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Health Headlines - October 16

Posted Oct 23 2008 2:24pm
Amish Split on How to Face Polio Threat

Residents of an isolated Amish community appear divided on what to do after doctors diagnosed four cases of the polio virus in their children. Some have decided on vaccinations to ward off future polio cases, while others prefer leaving the matter in God's hands.

About two dozen Amish households dot the hillsides in central Minnesota's rolling farm country. On Thursday, state health officials announced the four polio infections -— the first known cases in the United States in five years.

The Amish community -— it has no official name -— has seen a flurry of visitors from the state Health Department after three siblings under 16 were diagnosed. Two weeks earlier, an infant from the community had been diagnosed with polio, and state doctors expect more cases to turn up.

None of the four have developed symptoms, and health officials say most polio cases do not result in paralysis. But they have urged members of the community to be immunized as soon as possible to reduce the chances the virus will spread. Only unvaccinated people are at risk.

"The doctors were here to talk to us," said Susie Borntreger, a young Amish mother who was hunting down snakes with a hoe in her yard Friday. "They talked with my husband. They told us we should think about the vaccine."

The Borntregers decided to vaccinate their two sons, aged 2 and 1. But that decision is not universal. Some Amish families here don't trust vaccinations. Borntreger was vague when asked to explain her family's thinking, saying the decision was made by her husband.

"Some people are very open, some people want to think about it, some people just say no," said Harry Hull, the state epidemiologist.

After consulting with Amish community leaders, state and county officials decided to approach families separately about vaccinations to avoid social pressures in the extremely close-knit community.

Unlike other Amish communities that cater to tourists, this small, conservative settlement in sparsely populated Todd County has little interaction with modern society. The closest town, Clarissa, has hitching posts outside stores on Main Street, but residents say their Amish neighbors keep to themselves.

"They come to town to shop," said Diane Hanson, a drug store clerk. "They're nice, friendly, but they never stick around long. I don't know any of them, and I don't know many people who do."

Many of the Amish settled here in the last five years or so, migrating from communities in Wisconsin in search of inexpensive farmland. They raise turkeys, cows and pigs and cultivate corn and wheat.

On Friday, a group of Amish men and boys were building an addition to one family's home. They declined requests to talk, expressing fears that a public airing of concerns over the polio cases could drive a wedge between neighbors.

Seventeen-year-old Alma Miller said her mother was spending the weekend at the Minneapolis hospital where the infant was staying so its parents could come home and care for their other children.

"The mothers are taking turns going down there," said Miller, who became upset when a camera was pointed toward her.

Miller said she herself had not been vaccinated and was waiting to see what her parents decide.

The last reported cases of paralytic polio in the United States were three in 1999, and three the year before that. There was a significant outbreak in 1979 in Amish communities in Iowa, Wisconsin, Missouri and Pennsylvania.

Many Amish people were vaccinated after that outbreak, said Jane Seward, chief of the viral-vaccine preventable disease unit at the Centers for Disease Control.

Until 2000, the United States used a live virus vaccine for polio -— which caused about eight cases of paralytic polio a year. The United States and Canada now use an injected vaccine made from the killed virus, but some Amish still fear that a vaccination could inadvertently infect their children with polio.

State doctors don't know the source of the recent infection. Hull said it appears to be a mutated version of a live polio vaccine, which is still used in some countries.

Health officials consider polio eliminated in the Western Hemisphere. It persists in other parts of the world, including India, Nigeria, Yemen and Pakistan, according to the World Health Organization.

Deadly bird flu confirmed in Romania's Danube delta

Laboratory tests showed on Saturday that the same deadly H5N1 strain of bird flu as that found in Turkey and Asia had infected ducks in Romania, confirming the virus had reached mainland Europe.

A British laboratory testing Romanian samples established that three birds found dead in the Danube delta last week contained the H5N1 strain, which has killed more than 60 people and caused the death of millions of birds in Asia since 2003.

The World Health Organization's top influenza expert, echoing previous warnings, said the virus could mutate into a form that could kill thousands or millions of people around the world and urged governments to prepare for such a pandemic.

But encouraging news came from China, where state media said a new, improved vaccine for birds had been developed, a low-cost spray that could protect them from the H5N1 strain of avian flu.

The spread of the virus in Asia has been blamed on backyard farms and open-air markets where humans and birds mingle in often unsanitary conditions, and authorities have been unable to wipe it out despite large-scale culling and vaccination.

In Turkey, the state Anatolian news agency reported that nearly 1,000 chickens had died in the east, near the Iranian border, after being transported from the west of the country. It said samples had been sent for tests for possible bird flu, but did not say where exactly the birds had been moved from.

A Turkish Health Ministry official said earlier that nine people under observation in hospital for possible bird flu had been allowed to go home as tests showed they were not infected.

Turkish officials also said the incubation period for the avian flu found on a farm in the northwest was over, and the danger to humans had passed.

The EU Commission in Brussels confirmed that the H5N1 strain found in Romanian ducks was exactly the same as that detected in Turkish birds. "The link has now been confirmed," Health and Consumer Protection Commissioner Markos Kyprianou said in a statement.

Kyprianou said the European Union had already banned poultry and live bird imports from Romania, so no further measures were needed. EU veterinary experts will meet on Thursday to review the situation, he added.


Klaus Stoehr, director of the WHO influenza program, said "the virus has the potential to change and mutate and thus spark a terrible pandemic," echoing the fear of other experts that H5N1 may change into a form that spreads easily among humans.

"We don't know whether a pandemic will break out in the coming weeks, months or only in years," he told German NDR radio. "But there's no question that if such a pandemic occurs we'll be looking at hundreds of thousands or even millions of deaths worldwide."

Countries so far unaffected must assume the virus will spread further, Stoehr said. "It's not about speculating, it's about actually getting ready for an outbreak to occur, even in Europe."

In Romania, pharmacies ran out of regular flu vaccine and local media reported that worried citizens had bought up to 2 million doses of the vaccine in the past few days.

Flu vaccine protects people only against the latest strain of regular flu. Only if H5N1 mutates into a form that passes easily between humans will pharmaceutical firms be able to develop a vaccine specifically against that strain.

In Romania's southeast Danube delta area, six counties were cordoned off. Vehicles leaving the area were being disinfected at checkpoints and residents were being given antiviral drugs, officials said.

Television footage showed masked and gloved veterinarians gassing poultry and disinfecting farms in the delta village of Ceamurlia de Jos, part of a cull of more than 60,000 birds aimed at stopping the virus from spreading.

The Danube delta contains Europe's largest wetlands and is a major resting place for migratory wild birds -- the carriers of the virus -- coming from Russia, Scandinavia, Poland and Germany and heading for North Africa for winter.

Poland, responding to European Commission calls, said all poultry must be kept indoors from Monday to keep it away from migratory wild birds.

"The situation means quite a large danger for poultry in Poland, so I decided to impose some restrictions ... including a ban on keeping poultry in open spaces," Farm Minister Jerzy Pilarczyk told a news conference.

Hundreds May Have Used Botox Knockoff

Plastic surgeon Frederic Corbin was intrigued last year when he saw an ad for a product that offered the same protein used in the wildly popular wrinkle treatment Botox -— only much, much, cheaper.

"My initial reaction was, 'Hmm, Botox now has some competition,'" recalled Corbin, who practices in Beverly Hills, Calif.

But when he received a vial of the botulinum toxin in the mail, he was puzzled by the warning: "For Research Purposes Only. Not for Human Use."

He says he returned it and more or less forgot about it until he heard about four people last December whose mysterious paralysis was linked to the use of a Botox knockoff.

Authorities have found that dozens of doctors around the country bought unapproved botulinum, which in its raw form is one of the most potent neurotoxins on Earth. And investigative documents indicate that more than 1,000 people may have been injected with it, many unaware they weren't given federally approved Botox.

The company accused of selling the unapproved toxin and marketing it as a Botox substitute goes on trial next month in federal court in Fort Lauderdale, Fla.

"We don't know how dangerous it is, it's not as well controlled as the commercially available product," said Dr. Thomas Rohrer, a Boston dermatologic surgeon who has written extensively about botulinum, which he describes as more powerful than cyanide.

Tucson, Ariz.-based Toxin Research International and owners Chad Livdahl and Zarah Karim, who are jailed awaiting the trial, are accused of defrauding people who thought they were getting a safe, approved Botox treatment.

No one is known to have been hurt by TRI's toxin; the four paralyzed people were injected with a toxin bought straight from the manufacturer that supplied TRI, not from the company itself.

Eric and Bonnie Kaplan were allegedly injected by Dr. Bach McComb, who also injected himself and his girlfriend, Alma Hall. Federal prosecutors say McComb worked as a consultant for TRI.

Lawyers in the case say McComb injected himself and the others with the wrong dose. They have all partially recovered.

But last December, when McComb, Hall and the Kaplans lay paralyzed on ventilators and unable to swallow or see, investigators searching the clinic where McComb worked found marketing materials from TRI.

Although TRI hasn't been directly linked to the paralysis case, authorities say the Arizona company told other doctors its product was safe and on its way to being approved for people.

According to case documents, at least 180 doctors -— plastic surgeons, dermatologists, naturopaths -— ordered Botulinum Toxin Type A from TRI. A five-dose vial would cost $1,250, compared to about $2,000 for Botox.

TRI's lawyer Ben England said "we disagree" that TRI was acting fraudulently, and declined to elaborate.

Most doctors who bought the toxin haven't been publicly named, and officials say many patients don't know they got the unapproved toxin.

In Salem, Ore., Dr. Jerome Lentini is one the few who has been criminally charged, accused of injecting a TRI toxin into hundreds of patients, many of whom signed a consent form that implied they were getting FDA-approved Botox.

All charges against TRI involve misleading patients.

Some doctors and clinics say that's because the toxin is basically the same as what's used to make Botox.

The unapproved material "is a naturally occurring neurotoxin that ... appears to be identical," said Scott Hopes, an epidemiologist who also represents a north Florida surgery center where a doctor's license was suspended for buying the unapproved toxin.

Dr. Dale Abadir of New York City said she used it on herself and her husband. "I was interested in getting it and seeing if it worked," she said. "From what I could see it seemed to work as well as" Botox.

"Those people should think themselves very lucky," countered Dr. John Agwunobi, a U.S. Department of Health and Human Services official and former Florida health secretary.

Agwunobi and others said just because no one was injured yet, doesn't mean it won't happen in the future.

"The physicians who are buying it are just plain stupid," said Dr. Sue Ellen Cox, a dermatologic surgeon in Chapel Hill, N.C. "You could be injecting God knows what."

Expert Tips Make Raking Up Safer

Raking the leaves can provide good exercise and a chance to enjoy the autumn weather, but it can also result in back strain and sore muscles.

The Canadian Physiotherapy Association offers the following tips to keep raking risk-free:

If you have a heart condition or other medical problems, talk to your doctor before raking.
Wear well-fitting shoes with good soles that will prevent slipping.
Do stretches and warm-up exercises before you start raking.
When raking, hold the rake handle close to your body to help maintain good posture. Keep one hand near the top of the rake handle for better leverage. Use your arms and legs more than your spine when raking. Ergonomic rakes can help reduce the strain on your body.
Change sides frequently while raking and avoid twisting at the waist.
Pace yourself and take frequent breaks and/or change to a different activity.
When bagging leaves, lift manageable loads and keep your back straight and use your legs to do the lifting. If you have to stoop to pick up leaves, face the pile of leaves and don't twist as you lift.
Don't pile too many leaves into one bag -- especially if they're wet.
When you finish for the day, do cool-down exercises.

Food Fact:
Nothing fishy.

Follow a few savvy shopping tips, and seafood will be as good for your taste buds as it is for your heart. Here's what to know: Fresh fish smells good, like sea air, so walk away from a strong fishy smell or an off odor; fish fillets and steaks should look moist, with no gaps between the segments; scrub mussels and clams with a stiff-bristled brush under running water, and discard any that don't close when tapped.

Fitness Tip of the day:
Brain check.

Physical exercise may mean as much for your mind as it does for your body. Research shows exercise can relieve anxiety and depression, increase your energy levels, enhance your self-image, help release tension, and may improve sleeping patterns. Exercise also reduces your overall risk of dying prematurely and helps you control your weight.

FAQ of the day:
Can tomatoes and lycopene prevent breast cancer?

Tomatoes and lycopene probably can't protect against breast cancer, they are still a good nutritional choice for women because they'e so rich in antioxidants and vitamins. There is evidence that tomatoes may help protect men against prostate cancer.
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