News/ Trends/ Analysis

Sept. 1, 2010

Observatory

News/ Trends/ Analysis
News

Hepatitis B cases linked to free dental clinic. Nearly 2,000 people who attended or volunteered at a free dental clinic in Berkeley County, WV, in June 2009, are being urged to get hepatitis B tests after five people contracted the disease, according to state and county health officials. Two of the individuals were volunteers at the clinic, and three individuals received dental treatment. Notification letters are being sent to 1,137 patients and 826 volunteers who are also being advised to be tested for hepatitis C and HIV, though no cases have been reported. Investigation of the cases did not reveal any other common exposures, and lab studies suggest four patients may have been infected by the same source.

IDSA urges mandatory flu shots for health workers. The Infectious Diseases Society of America (IDSA) has formally asked federal health officials to recommend making influenza vaccination mandatory for healthcare workers (HCW). The IDSA made the recommendation in a letter commenting on proposed revisions in the Centers for Disease Control and Prevention's (CDC) guidance for controlling flu in healthcare settings. In the revised guidance, released in June, the CDC stresses the importance of flu shots for HCWs but does not call for requiring them. The proposed guidance also relaxes the CDC's respiratory-protection advice somewhat, saying that workers should wear surgical masks during the routine care of flu patients, rather than N-95 respirators as recommended previously.

Paramedic calls for change in blood-test protocol. A former paramedic in Winnipeg, Manitoba, who was exposed to a patient's blood, has been trying — so far unsuccessfully — to get the patient's blood tested for bloodborne diseases. The paramedic administered CPR to a man who was having a heart attack on July 16, CBC News reports. After the patient, whose name the paramedic never learned, left in an ambulance, the paramedic realized he had come in contact with the man's blood. Since then he has been trying to find out if he was exposed to any bloodborne diseases such as HIV. Officials, however, say releasing the man's name would violate privacy laws. There is legislation in place for a court to order blood tests from a victim whose blood or other body fluids come in contact with a first responder or Good Samaritan, but the name of the victim must be provided to the court to issue the order.

Infectious diseases

West Nile antibodies can persist for six years. Anti-West Nile virus (WNV) antibodies may persist as long as six years, meaning detection of the marker may not reliably indicate recent infection, researchers from the CDC reports. Researchers followed 59 patients hospitalized with confirmed WNV in 2003. Anti-WNV immunoglobulin-M was detected in eight (24%) of 33 patients who were still participating in the study at 72 months to 75 months. Those who had persistent antibodies were likely to be younger than those without them. The researchers suggest a patient's clinical and epidemiologic history be considered when interpreting positive antibody findings to determine if they suggest acute disease or a previous infection.

HIV/AIDS

Opt-out HIV tests a modest success. The CDC's suggested routine “opt-out” testing for HIV modestly increased the number of people identified with the virus when it was used in a large emergency department. But more than three-quarters of eligible patients, in fact, opted out of the testing, researchers reported in the July 21 issue of the Journal of the American Medical Association. Eligible patients coming to the emergency department were told during registration that rapid HIV testing would be conducted unless they refused it, which required them to check a box on the consent form and provide a signature to show they were opting out. The low uptake of screening in the study seems to challenge the hope of increased testing with the CDC's opt-out approach, according to some doctors.

New studies

New solution for blood-group genotyping. Scientists are reporting an advance toward enabling more blood banks to adopt so-called “extended blood-group typing,” which increases transfusion safety by better matching donors and recipients. Their report on a new, automated genetic method for determining a broader range of blood types appears the June 18 issue of Analytical Chemistry. Researchers explain that most blood banks still use a century-old blood approach to blood typing which identifies blood-group antigens on red blood cells — proteins that must match in donor and recipient to avoid potentially serious transfusion reactions. Most blood currently is typed for only a few of the 29 known human blood groups. Commercial technology does exist for extended typing with DNA tests; but because it is expensive and difficult to use, it is suited more for research labs than high-volume blood centers. The study describes evaluation of a new method, called the HiFi Blood 96, which types blood with DNA testing in a high-speed automated procedure. Tests on 293 human blood samples demonstrated the performance and reliability of the new method. The report compares HiFi Blood 96 to existing commercial tests and discusses improvements that are underway. Read more at http://pubs.acs.org.

Young-adult cholesterol screening rates low. Less than half of young adults get cholesterol screening even though up to a quarter of them have elevated cholesterol, according to a study by the CDC. The rate of elevated low-density lipoprotein cholesterol (LDL-C) among young adults ranges from 7% to 26%, the study says. The screening rate among this age group, however, is less than 50%, regardless of the number of individual risk factors. The report, in the July-August issue of Annals of Family Medicine, identifies the need to improve screening for and management of high LDL-C among young adults. Elevated LDL-C levels were found in 7% of young adults with no other risk factors, 12% with one other risk factor, and 26% with two or more other risk factors. Approximately 55% of American young adults (men aged 20 to 35 years; women aged 20 to 45 years) have at least one risk factor for coronary heart disease, such as high blood pressure, smoking, family history, or obesity, according to the study.

Men test positive for chlamydia twice as often as women. Men are more likely than women to have sexually transmitted infections but are less likely to be tested, according to a survey of more than 3,000 British adults. A survey performed by Lloydspharmacy, a community pharmacy chain in the U.K., indicated that 13% of men and 6% of women tested positive for chlamydia. Further findings show that 13% of men had unprotected sex with more than one partner over the last five years — making them more prone to sexually transmitted diseases. Only 7% of women displayed such risky sexual behavior.

HSV-1 may cause cognitive deficits. Exposure to herpes simplex virus 1 (HSV-1), the virus that causes cold sores, may be partially responsible for shrinking regions of the brain and the loss of concentration skills, memory, coordinated movement, and dexterity in patients with schizophrenia, according to research led by Johns Hopkins scientists. Blood tests showed that 25 schizophrenia patients had antibodies for HSV-1 and 15 did not. Results showed that patients with antibodies to HSV-1 performed significantly worse on the cognitive tests than patients without the antibodies. Though the researchers are not sure why schizophrenia might make brains more vulnerable to a viral assault, they say if schizophrenic patients with HSV-1 antibodies are identified early on, it might be possible to reduce the risk or the extent of cognitive deficits.

HPV test may detect more pre-cancerous cells than conventional cytology. Screening women with a human papillomavirus (HPV) DNA test first, with cytology triage if the result is positive, is more sensitive for the detection of cervical cancer and pre-cancerous lesions than conventional cytology, according to a study published online April 27 in British Medical Journal. Researchers from the Finnish Cancer Registry in Helsinki invited a total of 58,076 women (aged 30 to 60 years) to take part in a routine population-based screening program for cervical cancer from 2003 to 2005. Participants were selected to undergo a primary HPV DNA test (hybrid capture II) with cytology triage if the result was positive, or a conventional cytologic screening. The researchers correlated the screening results to incidence data for cervical cancer, cervical intraepithelial neoplasia (CIN) grade III, and adenocarcinoma in situ (combined in a composite outcome termed CIN III+) from the 2003 to 2007 national cancer registry. The researchers found that primary HPV screening with cytology triage was more sensitive than conventional cytology in detecting CIN III+ lesions.

Filtering blood may reduce complications. Researchers at the University of Rochester Medical Center (URMC) in New York say rates of acute transfusion-related lung injury decreased 83% in the years since the center's implementation of universal leukoreduction, a process that filters white cells from donated blood to be used for transfusions. The study, published online in Transfusion, also reports rates of transfusion-associated circulatory overload also were reduced by 49%. Both conditions are rare but are among the most common causes of death following a transfusion. The 14-year observational study was conducted during the seven years before and after 2000, when the URMC introduced universal leukoreduction. The researchers say observations do not prove cause and effect and, therefore require further investigation before it is certain that leukoreduction is responsible for fewer cardiopulmonary complications.

Blood test detects breast cancer. A blood test that detects breast cancer more than a year before any symptoms appear could dramatically improve survival rates. The test looks for raised levels of a certain protein that is already known to increase once cancer has developed. But in a new study, researchers found levels of the epidermal growth-factor receptor (EGFR) were already high up to 17 months before women were diagnosed with breast cancer. The test, announced at the recent annual meeting of the American Association for Cancer Research in Washington, DC, could herald a breakthrough in the search for a biomarker that indicates the presence of cancer. The latest development came from a study of more than 400 breast-cancer patients by scientists at the Fred Hutchinson Cancer Research Center in Seattle. A study called the Women's Health Initiative — a 15-year investigation that began in 1991 — involved more than 100,000 volunteers who donated blood samples to the study for routine testing. When researchers identified women who later developed breast cancer, the scientists analyzed the blood samples up to 17 months before the women's diagnoses. These blood samples were then compared with samples from cancer-free women from the same study. The results showed those with the highest levels of EGFR were nearly three times more likely to be diagnosed with cancer at a later date. Researchers say it is too early for the biomarker test to be used on its own as a cancer diagnosis, but it could one day form part of the screening process.

Conferences

Oct. 8. The 6th Annual Clinical Laboratory Day at Wake Technical Community College, Raleigh, NC, will demonstrate a simple model for understanding quality in the laboratory including the 12 building blocks of quality. In addition, it will define four types of quality costs: prevention, appraisal, internal failure, and external failure; and summarize the top 10 deficiencies found during CLIA inspections. Go to www.quia.com/sv/417979.html.

Oct. 9-12. The 2010 AABB Annual Meeting and CTTXPO at the Baltimore Convention Center will offer 120 education sessions, showcase the latest products and services from 200 exhibitors, and provide networking opportunities for attendees from the blood-banking, transfusion medicine, and cellular and related biological-therapy communities worldwide. Visit www.aabb.org.

Oct. 27-31. The ASCP Annual Meeting at the San Francisco Marriot Marquis will include more than a hundred informational and educational sessions, as well as diverse discussions and networking opportunities to address issues that impact the future of pathology. Go to www.ascp.org.

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