Hallmark/Westland recall: where's the beef?(industry news) - Frozen Food Age

The nation's largest beef recall to date continues to cause repercussions for the food industry, weeks after 143 million pounds of beef was recalled by the Hallmark/Westland Meat Company, Chino, Calif. on Feb. 17. According to federal officials, more than a third of the recalled meat went to federal nutrition programs, and about 35 million pounds of that have been accounted for. But the question now is: Where's the rest of the beef?

The USDA says that products containing any amount of the recalled beef should not be consumed, but the agency also told food industry representatives that manufacturers of products in which the beef was commingled with other beef would not have to notify their customers to return or destroy products, according to USA Today, quoting William Marler, a plaintiff's attorney who specializes in food-safety cases.

The USDA says that the recalled beef poses minimal health risks. None of the meat has been found to be contaminated and no cases of illness have been associated with the recalled products.

On March 6, lawmakers on the U.S. House of Representatives Appropriations Agriculture Subcommittee demanded that the Agriculture Department disclose which retailers sold meat that had been recalled. Richard Raymond, the department's undersecretary for food safety, said that the information is proprietary and can't be made public. Raymond said that some 10,000 establishments had received the potentially tainted meat, but that he couldn't reveal which ones. According to Raymond, the Agriculture Department's Food Safety and Inspection Service (FSIS) had proposed a rule change two years ago that would allow such disclosure, but the rule is in review and hasn't been finalized yet.

Rep. Maurice Hinchey, D-N.Y. complained, 'This is not proprietary information. This is information that is directly engaged in the health and safety of the American people, which we have a responsibility, along with you, to protect.' Hinchey demanded a list of the retailers by the second week in March. Raymond replied that he would consult with Agriculture Department attorneys on whether he should comply.

On its web site, California's Department of Public Health has posted a list of hundreds of retailers and restaurants that received the recalled meat, and another list of retail products containing the recalled meat. A state law passed in 2006 requires distributors of recalled meat to notify state officials where those products went, but there is currently no such law at the federal level.

Meanwhile, several national food manufacturers have been quietly notifying retailers that some meat from the Hallmark/Westland recall was used in their products and advised them to pull the products from their shelves, but they have not officially notified consumers, claiming they are not required to do so.

The H.J. Heinz Co., Pittsburgh, recalled 40,000 cases of its frozen Boston Market Lasagna with Meat Sauce in 12.5 oz. cartons, saying that a vendor used a small portion of ground beef from Westland/Hallmark. No other Boston Market frozen products or Heinz consumer products are affected, according to the company.

SoftwareMatrix MicroScience.(SUPPLIER NEWS) - The National Provisioner

SoftwareMatrix MicroScience has announced that one of its clients, the California Dept. of Public Health has won the prestigious International Association for Food Protection Food Safety Innovation Award. The presentation was made to the Microbiology Laboratory Staff of the CDPH Food & Drug Laboratory Branch, Richmond, Calif. at the IAFP 2007 Annual Meeting in Orlando, Fla.

Studies from M. Elrefaei et al add new findings in the area of HIV/AIDS.(Report) - AIDS Vaccine Week

'CD4(+) T cell dysfunction in HIV-1 infection is associated with increased CTLA-4 and TGF-beta expression. In this study we described a population of TGF-beta-positive CD4(+) T cells with multiple HIV specificities,' researchers in the United States report (see also HIV/AIDS).

'These HIV-specific TGF-beta-positive CD4(+) T cells did not display the immunophenotypic patterns traditionally attributed to regulatory CD4(+) T cells. TGF-beta-positive CD4(+) T cells were FOXP3 negative, CD25 negative, and displayed a heterogeneous surface expression of CD127. We also examined one potential mechanism for regulating TGF-beta expression by HIV-specific CD4(+) T cells. Blocking of the TGF-beta receptor II led to increased HIV-specific IFN-gamma-positive CD4(+) and CD8(+) T cell responses. Interestingly, HIV-specific TGF-beta-positive CD4(+) T cells did not substantially express CTLA-4. Nevertheless, CTLA-4 blockade resulted in a significant decrease in HIV-specific TGF-beta-positive CD4(+) T cell responses, and a concomitant increase in HIV-specific IFN-gamma-positive CD4(+) T cell responses,' wrote M. Elrefaei and colleagues.

The researchers concluded: 'Our study proposes a mechanism by which HIV-specific TGF-beta production may be regulated by CTLA-4 engagement.'

Elrefaei and colleagues published their study in AIDS Research and Human Retroviruses (HIV-Specific TGF-beta-Positive CD4(+) T Cells Do Not Express Regulatory Surface Markers and Are Regulated by CTLA-4. AIDS Research and Human Retroviruses, 2010;26(3):329-337).

For additional information, contact M. Elrefaei, California Dept. of Public Health, 850 Marina Bay Pkwy VRDL, Richmond, CA 94804, USA.

Publisher contact information for the journal AIDS Research and Human Retroviruses is: Mary Ann Liebert Inc., 140 Huguenot Street, 3RD FL, New Rochelle, NY 10801, USA.

Keywords: City:Richmond, State:CA, Country:United States, HIV Infections, HIV/AIDS, Primate Lentiviruses, RNA Viruses, Retroviridae, Vertebrate Viruses, Viral Sexually Transmitted Diseases

Studies from X.Y. Zhang and colleagues provide new data on agriculture and tobacco research. - Agriculture Week

'Using a social norm change paradigm model that reflects the California Tobacco Control Program's (CTCP) priorities, we compare the strength of the relationship of the social norm constructs to key smoking behavioural outcomes. Social norm constructs that correspond to CTCP's priority areas were created from selected California Adult Tobacco Survey knowledge, attitude and belief questions using confirmatory factor analysis,' scientists in the United States report.

'We then examined the relationship between these constructs and quitting behaviours using logistic regression. The secondhand smoke (SHS) and countering pro-tobacco influences'(CPTI) constructs followed a dose-response curve with quitting behaviours. Respondents who rated high on the SHS construct were about 70% more likely to have made a recent quit attempt in the last 12 months and about 100% more likely to intend to quit in the next 6 months than respondents who rated low on the SHS construct. For CPTI, respondents who rated high on this construct were 67% more likely to have made a recent quit attempt in the last 12 months and 62% more likely to have intentions to quit in the next 6 months than respondents who rated low on the CPTI construct. Social norm change constructs represent CTCP's priorities and are strongly related to desired individual behaviour outcomes,' wrote X.Y. Zhang and colleagues.

The researchers concluded: 'This analysis provides strong support for the framework underlying CTCP-namely, that changing social norms affects behaviour change at the individual level through changing population-level smoking-related behaviours.'

Zhang and colleagues published their study in Tobacco Control (The impact of social norm change strategies on smokers' quitting behaviours. Tobacco Control, 2010;19(Suppl. 1):I51-I55).

For more information, contact X.Y. Zhang, California Dept. of Public Health, Tobacco Control Program, MS 7206, POB 997377, Sacramento, CA 95899, USA.

Publisher contact information for the journal Tobacco Control is: B M J Publishing Group, British Med Association House, Tavistock Square, London WC1H 9JR, England.

Keywords: City:Sacramento, State:CA, Country:United States, Agriculture and Tobacco Research

Studies from M.V. Modayil et al in the area of agriculture and tobacco research described.(Report) - Agriculture Week

'We conducted this study to determine key community-level factors associated with higher tobacco control programme performance. A combination of surveys, administrative and fiscal data were collected to measure local county-level health department performance over a 7-year period,' researchers in the United States report.

'Longitudinal analyses were performed using generalised estimating equations to examine whether counties that exerted higher effort were successful in creating more tobacco retail licensing (TRL) and secondhand smoke policies. Several social, political and contextual factors were examined as confounders. Local county health departments (CHDs) that demonstrated high effort on their work plans increased the proportion of residents covered by TRL policies (7.2%; 95% CI - 1.7 to 16.1%) compared to CHDs with lower levels of effort. Having legislators who voted in favour of tobacco control bills was found to significantly increase the passage of local TRL policies. CHDs demonstrating higher efforts also increased the proportion of residents covered by secondhand smoke policies (9.2%; 95% CI - 3.5 to 21.9%). There was strong evidence that higher county-level efforts predicted an increasing number of local tobacco control policies,' wrote M.V. Modayil and colleagues.

The researchers concluded: 'Evaluations using integrated designs are recommended as effective strategies to provide a more accurate assessment of how well community-level interventions catalyse community-wide change.'

Modayil and colleagues published their study in Tobacco Control (An evaluation of the California community intervention. Tobacco Control, 2010;19(Suppl. 1):I30-I36).

For additional information, contact M.V. Modayil, California Dept. of Public Health, California Tobacco Control Program, MS 7206, POB 997377, Sacramento, CA 95899, USA.

Publisher contact information for the journal Tobacco Control is: B M J Publishing Group, British Med Association House, Tavistock Square, London WC1H 9JR, England.

Keywords: City:Sacramento, State:CA, Country:United States, Agriculture and Tobacco Research

Studies from H.Y. Park et al further understanding of agriculture and tobacco research. - Health & Medicine Week

According to a study from the United States, 'Current legislative language requires the California Department of Public Health, California Tobacco Control Program, to evaluate the effectiveness of the school-based Tobacco Use Prevention Education (TUPE) programme in California every 2 years. The objective of the study was to measure change and to identify the impact of school-based tobacco use prevention education activities on youth smoking prevalence and attitudes over time, spanning two school year surveys (2003-2004 and 2005-2006).'

'Evaluation focused on school-based tobacco use prevention activities in 57 schools (student sample size, n = 16 833) that participated in the in-school administration of the 2003-2004 and 2005-2006 California Student Tobacco Surveys. Hierarchical linear models were used to predict student tobacco use and precursors to tobacco use. Overall, student tobacco use, intention to smoke, number of friends smoking and perceived smoking prevalence by peers increased as students moved through grades 9 and 10 to grades 11 and 12. TUPE-related activities showed a suggestive association (p = 0.06) with reduced rate in student tobacco use between the two surveys after adjusting for other contextual factors such as each school's socioeconomic characteristics. TUPE activities appears to be beneficial in reducing tobacco use in California high school students over time,' wrote H.Y. Park and colleagues (see also Agriculture and Tobacco Research).

The researchers concluded: 'Other contextual factors were important moderating influences on student tobacco use.'

Park and colleagues published their study in Tobacco Control (Evaluation of California's in-school tobacco use prevention education (TUPE) activities using a nested school-longitudinal design, 2003-2004 and 2005-2006. Tobacco Control, 2010;19(Suppl. 1):I43-I50).

For more information, contact H.Y. Park, California Dept. of Public Health, California Tobacco Control Program, POB 997377, MS 7206, Sacramento, CA 95899, USA.

Publisher contact information for the journal Tobacco Control is: B M J Publishing Group, British Med Association House, Tavistock Square, London WC1H 9JR, England.

Keywords: City:Sacramento, State:CA, Country:United States, Agriculture and Tobacco Research

Research findings from D.W. Cowling et al update understanding of agriculture and tobacco research. - Health & Medicine Week

'The relation between aided ad recall and level of television ad placement in a public health setting is not well established. We examine this association by looking back at 8 years of the California's Tobacco Control Program's (CTCP) media campaign,' scientists writing in the journal Tobacco Control report (see also Agriculture and Tobacco Research).

'Starting in July 2001, California's campaign was continuously monitored using five telephone series of surveys and six web-based series of surveys immediately following a media flight. We used population-based statewide surveys to measure aided recall for advertisements that were placed in each of these media flights. Targeted rating points (TRPs) were used to measure ad placement intensity throughout the state. Cumulative TRPs exhibited a stronger relation with aided ad recall than flight TRPs or TRP density. This association increased after log-transforming cumulative TRP values. We found that a one-unit increase in log-cumulative TRPs led to a 13.6% increase in aided ad recall using web-based survey data, compared to a 5.3% increase in aided ad recall using telephone survey data,' wrote D.W. Cowling and colleagues.

The researchers concluded: 'In California, the relation between aided ad recall and cumulative TRPs showed a diminishing return after a large volume of ad placements These findings may be useful in planning future ad placement for CTCP's media campaign.'

Cowling and colleagues published their study in Tobacco Control (Assessing the relationship between ad volume and awareness of a tobacco education media campaign. Tobacco Control, 2010;19(Suppl. 1):I37-I42).

Additional information can be obtained by contacting D.W. Cowling, California Dept. of Public Health, California Tobacco Control Program, POB 997377, MS 7206, Sacramento, CA 95899, USA.

The publisher of the journal Tobacco Control can be contacted at: B M J Publishing Group, British Med Association House, Tavistock Square, London WC1H 9JR, England.

Keywords: City:Sacramento, State:CA, Country:United States, Agriculture and Tobacco Research

Research on life sciences published by S. Hoshiko et al. - Biotech Week

Investigators publish new data in the report 'A simple method for estimating excess mortality due to heat waves, as applied to the 2006 California heat wave.' In this recently published article, scientists in the United States conducted a study 'To characterize excess mortality during a major heat wave in California and its regions; to assess the validity of a simple method. We calculated mortality rate ratios for the heat-wave period, using a reference period of the same number of days from the same summer.'

'We conducted alternative analyses and compared our results with those from a time-series model. We estimated 655 excess deaths, a 6% increase (95% confidence interval, 3-9%), impacting varied geographic/climate regions. Alternate analyses supported model validity. California experienced excess heat-wave related mortality not restricted to high heat regions,' wrote S. Hoshiko and colleagues, (see also Life Sciences).

The researchers concluded: 'As climate change is anticipated to increase heat events, public health efforts to monitor effects assume greater importance.'

Hoshiko and colleagues published their study in International Journal of Public Health (A simple method for estimating excess mortality due to heat waves, as applied to the 2006 California heat wave. International Journal of Public Health, 2010;55(2):133-7).

For more information, contact S. Hoshiko, Environmental Health Investigations Branch, California Dept. of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804 USA.

Publisher contact information for the International Journal of Public Health is: Springer, 233 Spring Street, New York, NY 10013, USA.

Keywords: City:Richmond, State:CA, Country:United States, Life Sciences, Public Health, Epidemiology.

New mosquito control study findings reported from Center for Infectious Diseases, Department of Public Health. - Science Letter

A report, 'The need for collaboration among government agencies to reduce mosquito production in mandated stormwater treatment structures,' is newly published data in Journal of the American Mosquito Control Association. According to recent research from the United States, 'Efforts to improve water quality increasingly rely on structural stormwater best management practices (BMPs) to remove pollutants from urban runoff. These structures can unintentionally produce mosquitoes and may play a role in the spread of mosquito-borne diseases.'

'A questionnaire was distributed to over 300 stormwater and mosquito control agencies in the United States to assess the prevalence of BMPs and associated mosquito production, identify current measures to control mosquitoes within BMPs, and elucidate the extent of collaboration between these agencies. Responses suggest that agencies often lack basic information relevant to minimizing mosquitoes in BMPs, such as the number of structures within an agency's jurisdiction and the frequency of their maintenance, and that greater interagency collaboration could improve control efforts. Approximately 40% of agencies reported regular collaboration to minimize mosquito production in BMPs; however, barriers to such collaborative work included confusion over roles and responsibilities and a lack of interest,' wrote J.E. Harbison and colleagues, Center for Infectious Diseases, Department of Public Health (see also Mosquito Control).

The researchers concluded: 'The rapid increase of BMPs in urban environments resulting from increasingly stringent water-quality regulations provides justification for increased collaboration between stormwater and mosquito control sectors of government to aid and strengthen public health efforts.'

Harbison and colleagues published their study in the Journal of the American Mosquito Control Association (The need for collaboration among government agencies to reduce mosquito production in mandated stormwater treatment structures. Journal of the American Mosquito Control Association, 2010;26(2):198-204).

For additional information, contact J.E. Harbison, Vector-Borne Disease Section, California Dept. of Public Health, Center for Infectious Diseases, 2151 Convention Center Way, Suite 218B, Ontario, CA 91764 USA.

Publisher contact information for the Journal of the American Mosquito Control Association is: American Mosquito Control Association, PO Box 234, Eatontown, NJ 07724-0234, USA.

Keywords: City:Ontario, State:CA, Country:United States, Communicable Disease Control, Insect Control, Mosquito Control, Pest Control, Public Health Practice.

THE HARMAN REPORT: MARCH 16, 2011. - States News Service

SACRAMENTO, CA -- The following information was released by California State Senator Tom Harman:

Economic Concerns Rank #1

A snapshot of unemployment in America: U.S. unemployment is 8.9%, in North Dakota it is 3.8% and in California it is a whopping 12.4%. Unemployment in the U.S. fell in February for the third month in a row to 8.9 percent. But California's jobless figures remain the same - the second highest in the nation. While the rest of the nation is starting to see growth, we are stuck in an economic quagmire where few businesses expand and even fewer are hiring.

Without addressing the problems that thwart our ability to recover, Californians can expect no different. Over-burdened with regulations, high taxes and bureaucracy our small businesses are not growing and hiring new employees, they are struggling to survive. Californians recognize how important it is to get 2,000,000 jobless Californians back to work.

According to a new Gallup poll on Americans' Concerns (1,021 surveyed), seventy-two percent of Americans cite some aspect of the U.S. economy as the 'most important problem' facing the country today. This is the highest net mention of the economy since February 2010, although still below the 86% peak recorded in February 2009 as Washington was focused on passing an economic stimulus plan. Gallup began asking the 'most important problem' question in 1939 and established monthly updates in 2001. Economic concerns became dominant for Americans in April 2008 and have since tied or outpaced non-economic concerns in all but four months. Despite the political turmoil in the Middle East, including uprisings in Egypt and Libya, no more than 1% of Americans mention any of these issues as the country's most important problem.

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Tsunami

I am terribly saddened by the tragic loss of life caused by the series of powerful earthquakes and tsunami that struck North East Japan. My wife Dianne and I join with Orange County's 35th Senate District community, and especially those Americans of Japanese descent, in extending my heartfelt sympathy and deepest condolences.

For those who are trying to locate someone, Japanese or American, or if you have information about someone that you would like to share, please visit the Google Crises Response site here. In addition, the Japanese-American Society of southern California is working to coordinate relief efforts. The Society will keep its members and the public updated on the situation through its website, www.jas-socal.org.

Current estimates predict loss of life in the thousands, and millions are without shelter, food or heat as they brave winter temperatures. Relief organizations around the world are mobilizing to provide relief to those affected by the disaster.

The following link to the US State Department website contains additional information about Japan and the earthquake and tsunami relief efforts http://www.state.gov/p/eap/regional/158236.htm.

I was overwhelmed with the hospitality that the Japanese people showed me when I attended the International Rotary Convention there back in 1974. My and Dianne's thoughts and prayers are with everyone living in Japan or with loved ones who have been affected by the terrible disaster.

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Radiation Update

Today my staff participated in a conference call hosted by the California Emergency Management Agency along with the California Department of Public Health and the Federal Emergency Management Agency, to address concerns regarding potential exposure to radioactive fallout resulting from damage to a nuclear facility during the recent earthquake and tsunami in Japan.

On the call were representatives from the Federal and Cal EPA, the DOE, and the NRC.

At present, the Nuclear Regulatory Commission (NRC) indicates Japan's nuclear emergency presents no danger to California.

You can find additional information at the California Dept. of Public Health website.

A staffed helpline is available 8 AM to 5 PM M-F: (916) 341-3947 for questions or concerns.

And the Department has a FAQs page to answer questions about the risk of radiation.

*** Please take note that both California Public Health officials as well as the emergency personal want to be very clear on one point:

Californians should not take potassium iodide as a precautionary measure. It is not necessary given the current circumstances in Japan, it can present a danger to people with allergies to iodine, shellfish or who have thyroid problems, and taken inappropriately it can have serious side effects including abnormal heart rhythms, nausea, vomiting, electrolyte abnormalities and bleeding.

The following update may also be of interest:

The DOE has a 34-member team arriving in Japan at 1900 EST to assess and monitor the situation in Japan.

As far as monitoring radiation exposure, the EPA has 11 fixed radiation monitoring stations throughout California. The EPA is in the process of installing mobile monitors in the Aleutian Islands and Hawaii (closer to the source of any radiation). These are not in place yet but will be in the next few days.

Two types of monitors are at these stations: one monitor picks up gamma ray radiation and any spikes in radiation will be immediately known to the EPA. The public would get knowledge of any hazardous radiation after the EPA made a concrete determination and then inform Cal EMA who would activate their dialogical warning system. The CA Dept. of Health and the relevant county public health officers will also be contacted.

The other monitor picks up particle matter. It does this every 3 days and then the results are sent to Alabama for testing and it takes 2 days to get the results back.

Any harmful radiation emanating from Japan would take about 6-8 days to get here, but that time period is very variable depending on the weather conditions.

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Groundhog Day

Today the legislature is set to vote on the budget. Contrary to what the Governor and Democrat leadership have indicated, the budget before us does not consist of half spending reductions and half proposed tax increases. The Governor has proposed only $8 billion in one-time cuts and another $6.5 billion in accounting gimmicks. His tax increase proposal however translates to a $50 billion dollar hit on the taxpayer over the next 5 years - $14 billion of it this year alone. Clearly the reductions do not equal the taxes proposed.

Reports Summarize Aeromonas Research from Center for Infectious Diseases, Department of Public Health. - Obesity, Fitness & Wellness Week

A report, 'The genus Aeromonas: taxonomy, pathogenicity, and infection,' is newly published data in Clinical Microbiology Reviews. According to a study from the United States, 'Over the past decade, the genus Aeromonas has undergone a number of significant changes of practical importance to clinical microbiologists and scientists alike. In parallel with the molecular revolution in microbiology, several new species have been identified on a phylogenetic basis, and the genome of the type species, A. hydrophila ATCC 7966, has been sequenced.'

'In addition to established disease associations, Aeromonas has been shown to be a significant cause of infections associated with natural disasters (hurricanes, tsunamis, and earthquakes) and has been linked to emerging or new illnesses, including near-drowning events, prostatitis, and hemolytic-uremic syndrome. Despite these achievements, issues still remain regarding the role that Aeromonas plays in bacterial gastroenteritis, the extent to which species identification should be attempted in the clinical laboratory, and laboratory reporting of test results from contaminated body sites containing aeromonads,' wrote J.M. Janda and colleagues, Center for Infectious Diseases, Department of Public Health (see also Aeromonas).

The researchers concluded: 'This article provides an extensive review of these topics, in addition to others, such as taxonomic issues, microbial pathogenicity, and antimicrobial resistance markers.'

Janda and colleagues published their study in Clinical Microbiology Reviews (The genus Aeromonas: taxonomy, pathogenicity, and infection. Clinical Microbiology Reviews, 2010;23(1):35-73).

For more information, contact J.M. Janda, Microbial Diseases Laboratory, California Dept. of Public Health, Center for Infectious Diseases, Richmond, Richmond, California 94804 USA.

Keywords: City:Richmond, State:California, Country:United States, Aeromonadaceae, Aeromonas, Gammaproteobacteria, Gram Negative Bacteria, Gram Negative Facultatively Anaerobic Rods.

Research from L. Feuchtbaum and co-researchers in the area of genetics described.(Report) - Pediatrics Week

Research findings, 'The context and approach for the California newborn screening short- and long-term follow-up data system: Preliminary findings,' are discussed in a new report. According to recent research from the United States, 'State newborn screening programs are designed to prevent morbidity and mortality from hereditary disorders through early detection and ongoing disease management. These programs have traditionally focused on short-term follow-up.'

'However, capturing data on the long-term follow-up process is emerging as a new priority. Long-term follow-up data can be used to assess the accessibility, continuity, and quality of care provided to these children. The California Newborn Screening Program uses a Web-based data collection system for short-and long-term follow-up,' wrote L. Feuchtbaum and colleagues.

The researchers concluded: 'This article provides a description of the follow-up data collection system in addition to preliminary findings to demonstrate the efficacy of the California data collection approach.'

Feuchtbaum and colleagues published their study in Genetics In Medicine (The context and approach for the California newborn screening short- and long-term follow-up data system: Preliminary findings. Genetics In Medicine, 2010;12(12 Suppl):S242-50).

For additional information, contact L. Feuchtbaum, Genetic Disease Screening Program, California Dept. of Public Health, Richmond, California 94804 USA.

Keywords: City:Richmond, State:California, Country:United States, Genetics, Pediatrics.

Study findings from University of California broaden understanding of autism. - Education Letter

According to a study from the United States, 'We conducted a case control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China.'

'were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism,' wrote X. Zhang and colleagues, University of California.

The researchers concluded: 'In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (< 35 or > 42 weeks), nuchal cord, gravidity > 1, and advanced paternal age at delivery (> 30 year-old).'

Zhang and colleagues published the results of their research in the Journal of Autism and Developmental Disorders (Prenatal and Perinatal Risk Factors for Autism in China. Journal of Autism and Developmental Disorders, 2010;40(11):1311-1321).

For additional information, contact L.H. Qi, University of California, Dept. of Public Health Science, School Medical, Davis, CA 95616, USA.

The publisher of the Journal of Autism and Developmental Disorders can be contacted at: Springer, Plenum Publishers, 233 Spring St., New York, NY 10013, USA.

Keywords: City:Davis, State:CA, Country:United States, Autism, Developmental Disabilities, Developmental Disorders, Neurology, Special Education

Reports from University of California, Department of Public Health Sciences add new data to research in diet and nutrition.(Report) - Health & Medicine Week

Scientists discuss in 'Risk factors for early lactation problems among Peruvian primiparous mothers' new findings in diet and nutrition. According to a study from the United States, 'The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study.'

'Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as <or=10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as >or=10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), <8 breastfeeds during the first 24 h (days 0 and 3), and gestational age <39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score <8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency,' wrote S.L. Matias and colleagues, University of California, Department of Public Health Sciences (see also Diet and Nutrition).

The researchers concluded: 'Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.'

Matias and colleagues published the results of their research in Maternal & Child Nutrition (Risk factors for early lactation problems among Peruvian primiparous mothers. Maternal & Child Nutrition, 2010;6(2):120-33).

For additional information, contact S.L. Matias, University of California, Dept. of Public Health Sciences, Davis, California 95616 USA.

Keywords: City:Davis, State:California, Country:United States, Diet and Nutrition, Hospital.

Studies from University of California, Department of Public Health Sciences further understanding of obesity, fitness and wellness. - Obesity, Fitness & Wellness Week

Investigators publish new data in the report 'Usage pattern of personal care products in California households.' 'Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of ~30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated,' scientists in the United States report (see also Obesity, Fitness and Wellness).

'Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderately correlated, which may impact aggregate exposures. Use frequencies observed in this study were generally in the same range as those reported in the EPA Exposure Factor Handbook, but we found differences for some individual products. Our study provides additional data on population-based usage patterns of a large collection of commonly used personal care products pertaining to several age groups and socio-demographic strata,' wrote X.M. Wu and colleagues, University of California, Department of Public Health Sciences.

The researchers concluded: 'This information will be valuable for exposure and risk assessments.'

Wu and colleagues published their study in Food and Chemical Toxicology (Usage pattern of personal care products in California households. Food and Chemical Toxicology, 2010;48(11):3109-19).

For additional information, contact X.M. Wu, University of California, Dept. of Public Health Sciences, Davis, CA 95616 USA.

Keywords: City:Davis, State:CA, Country:United States, Obesity, Fitness and Wellness, Toxicology.

New mental health research from University of California, Department of Public Health discussed. - Psychology & Psychiatry Journal

New investigation results, 'Involuntary civil commitments after the implementation of California's Mental Health Services Act,' are detailed in a study published in Psychiatric Services. According to a study from the United States, 'As of fiscal year 2008-2009, California's Mental Health Services Act (MHSA) has distributed $3.2 billion in new tax revenues to county mental health systems. This voter-approved act attempts to address the needs of unserved and underserved consumers with severe mental illness by implementing a 'whatever it takes' approach.'

'The research literature indicates that the incidence of involuntary treatment may gauge the overall functioning of the public mental health system. Consistent with the notion that the MHSA may facilitate effective treatment of severe mental illness, the authors tested the hypothesis that the incidence of two types of involuntary treatment-72-hour holds and 14-day psychiatric civil commitments--declines as the enhancement of service access and quality is supported by MHSA funds. The investigators obtained quarterly counts of involuntary 72-hour holds (N=593,751) and 14-day psychiatric hospitalizations (N=202,554) for 28 counties, with over 22 million inhabitants, from July 2000 to June 2007. A fixed-effects regression approach adjusted for temporal patterns in treatment. The petitions for involuntary 14-day hospitalizations, but not involuntary 72-hour holds, fell below expected values after disbursement of MHSA funds. In these counties, 3,073 fewer involuntary 14-day treatments-approximately 10% below expected levels-could be attributed to disbursement of MHSA funds. Results remained robust to alternative regression specifications. Fewer than expected involuntary 14-day holds for continued hospitalization may indicate an important shift in service delivery,' wrote T.A. Bruckner and colleagues, University of California, Department of Public Health.

The researchers concluded: 'MHSA funds may have facilitated the discharge of clients from the hospital by providing enhanced resources and access to a range of less-restrictive community-based treatment alternatives.'

Bruckner and colleagues published the results of their research in Psychiatric Services (Involuntary civil commitments after the implementation of California's Mental Health Services Act. Psychiatric Services, 2010;61(10):1006-11).

For additional information, contact T.A. Bruckner, University of California, Dept. of Public Health, Irvine, 202 Social Ecology I, Irvine, CA 92697-7075 USA.

Keywords: City:Irvine, State:CA, Country:United States, Mental Health, Mental Illness, Psychiatric, Psychiatry.

Research from T.H Dunnebacke and co-authors yields new data on parasitology. - Science Letter

Researchers detail in 'Balamuthia mandrillaris: the multiple nuclei of Balamuthia amebas; their location, activity, and site of development,' new data in parasitology. According to recent research from the United States, 'Multiple nuclei were first noted in the pseudopodia of Balamuthia mandrillaris amebas feeding on mammalian cells. Phase microscope observations of live amebas in vitro reveal that while many amebas have a single nucleus, others have multiple nuclear-like structures, now confirmed as nuclei with hematoxylin and Feulgen stains.'

'In the live cultures, two nuclei located near the tip of an extended pseudopodium were seen to fuse resulting in one larger morphologic unit. Such merging of nuclei has not been previously reported. Other nuclei were located at positions that subsequently became the site for the outgrowth of an additional pseudopod branch. A newly discovered large structure, a polyploid nucleus, was located in the mid-part of the ameba,' wrote T.H Dunnebacke and colleagues (see also Parasitology).

The researchers concluded: 'Nucleoli of uniform size were seen to develop from the central mass of chromatin and each became surrounded by a vesicular component as they moved into the protoplasm as morphologically complete nuclei.'

Dunnebacke and colleagues published their study in Experimental Parasitology (Balamuthia mandrillaris: the multiple nuclei of Balamuthia amebas; their location, activity, and site of development. Experimental Parasitology, 2010;126(1):14-21).

For additional information, contact T.H. Dunnebacke, Viral and Rickettsial Disease Laboratory, California Dept. of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804-6403 USA.

Keywords: City:Richmond, State:CA, Country:United States, Parasitology.

Research Results from M.P. Walsh and Colleagues Update Understanding of Mastadenovirus. - Genomics & Genetics Weekly

According to the authors of recent research from Richmond, California, 'Human adenovirus C (HAdV-C) species are a common cause of respiratory infections and can occasionally produce severe clinical manifestations. A deeper understanding of the variation and evolution in species HAdV-C is especially important since these viruses, including HAdV-C6, are used as gene delivery vectors for human gene therapy and in other biotechnological applications.'

'Here, the full-genome analysis of the prototype HAdV-C6 and a recently identified virus provisionally termed HAdV-C57 are reported. Although the genomes of all species HAdV-C members are very similar to each other, the E3 region, hexon and fiber (ten proteins total) present a wide range of identity values at the amino acid level. Studies of these viruses in comparison to the other three HAdV-C prototypes (1, 2, and 5) comprise a comprehensive analysis of the diversity and conservation within HAdV-C species. HAdV-C6 contains a recombination event within the constant region of the hexon gene,' wrote M.P. Walsh and colleagues (see also Mastadenovirus).

The researchers concluded: 'HAdV-C57 is a recombinant virus with a fiber gene nearly identical to HAdV-C6 and a unique hexon distinguished by its loop 2 motif.'

Walsh and colleagues published their study in the Journal of Clinical Microbiology (Computational Analysis of Two Species C Human Adenoviruses Provides Evidence of a Novel Virus. Journal of Clinical Microbiology, 2011;49(10):3482-3490).

For additional information, contact M.P. Walsh, California Dept. of Public Health, Viral & Rickettsial Diseases Laboratory, Richmond, CA 94804, United States.

Publisher contact information for the Journal of Clinical Microbiology is: American Society Microbiology, 1752 N St. NW, Washington, DC 20036-2904, USA.

Keywords: City:Richmond, State:California, Country:United States, Region:North and Central America, Genetics, Virology, DNA Viruses, Mastadenovirus, Vertebrate Viruses

Research from University of California Provide New Insights into Environmental Health.(Clinical report) - Health & Medicine Week

According to the authors of recent research published in the journal Environmental Health, 'Longitudinal time-activity data are important for exposure modeling, since the extent to which short-term time-activity data represent long-term activity patterns is not well understood. This study was designed to evaluate longitudinal variations in human time-activity patterns.'

'We report on 24-hour recall diaries and questionnaires collected via the internet from 151 parents of young children (mostly under age 55), and from 55 older adults of ages 55 and older, for both a weekday and a weekend day every three months over an 18-month period. Parents also provided data for their children. The self-administrated diary and questionnaire distinguished similar to 30 frequently visited microenvironments and similar to 20 activities which we selected to represent opportunities for exposure to toxic environmental compounds. Due to the non-normal distribution of time-location/activity data, we employed generalized linear mixed-distribution mixed-effect models to examine intra-and inter-individual variations. Here we describe variation in the likelihood of and time spent engaging in an activity or being in a microenvironment by age group, day-type (weekday/weekend), season (warm/cool), sex, employment status, and over the follow-up period. As expected, day-type and season influence time spent in many location and activity categories. Longitudinal changes were also observed, e.g., young children slept less with increasing follow-up, transit time increased, and time spent on working and shopping decreased during the study, possibly related to human physiological changes with age and changes in macro-economic factors such as gas prices and the economic recession. This study provides valuable new information about time-activity assessed longitudinally in three major age groups and greatly expands our knowledge about intra-and inter-individual variations in time-location/activity patterns,' wrote X.M. Wu and colleagues, University of California (see also Environmental Health).

The researchers concluded: 'Longitudinal variations beyond weekly and seasonal patterns should be taken into account in simulating long-term time-activity patterns in exposure modeling.'

Wu and colleagues published their study in Environmental Health (Longitudinal variability of time-location/activity patterns of population at different ages: a longitudinal study in California. Environmental Health, 2011;10():1-15).

For additional information, contact X.M. Wu, University of California, Dept. of Public Health Science, Los Angeles, CA, United States.

The publisher's contact information for the journal Environmental Health is: Biomedical Central Ltd, 236 Grays Inn Rd., Floor 6, London WC1X 8HL, England.

Keywords: City:Los Angeles, State:California, Country:United States, Region:North and Central America

Data on Pesticides Discussed by Researchers at University of California. - Health & Medicine Week

'Information on residential pesticide usage and behaviors that may influence pesticide exposure was collected in three population-based studies of older adults residing in the three Central California counties of Fresno, Kern, and Tulare. We present data from participants in the Study of Use of Products and Exposure Related Behaviors (SUPERB) study (N = 153) and from community controls ascertained in two Parkinson's disease studies, the Parkinson's Environment and Gene (PEG) study (N = 359) and The Center for Gene-Environment Studies in Parkinson's Disease (CGEP; N = 297),' scientists in Davis, California report (see also Pesticides).

'All participants were interviewed by telephone to obtain information on recent and lifetime indoor and outdoor residential pesticide use. Interviews ascertained type of product used, frequency of use, and behaviors that may influence exposure to pesticides during and after application. Well over half of all participants reported ever using indoor and outdoor pesticides; yet frequency of pesticide use was relatively low, and appeared to increase slightly with age. Few participants engaged in behaviors to protect themselves or family members and limit exposure to pesticides during and after treatment, such as ventilating and cleaning treated areas, or using protective equipment during application,' wrote M.N. Armes and colleagues, University of California.

The researchers concluded: 'Our findings on frequency of use over lifetime and exposure related behaviors will inform future efforts to develop population pesticide exposure models and risk assessment.'

Armes and colleagues published their study in International Journal of Environmental Research and Public Health (Residential Pesticide Usage in Older Adults Residing in Central California. International Journal of Environmental Research and Public Health, 2011;8(8):3114-3133).

For more information, contact M.N. Armes, University of California, Dept. of Public Health Science, Davis, CA 95616, United States.

Publisher contact information for the International Journal of Environmental Research and Public Health is: Mdpi Ag, Postfach, Ch-4005 Basel, Switzerland.

Keywords: City:Davis, State:California, Country:United States, Region:North and Central America, Agrochemicals,

New Findings from D.A. Edwards and Co-Researchers in the Area of Homeland Security and Emergency Management Described. - Bioterrorism Week

According to the authors of recent research from San Francisco, California, 'This study examines feedback from automated reports and a participant survey concerning implementation of an emergency notification system (ENS) in a multi-agency functional flood exercise hosted by Maricopa County Department of Emergency Management. Representatives from nearly two dozen agencies were present.'

'Emergency notifications through the ENS were reported after the exercise to have generally been useful in terms of keeping agencies appropriately informed in a timely manner. Most exercise users indicated that they were pleased overall with the results of using the ENS. One aspect of the experience that they noted having appreciated was the opportunity to replay messages if they wished to do so. However, technical problems with use of the ENS did exist. For example, text-to-speech (TTS) rendering in some instances produced messages with poor intelligibility, confirming the need for care in choosing well-functioning text-to-speech software and in crafting TTS messages appropriately for TTS rendering. Some messages going to voice mail during the exercise were clipped, such that recipients could not hear the entire message, a flaw. While nearly all exercise players received emergency notifications from the ENS via one or more communication devices, less than half of the total messages were listened to during the timeframe of the exercise. This confirmed the wisdom of keeping messages sent through different communication systems and channels consistent, because not all contacts listen to all messages on all receiving devices,' wrote D.A. Edwards and colleagues (see also Homeland Security and Emergency Management).

The researchers concluded: 'Exercise players indicated a need for (i) notification messages to be crafted to be short, concise and easy to understand, (ii) the messages to have a date and time associated with them, and (iii) the messages to contain geographic locations, information on emergency impacts, and other intelligence needed to allow users to make appropriate responses.'

Edwards and colleagues published their study in the Journal of Homeland Security and Emergency Management (Use of an Emergency Notification System in a Multi-Agency Functional Emergency Exercise: Feedback from Participants. Journal of Homeland Security and Emergency Management, 2011;8(1):1-17).

For additional information, contact D.A. Edwards, California Dept. of Public Health, San Francisco, CA, United States.

Publisher contact information for the Journal of Homeland Security and Emergency Management is: Berkeley Electronic Press, 2809 Telegraph Avenue, Ste. 202, Berkeley, CA 94705, USA.

Keywords: City:San Francisco, State:California, Country:United States, Region:North and Central America

Data on Risk Management Reported by M.L. Tan and Co-Researchers.(Report) - Insurance Weekly News

'State agencies face many challenges in creating sport fish consumption advisories that can be readily understood by diverse populations. In this study, our objectives were to identify barriers to understanding consumption advisories and recommend more effective approaches for communicating advisory concepts,' scientists writing in the journal Risk Analysis report.

'We conducted key informant interviews with demographically diverse consumers of sport fish from the Sacramento-San Joaquin Delta watershed in California to explore how intended audiences perceive consumption advisories and identify factors that influence comprehension. Some barriers to communication included the use of portion sizes that departed from commonly consumed amounts, poorly understood terminology, misleading category headings, and ineffective visual tools. Comprehension was enhanced when advisory information did not contradict existing beliefs about fish or fish consumption, and when advisories provided information about contaminant levels in specific kinds of fish,' wrote M.L. Tan and colleagues.

The researchers concluded: 'Using certain methods, such as portion sizes that reflect commonly consumed amounts, mercury meters to convey contaminant levels, three advice categories (e. g., high, medium, low), and population definitions that identify specific age ranges, improved the clarity of advisory concepts for intended audiences.'

Tan and colleagues published their study in Risk Analysis (Communicating Fish Consumption Advisories in California: What Works, What Doesn't. Risk Analysis, 2011;31(7):1095-1106).

Additional information can be obtained by contacting A. Ujihara, California Dept. of Public Health, Environmental Health Invest Branch, Richmond, CA 94804, United States.

The publisher of the journal Risk Analysis can be contacted at: Wiley-Blackwell, Commerce Place, 350 Main St., Malden 02148, MA, USA.

Keywords: City:Richmond, State:California, Country:United States, Region:North and Central America, Risk Management

New Asthma Study Findings Recently Were Published by M.J. Mendell and Co-Researchers. - Pediatrics Week

'Many studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured microbiologic factors have received little review,' scientists in Richmond, United States report.

'We conducted an updated, comprehensive review on these topics. We reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects. We evaluated evidence for causation or association between qualitative/subjective assessments of dampness or mold (considered together) and specific health outcomes. We separately considered evidence for associations between specific quantitative measurements of microbiologic factors and each health outcome. Evidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children. Suggestive evidence was available for only a few specific measured microbiologic factors and was in part equivocal, suggesting both adverse and protective associations with health. Evident dampness or mold had consistent positive associations with multiple allergic and respiratory effects. Measured microbiologic agents in dust had limited suggestive associations, including both positive and negative associations for some agents,' wrote M.J. Mendell and colleagues.

The researchers concluded: 'Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.'

Mendell and colleagues published their study in Environmental Health Perspectives (Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence. Environmental Health Perspectives, 2011;119(6):748-756).

For additional information, contact M.J. Mendell, California Dept. of Public Health, Indoor Air Qual Sect, Environmental Health Laboratory Branch, 850 Marina Bay Pkwy, G365, Richmond, CA 94804, United States.

The publisher's contact information for the journal Environmental Health Perspectives is: Us Dept. Health Human Sciences Public Health Science, National Institute Health, National Institute Environmental Health Sciences, PO Box 12233, Research Triangle Pk, NC 27709-2233, USA.

Keywords: City:Richmond, State:California, Country:United States, Region:North and Central America, Ecology, Pediatrics, Conservation, Bronchial Diseases, Obstructive Lung Diseases, Respiratory Tract Diseases, Respiratory Hypersensitivity

Study Results from University of California Update Understanding of Autism. - Pediatrics Week

According to the authors of recent research from Davis, United States, 'Causes of autism are unknown. Associations with maternal nutritional factors and their interactions with gene variants have not been reported.'

'Northern California families were enrolled from 2003 to 2009 in the CHARGE (CHildhood Autism Risks from Genetics and Environment) population-based case-control study. Children aged 24-60 months were evaluated and confirmed to have autism (n = 288), autism spectrum disorder (n = 141), or typical development (n = 278) at the University of California-Davis Medical Investigation of Neurodevelopmental Disorders Institute using standardized clinical assessments. We calculated adjusted odds ratios (ORs) for associations between autism and retrospectively collected data on maternal vitamin intake before and during pregnancy. We explored interaction effects with functional genetic variants involved in one-carbon metabolism (MTHFR, COMT, MTRR, BHMT, FOLR2, CBS, and TCN2) as carried by the mother or child. Mothers of children with autism were less likely than those of typically developing children to report having taken prenatal vitamins during the 3 months before pregnancy or the first month of pregnancy (OR = 0.62 [95% confidence interval = 0.42-0.93]). Significant interaction effects were observed for maternal MTHFR 677 TT, CBS rs234715 GT + TT, and child COMT 472 AA genotypes, with greater risk for autism when mothers did not report taking prenatal vitamins periconceptionally (4.5 [1.4-14.6]; 2.6 [1.2-5.4]; and 7.2 [2.3-22.4], respectively). Greater risk was also observed for children whose mothers had other one-carbon metabolism pathway gene variants and reported no prenatal vitamin intake. Periconceptional use of prenatal vitamins may reduce the risk of having children with autism, especially for genetically susceptible mothers and children,' wrote R.J. Schmidt and colleagues, University of California.

The researchers concluded: 'Replication and mechanistic investigations are warranted.'

Schmidt and colleagues published their study in Epidemiology (Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism. Epidemiology, 2011;22(4):476-485).

For additional information, contact R.J. Schmidt, University of California, Dept. of Public Health Science, School Medical, 123 MS1C, 1 Shields Avenue, Davis, CA 95616, United States.

Publisher contact information for the journal Epidemiology is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

Keywords: City:Davis, State:California, Country:United States, Region:North and Central America, Elements, Neurology, Pediatrics, Developmental Disabilities

Studies from University of California Have Provided New Data on Autism. - Pediatrics Week

'Studies of season of birth or season of conception can provide clues about etiology. We investigated whether certain months or seasons of conception are associated with increased risk of autism spectrum disorders, for which etiology is particularly obscure,' investigators in Davis, United States report.

'The study population comprises 6,604,975 children born from 1990 to 2002 in California. Autism cases (n = 19,238) were identified from 1990 through 2008 in databases of the California Department of Developmental Services, which coordinates services for people with developmental disorders. The outcome in this analysis was autism diagnosed before the child's sixth birth date. The main independent variables were month of conception and season of conception (winter, spring, summer, and fall). Multivariate logistic regression models were used to estimate odds ratios (ORs) with their 95% confidence intervals (CIs) for autism by month of conception. Children conceived in December (OR = 1.09 [95% CI = 1.02-1.17]), January (1.08 [1.00-1.17]), February (1.12 [1.041.20]), or March (1.16 [1.08-1.24]) had higher risk of developing autism compared with those conceived in July. Conception in the winter season (December, January, and February) was associated with a 6% (OR = 1.06, 95% CI = 1.02-1.10) increased risk compared with summer,' wrote O. Zerbo and colleagues, University of California.

The researchers concluded: 'Higher risks for autism among those conceived in winter months suggest the presence of environmental causes of autism that vary by season.'

Zerbo and colleagues published their study in Epidemiology (Month of Conception and Risk of Autism. Epidemiology, 2011;22(4):469-475).

For additional information, contact O. Zerbo, University of California, Dept. of Public Health Science, School Medical, MS1C, Davis, CA 95616, United States.

The publisher of the journal Epidemiology can be contacted at: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

Keywords: City:Davis, State:California, Country:United States, Region:North and Central America, Neurology, Pediatrics, Developmental Disabilities

Recent Studies by M.V. Modayil and Co-Authors Add New Data to Health Promotion Findings. - Obesity, Fitness & Wellness Week

A report, 'Cost-effective smoke-free multiunit housing media campaigns: connecting with local communities,' is newly published data in Health Promotion Practice. According to the authors of recent research from Sacramento, California, 'Presented are cost-effective paid media strategies to educate Californians to advocate for stronger smoke-free multiunit housing (SF-MUH) policies between 2006 and 2008. Included is a summary of general market and specific ethnic market costs that correspond to SF-MUH attitudes and home smoking bans.'

'Statewide questionnaires indicated that half of the intended general market saw an antitobacco TV ad and half of the intended ethnic markets heard radio ads. Analyses indicated that it cost $0.67 and $0.78 per person to see Caution Tape and Apartment TV ads, respectively. Slightly higher per capita costs corresponded with positive attitudes toward SF-MUH: $0.87 for Caution Tape and $1.00 for Apartment,' wrote M.V. Modayil and colleagues (see also Health Promotion).

The researchers concluded: 'Lessons learned from this campaign included effectiveness of specific ads in ethnic markets, impact on SF-MUH work plan policy objectives, and the need for collaborations among state and local partners throughout the message development process.'

Modayil and colleagues published their study in Health Promotion Practice (Cost-effective smoke-free multiunit housing media campaigns: connecting with local communities. Health Promotion Practice, 2011;12(6 Suppl 2):173S-85S).

For additional information, contact M.V. Modayil, California Dept. of Public Health, Sacramento, CA, United States.

Publisher contact information for the journal Health Promotion Practice is: SAGE Publications, USA , 2455 Teller Road, Thousand Oaks, CA 91320, USA.

Keywords: City:Sacramento, State:California, Country:United States, Region:North and Central America.

Update on Human Salmonella Typhimurium Infections Associated with Aquatic Frogs - United States, 2009-2011 - MMWR. Morbidity and Mortality Weekly Report

CDC is collaborating with state and local public health departments in an ongoing investigation of human Salmonella Typhimurium infections associated with African dwarf frogs (ADFs) (1). ADFs are aquatic frogs of the genus Hymenochirus commonly kept in home aquariums as pets. From April 1, 2009 to May 10, 201 1, a total of 224 human infections with a unique strain of S. Typhimurium were reported from 42 states. The isolates are indistinguishable by pulsed-field gel electrophoresis and multiple-locus variable-number tandem repeat analysis. This outbreak likely includes considerably more than the 224 laboratory-confirmed cases reported to CDC; only an estimated 3% of Salmonella infections are laboratory confirmed and reported to surveillance systems (2). Surveillance for additional cases continues through PulseNet, the national molecular subtyping network for foodborne disease surveillance.

The median age of patients in this outbreak was 5 years (range: < 1-67 years), and 70% (156 of 223) were aged <10 years. Approximately 52% (111 of 21 5) were female. No deaths have been reported, but 30% (37 of 123) of patients were hospitalized. Sixty-five percent (56 of 86) of patients interviewed reported contact with frogs in the week before illness; 82% (45 of 55) reported that this contact took place in the home. Of those who could recall the type of frog, 85% (29 of 34) identified ADFs. Median time from acquiring a frog to illness onset was 15 days (range: 7-240 days).

Samples collected during 2009-201 1 from aquariums housing ADFs in six homes of patients yielded the S. Typhimurium outbreak strain. Traceback investigations conducted during 2009-2011 from 21 patient homes and two ADF distributors identified a breeder in California as the common source of ADFs. This breeder sells ADFs to distributors, not directly to pet stores or to the public. Environmental samples collected at the breeding facility in January 2010, April 2010, and March 2011 yielded the outbreak strain. Based on these epidemiologic, traceback, and laboratory findings, the breeder voluntarily suspended distribution of ADFs on April 19, 201 1 . Public health officials are working with the breeder to implement control measures.

Distribution of ADFs currently is unregulated by federal or state agencies. To prevent infection, the public needs to be aware of the risk of Salmonella infections associated with keeping amphibians, including frogs, as pets. Education of consumers, health-care professionals, and the pet industry is needed. Persons at high-risk for Salmonella infections, especially children <5 years, pregnant women, and immunocompromised persons, should avoid contact with frogs, water used by the frogs, and their habitats. Additional information is available at http://www.cdc.gov/salmonella/water-frogs-04l 1.

[Reference]

References

1 . CDC. Multistate outbreak of human SalmonelL� Typhimurium infections associated with aquatic frogs - United States, 2009. MMWR 2010;58: 1433-6.

2. Voetsch AC, Van Gilder TJ, Angulo FJ, et al. FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States. Clin Infect Dis 2004;38:S 127-34.

[Author Affiliation]

Reported by

JillYaeger, PhilHudecek, Madera County Dept of Environmental Health. Curtis L. Fritz, Debra Gilliss, Due J. Vugia, Gregory Inami, Rita A. Br enden, California Dept of Public Health. Jennifer K. Adams, Cheryl A. Bopp, Eija Trees, Vincent Hill, Amy Kahler, Jeshua Pringle, Ian Williams, Casey Barton Behravesh, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases; Sarah D. Bennett, Sh auna L. Mettee, EIS officers, CDC

Research on Autism Detailed by Scientists at Department of Public Health. - Pediatrics Week

Current study results from the report, 'Birth prevalence of autism spectrum disorders in the San Francisco Bay area by demographic and ascertainment source characteristics,' have been published. 'Using standardized methods for multi-source surveillance, we calculated the prevalence of autism spectrum disorders (ASD) among children born in a racially diverse region in 1994 or 1996 as 4.7/1000 live births. Children with ASD before age 9 were identified through chart abstraction at health-related sources; three-quarters were being served by the state-wide Department of Developmental Services,' scientists in Richmond, California report.

'In adjusted models, we found a male:female ratio of 6:1, a doubling of ASD prevalence among children of older mothers (40+), and lower prevalence with lower paternal education. Children of Black or Hispanic mothers had lower prevalence than those of White, non-Hispanic mothers, but these differences were attenuated after adjustment. Prevalence in children of Asian mothers was similar to Whites,' wrote G.C. Windham and colleagues, Department of Public Health.

The researchers concluded: 'Potential under-counting is discussed.'

Windham and colleagues published their study in the Journal of Autism and Developmental Disorders (Birth prevalence of autism spectrum disorders in the San Francisco Bay area by demographic and ascertainment source characteristics. Journal of Autism and Developmental Disorders, 2011;41(10):1362-72).

For additional information, contact G.C. Windham, Environmental Health Investigations Branch, California Dept. of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States.

The publisher's contact information for the Journal of Autism and Developmental Disorders is: Springer, 233 Spring Street, New York, NY 10013, USA.

Keywords: City:Richmond, State:California, Country:United States, Region:North and Central America, Neurology, Pediatrics, Developmental Disabilities.

Studies from Department of Public Health Further Understanding of Down Syndrome. - Genomics & Genetics Weekly

A new study, 'The California Prenatal Screening Program: 'options and choices' not 'coercion and eugenics',' is now available. 'The California Prenatal Screening Program is designed to make prenatal screening available to the state's large and diverse population. The Program provides information to women which will allow them to make informed choices regarding prenatal screening and prenatal diagnosis,' scientists in Richmond, California report (see also Down Syndrome).

'Since the Program's inception in 1986, women in California have had the option to participate in prenatal screening or to decline prenatal screening. The California Program offers prenatal diagnostic services to women whose screening tests indicate an increased risk for birth defects, including Down syndrome. Women can decline any or all of these follow-up services. Genetic counseling, diagnostic services, and the presentation of diagnostic results are performed by medical professionals (not State staff) who follow established guidelines for nondirective counseling. Program data clearly demonstrate that women in California have a wide range of options and make a wide range of choices regarding prenatal screening and prenatal diagnosis. California's comprehensive Prenatal Screening Program promotes optimal care for all women within all options and choices,' wrote M.C. Flessel and colleagues, Department of Public Health.

The researchers concluded: 'The important and necessary communication among organizations and stakeholders involved in prenatal screening and diagnosis, and in related care for pregnant women and for people with Down syndrome, is not served by misrepresentation and inflammatory rhetoric.'

Flessel and colleagues published their study in Genetics In Medicine (The California Prenatal Screening Program: 'options and choices' not 'coercion and eugenics'. Genetics In Medicine, 2011;13(8):711-3).

For more information, contact M.C. Flessel, Prenatal Screening Branch, California Dept. of Public Health, Richmond, California 94804, United States.

Keywords: City:Richmond, State:California, Country:United States, Region:North and Central America, Genomics, Mental Retardation, Chromosome Disorders, Nervous System Diseases, Congenital Abnormalities, Neurologic Manifestations, Developmental Disabilities, Neurobehavioral Manifestations.

Toxic Waste candy recalled for being toxic.(JustDesserts) - Food Management

The irony here couldn't be deeper. A candy imported from Pakistan and marketed under the brand name Toxic Waste has been recalled by importer City Circle Marketing & Distributing (dba Candy Dynamics) for being ... well, toxic. The California Dept. of Public Health found several flavors of the product contain elevated levels of lead.

Well, at least they can claim that anyone who ate it and got sick was forewarned. After all, the stuff is called Toxic Waste (in fact, the particular flavors the regulators fingered for excessive lead were from the Nuclear Sludge line, so consume at your own risk ...).

Of course, there is also the question of why anyone would want to name, much less consume, anything named Toxic Waste. What, was Raw Sewage already taken?

Studies from R.A. Pollini and Co-Researchers Update Current Data on HIV/AIDS. - Health & Medicine Week

According to the authors of a study from Sacramento, California, 'Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n = 100) with a reference population of HIV-positive persons currently in care (n = 115) to identify potential barriers to treatment initiation.'

'Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [ AOR] = 0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR = 0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR = 0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR= 0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR = 0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR = 3.57; 95% CI: 1.22, 10.46),' wrote R.A. Pollini and colleagues (see also HIV/AIDS).

The researchers concluded: 'Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.'

Pollini and colleagues published the results of their research in Aids Patient Care and STDS (A Community-Based Study of Barriers to HIV Care Initiation. Aids Patient Care and STDS, 2011;25(10):601-609).

For additional information, contact R.A. Pollini, California Dept. of Public Health, Center Infectious Disease, Off AIDS, Sacramento, CA, United States.

The publisher of the journal Aids Patient Care and STDS can be contacted at: Mary Ann Liebert Inc., 140 Huguenot Street, 3RD Fl, New Rochelle, NY 10801, USA.

Keywords: City:Sacramento, State:California, Country:United States, Region:North and Central America, RNA Viruses, Retroviridae, Vertebrate Viruses, Primate Lentiviruses, Viral Sexually Transmitted Diseases

Study results from J.K. Louie et al provide new insights into pandemics. - Women's Health Weekly

According to a study from the United States, 'Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women. Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health.'

'We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died -nonpregnant women, pregnant women, and postpartum women (those who had delivered <= 2 weeks previously). Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered <= 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3. 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women,' wrote J.K. Louie and colleagues (see also Pandemics).

The researchers concluded: 'The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.'

Louie and colleagues published their study in New U.K. Journal of Medicine (Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California. New U.K. Journal of Medicine, UNKNOWN DATE;362(1):27-35).

For more information, contact J.K. Louie, California Dept. of Public Health, 850 Marina Bay Pkwy, Richmond, CA 94804, USA.

Publisher contact information for the New U.K. Journal of Medicine is: Massachusetts Medical Society, Waltham Woods Center, 860 Winter St., Waltham, MA 02451-1413, USA.

Keywords: City:Richmond, State:CA, Country:United States, Cesarean Section, Epidemics, H1N1 Virus, Infectious Disease, Maternal Mortality, Obstetrics, Pandemics, Pregnancy, Public Health, Swine Flu, Swine Influenza, Women's Health

Recent findings from P.J. Patiris and co-authors highlight research in encephalitis. - Health & Medicine Week

Data detailed in 'Serologic diagnosis of West Nile and St. Louis encephalitis virus infections in domestic chickens' have been presented. 'Adult domestic chickens were infected with West Nile virus (WNV) or St. Louis encephalitis virus (SLEV) and challenged with homologous or heterologous virus at 21 or 56 days postinfection (dpi),' scientists in the United States report (see also Encephalitis).

'Sera were collected at selected time points after infection and assayed by enzyme immunoassay (EIA), plaque reduction neutralization test (PRNT), and a Western blot (WB) alternative to PRNT. EIA results were sensitive and accurate (few false positives) but not specific, requiring a confirmatory test to determine virus infection history. PRNT results generally were specific until challenge, after which test results were frequently equivocal and inadequate to determine first or second infecting virus. WB results confirmed the serologic cross-reactivity between WNV and SLEV envelope protein. Non-structural protein 1 and pre-membrane protein reactivities were highly specific for WNV during SLEV infection, but less specific for SLEV during WNV infection,' wrote P.J. Patiris and colleagues, .

The researchers concluded: 'WB and PRNT specificities were similar for both viruses from 6 to 14 dpi, and sensitivities to WNV were virtually identical.'

Patiris and colleagues published their study in The American Journal of Tropical Medicine and Hygiene (Serologic diagnosis of West Nile and St. Louis encephalitis virus infections in domestic chickens. The American Journal of Tropical Medicine and Hygiene, 2008;78(3):434-41).

For additional information, contact P.J. Patiris, Viral and Rickettsial Disease Laboratory, California Dept. of Public Health, Richmond, California 94804 USA..

The publisher's contact information for the The American Journal of Tropical Medicine and Hygiene is: American Society Trop Med & Hygiene, 8000 Westpark Dr., Ste. 130, Mclean, VA 22101, USA.

Keywords: United States, Richmond, Arbovirus Encephalitis, Central Nervous System Disease, Encephalitis, Hygiene, Immunoassay, Infectious Disease, Parasitic Disease, St. Louis Encephalitis, Vectors, West Nile Fever, West Nile Virus, Zoonoses.

Reports outline science study results from M.E. Harnly et al. - Food Weekly News

'We collected indoor dust samples from homes in the Salinas Valley of California. Of 22 pesticides measured in 504 samples, permethrins and the organophosphate chlorpyrifos were present in highest amounts,' scientists writing in the journal Environmental Science & Technology report.

'In multivariate Tobit regression models among samples from 197 separate residences, reported agricultural uses of chlorpyrifos, a herbicide (2,3,5,6-tetrachloroterephthalate (DCPA)), and a fungicide (iprodione) on agricultural fields were significantly (p < 0.01) associated, with 83%, 19%, and 49% increases, respectively, in dust concentrations for each kg applied per day, near participant homes, in the month or season prior to sample collection. However, agricultural use of diazinon, which was 2.2 times that of chlorpyrifos, and of permethrin were not significantly associated with dust levels. Other variables independently associated with dust levels included temperature and rainfall, farmworkers storing work shoes in the home, storing a diazinon product in the home, housing density, having a home less clean, and having an air conditioner. Permethrins, chlorpyrifos, DCPA, and iprodione have either a log octanol-water partition coefficient (K-ow,) greater than 4.0, a very low vapor pressure, or both,' wrote M.E. Harnly and colleagues.

The researchers concluded: 'Health risk assessments for pesticides that have these properties may need to include evaluation of exposures to house dust.'

Harnly and colleagues published their study in Environmental Science & Technology (Pesticides in Dust from Homes in an Agricultural Area. Environmental Science & Technology, 2009;43(23):8767-8774).

Additional information can be obtained by contacting M.E. Harnly, California Dept. of Public Health, Environmental Health Invest Branch, Richmond, CA, USA.

The publisher of the journal Environmental Science & Technology can be contacted at: American Chemical Society, 1155 16th St., NW, Washington, DC 20036, USA.

Keywords: Agricultural, Agriculture, Farmworker.

Research from J.K. Louie and co-authors provides new data about tics. - Virus Weekly

'Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease,' scientists in the United States report (see also Tics).

'To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death. Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009. Characteristics of hospitalized and fatal cases. During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome. In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized,' wrote J.K. Louie and colleagues.

The researchers concluded: 'Most cases had established risk factors for complications of seasonal influenza. JAMA. 2009;302(17):1896-1902.'

Louie and colleagues published their study in Jama - Journal of the American Medical Association (Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California. Jama - Journal of the American Medical Association, 2009;302(17):1896-1902).

For additional information, contact J.K. Louie, California Dept. of Public Health, 850 Marina Bay Pkwy, Richmond, CA 94804, USA.

The publisher's contact information for the Jama - Journal of the American Medical Association is: American Medical Association, 515 N State St., Chicago, IL 60610-0946, USA.

Keywords: City:Richmond, State:CA, Country:United States, Epidemiology, H1N1 Virus, Infectious Disease, Pandemics, Public Health, Swine Flu, Swine Influenza, Tics

Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza a (H1N1)--United States, May-August 2009.(Clinical report) - MMWR. Morbidity and Mortality Weekly Report

On September 29, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/ mmwr).

In previous influenza pandemics, studies of autopsy specimens have shown that most deaths attributed to influenza A virus infection occurred concurrently with bacterial pneumonia (1), but such evidence has been lacking for 2009 pandemic influenza A (H1N1). To help determine the role of bacterial coinfection in the current influenza pandemic, CDC examined postmortem lung specimens from patients with fatal cases of 2009 pandemic influenza A (H1N1) for bacterial causes of pneumonia. During May 1-August 20, 2009, medical examiners and local and state health departments submitted specimens to CDC from 77 U.S. patients with fatal cases of confirmed 2009 pandemic influenza A (H1N1). This report summarizes the demographic and clinical findings from these cases and the laboratory evaluation of the specimens. Evidence of concurrent bacterial infection was found in specimens from 22 (29%) of the 77 patients, including 10 caused by Streptococcus pneumoniae (pneumococcus). Duration of illness was available for 17 of the 22 patients; median duration was 6 days (range: 1-25 days). Fourteen of 18 patients for whom information was available sought medical care while ill, and eight (44%) were hospitalized. These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza.

CDC receives tissue specimens routinely from patients with confirmed or suspected infectious diseases and provides histopathologic, immunohistochemical, and molecular evaluations. Early in the 2009 influenza A (H1N1) virus pandemic, CDC provided guidelines for submission of tissue specimens for evaluation of influenza virus infections. [*] Confirmed fatal cases of 2009 pandemic influenza A (H1N1) were defined as influenza-like illness or postmortem findings suggestive of viral pneumonia and laboratory-confirmed 2009 pandemic influenza A (H1N1) virus infection by real time reverse transcriptase--polymerase chain reaction (rRT-PCR). Respiratory specimens (i.e., lung, trachea, and large-airway specimens) collected at autopsy were submitted to CDC by medical examiners, hospitals, and local and state health departments for additional evaluation.

Specimens were received from 77 patients who had 2009 pandemic influenza A (H1N1) virus infection confirmed before death (N = 41) or after death (N = 36). Of the 77 cases evaluated, 56 (72%) had at least some clinical information available, and 35 (45%) had preliminary autopsy reports submitted with the tissue specimens. All specimens were examined using hematoxylin and eosin stain, Lillie-Twort tissue Gram stain, and Warthin-Starry silver stain (Figure). Tissue specimens also were evaluated by various immunohistochemical assays using antibodies that are specifically reactive with S. pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, or Haemophilus influenzae. All bacteria were evaluated by a broad-range PCR assay that targets a segment of the 16S ribosomal DNA gene in DNA extracted from formalin-fixed, paraffin-embedded tissue (2). PCR for lytA and spy genes and pneumococcal serotyping by multiplex PCR were conducted to further characterize streptococcal coinfections. ([dagger])

Of the 77 confirmed cases evaluated, 22 had histopathologic, immnohistochemical, and molecular evidence of coinfection with an identified bacteria, including 10 cases with S. pneumoniae, six with S. pyogenes, seven with S. aureus, two with Streptococcus mitis, and one with H. influenzae; four cases involved multiple pathogens (Table). The median age of the 22 patients was 31 years (range: 2 months-56 years); 11 (50%) were male. The cases were reported from eight states: California, Hawaii, Illinois, New Jersey, New York, Texas, Utah, and Virginia.

Duration of illness was available for 17 of the 22 patients; median duration was 6 days (range: 1-25 days). Fourteen of 18 patients with information available sought medical care while ill, and eight were hospitalized. Of the seven hospitalized patients with information available, all required mechanical ventilation. Seven of nine patients with information available on antimicrobial therapy were treated with antibiotics. Sixteen of the 21 patients for whom previous medical history was known had underlying medical conditions that were known to increase the risk for influenza-associated complications (16 patients) (3) or that were indications for vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) (15 patients). ([section])

[FIGURE OMITTED]

Reported by: J Louie, MD, C Jean, MPH, California Dept of Public Health. T-H Chen, MD, S Park, MD, R Ueki, Hawaii State Dept of Health. T Harper, MD, Stroger Hospital of Cook County; Chicago Dept of Public Health. E Chmara, MD, Northern Region Medical Examiner Office; New Jersey Dept of Health and Senior Svcs. J Myers, Erie County Medical Center; R Stoppacher, MD, Onondaga County Medical Examiner's Office; C Catanese, MD, Orange County Medical Examiner's Office; City of New York Office of the Chief Medical Examiner; New York City Dept of Health and Mental Hygiene; New York State Dept of Health. N Farley, MD, Valley Forensics, P.L.L.C.; Texas Dept of State Health Svcs. E Leis, MD, Utah Office of the Medical Examiner; Utah Dept of Public Health. C DiAngelo, MD, Northern District Office of the Chief Medical Examiner, Virginia; Virginia Dept of Health. AM Fry, MD, L Finelli, DrPH, Influenza Div, MG Carvalho, PhD, B Beall, PhD, M Moore, MD, C Whitney, MD, Div of Bacterial Diseases, National Center for Immunization and Respiratory Diseases; Infectious Diseases Pathology Br, National Center for Zoonotic, Vector-Borne, and Enteric Diseases; DM Blau, DVM, PhD, EIS Officer, CDC.

Editorial Note: During previous influenza pandemics, bacterial coinfections caused by S. pneumoniae, H. influenzae, S. aureus, and group A Streptococcus have been important contributors to morbidity and mortality (1,4). However, two early reviews of severe cases of 2009 pandemic influenza A (H1N1) showed no evidence of bacterial pneumonia among 30 hospitalized patients with laboratory-confirmed cases in California (5) and 10 intensive-care patients in Michigan (6). These reports might have led to a perception that bacterial coinfections are playing a limited role or no role in influenza deaths during the current pandemic. However, failure to document bacterial lung infections might reflect the difficulty of establishing specific bacterial diagnoses among persons with bacterial coinfections. Routine clinical tests used to identify bacterial infections among patients with pneumonia do not detect many of these infections. For example, <10% of patients who are hospitalized with clinically diagnosed pneumonia have blood cultures that are positive for bacterial infections (7). Histopathologic evaluation and testing of lung tissue, especially using PCR and immunochemistry methods, can detect many bacterial lung infections missed by standard clinical methods (2). The findings in this report indicate that, as during previous influenza pandemics, bacterial pneumonia is contributing to deaths associated with pandemic H1N1 and that histopathologic methods can be used to identify bacterial coinfections after death.

Although the findings in this report confirm the presence of bacterial lung coinfection, the results cannot be used to assess the prevalence of bacterial pneumonia among patients who have died from pandemic H1N1. The cases in this report do not come from a systematic sample and might not be representative of all pandemic H1N1 deaths or all pandemic H1N1 deaths associated with bacterial pneumonia. Systematic research is needed to determine the incidence and outcome of bacterial lung coinfections among patients with pandemic H1N1 virus infection and to quantify the role of these infections in fatal cases.

Medical examiners and coroners have an important role in the surveillance of deaths caused by the 2009 pandemic influenza A (H1N1) virus (8). Histopathologic techniques can assist with postmortem diagnosis of coinfections in patients in whom culture, antemortem or postmortem, does not detect bacteria. When autopsies are performed for patients with confirmed or suspected influenza who die after acute respiratory disease, a pathological evaluation of respiratory tissues should be conducted and should include testing for both viral and bacterial pathogens (8).

The findings in this report are subject to at least three limitations. First, not all potential bacterial pathogens (e.g., Legionella species) were evaluated. Second, the analysis of patient characteristics was based on limited patient information. Because medical records and death certificates generally were not available, no conclusion could be drawn about whether the cause of death was influenza, bacterial infection, or both. Third, because assessments of bacterial coinfections were conducted at autopsy, inadequate sampling, collection of specimens from unaffected portions of the lung, or prolonged illness and treatment before death might have prevented identification of bacteria.

The most common bacteria found in patients described in this report were S. pneumoniae. This infection was documented in 10 of the 22 patients. Although no data were available on the vaccination status of the 22 patients, one patient was aged <5 years and was therefore a candidate for pneumococcal conjugate vaccine, and 15 others had underlying medical conditions that were indications for PPSV23 vaccine (9,10). Persons at greatest risk for invasive pneumococcal disease include young children, older adults, and persons of any age with certain conditions, including chronic lung or cardiovascular disease and immunosuppressive conditions. All children aged <5 years should receive pneumococcal conjugate vaccine according to current Advisory Committee on Immunization Practices (ACIP) recommendations (9). In addition, PPSV23 is recommended for all persons aged 2-64 years with certain health conditions and all persons aged [greater than or equal to] 65 years ([paragraph]). Available vaccination coverage data indicate that only a small proportion of persons aged 2-64 years in the United States who are recommended by ACIP to receive pneumococcal vaccine have received the vaccine. One study indicated that only 16% of persons aged 18-49 years with indications for PPSV23 vaccine had received the vaccine. (* *) Because of the higher rates of 2009 pandemic H1N1 illness and death among persons aged 2-64 years, providers should target persons in this group who have existing ACIP indications for PPSV23 to receive the vaccine.

The findings in this report also underscore the importance of managing patients with influenza who also might have bacterial pneumonia with both empiric antibacterial therapy and antiviral medications.([dagger]) ([dagger]) In addition, public health departments should encourage the use of pneumococcal vaccine, seasonal influenza vaccine, and, when the vaccine becomes available, pandemic influenza A (H1N1) 2009 monovalent vaccine.

References

(1.) Morens DM, Taubenberger, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis 2008;198:962-70.

(2.) Guarner J, Packard MM, Nolte KB, et al. Usefulness of immunohistochemical diagnosis of Streptococcus pneumoniae in formalin-fixed, paraffin-embedded specimens compared with culture and gram stain techniques. Am J Clin Pathol 2007;127:612-8.

(3.) CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR 2009;58(No. RR-8).

(4.) Brundage JF, Shanks GD. Deaths from bacterial pneumonia during the 1918-19 influenza pandemic. Emerg Infect Dis 2008;14:1193-9.

(5.) CDC. Hospitalized patients with novel influenza A (H1N1) virus infection--California, April-May, 2009. MMWR 2009;58:536-41.

(6.) CDC. Intensive-care patients with severe novel influenza A (H1N1) virus infection--Michigan, June 2009. MMWR 2009;58:749-52.

(7.) Metersky ML, Ma A, Bratzler DW, Houck PM. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 2004;169:342-7.

(8.) Nolte KB, Lathrop SL, Nashelsky MB, et al. 'Med-X': a medical examiner surveillance model for bioterrorism and infectious disease mortality. Hum Pathol 2007;38:718-25.

(9.) CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-9).

(10.) CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8).

(*) Additional information available at http://www.cdc.gov/h1n1flu/ tissuesubmission.htm.

([dagger]) Additional information available at http://www.cdc.gov/ncidod/biotech/strep/ protocols.htm.

([section]) Additional information available at http://www.cdc.gov/h1n1flu/guidance/ ppsv_h1n1.htm.

([paragraph]) Additional information available at http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm.

(* *) Additional information available at http://www.cdc.gov/flu/professionals/ vaccination/pdf/NHIS89_07ppvvaxtrendtab.pdf.