Influenza-associated pediatric mortality and Staphylococcus aureus co-infection

CDC is requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. This health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations. Since 2004, the Influenza-Associated Pediatric Mortality Surveillance System has collected information on deaths among children due to laboratory-confirmed influenza, including the presence of other medical conditions and bacterial infections at the time of death. From October 1, 2006 through September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus.

The number of pediatric influenza-associated deaths reported during 2006-07 was moderately higher than the number reported during the two previous surveillance years; the number of these deaths in which pneumonia or bacteremia due to S. aureus was noted represents a five-fold increase. Of the 22 influenza deaths reported with S. aureus in 2006-2007, 15 children had infections with methicillin-resistant S. aureus (MRSA). The median age of children with S. aureus co-infection was older than children without S. aureus co-infection (10 years versus 5 years) and children with co-infection were more likely to have pneumonia and Acute Respiratory Distress Syndrome (ARDS). Influenza strains isolated from these children were not different from common strains circulating in the community, and the MRSA strains have been similar to those associated with MRSA skin infection outbreaks in the U.S. 

Healthcare providers should test persons hospitalized with respiratory illness for influenza, including those with suspected community-acquired pneumonia. Healthcare providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures if children are severely ill or when community-acquired pneumonia is suspected. Healthcare providers should be aware of the prevalence of methicillin-resistant S. aureas strains in their communities when choosing empiric therapy for patients with suspected influenza-related pneumonia. Clinicians, healthcare providers, and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children associated with laboratory-confirmed influenza are identified.

CDC requests that state health departments report all cases of pediatric influenza-associated deaths to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated from sterile sites and/or from sputum or endotracheal aspirates be completed on the Influenza-Associated Pediatric Mortality Surveillance System case report form. If the influenza death was complicated by S. aureus infection, state health departments are asked to please contact the clinical agency that reported the case to determine if the S. aureus isolate is available. CDC will receive S. aureus isolates in order to better characterize those S. aureus isolates from children who have died from influenza. If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at 404-639-3747.

Study finds patients diagnosed with coronary heart disease continue poor diets

More than 13 million Americans have survived a heart attack or have been diagnosed with coronary heart disease (CHD), the number one cause of death in the United States. In addition to medications, lifestyle changes, such as a healthy diet and exercise, are known to reduce the risk for subsequent cardiac events. Despite this evidence, a high proportion of heart attack survivors do not follow their doctor’s advice to adhere to a healthy diet, according to researchers at the University of Massachusetts Medical School (UMMS).

Many studies have centered on determining dietary risk factors for developing CHD, but few investigations have studied the diets of CHD patients following diagnosis. In “Dietary Quality 1 Year after Diagnosis of Coronary Heart Disease,” published in the February issue of the Journal of the American Dietetic Association, researchers measured the diet quality of 555 CHD patients one year after a diagnostic coronary angiography. Using the Alternative Health Eating Index (AHEI) to assess diet quality, they found that a high proportion of those patients had not made the necessary improvements to their diets to help reduce the risk of a secondary CHD event. Proven to be a strong predictor of CHD, the AHEI is a measure that isolates dietary components that are most strongly linked to CHD risk reduction. “This study found that CHD patients’ diets had not improved in the year after being diagnosed,” said Yunsheng Ma, MD, PhD, MPH, assistant professor of medicine and one of the study’s lead authors. 

Of a maximum 80 points, which indicates the healthiest diet, the average AHEI score was 30.8, with individual scores ranging between 5.1 and 69.8. The mean AHEI score was poorer than scores reported for samples of healthy individuals from the Health Professional’s Follow-up Study and the Nurses’ Health Study. In a previous study by Ma and colleagues, the AHEI of several popular weight loss plans was calculated; the highest scoring diet was the Ornish Diet (AHEI = 64.6) and lowest scoring diet was the Atkins diet (AHEI= 42.3). The fact that one year after a coronary event patients with known CHD still have lower AHEI scores than these popular diets may be indicative of the complex issues of effecting and sustaining behavioral change and the confusion patients may face in navigating through dietary recommendations.

When examining AHEI components, only 12.4 percent of the participants met the optimal daily consumption of vegetables and 7.8 percent for fruit. Only 8 percent of the patients met the cereal fiber recommendation, and 5.2 percent of the participants limited their trans-fat intake to 0.5 percent of total calories or less. In addition, nearly 11 percent of calories were from saturated fat (less than 7 percent is recommended), while total fiber was only 16.8 grams per day (25 grams or less per day is recommended). The researchers found that low dietary quality was associated with smoking, lower educational levels, obesity, high-fat intake and a lower calorie intake. On average, smokers scored six units lower than non-smokers; participants with education beyond high school scored three units higher than participants with a high school education; and obese participants scored four units lower than normal weight or overweight participants.

“An overwhelming number of CHD patients, roughly 80 percent, do not attend cardiac rehabilitation programs, which instruct CHD patients about proper diet and exercise,” said Ira Ockene, MD, the David and Barbara Milliken Professor of Preventive Cardiology and professor of medicine at UMMS and cardiologist at UMass Memorial Medical Center. “Changing one’s eating habits is a long-term process, and optimal care should include cardiac rehabilitation and appointments with dietitians, which can build upon the patient’s initial foundations to improve his or her diet and overall health.”

Don't be a Super Bowl statistic; Stress of watching the big game can be hazardous to heart, research suggests

Most sports fans can recall a close game that made their hearts skip a figurative beat, but a new study suggests that the stressful emotions of big contests may in fact increase the risk of chest pains or cardiac arrest in spectators. Though the study examined the effects of World Cup soccer matches on Germans, many cardiologists said the findings would apply equally to viewers of the Super Bowl or other tension-drenched games. Doctors have long suspected a link between sports-watching and heart trouble, but the new report in the New England Journal of Medicine provides some of the most solid evidence to date. An analysis of 4,279 heart patients in Bavaria found that the rate of heart attacks among men was three times greater on days when the German national team was playing than during other periods.

Experts said the lesson for Super Bowl Sunday is clear. Spectators with a known heart condition, they warned, should make an extra effort to relax during games and not overindulge in the usual offerings of alcohol and fatty foods, which can quickly increase the risk of heart attack. Dr. Parag Patel, head of the cardiac intensive care unit at Advocate Lutheran General Hospital in Park Ridge, IL, said one of his patients had a heart attack in 2003 immediately after attending Game 6 of the Cubs' playoff series with the Florida Marlins. Chicago blew a three-run lead late in that fateful match. The patient recovered from his coronary. But Patel forbade him to watch Game 7 while he was treated in the hospital. "He just had to relax," Patel said. "A lot of people felt heartbroken after that series, but he had the real deal."

In a 2006 study German researchers recorded 43 heart events per day on average during the World Cup period, compared with slightly fewer than 15 per day during normal times. The heart troubles patients experienced included full cardiac arrest, prolonged chest pain, abnormal heart beat and discharge of implantable defibrillators as a result of unusual heart rhythms. Men suffered more game-day events than women, and people with a known history of heart disease were hit especially hard. Those high-risk patients sustained heart attacks on game days at a rate four times higher than usual.  

Scientists believe that stress can release adrenaline and other hormones that result in higher blood pressure and heart rate, narrower arteries and perhaps an increased tendency of blood to form clots that can block coronary arteries. Eating, smoking and drinking alcohol during a game also increase the danger for high-risk patients. Dr. John Barron, a cardiologist at Loyola University Medical Center in Maywood, said he sometimes advises heart patients to take more beta blockers before a big game; the drugs blunt the effect of adrenaline on heart muscle and lower blood pressure. It also helps to remember it's just a game. (The Chicago Tribune) See THIS LINK.

Dip once or dip twice?

FDA alerts healthcare providers to risk of suicidal thoughts and behavior with antiepileptic medications

Anti-malaria efforts yield new success

Widespread use of insecticide-treated mosquito nets and state-of-the-art drugs has succeeded in cutting malaria deaths in half in two countries most heavily affected by the disease, the World Health Organization is reporting. The findings from Rwanda and Ethiopia are the first to show a greater than 50 percent reduction in malaria mortality nationwide in "high burden" countries. Such dramatic reductions had been achieved previously only in smaller regions or in countries where the disease is less pervasive. The results suggest what may be possible in dozens of other countries, and they are likely to spur efforts already underway to roll out the relatively low-cost measures.

Malaria is responsible for 2 percent of all deaths worldwide and 9 percent of deaths in Africa. Each year, about 1.1 million deaths, almost all in children, are directly attributable to the disease, and at least a million more occur from complications such as severe anemia. In Africa, where most cases occur, malaria costs $12 billion a year in medical expenses and lost productivity. "This is the first time we have seen these results with the new tools," said Arata Kochi, head of malaria programs for WHO. "This is a genuinely historic achievement," said Richard G.A. Feachem, former director of the Global Fund to Fight AIDS, Tuberculosis and Malaria who is now the director of the Global Health Group at the University of California at San Francisco. "This is not theoretical. We do not have to wait for a vaccine or new drugs. If we implement today's technologies aggressively on a national scale, we will have a big impact."
 

Two key items in the current "tool kit" are bed nets treated with insecticide that lasts as much as five years, and treatment with at least two drugs, one of them artemisinin, a compound derived from a Chinese herbal medicine. The nets repel or kill mosquitoes and work even if they have holes in them. When used by 80 percent of households, the nets can reduce infections in African villages even among people who do not have them, a phenomenon similar to the "herd immunity" provided by vaccines. Artemisinin-containing therapies (ACTs) are oral drugs that work quickly and are often life-saving when the brain is infected by the malaria parasite. (Washington Post) See  THIS LINK.

MedAssets’ CrossWalk product enables accurate and defensible pricing of medical supplies

MedAssets Inc. announced the release of version 3.0 of CrossWalk, the first technology of its kind, created to automatically and continuously link healthcare providers’ supply cost data to charge data to ensure that charges adequately provide for defensible margins as compared to supply acquisition costs. Initially launched in March 2005, CrossWalk links a hospital’s supply item file to its chargemaster enabling a process by which mark up strategies can be modeled before implementation to understand gross and net revenue impact. The linkage also allows ongoing monitoring of the markup strategy and provides the ability to continuously enforce accurate and defensible pricing of supplies. Additionally, CrossWalk helps hospitals identify costly items not in the supply item file and items that are being purchased off-contract and outside of the standard purchasing processes.

CrossWalk is the keystone of the Merge Technology platform, MedAssets’ suite of revenue and spend management solutions designed to solve healthcare providers’ financial and operational problems and improve cash flow from existing operations. MedAssets’ portfolio of revenue solutions promotes revenue integrity by cleansing data and providing actionable information that helps improve business processes and financial outcomes.

The latest release of CrossWalk increases the accuracy and defensibility of supply charges by allowing users to pull cost data from multiple sources, including the supply item file and invoice records, and provides new and improved cost validation. CrossWalk incorporates this more complete and accurate cost data into the application and makes it readily viewable so users can cross-check and identify discrepancies in their data. The availability of this improved data also enhances reporting options within CrossWalk and helps identify specific supply item file issues such as items being purchased off-contract and items missing from the supply item file. CrossWalk increases transparency into these costly occurrences and helps hospitals better understand purchasing behavior so they can correct business processes that are causing cash leakage.