New Jersey man
diagnosed with Lassa fever dies after Liberia trip
State and federal health authorities said Tuesday that the death this week
of a 55-year-old Essex County man in a Newark hospital from Lassa fever, a
disease rarely seen in the U.S., poses an â€śextremely lowâ€ť risk to the
The man, who traveled from Liberia in West Africa to Morocco to John F.
Kennedy International Airport on May 17, had no symptoms and was not
screened at the airport, according to the federal Centers for Disease
Control and Prevention.
A day later, he went to an unnamed New Jersey hospital complaining of a sore
throat, fever and fatigue. When asked his travel history, he did not mention
his trip to West Africa, according to the CDC. The patient was sent home the
same day, then returned to the hospital on May 21 when his symptoms
He was placed in isolation, according to the CDC and the state Department of
Health, then transferred two days later to University Hospital in Newark,
one of three medical centers in the state designated to treat viral
hemorrhagic fevers, which include Ebola. Samples submitted to the CDC tested
positive for Lassa fever Monday morning while tests for Ebola and other
viral illnesses were negative. The patient was in isolation when he died
Monday evening, according to the CDC.
â€śGiven what we know about how Lassa virus spreads to people, we think the
risk to the public is extremely low,â€ť said State Epidemiologist Dr. Tina
University Hospital spokeswoman Stacie J. Newton said Tuesday that the man
was in isolation for the duration of his care.
â€śWe are taking every appropriate precaution to ensure the health and safety
of our staff and are reviewing all staff contacts to establish if there was
any risk exposure with this patient and educating staff and the public
regarding Lassa fever,â€™â€™ Newton said.
Lassa fever is a viral disease that is common in West Africa, but rarely
seen in the United States. Although Lassa fever can produce symptoms similar
to Ebola, including diarrhea, vomiting and bleeding, the disease is much
less fatal than Ebola â€” about one percent of cases compared to 70 percent
Lassa fever is not spread through casual contact or through the air and,
according to the CDC, there has never been a person-to-person transmission
of Lassa fever documented in the U.S. In rare cases, it can be transmitted
through direct contact with a sick personâ€™s blood or bodily fluids or
through sexual contact.
In West Africa, Lassa virus is carried by rodents and transmitted to humans
through contact with urine or the droppings of infected rodents. There have
been 100,000 to 300,000 cases and 5,000 deaths. Countries reporting
substantial outbreaks include Nigeria, New Guinea, Sierra Leone and Liberia,
according to the CDC.
Out of an abundance of caution, the state Department of Health said it is
working with hospital officials to identify anyone who had close contact
with the victim, including healthcare workers and family members.
They will be monitored for symptoms for 21 days by the state in coordination
with the staff of the two hospitals and local health officials.
Visit North Jersey for the story.
chemotherapy medical mystery
The memories remain so vivid that Kathy Lang Albright still goes out of her
way to avoid driving past the clinic where she received her first
chemotherapy treatments. Albright, now 65, remembers how her legs shook with
fear as she walked into the clinic for her fourth round of chemotherapy in
November 2013, anticipating the ceaseless diarrhea that would follow, which
made it nearly impossible for her to leave her home on the outskirts of
Atlanta. She knew that a new crop of painful mouth sores would make
swallowing excruciating. Her hands were sore and sunburned-looking, the skin
on her eyelids was peeling and her feet were cracked, spotting her socks
with blood. In less than six weeks she had lost 14 pounds.
Every time she asked the nurses who administered chemotherapy whether her
side effects were normal, their answer was unvarying. Several months later,
she would learn that there was a biological reason for her suffering, one
that had been overlooked for months. Armed with that knowledge and a new
oncologist, Albright completed cancer treatment last year, largely spared
the toxic side effects that had made her so sick. Now in remission, she says
she has made the transition from â€ścancer victim to one of cancerâ€™s alumni.â€ť
In August 2013 Albright began experiencing searing abdominal pain. Her
internist diagnosed diverticulitis, an inflammation of the intestinal wall,
and sent her to a gastroenterologist for a colonoscopy. The results of the
colonoscopy revealed she did not have diverticulitis, but rather Stage 4
colon cancer, the most advanced form. The disease had spread to her liver.
In late September Albright and her husband met with an oncologist at their
HMO to discuss treatment. He recommended a biweekly chemo regimen called
FOLFOX for three to four months, followed by surgery to remove the tumor and
then more chemo. The FOLFOX regimen, a standard treatment for colon cancer,
consists of a cocktail of drugs: leucovorin, fluorouracil (also known as
5-FU) and oxaliplatin. Albright also received infusions of Erbitux, a drug
approved to treat metastatic colon cancer.
By early December Albright was so sick she could barely stand up and went to
the HMOâ€™s urgent care center twice in one week. Initially, doctors who
treated her during her five-day hospitalization suspected that Albright had
contracted an infection, a consequence of an immune system weakened by
chemotherapy. A CT scan revealed that her colon was severely inflamed.
Galvanized by her ordeal, Albright began researching sensitivity to
chemotherapy. She stumbled across a description of DPD deficiency, short for
dihydropyrimidine dehydrogenase deficiency, which described many of the
problems she had suffered.
DPD deficiency is an inherited metabolic disorder caused by mutations in the
DPDY gene, which provides instructions for making an enzyme involved in
breaking down two molecules when the body does not need them.
Mutations that result in complete deficiency are rare and are apparent in
infancy; they are characterized by repeated seizures, small head size,
delayed motor skills and intellectual disability. Cases of partial
deficiency, believed to affect 2 to 8 percent of the population, show no
symptoms â€” unless such a person is given certain chemotherapy drugs,
including 5-FU, one of the drugs Albright received.
In these cases, 5-FU is not metabolized normally but instead accumulates to
toxic levels, causing ulceration of the lining of the gastrointestinal
tract, severe diarrhea, mouth sores called mucositis, low white blood cell
counts and peeling skin on the palms and soles of the feet â€” all of which
Albright experienced. If left untreated, death can result.
In late December 2013, Albright began seeing Robert Allen, the Atlanta
oncologist who had successfully treated her friend for colon cancer.
Albright said that at their first meeting Allen reviewed her records, then
told her that based on his calculations, she had received an overdose of
chemo: 30 percent too much for her weight and height.
Visit the Washington Post for the story.
Healthcare recognized for collaboration efforts between infection prevention
and environmental services
PDI has announced that Oakwood Healthcare in Dearborn, MI, has been selected
as the winning entry in Delivering the Difference, a contest recognizing
industry professionals who display excellence in building collaborative
relationships between infection prevention (IP) and environmental services
(ES) teams in healthcare facilities.
Oakwood Healthcare's infection preventionist, Priscila Bercea, collaborated
with environmental services regional manager, Alissa Bachnak, and the
corporate IP and ES teams to address key challenges, including poor
compliance with routine cleaning of high-touch areas and multi-use
equipment, overuse of bleach products resulting in surface damage and
general education deficiencies around product use.
Together, the teams established a structured approach that improved
environmental hygiene and networking across the entire healthcare system.
The following key initiatives developed through the successful collaboration
continue to drive positive results for the facility:
Implementation of a recognizable product line that is strategically placed
in the appropriate rooms
Installation of brackets on mobile and multi-use equipment to promote
Placement of educational posters and contact time stickers on all compliance
tools to clearly communicate the "what, when and how" of each product
Establishment of a monthly Infection Control Liaison Program composed of the
IP, a clinical staff member and an ES liaison from every department to share
important data and facilitate discussion
Attendance by both the infection preventionist and ES management director at
monthly corporate IP and ES meetings
"We are honored and proud to be recognized by PDI and Delivering the
Difference for the improvements and collaboration we implemented in our
facilities," said Bercea. "The journey over the past few years between
infection prevention and environmental services has increased our mutual
passion toward a positive patient outcome and family experience."
PDI will host a booth at the 2015 APIC Annual Conference in Nashville, TN
from June 27 to 29, 2015, and Bercea and Bachnak will be part of a
presentation on Delivering the Difference where they will share a case study
on Oakwood Healthcare. They will also present with PDI at the 2015 AHE
Exchange in Grapevine, TX. on September 21, 2015. PDI continues to have a
strong partnership with both APIC and AHE.
Visit here for the release.
medical-research law raises safety concerns
Legislation aimed at boosting U.S. medical research funding and revamping
some rules over drug and medical-device safety is headed toward a vote in
the full House of Representatives, likely in June.
But while the bill, known as the 21st Century Cures Act, passed the House
Energy & Commerce Committee unanimously last week and opposition has been
muted, some critics are beginning to question whether it would open the way
for companies to sell drugs and devices that arenâ€™t fully tested.
The measure would boost funding for the cash-strapped National Institutes of
Health by $10 billion over five years. The federal research agency would be
allowed to use some of that money for President Barack Obamaâ€™s $215 million
â€śprecision-medicineâ€ť initiative, which among other things would create an
enormous database of genomic information obtained from one million U.S.
patients who volunteer to participate.
The bill would offset some of the costs by changing the timing of certain
government payments to prescription drug plans for Medicare drug benefits.
Americaâ€™s Health Insurance Plans said that change will narrow drug coverage
for Americaâ€™s seniors.
Rep. Fred Upton (R., MI.), chairman of the House committee, told The Wall
Street Journal that the bill â€śis about unleashing a whole new generation
of health-care innovation and hope for patients. Rather than reacting to a
single health crisis or reforming a single piece of the innovation puzzle,
we are addressing the entire system.â€ť
The bill was authored by Upton along with others, including the committeeâ€™s
top Democrat, Rep. Frank Pallone of New Jersey; Rep. Diane DeGette of
Colorado, the top Democrat on the Oversight and Investigations subcommittee;
Health subcommittee chairman, Rep. Joe Pitts (R., PA), and Health
subcommitteeâ€™s top Democrat, Rep. Gene Green of Texas.
The Senate isnâ€™t expected to consider parallel legislation until at least
late in the year. The House bill includes a number of pro-industry
initiatives regarding drug approval and regulation of drug marketing by the
Food and Drug Administration.
The health advocacy group Public Citizen, in a letter last week to House
members, cited several portions of the bill that it says â€śwould undermine
public health and threaten patient safety.â€ť
Antibiotics are an example. They are a cause of great concern now, since
several have become less effective because of drug-resistant bacteria. The
bill would ease certain requirements for approval of new antibiotics. In a
letter to the House committee, 23 public-health groups announced their
support for the provision, saying, â€śIt is often not feasible for these drugs
to be developed using traditional, large clinical trials.â€ť The groups
include the Infectious Diseases Society of America and the American Academy
Visit the Wall Street Journal for the report.
CMS proposes rule
to strengthen managed care for Medicaid and CHIP Enrollees
The Centers for Medicare & Medicaid Services (CMS) proposed to modernize
Medicaid and Childrenâ€™s Health Insurance Program (CHIP) managed care
regulations to update the programsâ€™ rules and strengthen the delivery of
quality care for beneficiaries. This proposed rule is the first major update
to Medicaid and CHIP managed care regulations in more than a decade.
It would improve beneficiary communications and access, provide new program
integrity tools, support state efforts to deliver higher quality care in a
cost-effective way, and better align Medicaid and CHIP managed care rules
and practices with other sources of health insurance coverage. Overall, this
proposed rule supports the agencyâ€™s mission of better care, smarter
spending, and healthier people.
Since CMS last issued managed care regulations in 2002 and 2003, the
healthcare delivery landscape has changed and grown substantially. States
have expanded managed care to several new populations including seniors and
persons with disabilities. The growth of managed care in the Marketplace and
Medicare Advantage further highlights the importance of policy alignment
when appropriate across programs in order to ease the transition for
consumers whose circumstances change during the year.
CMS proposes to modernize Medicaid managed care regulations in the following
Supporting statesâ€™ efforts to encourage delivery system reform initiatives
within managed care programs that aim to improve healthcare outcomes and
beneficiary experience while controlling costs; and
Strengthening the quality of care provided to beneficiaries by strengthening
transparency and measurement, establishing a quality rating system, and
broadening state quality strategies and consumer and stakeholder engagement;
Improving consumer experience in the areas of enrollment, communications,
care coordination, and the availability and accessibility of covered
Implementing best practices identified in existing managed long term
services and supports programs;
Aligning Medicaid managed care policies to a much greater extent with those
of Medicare Advantage and the private market;
Strengthening the fiscal and programmatic integrity of Medicaid managed care
programs and rate setting;
Aligning the CHIP managed care regulations with many of the proposed
revisions to the Medicaid managed care rules strengthen quality and access
in CHIP managed care programs.
The proposed rule is available
here and can be viewed at the
Federal Register web site starting June 1. The deadline to submit
comments is July 27, 2015.
Visit here for the CMS Fact Sheet.
New urine test
could reduce need for blood samples
If you've been to the doctor, you probably know what to do when you're
handed a plastic cup and shown to the bathroom. Most patients hand over the
sample and give little thought to what happens when it's shipped to the lab
Ken Marcus and his students are the exceptions. They have developed a new
testing method that they believe will reduce costs, get faster results and
lower the volume of urine needed for a sample.
It's great news for patients who get the willies when the nurse pulls out
the needle to draw blood. The method Marcus and his students have developed
could help make it possible to use urine instead of blood to test for more
Proteins in urine, for example, could help detect early signs of coronary
heart disease, tell whether the body is rejecting a transplanted kidney and
show whether someone has sleeping sickness.
The trouble with testing urine is that it's awash in salt, Marcus said. It
can be tricky to isolate the proteins that act as biomarkers. Those
biomarkers are the clues that tell whether the patient is sick or has
ingested a drug.
The magic ingredient in the group's research looks like kite string, but
it's no ordinary twine. It's made of capillary-channeled polymer fibers.
As part of a study, Marcus and his students packed the fibers into plastic
tubes and then passed urine samples through the tubes by spinning them in a
centrifuge for 30 seconds. Then the researchers ran de-ionized water through
the tubes for a minute to wash off salt and other contaminants.
Proteins are hydrophobic, so they remained stuck to the fibers. Researchers
extracted the proteins by running a solvent through the tubes in the
centrifuge for 30 seconds.
When it was all done, researchers were left with purified proteins that
could be stored in a plastic vial and refrigerated until it's time for
testing. The team was able to extract 12 samples in about five minutes,
limited only by centrifuge capacity.
In urine tests commonly used now, polymer beads extract the proteins.
The team's work was recently published by the journal Proteomics-Clinical
Applications. The authors were Benjamin T. Manard, Sarah M.H. Jones and
In a review of the article, professor Youhe Gao of Beijing Normal University
wrote that the method "may have more profound implications than the authors
have claimed, simply because urine is more important than most biomarker
Various mechanisms in the body limit changes in the blood. Urine, however,
"accumulates all kinds of changes and should be a better biomarker source
than blood," Gao wrote.
Further, urine is the mostly easily obtained bodily fluid, he wrote. Sweat
can also be obtained noninvasively, but it may not be as informative and
free of contaminants as urine, Gao wrote.
The new method should also make it easier to test urine samples from babies,
Marcus said. One of the challenges now is getting a large enough sample. But
the new method requires only a few microliters of urine.
Visit Science News for the study.
threatens Ebola battle, WHO says
The numbers of Ebola cases in Sierra Leone and Guinea have been rising and
falling since Liberia was declared Ebola-free on May 9. The World Health
Organization says that the road to zero will be bumpy, but that for the most
part, progress in stopping transmission of the virus has been good.
The latest WHO figures put the number of cases in the three West African
countries at 27,001, with 11,132 deaths. Over the past week, WHO reported
12 new cases of the disease â€” nine in Guinea and three in Sierra Leone, from
a total of five districts or prefectures.
Bruce Aylward, WHO assistant director-general for emergencies, said this was
a good sign. â€śThat is another bit of a landmark and important to recognize,"
he said. "Over the past month, we have been dealing with six or fewer
districts and prefectures with active transmission. That is the lowest
number of infected areas that we have been dealing with for a full year. So
there is real progress in terms of the numbers, in terms of the geography.â€ť
While the trends are positive, Aylward said it would take time to get the
job done. He noted that Liberia took four months from the time it hit a
similar caseload to get to zero cases. Aylward said that in the best-case
scenario, Sierra Leone and Guinea could be Ebola-free by September, but that
a likelier scenario would be for them to reach that goal by the end of the
Aylward said many challenges lie ahead, including the rainy season, during
which it will be extremely difficult to move people and supplies around, fly
helicopters to remote areas and ensure water is not leaking into treatment
Moreover, he said, during the rainy season there is an surge in diseases
such as malaria and diarrhea, which present symptoms that often are mistaken
Another, perhaps bigger challenge, Aylward said, is lack of money. â€śMoney is
falling faster than cases. ... The situation with respect to the logistics
of the rainy season and the operations â€” that is getting sorted out. The
financing of it is not, and that is the challenge," he said. "There is no
reason that Ebola cannot be beaten, but financing is increasingly becoming
the most glaring potential reason for failure.â€ť
The rains already have begun in West Africa, and they will become extremely
heavy and unmanageable in June and July. Aylward said the World Food Program
would need $50 million to fly people and supplies to remote Ebola-stricken
areas over the next six months.
He said the WHO had been told to tighten its belt, but even after doing
that, he added, the agency still is $100 million short of what it needs to
run its many lifesaving operations. Aylward said the United Nations was
developing a revised budget to include all U.N. agencies working on Ebola
relief in West Africa.
Visit Voice of America for the story.