Oct 7, 2009

Many polio survivors at risk for post-polio syndrome later in life

 Many polio survivors at risk for post-polio syndrome later in life

By PETER GOTT, M.D. Newspaper Enterprise Association
Published: 10/8/2009  2:21 AM
Last Modified: 10/8/2009  3:56 AM

Dear Dr. Gott: About 20 years ago, I started experiencing leg aches and generalized fatigue. When I was 21, I had polio (I am now 60), and research on the Internet led me to the conclusion I have post-polio syndrome. The last neurologist I saw six months ago said she had never heard of such a thing. Where should I go from here?

Dear Reader: To another neurologist. The National Center for Health Statistics indicates almost 450,000 polio survivors in the United States may be at risk for the condition. In fact, 25 percent to 50 percent of those previously diagnosed with polio will ultimately have some degree of post-polio syndrome (PPS) later in life.

Scientists have concentrated on a number of medications that have failed to provide positive results. Despite this, there are recommended management strategies. Exercise with caution, and only under the direction of a qualified therapist. Avoid activities that cause pain or fatigue lasting longer than 10 minutes. Get adequate sleep, eat healthful 
meals, discontinue cigarette smoking and take over-the-counter anti-inflammatory medications for pain management. Participate in support groups or counseling.Ask your local hospital or healthcare facility for the name of an appropriate specialist in your area. Write Dr. Gott c/o United Media, 200 Madison Ave. 4th floor, New York, NY 10016.By PETER GOTT, M.D. Newspaper Enterprise Association.

Many years later, a scourge returns

Post-polio syndrome afflicts many who thought they’d left disease behind

MONDAY, NOVEMBER 16, 2009 AT 1:29 A.M.
Rick Kneeshaw of Scripps Ranch suffered from polio as a child (inset, right). Now he is battling post-polio syndrome, a disease that can strike former polio victims decades after they have recovered from the initial disease.
Rick Kneeshaw of Scripps Ranch suffered from polio as a child (inset, right). Now he is battling post-polio syndrome, a disease that can strike former polio victims decades after they have recovered from the initial disease.
In 1950, when he was 31⁄2 years old, Rick Kneeshaw contracted polio.
Within days, the healthy toddler was crippled, paralysis quickly numbing and immobilizing his left leg, hip and parts of his back. Over the next 12 years, Kneeshaw would endure many operations, each attempting to restore at least partial muscle and nerve function. Between surgeries, Kneeshaw would spend hours in physical therapy, going and growing through countless braces, crutches and other supports.
“By the time I was 16, I figure I’d spent a quarter of my life in hospitals,” he said.
The payoff was partial recovery. He was able to walk without braces or crutches — at least on level surfaces for short distances. “It gave me nighttime mobility at least. I could get out of bed, go to the bathroom. That was something.”
But something changed in 1971. At age 25, Kneeshaw’s joints on his polio-damaged left side began to ache and act up, forcing him to resume wearing a leg brace. He would never again be without it. He took up using crutches again. And in 1984, his right leg — the healthy one — began to progressively weaken. It got to the point where he could only stand for brief periods. He began using a wheelchair.
Kneeshaw knew he had never actually conquered polio, but he thought he had put it behind him. He had moved on, becoming an electrical engineer, marrying, having children. Polio caught up.
In the late 1940s and 1950s, paralytic poliomyelitis was a scourge and nightmare, the most terrifying public health threat in post-World War II America. The causative agent — a virus that inhabits the gastrointestinal tract — had been identified only a few decades earlier. It was extraordinarily infectious, easily transmitted via contaminated food or water. Epidemics were annual occurrences, each seemingly worse than the last. By 1952, polio was killing more Americans than any other communicable disease: More than 300,000 cases and 58,000 deaths in that year alone. Most of the victims were children, their young immune systems unprepared for the viral onslaught.
After infecting a body and incubating for several days in gastrointestinal cells, the poliovirus spreads along key nerve fiber pathways, replicating in and destroying motor neurons in the spinal cord and brain stem. With their nerve connections destroyed, affected muscles atrophy from lack of stimulation, weakening until permanent paralysis sets in. The damage can be limited to a single finger joint or affect almost the entire body. During one of his stays in a hospital ward occupied entirely by teens with polio, Kneeshaw recalls a girlfriend who was completely paralyzed except for her left arm.
To be sure, the majority of infected children escaped relatively unscathed, acquiring lifelong immunity while suffering only temporary, flu-like symptoms or no symptoms at all. But a small percentage were devastated, the disease exacting permanent, crippling damage. In the worst cases, the virus destroyed motor neurons that control breathing. Many of these polio victims, if they survived, spent the rest of their shortened lives inside “iron lungs” — ungainly, tubular tanks that inflated and deflated their paralyzed lungs by alternating air pressure inside the device.
The polio vaccine, developed by Jonas Salk and introduced in 1955, profoundly changed the equation. The Salk vaccine, which used a killed virus to generate immunity, and a subsequent oral vaccine developed by Albert Sabin (using an attenuated live virus), dramatically reduced the incidence of polio in the United States. New cases declined to less than 1,000 in 1962 and just 121 in 1964. The last reported case of “wild polio” in the United States occurred in 1979. The infrequent infections reported since have all been imported cases or the result of a rare immunological response to the vaccine, which remains one of the major inoculations of childhood.
It’s estimated that up to 600,000 Americans today once had polio. Many are like Kneeshaw, “polio survivors” who labored to rebound from the disease. With treatments and hard work, their bodies overcame at least some of the effects of polio. Motor neurons that survived the initial infection sprouted new and additional fibers, extending into damaged areas to restore at least limited muscle function.
Such was the case with Nan Kaufman, who was 6 years old and living in Texas when she came down with polio in 1954. Her parents thought she had a bad case of the flu until Kaufman collapsed on the way to the doctor, suddenly unable to stand or walk. The disease permanently disabled her right side, stunting growth in her arm and leg, though Kaufman learned to compensate and to persevere.
“I was pretty determined to do what I wanted to do, which was be like other children,” she said. “I learned to ride a bike. I ran, even though my right leg was thinner and shorter. I swam competitively, even though my right hand and arm were chronically weak. There was a good deal of denial and magical thinking. People with polio often become overachievers.”
Kaufman, who now lives in Point Loma, became a pediatrician. She retired in 2006 after years of escalating pain, weakness and fatigue convinced her that she could no longer do her job effectively or safely. “It’s hard to say when symptoms first emerged. I had spent my life pushing pretty hard, raising four children, working long hours as a doctor. I had always had bad days, but I thought it was just that I was tired. Then I started having trouble with my ankle. I fell a lot. I dropped things. I became afraid I might one day drop a baby.”
Kaufman saw doctor after doctor, but no one could pinpoint the problem. She worried she had amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, a progressive and fatal neurodegenerative disease that destroys voluntary muscle control. A neurologist finally identified the real problem: post-polio syndrome. Like Kneeshaw, an old nemesis had come back.
Very little is known about post-polio syndrome, or PPS. No one knows why the condition seems to emerge 30 to 40 years after the original infection. The working hypothesis is that years of overcompensation takes its toll, that surviving, functional, motor neurons and muscles are overworked and simply begin to wear out and shut down. There is evidence that people who had milder cases of polio, who had more surviving motor neurons, are at greater risk of developing PPS than those who suffered significant, permanent damage.
“People who essentially had no recovery from the original polio are much less likely to have PPS symptoms than those with good recovery,” said Dr. Susan Perlman, a neurologist at the University of California Los Angeles.
It is confoundingly difficult to identify PPS. Symptoms such as fatigue, breathing difficulties and muscle weakness tend to be subtle and gradual. They may be associated with many other conditions, from simple exhaustion to other serious neurodegenerative diseases. The situation is further complicated by likely pre-existing health problems and aging.
“Remember, this condition arises in the context of someone who has probably already suffered some degree of paralysis or disability for most of their lives, so it can be hard to separate new symptoms from old ones,” said Dr. Sam Pfaff, a neurobiologist at the Salk Institute for Biological Studies in La Jolla. “Plus, the syndrome is superimposed upon the aging process.”
It doesn’t help that most doctors have never treated an active case of polio or that there’s no definitive diagnostic test.
“There are no biomarkers,” said Pfaff. “Identifying the condition means doing a careful work-up of the patient, knowing and understanding the patient’s history. Post-polio syndrome is the answer you get after you’ve excluded all other possibilities.”
There is no cure for PPS. Treatment consists of ameliorating symptoms and limiting circumstances and behaviors that can accelerate or exacerbate health problems. “The only thing you can do to prevent the disease from progressing is to pace yourself,” said Kaufman. “Telling yourself to push through it, to just get on with life, only makes it worse.”
Not surprisingly, people like Kaufman and Kneeshaw, who was actually a poster child for anti-polio efforts in the 1950s, are strong advocates for more and better research into PPS. They would like to see new therapies, a cure if possible. But they also recognize a harsh reality: Theirs is an affliction that strikes only a distinct and shrinking population of people, particularly in the United States. Unless polio re-emerges as a major public health threat, post-polio syndrome will inevitably decline and disappear as polio survivors do the same.
“We’re a dying breed,” said Gladys Swensrud, who got polio as a 3-year-old living in Escondido in 1951 and now suffers from muscle weakness and breathing problems that require her to use a respirator at night when sleeping.
Swensrud would like to feel better. She argues, as do others with PPS, that it is shortsighted and foolish to simply (and cruelly) write off post-polio syndrome as a health problem that will solve itself as PPS patients pass away. Pfaff at the Salk Institute agrees:
“Polio is not a big public health problem anymore, but it hasn’t been completely eliminated. There are still occasional outbreaks in other parts of world, particularly Africa and Asia. There are thousands of other polio survivors in the world.”
A better understanding of PPS could improve treatments and ease the burden upon survivors around the world. It might also fill in knowledge gaps about the basic biology and pathology of the human body, providing “information that’s relevant to other neurological diseases and other biological systems.”
And that, said Kneeshaw, sitting in his wheelchair, is always a step in the right direction.
IPPSO Press Release

Oct 3, 2009

H1N1 (Swine Influenza) Experts At The Johns Hopkins Medical Institutions

6 puntos para un plan contra influenza 6 Octubre 2009 Para evitar el contagio del virus A/H1N1 es necesario mantener la higiene en los centros de trabajo; el Gobierno ha establecido guías informativas para que los empleadores controlen la epidemia. Ante el repunte de casos de influenza A H1N1, las empresas buscan trabajar para controlar la propagación de esta epidemia, y para ello cuentan con recursos como la Guía de Recomendaciones para Instrumentar el Plan de Emergencia en los Centros de Trabajo por la Epidemia de Influenza, “que pueden instaurar los centros de trabajo para contener la epidemia”, puntualiza un reporte emitido por la Secretaría del Trabajo y Previsión Social (STPS). De acuerdo con datos de la Secretaría de Salud en México, el pasado 7 de septiembre se contabilizó la cifra más alta de casos nuevos, 483 en un solo día, desde el inicio de la epidemia en marzo. Esto despertó la ‘alerta’ para que los empleadores reforzaran las acciones de prevención y promoción de salud, y se llevara a cabo una reunión con las cúpulas empresariales para reiterar que existe el compromiso de apoyar al trabajador en caso de confirmarse diagnóstico por este virus, en particular en lo referido al respeto de sus derechos laborales. Focalizarse en las actividades que establezcan las empresas es vital “porque en estos centros a veces se facilita que los grupos de trabajadores tengan una cercanía y eso favorece la transmisión de las infecciones. Hay que tener recomendaciones para contar con un plan, el cual debe incluir, por lo menos: difusión de las medidas útiles para prevenir la transmisión, así como información relacionada con los síntomas de la enfermedad”, señala Samuel Ponce de León Rosales, director de los Laboratorios de Biológicos y Reactivos de México, Birmex.

Simultáneamente, dice, la empresa debe ofrecer elementos para mantener una condición de higiene y eficiencia respiratoria, como: facilidad para lavarse las manos y desinfectarse con alcohol-gel; dar información sobre la manera de estornudar y toser, y las facilidades para no acudir al trabajo en caso de presentar signos de enfermedad. “Las mamás que deben ausentarse del trabajo, por ejemplo, porque sus hijos están enfermos (por este virus) deben tener facilidades para cumplir con esto, sin ser sancionadas en su salario”, aclara. El especialista recordó que además del rebrote por A H1N1, las medidas de prevención deben fortalecerse ante la presencia de influenza estacional que, en los últimos 10 años ha impactado a “10% de la población mexicana”. “Debido a que las dos se transmiten de la misma forma, es importante que las compañías incrementen su difusión en temas de higiene, vacunación y alerta de síntomas. Cualquier molestia intensa de vías respiratorias hay que revisarla con el especialista. Cabe recordar que para influenza estacional, las vacunas comenzaron a aplicarse el lunes 5 de octubre a niños pequeños, adultos mayores y trabajadores de la salud, mientras que a finales de mes empezará a distribuirse la vacuna por A H1N1 a personas con alto riesgo de complicaciones, trabajadores de la salud y niños”, detalla el especialista en enfermedades respiratorias. Alerta sin pánico Información de la Secretaría de Salud refiere que si la persona está enferma debe ir con el doctor y si éste emite un certificado de A/H1N1 tiene que resguardarse siete días en su casa para evitar el contagio. De acuerdo con Samuel Ponce de León, el aumento en los casos es una realidad por la magnitud de la contingencia, pero en lugar de llegar a un estado de máxima ‘desesperación’, las organizaciones deben enfocarse a informar a los trabajadores para prevenir los contagios. “Hay suficiente información por todos lados, por ejemplo en la página de la Secretaría de Salud, los materiales están listos para imprimir y distribuirse en las empresas”, añade. Por su parte, la guía establecida por la STPS, instruye al empleador sobre cómo establecer un proyecto de Plan de Emergencia, cumpliendo con puntos muy específicos, entre éstos: que todos los trabajadores participen del programa; se respete los derechos de los trabajadores, en particular si existe un caso de contagio que pudiera ser motivo de “discriminación”; y que las organizaciones fijen un canal de comunicación para informar, continuamente, sobre las medidas para proteger su salud. Este documento incluye 74 recomendaciones, agrupadas en seis apartados: planeación y dirección; capacitación e información a los trabajadores; medidas de prevención; medidas de protección; políticas temporales, y supervisión y vigilancia por parte de los servicios preventivos de medicina del trabajo y las comisiones mixtas de seguridad e higiene. Para el apartado de acciones para planeación, por ejemplo, establece los siguientes aspectos: * Designar a un responsable y a un equipo con funciones definidas, del cual formen

parte los representantes de los trabajadores. * Determinar el grado de riesgo del centro de trabajo y de exposición del personal. * Definir los requerimientos de insumos, tales como: cubre bocas, guantes 

desechables, jabón líquido, toallas desechables, secadoras eléctricas, pañuelos 

desechables, bolsas de plástico, etcétera. * Prever los recursos financieros para la adquisición de los insumos. * Evaluar la disponibilidad de los servicios médicos para sus trabajadores. * Reforzar el servicio médico de la empresa. El documento está disponible en la página electrónica de la Secretaría del Trabajo (www.stps.gob.mx) y también se puede consultar el sitio web de la Secretaría de Salud (www.promocion.salud.gob.mx).

Is handwashing enough?

Washing your hands is great, but it isn’t enough to stop the spread of influenza. Experts from the University of California-Berkeley, Mark Nicas (Environmental Health Sciences) and Arthur Reingold (Epidemiology) say handwashing is one of several ways to combat influenza. Other ways include not touching your face (eyes nose, or mouth) and staying home from school or work if sick.

Reingold says you’re more likely to get sick from influenza, especially the H1N1 virus, from airborne particles because inhaling the flu particles gives you a larger dose than by touching a contaminated object. And, according to Nicas, students at UC Berkeley touch their face an average of 16 times per hour. That is 384 times to transmit what ever is on your hands into mucus glands located in your mouth, eyes, and nose in one day.

Since influenza transmission hasn’t been studied as much as other viruses, like the rhinovirus, the best method of prevention remains unknown. Still, handwashing is a wonderful tool to use; we must remember other preventative ways as well. Stay home and away from others if you’re sick or you feel like you’re getting sick, don’t touch your face, and cover your nose and mouth with your elbow when sneezing and coughing.

Latest News

MayoClinic.com Provides Credible, Up-to-Date Information And Decision-Support Tools For Flu Season

Main Category: Swine Flu
Also Included In: Flu / Cold / SARS;  Public Health
Article Date: 05 Nov 2009 - 9:00 PST

"My body aches and my head is throbbing. Do I have the fluor is it just because I'm stressed or tired? Do I need a flu shot? Do I need the H1N1vaccine, too?"

Millions of Americans will be asking themselves these and more questions this fall and winter as news reports and health care providers continue to warn about seasonalinfluenza and novel H1N1 influenza, otherwise known asswine flu.

The flu symptoms self-assessment tool on MayoClinic.com helps you assess whether you or your loved ones have some form of flu, or just a cold. If you possibly or likely have the flu, you'll also learn whether antiviral medication is an option. And you can check a concise list of high-risk groups who should seek medical attention for the flu.

Influenza is a viral infection that attacks the respiratory system, including the nose, throat, bronchial tubes and lungs. If you're generally healthy and you catch influenza - commonly called the flu - you're likely to feel rotten for a few days, but you probably won't develop complications or need hospital care. If you have a weakened immune system or chronic illness though, influenza can be fatal.

Novel H1N1 flu, popularly known as swine flu , is a respiratory infection caused by an influenza virus first recognized in spring 2009. The new virus, which is officially called swine influenza A (H1N1), contains genetic material from human, swine and avian flu viruses. Unlike typical swine flu, H1N1 flu spreads quickly and easily.

Based on the expertise of Mayo Clinic infectious disease and epidemiology scientists and physicians, and other specialists for specific populations such as children or pregnant women, MayoClinic.com provides continually-updated and credible information regarding the seasonal flu and H1N1 flu vaccines and treatment recommendations.


H1N1 (Swine Influenza) Experts At The Johns Hopkins Medical Institutions
03 October 2009
Johns Hopkins has a wide range of experts available for interviews and comments about H1N1 and seasonal flu, emergency preparedness, infection control, transmission in children, vaccine safety, flu treatment, public health...
[read article]

Face Masks Offer Protection Against Spreading H1N1
03 October 2009
With flu season officially underway on October 4th, Cantel Medical Corp. (NYSE: CMN), a company dedicated to infection prevention and control, recommends that Americans take extra precautions against spreading H1N1 influenza...
[read article]

Public Tells Health Care Workers: Get Your H1N1 Flu Vaccine!
03 October 2009
As H1N1 influenza vaccine begins to be shipped across the country, the Centers for Disease Control and Prevention emphasize getting the first doses to high-priority groups. One such group is health care workers. A report released today by the C.S...
[read article]

Swine Flu News Articles Archive  -   Page 1

02 October 2009

01 October 2009

30 September 2009

29 September 2009

28 September 2009

26 September 2009

25 September 2009

24 September 2009

23 September 2009

Flu Can Trigger Heart Attacks But Vaccine May Offer Protection For Cardiac Patients

Swine Flu Map

This Swine flu map was created by L R - a computer scientist working in the UK, together with a team of 18 other people.

Swine Flu Map - Key
  • Red markers are confirmed infections of swine flu H1N1
  • Pink markers are probable infections
  • Black markers are confirmed deaths
  • Grey markers are unconfirmed deaths
  • Blue markers are influenza-like illness
Click on any marker to view information on that case.

2009 Swine Flu (H1N1) Outbreak Map in a larger map

Swine Flu: Top 20 Questions and Answers

Rumors are rife as the swine flu theme evolves. Here are twenty questions answered by Charles Ericsson M.D., Prof. Internal Medicine, Director of Travel Medicine, University of Texas Medical School, and Robert Emery DrPH, VP Safety, Health, Environment & Risk Management, UT Health Science Center, and Associate Prof. at the UT School of Public Health.

Because new reports have come in, parts of this text were edited and updated on 16th July, 2009, by Christian Nordqvist, Editor, Medical News Today.

Read this more recent report on the A (H1N1) swine flu virus:
A new, highly detailed study of the H1N1 flu virus shows that the pathogen is more virulent than previously thought.

Writing in a fast-tracked report published in the journal Nature, an international team of researchers led by University of Wisconsin-Madison virologist Yoshihiro Kawaoka provides a detailed portrait of the pandemic virus and its pathogenic qualities.

In contrast with run-of-the-mill seasonal flu viruses, the H1N1virus exhibits an ability to infect cells deep in the lungs, where it can cause pneumonia and, in severe cases, death. Seasonal viruses typically infect only cells in the upper respiratory system.

"There is a misunderstanding about this virus," says Kawaoka, a professor of pathobiological sciences at the UW-Madison School of Veterinary Medicine and a leading authority on influenza. "People think this pathogen may be similar to seasonal influenza. This study shows that is not the case. There is clear evidence the virus is different than seasonal influenza."

The ability to infect the lungs, notes Kawaoka, is a quality frighteningly similar to those of other pandemic viruses, notably the 1918 virus, which killed tens of millions of people at the tail end of World War I. There are likely other similarities to the 1918 virus, says Kawaoka, as the study also showed that people born before 1918 harbor antibodies that protect against the new H1N1 virus.

And it is possible, he adds, that the virus could become even more pathogenic as the current pandemic runs its course and the virus evolves to acquire new features. It is now flu season in the world's southern hemisphere, and the virus is expected to return in force to the northern hemisphere during the fall and winter flu season.

To assess the pathogenic nature of the H1N1 virus, Kawaoka and his colleagues infected different groups of mice, ferrets and non-human primates - all widely accepted models for studies of influenza - with the pandemic virus and a seasonal flu virus. They found that the H1N1 virus replicates much more efficiently in the respiratory system than seasonal flu and causes severe lesions in the lungs similar to those caused by other more virulent types of pandemic flu.

"When we conducted the experiments in ferrets and monkeys, the seasonal virus did not replicate in the lungs," Kawaoka explains. "The H1N1 virus replicates significantly better in the lungs."

The new study was conducted with samples of the virus obtained from patients in California, Wisconsin, the Netherlands and Japan.

The new Nature report also assessed the immune response of different groups to the new virus. The most intriguing finding, according to Kawaoka, is that those people exposed to the 1918 virus, all of whom are now in advanced old age, have antibodies that neutralize the H1N1 virus. "The people who have high antibody titers are the people born before 1918," he notes.

Kawaoka says that while finding the H1N1 virus to be a more serious pathogen than previously reported is worrisome, the new study also indicates that existing and experimental antiviral drugs can form an effective first line of defense against the virus and slow its spread.

There are currently three approved antiviral compounds, according to Kawaoka, whose team tested the efficacy of two of those compounds and the two experimental antiviral drugs in mice. "The existing and experimental drugs work well in animal models, suggesting they will work in humans," Kawaoka says.

Antiviral drugs are viewed as a first line of defense, as the development and production of mass quantities of vaccines take months at best.

In addition to his appointment at UW-Madison, Kawaoka also is a professor at the University of Tokyo. The new study was funded by grants from the U.S. National Institutes of Health, and the Japanese Ministry of Education, Culture, Sports, Science and Technology. Source University of Wisconsin-Madison 

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