WHO says bird flu drug maker on alert
The biggest case yet of humans possibly infecting others with bird flu prompted the World Health Organization to put the maker of the anti-viral drug Tamiflu on alert for possible shipment of the global stockpile for the first time, officials said Saturday.
No further action on the emergency supply was expected for now, according to the U.N. health agency, which called the alert part of its standard operating procedure when a case arises like that in Indonesia.
"We have no intention of shipping that stockpile," WHO spokesman Dick Thompson cautioned. "We see this as a practice run."
Meanwhile, Indonesia confirmed three more bird flu deaths as the country grapples with a spike in human cases. Bird flu is known to have infected 48 people in Indonesia, with 36 deaths Â— second highest after Vietnam's 42 deaths.
A precautionary 9,500 treatment doses of Tamiflu from a separate WHO stockpile, along with protective gear, were flown into Indonesia on Friday. The tablets will likely be handed over to the Indonesian government, WHO spokeswoman Maria Cheng said in Geneva.
Officials revealed the stockpile alert came last Monday as experts puzzled over why six of seven Indonesians from a family in a North Sumatra village died after became infected by the H5N1 virus. An eighth was buried before tests could be done, but she is believed to have been infected.
Despite the cluster of deaths, the virus has not mutated into a form easily passed among humans, experts said. Scientists have seen examples of bird flu passing between family members in a handful of smaller cases.
"If this virus had evolved into a form that is more easily passed between people, you would have seen some other cases (outside the family) by now," Cheng said. "The virus hasn't passed beyond the family."
No health workers could be seen Saturday in the family's village of Kubu Simbelang, where dozens of chickens ran among houses and through backyards framed by high mountains and surrounded by rich fields of chilies, oranges and limes.
The family infected by the virus lived in three houses near the church in the Christian village.
Indonesia's number of human bird flu cases has jumped this year, but public awareness of the disease remains low and government efforts have not equaled that of other countries. Indonesia's reaction has raised concerns it is moving slowly and ineffectively in containing the disease.
Vietnam, the country hit hardest by bird flu, has been hailed for controlling the virus through mass poultry vaccination, among other measures. No human cases have been reported there since November.
Indonesia, a sprawling nation of 17,000 islands, has refused to carry out mass slaughters of poultry in all infected areas Â— a basic containment guideline Â— saying it cannot afford to compensate farmers. And bio-security measures are virtually nonexistent in the densely populated countryside, with its hundreds of millions of backyard chickens.
WHO officials in Jakarta received word about the Kubu Simbelang cluster from the Indonesian Health Ministry on Monday. That led the Geneva-based agency to alert the Swiss pharmaceutical company Roche Holding AG within hours about possible Tamiflu shipments, said Jules Pieters, director of WHO's rapid response and containment group.
"We were quite keen to inform Roche quite timely," Pieters said. "We knew Thursday would be a holiday in Europe and wanted to make sure Roche warehouses would be open."
He said Roche would remain on alert for approximately the next two weeks, or twice the incubation period of the last reported H5N1 case.
Roche spokesman Baschi Duerr said the emergency stockpile, which consists of 3 million treatment courses, is ready to be shipped wherever it is needed.
"We are in very close contact with WHO, even today, and our readiness is geared to be able to deliver," Duerr said.
Meanwhile, Nyoman Kandun, a senior official at Indonesia's health ministry, said a WHO laboratory in Hong Kong had confirmed five more cases of human bird flu, three of which were fatal. All five had earlier tested positive for the virus in a local laboratory.
The latest confirmed deaths were a 39-year-old man from Jakarta, a 10-year-old girl from West Java and a 32-year-old man, who on Monday became the last to die in the Kubu Simbelang cluster.
Experts have been unable to link the cluster family members to contact with infected birds, and tests on poultry in their village have come back negative. No one else in the village has fallen ill.
So far, most human cases have been traced to contact with infected poultry. But there is evidence of isolated cases of limited transmission between people in very close contact with each other.
Scientists are unsure how this occurred, but they theorize the virus may pass from one person to another through droplets sneezed or coughed into the air or onto food or other surfaces.
It has been suggested some people may have a genetic susceptibility to the disease. In all, WHO has recorded four family clusters of bird flu so far and only direct blood relatives Â— not spouses Â— have become ill.
Experts are exploring whether the first woman sickened in the Kubu Simbelang cluster may have had contact with sick or dead chickens. She worked at a market where chickens are sold and may have used chicken feces as a garden fertilizer, WHO officials said.
Bird flu has killed at least 124 people worldwide since the virus began ravaging Asian poultry stocks in late 2003.
Strategies for Stretching Your Health-Care Dollar
When it comes to health care, it's not the uncomfortable needle pricks that Americans mind so much. It's the cost of medical care.
Lately, consumers have been feeling pinched when they visit the doctor or receive care at the hospital, new government statistics reveal. In 2004, spending for these services grew at levels not seen since the early 1990s.
And workers' share of health-care premiums is mounting, too. People who get health insurance benefits through their employer can expect to pay out 10 percent more, on average, in 2006, according to benefit-consulting firm Towers Perrin.
To make your health-care budget stretch farther and avoid piling up medical debt, you've got to plan ahead, advised Jessica Cecere, president of Consumer Credit Counseling Service of Palm Beach County/Treasure Coast in Florida.
"Nobody plans to have huge medical expenses," she said, "and that's why they're so huge."
For starters, consumers need to know exactly what their health insurance will and won't cover. Cecere recommends that people read and understand their policy before there's an emergency.
Using facilities that are not part of your insurer's provider network, for example, could cost you more than you anticipated. To keep your out-of-pocket costs at a minimum, stay in-network, she said.
Plus, if you don't use what you're entitled to, you could end up leaving money on the table, cautioned Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change in Washington, D.C.
For example, some employers allow workers to set aside pre-tax dollars in a flexible spending account each year to pay for qualified medical expenses, including doctor fees and preventive care. But if you don't spend the money by the annual deadline your employer has established, you forfeit those funds.
In 2005, the U.S. Treasury Department modified an existing rule that required any leftover funds to be spent by the end of the plan year. Now, employers are allowed to give workers a grace period of two-and-a-half months. Check with your employer to find out what the deadline is.
"If you have a flexible spending account, use it," Cassil said. "You can use it for over-the-counter medications now, so there's no reason to lose it. Go buy ibuprofen for the next two years."
To save money on prescription drugs, consumer advocates suggest switching from brand-name products to less expensive generic alternatives. Shopping around for best prices also can help.
Consumers Union, publisher of Consumer Reports magazine, has produced a series of reports comparing prescription drugs by category. Each report sizes up medicines by price, effectiveness and safety. The information is intended to help consumers have a conversation with their doctors about the best drug for their condition, while also taking price into account.
If you find yourself between jobs and you think health insurance is too expensive, think again. Going without coverage for a period of time, as people often do, is a huge risk, Cecere said.
"If you do fall off a ladder and have to go into the hospital for a week, that is devastating," she said. And that's why people should plan ahead. "The way you plan for it is you have some sort of coverage for that," even if it's a bare-bones policy that covers only "catastrophic" medical costs, she added.
Here's another tip: If you don't require emergency care, make an appointment with your doctor. Using the emergency room for routine medical care is a good way to start sinking into debt.
"You might get charged $1,000 for walking in the door," Cecere cautioned.
Latinas Have New Online Breast Cancer Resource
Spanish-speaking breast cancer patients and their families have a new online resource to turn to, funded by the U.S. National Cancer Institute.
The Web site, launched in May by the University of Wisconsin-Madison Center of Excellence in Cancer Communications Research, is called Conviviendo con el Cancer de Seno, -- a translation of Living With Breast Cancer.
That's the title of a program found on an English-language Web resource called the Comprehensive Health Enhancement Support System (CHESS).
In earlier research, the English-language site seemed to have a consistently positive impact on the outcomes of the breast cancer patients who participated in the program. A team of representatives from Mexico, Argentina and Venezuela translated the site into Spanish, with assistance from the Dane County Latino Health Council. Redes en Accion: The National Latino Cancer Network and the Center for Patient Partnerships also contributed to the translations.
"To the best of our knowledge, this new site is the most comprehensive and culturally relevant resource on the Web for Latinas with breast cancer," said project manager Susana Torres-Corona. "The site offers an extensive database of original content, and it also serves as an information clearinghouse linking directly to other high-quality educational materials in Spanish for Latinas created by trusted sources such as the National Cancer Institute, the American Cancer Society and the Susan G. Komen Breast Cancer Foundation," said Torres-Corona.
As breast cancer causes the most deaths from cancer in Hispanic women, and survival rates are lower than other ethnicities, the site was developed to serve and help that population, said Dr. Bret Shaw, lead investigator for the Web site project.
"By adding Spanish-speaking women to other underserved demographic groups already benefiting from our program, we anticipate reduced health information disparities between Spanish-speaking breast cancer patients and other demographic groups, as well as improved quality of life for Latina breast cancer patients and their families," said Shaw.
New Moms Should Baby Their Hands
New moms can always use a helping hand, but experts say they may need help for their hands, too.
Proper baby-handling and baby-care techniques can help prevent hand, wrist, and arm problems that are common to new mothers, experts say.
"Get yourself into good habits right away. Moms do the same activities repetitively, such as burping, rocking and lifting their babies. Take breaks and maintain good posture. Even a small change like switching positions can make a big difference," Stacey Doyon, president-elect of the American Society of Hand Therapists (ASHT), said in a prepared statement.
The ASHT offers the following injury and pain prevention tips for new mothers:
* Burp your baby over your shoulder.
* Use nursing support. "When nursing the baby, try to use devices such as Boppies that help support baby and mommy," Doyon said. "Be sure to sit in a reclined position so that the baby's weight can be held by your body and larger joints versus shoulders, arms and strained hands. If you are nursing and need to use a pump, consider using the express electronic pumps that are easier on hands and fingers than manual pumps."
* Keep the crib mattress height as high as safely possible, based on the baby's development. Move all mobiles and toys out of the way, lower the crib rail, and lift the baby with two hands.
* When holding and rocking the baby, listen to gentle music rather than fast-paced music. Keep your wrists straight and in neutral position. Hold the baby's head closer to the neck versus higher up on the head. Walk slowly, rock gently and switch your arms and position as needed to avoid getting stiff or sore. If you're sitting down, use a lap pillow or Boppie for support.
* When carrying car seats and/or baby carriers, make sure the handle is lengthwise with the carrier so that your hand and forearm are in neutral -- the thumb-forward position -- instead of the palm of your hand facing forward.
"Many moms strain their hands carrying car seats and heavy bags stuffed with baby supplies. Use common sense. Don't try to carry more than you can handle," Doyon said.