 2005 to 2009. The couples were part of the Longitudinal Investigation of Fertility and the Environment (LIFE) study, established to examine the relationship between fertility and exposure to environmental chemicals and lifestyle. Previous analyses from the LIFE study found that high levels of PCBs as well as of lead and cadmium also were linked to pregnancy delay.

The women taking part in the study ranged from 18 to 44 years of age, and the men were over 18. Couples provided urine samples that were analyzed for BPA and the 14 other phthalate compounds. Women kept journals to record their monthly menstrual cycles, intercourse and the results of home pregnancy tests. The couples were followed until pregnancy or for up to one year of trying.

The researchers calculated the probability that a couple would achieve pregnancy by using a statistical measure called the fecundability odds ratio (FOR). The measure estimates couples’ probability of pregnancy each cycle, based on their urinary concentration of the compounds. A ratio less than one suggests a longer time to pregnancy, while a ratio greater than one suggests a shorter time to pregnancy.

BPA concentrations were not associated with a longer time to pregnancy However, male urinary concentrations of the three metabolites of phthalates were associated with approximately a 20 percent increase in the time it took for the couples to achieve pregnancy:

Female urinary concentrations of these three metabolites were not associated with a delay in pregnancy.

“The delays in pregnancy we saw were comparable to those seen for cigarette smoking or with obesity,” Dr. Buck Louis said.

Dr. Buck Louis added that the findings demonstrate that it’s important to study both partners when assessing the effects of environmental substances on pregnancy outcomes. If the researchers had only studied the female partners, she added, they would have missed the association between these three phthalates and a delay in the time the couples took to achieve pregnancy.

“Clearly, in studies of this kind, males matter,” she said.

According to the CDC, monomethyl pthalate is excreted in the urine of people exposed to dimethyl phthalate, which is used in manufacturing rocket propellant and consumer products such as insect repellents and plastics. Mono-n-butyl phthalate , excreted in the urine of people exposed to the dibutyl phthalates, is used as additives to personal care products such as nail products and cosmetics, and in printing inks, pharmaceutical coatings, and insecticides. Mono-n-benzyl phthalate , excreted in the urine of people exposed to benzylbutyl phthalate, is used in products such as adhesives, vinyl tile, sealants, car care products, and some personal care products. People exposed to benzylbutyl phthalate also excrete small amounts of mono-n-butyl phthalate in their urine.

The study authors noted that earlier studies had found that men with high concentrations of monomethyl phthalate had abnormalities in their semen and that men with high concentrations of mono-n-butyl phthalate had diminished sperm motility and reduced sperm count.