Health Spectator

A special advisory panel to the Food and Drug Administration recommended Tuesday that Vicodin and Percocet—two prescription pain-killers that combine acetominophen with narcotics—should be banned. The panel noted that prolonged use of aceominophen, which is the primary ingredient in Tylenol, causes liver damage in many patients and further recommended that at least seven other medications that combine acetominophen with narcotics should have their use discontinued.

Doctors would still be allowed to prescribe the narcotics, which include oxycodone (found in Percocet) and hydrocodone (found in Vicodin). They would further be allowed to prescribe acetominophen if they wished, but many doctors are already reluctant to prescribe medications that combine acetominophen with narcotics because of its known toxicity to the liver.

In fact, the same panel voted 24 to 13 to recommend that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter pills such as Tylenol to 325 milligrams, from the currently allowed 500 mg. They further voted 21 to 16 to reduce the maximum daily dosage of the drug to less than 4,000 mg.

The FDA is not required to follow the panel’s recommendations but generally does follow such advice. The measure was taken because there have been increasing numbers of accidental deaths from acetominophen in recent years. More than 400 people die and 42,000 are hospitalized every year in the U.S. from acetominophen overdoses. In 2005, American consumers bought 28 billion doses of products containing the ingredient.

Even the currently legally recommended doses of aceotminophen have caused liver damage in some people.

The advisory committee decided not to reduce the number of acetominophen pills allowed to be purchased in a single bottle, since it might provide a greater hardship for the poor and those who live in rural areas who are more likely to buy larger quantities at one time in an effort to save money or out of a need to shop for medications less frequently.

Surprisingly, the Centers for Disease Control and Prevention’s swine flu tally for all 50 states plus the District of Columbia, Puerto Rico and the U.S. Virgin Islands does not appear to have changed much since the last time we looked. This week, the CDC changed its normal schedule of updating the figures on Friday in honor of the Advisory Committee on Immunization Practices meeting yesterday. Yesterday’s figures, which are the final figure for the week, were effective as of 7:00 PM Thursday, June 25 EDT.

The U.S. is reporting 27,717 confirmed or probable swine flu cases with 127 deaths confirmed to be the result of swine flu. Wisconsin continues to lead the states with 4,273 cases reported and 4 deaths. Texas and Utah have 10 deaths apiece, while New York has 35, California 16, and Illinois has 12.

A story by AP reporter Michael Stobbe says one U.S. official has estimated that more than one million Americans may have become infected with the novel H1N1 swine flu at this point.

Stobbe attributes the estimate to Lyn Finelli, an official with the Centers for Disease Control and Prevention (CDC). Finelli gave a presentation at a meeting of the vaccine advisory committee in Atlanta on Thursday.

Currently, the CDC is reporting just under 28,000 confirmed or probable cases of the swine flu, with 127 deaths in the U.S. Those figures were as of last Friday and will be updated again this Friday am. The difference between the 28,000 actual and one million estimated figures is that the actual figures reflect testing for the flu virus, while the estimate Finelli provided is based on mathematical modeling. Such modeling assumes that the actual reported cases—arrived at because they represent acute infections or hospitalizations that aroused the suspicion of examining physicians that they might represent an infection by the novel H1N1 virus, or swine flu—are just the tip of the iceberg, with many more people infected with the virus suffering symptoms that do not prompt them to seek medical help.

And not all those who do seek medical help will necessarily arouse sufficient alarm on the part of health practitioners to warrant testing for swine flu. Hence, the one-million-case estimate, which also suggests that half the world’s cases of swine flu are right here in the U.S.

Health Spectator will report the CDC’s new confirmed and probable case counts as usual on Friday.

The World Health Organization (WHO) is investigating a reported bubonic plague outbreak in the Libyan coastal town of Tubruq, which sits on the Mediterranean.

According to reports attributed to John Jabhour, a WHO emerging diseases expert based in Cairo, about 16 to 18 people have been affected so far, with one dead. A WHO team was on its way to investigate the outbreak and confirm whether it was indeed bubonic plague.

In fact, bubonic plague outbreaks are not all that uncommon, and 10 or 20 cases are reported within the United States annually. The disease—which mainly infects rodents and is spread by insect bites, especially fleas—afflicts 1,000 to 2,000 people each year. If confirmed, these will be the first cases of bubonic plague in Libya for twenty years, but outbreaks have been occurring in the Congo, Mozambique, Malawi and Madagascar with relative frequency since at least 2002. Algeria had its first outbreak in 50 years in 2003.

Fortunately, the bacterial infection is treatable with antibiotics (streptomycin is the drug of choice, according to WHO) if detected early.

While the bubonic form of the plague is generally treatable—this is the form referred to as the Black Death during the Middle Ages—a newer form called pneumonic plague (which, just as it sounds affects the lungs) is highly contagious via airborne particles. There is also a septicemic form of the disease, which infects the blood.

First pandemic declared in 41 years

Acceding to a global rise in A(H1N1) infections, the World Health Organization today raised its pandemic alert level for swine flu to level 6—its highest level.

Asking member nations not to impose restrictions on travel or anything that might interfere with commerce, the organization stressed that the alert level reflects the widespread nature of the flu—its “unstoppability”—but not the severity of its symptoms or the number of its fatalities, which so far appear to be below the levels posed by so-called “seasonal” flu.

Indeed, WHO recommends that drug manufacturers stay on track with producing their annual allotments of seasonal flu vaccines before switching over to produce vaccines for swine flu.

In a report early last week, Health Spectator had reported that the novel H1N1 epidemic had technically achieved pandemic status according to WHO’s guidelines just by virtue of its rapid spread in Australia. The outbreak began in North America, and WHO guidelines specify a pandemic level 6 when the infection has achieved uncontrolled human-to-human transmission in more than one part of the globe.

There have been 28,774 infections reported in 74 countries to date, including 144 deaths, according to WHO’s latest tally of laboratory-confirmed cases.

We mentioned in our last posting on swine flu that if cases in Australia increased significantly, the World Health Organization (WHO) may be forced to declare A(H1N1) a pandemic.

Cases in Australia have continued to mount. Friday’s figure was 876 confirmed cases in Australia, according to WHO statistics, which are updated Mondays, Wednesdays and Fridays. As of today, WHO is reporting 1,051 cases in Australia, while the local weblog Swine Flu in Australia, is reporting that Australian cases have reached 1,207.

Since Australia is just now entering the winter season, its swine flu caseload could explode. Swine Flu in Australia is also reporting that thanks to a soccer match last week, “the entire Queensland team is now in quarantine after a player tested positive to Swine Flu.”

The latest WHO figures put the global swine flu count at 25,288 cases, with 139 dead and 73 countries affected. Those figures were released as of 6:00 am GMT, Monday, June 8.

Meanwhile, Dehli reported its first swine flu case yesterday, bringing India’s total swine flu caseload to 10 as of Sunday. Those figures are not reflected in this morning’s WHO report.

As the “new” A(H1N1) swine flu spreads in the U.S., 13,217 cases are current in all 50 states plus the District of Columbia and Puerto Rico. There were 27 U.S. deaths from the flu as of 11 am today, according to the Centers for Disease Control (CDC) in Atlanta. At the time of our last report on U.S. fatalities a week ago, deaths totaled 15, with 48 states and Washington, DC claiming 8,975 infections.

That gives the U.S. an increase of 4,242 cases in one week, with 12 more dead over the same period—an 80% increase in deaths for a 47% increase in cases. Read the rest of this entry »

World Health Organization’s Keiji Fukuda, chief of that organization’s influenza group, said today that WHO is “getting closer” to declaring a stage 6 (pandemic) status for the A(H1N1) swine flu, according to the Associated Press.

Today’s update on WHO’s website had not yet appeared as of 2:26 pm EST, but early reports say WHO is setting the number of global infections at 18,965 across 64 countries, with 117 deaths. That number contrasts with the figures of 17,410 cases across 62 countries and 115 deaths posted on June 1.

India has reported two more cases of the “new” swine flu, bring that country’s total to three infections. Those individuals are being quarantined. Egypt has reported its first case of swine flu, despite having ordered the country-wide slaughter of all pigs.

Meanwhile, an 11-week-old child has become New York City’s fifth casualty to swine flu, according to reports from AP and the Daily News. The Daily News identifies the child as Steven Montanez, from the Bronx.

15 swine-flu deaths in U.S. as of May 29

According to Centers for Disease Control (CDC) data released at 11 am, Friday, May 29, the number of H1N1 (”swine flu”) cases in the U.S. is rapidly approaching the 10,000 mark. (see table) In fact, it likely will have reached that level by the time you read this, given the rate at which cases have increased over approximately the past week.

Meanwhile, health officials seem intent upon emphasizing the relatively mild symptoms of this so-called “new” or “novel” H1N1 influenza, as the CDC calls it. At the same time, the U.S. government has entered into a deal to acquire swine flu vaccine for persons it deems most worthy. Read the rest of this entry »

We reported more than a year ago on a study that claimed to show a link between consumption of red meat and various cancers, including breast and colorectal cancers. That study came from the American Institute for Cancer Research (AICR) in collaboration with its parent institution, the World Cancer Research Fund, and was controversial because of its findings.

Now, a new study based on the NIH-AARP Diet and Health Study shows no correlations between consumption of meat and postmenopausal breast cancer. Read the rest of this entry »