News Trends Analysis

May 1, 2011

The Observatory


38 patients at risk of CJD after surgery.

Public Health Wales has contacted 38 patients who may have been put at risk of contracting Creutzfeldt-Jakob Disease (CJD) during surgery, according to a March 29, 2011, BBC report. A patient who underwent surgery in a hospital in the Abertawe Bro Morgannwg Health Board area in 2007 was at high risk of the disease. The patient's risk of CJD was not known until 2009, so the instruments used in the operation were used in other surgical procedures from 2007 to 2009. Doctors say it is possible that proteins that cause CJD were not killed by normal sterilization procedures. Health officials then investigated what instruments had been used in the original operation and their subsequent usage. It was not until February 2011 that the 38 patients involved were contacted. Public Health Wales says that the risk of transmission of CJD from one patient to another via surgical instruments is extremely low. There have been six cases worldwide of any form of CJD being transmitted via surgery.

U.S. TB cases reach record low.

There were a total of 11,181 cases of tuberculosis (TB) in the United States in 2010 — 3.6 cases per 100,000 population — which is the lowest rate since national reporting of TB began in 1953. The majority of cases of TB were among people who were foreign born (60%). The study, published in the March 25, 2011, issue of Morbidity and Mortality Weekly Report (MMWR), found that the TB rate was 11 times higher among those born outside the United States. Of the foreign-born cases, which represents 6,707 cases, more than half of those cases were among people born in four countries: Mexico (23%), the Philippines (11%), India (8.6%), and Vietnam (7.7%). The report also shows disparities based on race and ethnicity among U.S.-born persons. Infection rates were seven times higher for Hispanics, eight times higher for blacks, and 25 times higher for Asians than for whites, researchers found. The state with the lowest rate of TB was Maine (0.6) while the state with the highest rate was Hawaii (8.8).

Highly resistant bug on the rise in California.

A highly antibiotic-resistant bacteria that was thought to be confined mainly to the East Coast is invading healthcare facilities in the Los Angeles area, according to a report from the Society for Healthcare Epidemiology of America. Los Angeles County reported about 350 cases of carbapenem-resistant Klebsiella pneumoniae between June and December 2010, ABC News reported March 25, 2011. This superbug is dangerous because it tends to affect people who have been in the hospital for long periods of time, have underlying medical problems, or have been in nursing homes. In a 2010 study by researchers at the Columbia University Medical Center in New York City, for instance, 42% of infected patients died within 30 days after infection. Visit CDC.

Hawaii reports dengue cases.

The Hawaii Department of Health (HDH) is investigating four confirmed dengue fever cases and 12 suspected cases among Oahu residents according to an HDH press release. An investigation into the confirmed cases suggests the patients were infected near their homes by mosquitoes. Hawaii identified its first locally acquired dengue case in 56 years in 2001, which led to an outbreak with 122 confirmed cases on three of the state's eight main islands.

26 million in U.S. have diabetes.

Nearly 26 million Americans have diabetes, according to new estimates from the Centers for Disease Control and Prevention (CDC). In addition, an estimated 79 million U.S. adults have prediabetes, a condition in which blood-sugar levels are higher than normal but not high enough to be diagnosed as diabetes. In 2008, the CDC estimated that 23.6 million Americans, or 7.8% of the population, had diabetes, and another 57 million adults had prediabetes. Diabetes affects 8.3% of Americans of all ages, according to the National Diabetes Fact Sheet for 2011. Prediabetes affects 35% of adults age 20 and older. About 27% of those with diabetes — 7 million Americans — do not know they have the disease. The CDC projects that as many as one in three U.S. adults could have diabetes by 2050 if current trends continue.


TB transmitted from elephants to humans.

A study in the March 2011 issue of Emerging Infectious Diseases reveals that nine employees working on an elephant refuge in Tennessee contracted TB from elephants. After receiving positive tuberculin skin tests in 2009, officials from the Tennessee Department of Health conducted a cohort study and on-site assessment. In 2006, the refuge accepted eight elephants from an exotic animal farm where they had been exposed to TB and were, therefore, quarantined. The study of 46 refuge employees identified nine workers who had positive tuberculin skin tests between 2006 and 2009. Employees who worked more than four hours in the quarantine barn during 2009 were 20 times more likely to have TB, and those who worked in adjacent offices were also at increased risk of infection.


HIV spread through kidney transplant.

A kidney-transplant patient in New York contracted HIV from a living organ donor in 2009, the first such case known in the U.S. since screening for the virus began in 1985, the CDC reported in the March 18 issue of MMWR. The male donor was tested for HIV about 10 weeks before he donated a kidney, and the results were negative. Health officials believe the donor became infected between that test and the surgery. Living organ donors in the U.S. are routinely tested for infectious diseases (e.g., hepatitis and HIV), but the organization that oversees organ transplants in the U.S. does not have an explicit policy on when such screening should be done. “To reduce the risk for transplant-transmitted HIV infection, living donors should be rescreened with both HIV serologic tests and nucleic-acid testing as close to the time of organ recovery as logistically feasible, but no longer than seven days before organ donation,” CDC researchers advise.

New studies

Nicotine raises blood-sugar levels.

Researchers have discovered that nicotine raises blood-sugar levels, and the more nicotine present, the higher the blood-sugar levels, according to a March 27, 2011, U.S. News & World Report article. Researchers from California State Polytechnic University-Pomona added equal amounts of glucose to samples of human red blood cells and also added varying levels of nicotine to each sample for either one day or two days. They then tested the HbA1C levels of the samples. The research, reported at the 241st national meeting of the American Chemical Society in Anaheim, CA, March 27-31, 2011, reveals that nicotine raised HbA1C. The smallest dose increased HbA1C levels by 8.8%. The highest dose — after two days of nicotine treatment — increased blood-sugar levels by 34.5%.

High blood-sugar levels increases death risk in hospitalized elderly.

A recent study found that many elderly patients die from undiagnosed blood-sugar-related problems while in the hospital. Researchers from the Hospital Ramon y Cajal in Madrid administered blood-sugar tests to 808 patients over the age of 60 who were admitted to hospitals in Spain and Italy. When researchers excluded patients who had already been diagnosed with diabetes, they found 25% of the participants had fasting blood-sugar tests that would qualify them for the disease. Furthermore, these patients were significantly more likely to die while hospitalized. Individuals with blood-sugar levels between 126 mg/dL and 180 mg/dL had a death rate of 18%, while the death rate for those with blood sugar over 180 mg/dL was 31%. Only 8% of those with normal blood sugar died. The death rate for patients with diagnosed diabetes was between 14% and 23%.


NFL wants to implement HGH testing.

The National Football League (NFL) wants a new collective-bargaining agreement to include provisions allowing players to be tested for the use of human growth hormone (HGH), according to a March 25, 2011, report. HGH is currently banned by the NFL, but players are only subject to discipline if caught using the substance through means other than testing. HGH can only be detected by blood tests, to which NFL players object. The NFL currently uses urine tests for other performance-enhancing and recreational drugs. There currently is no reliable HGH urine test, although research is being done to create one.

States unclear about use of babies' blood samples.

State laws governing the storage and use of surplus blood samples taken from newborns range from explicit to non-existent, Medical News Today reports. Newborns in all 50 states, plus the District of Columbia, are routinely screened for a variety of genetic disorders. Once the screening has been completed, a small amount of dried blood often remains. This residual blood is often used for quality-assurance purposes to improve the operation of state newborn-screening programs. A team led by the Johns Hopkins Berman Institute of Bioethics with researchers from the University of Utah report in the March 28, 2011, issue of Pediatrics that sometimes the samples are also used for other types of biomedical research, including research unrelated to newborn screening. The research team also notes that state laws in only 13 states specify how residual samples of infant blood might be used. Overall, most states lack any requirement that parents be informed that their child's blood samples may be retained for future use, the researchers found.

Blood test improves diagnosis of heart attack.

In patients with a suspected acute coronary syndrome (e.g., heart attack or unstable angina), use of a more sensitive test to detect the protein troponin in blood was associated with increased diagnosis of a heart attack and improved identification of patients at high risk of another heart attack and death in the following year, according to a study in the March 23, 2011, issue of Journal of the American Medical Association. Scientists used a new test to detect very low levels of troponin, which is released into the blood when heart-muscle cells are damaged. In a study of patients with a suspected heart attack, U.K. researchers found that the test could detect troponin at levels four times lower than the standard blood test. As a result, one-third more patients were diagnosed with heart attack.

Infectious diseases

One smallpox shot linked to four vaccinia cases.

Four people contracted vaccinia-virus infections as a result of contact with a U.S. military member who received a smallpox shot, according to a report in April's Emerging Infectious Diseases. The military member preparing for deployment was vaccinated on Feb. 23, 2010; and on Feb. 27, he participated in semiprofessional wrestling matches with two men. Both of those wrestlers suffered skin lesions within three days. One of the wrestlers participated in another wrestling match, exposing a third person. In addition, a household contact of one of the wrestlers suffered lesions, followed by fever, chills, joint pain, and swelling. Vaccinia virus was confirmed in all four patients, and gene sequencing in three of the cases linked the virus to the ACAM2000 smallpox vaccine.

Mom's yellow-fever shot transmitted virus to infant.

A five-week-old Canadian infant developed yellow fever after his mother was vaccinated against the disease, with the virus apparently transmitted through breast milk, researchers say. MedPage Today reports that the baby came to the hospital with focal seizures, poor appetite, and a two-week history of runny nose and cough. About four weeks before, when he was 10 days old, his mother had been vaccinated against yellow fever. She breast-fed the infant throughout the period. The researchers report in CMAJ, the Canadian Medical Association's journal, that serological testing for yellow fever in serum was positive for immunoglobulin M (IgM) but not for IgG. Doctors also drew a cerebrospinal fluid (CSF) sample, and it also was positive for yellow fever IgM. Molecular testing failed to identify the yellow fever virus itself in CSF. Although the mother's breast milk was not available for testing, researchers determined that the mother's vaccination was the most likely route of infection.