Zika might spread in sweat and tears, doctors warn
The Zika virus may spread in sweat and tears in some cases, doctors
cautioned Thursday. The case of a Utah man who infected his adult son before
he died leaves no other alternatives, the team at the University of Utah
School of Medicine said. And - more bad news - the 73-year-old patient who
died really was not very sick before he caught Zika, which suggests that the
virus can occasionally kill people who are not frail and ill.
Dr. Sankar Swaminathan and colleagues describe the case in the New
England Journal of Medicine. "Given the very high level of viremia in
patient 1, infectious levels of virus may have been present in sweat or
The patient, who died in July, was the first in the 50 U.S. states to be
killed by Zika. He'd been treated for prostate cancer but wasn't especially
ill from that, the team wrote in their report. "Eight days before admission,
he had returned from a 3-week trip to the southwest coast of Mexico, where
Zika virus transmission had been reported. He was well during his trip but
reported being bitten by mosquitoes," the team wrote. He developed muscle
aches, diarrhea and other symptoms. The team thought he had dengue, a virus
very closely related to Zika that's spread by the same mosquitoes.
He died from respiratory and kidney failure four days after being infected,
they said. Later tests showed the older man in fact had Zika, and had an
extraordinary amount of the virus in his blood - thousands of times more
than usual. He'd had dengue in the past, but not recently.
Then his 38-year-old son got sick, and developed the rash that's
characteristic of Zika infection.
"Patient 2 reported having assisted a nurse in repositioning Patient 1 in
bed without using gloves. Patient 2 also reported having wiped Patient 1's
eyes during the hospitalization but reported having had no other overt
contact with blood or other body fluids, including splashes or mucous
membrane exposure," the team wrote.
The younger man had not traveled, and the mosquitoes that spread Zika are
not found in Utah. Investigators spent weeks trying to figure out how he got
"Given the very high level of viremia in Patient 1, infectious levels of
virus may have been present in sweat or tears, both of which Patient 2
contacted without gloves," Swaminathan's team concluded.
That's known to happen with Ebola, a different type of virus. When patients
got extremely high levels of the virus in their blood, even their sweat
became infectious to others. Also like Ebola, Zika virus has been found in
the eyes of patients.
"These two cases illustrate several important points. The spectrum of those
at risk for fulminant (sudden and severe) Zika infection may be broader than
previously recognized, and those who are not severely immunocompromised or
chronically ill may nevertheless be at risk for fatal infection," they said.
"Whether contact with highly infectious body fluids from patients with
severe Zika virus infection poses an increased risk of transmission is an
important question that requires further research."
Zika is mostly spread by mosquitoes, but the ongoing epidemic has shown it
can also be spread through all forms of sex. The biggest danger is when a
pregnant woman becomes infected, because the virus can get to the developing
fetus and cause severe birth defects.
The virus can also cause a range of complications in some patients,
including the paralyzing condition called Guillain-BarrĂ© syndrome, as well
as inflammation of the brain and spinal cord.
Visit NBC News for the report.
printed bone material acts like real bone for custom-made implant
Researchers have invented a new type of artificial bone that can be shaped
using a 3-D printer for customized implants. The new material, which they
call hyper-elastic bone, appears to act like natural bone in the body and
can repair deformed bones and some injuries, the team reports in the journal
Science Translational Medicine.
When the material was tested in a monkey, the bone fused to the animalâs
skull, and new blood vessels grew into it, the team at Northwestern
âWithin four weeks, the implant had fully integrated, fully vascularized
with the monkeyâs own skull. And there is actually evidence of new bone
formation,â Adam Jakus, a postdoctoral fellow in the department of materials
science and engineering at Northwestern, told reporters in a telephone
They hope to gain permission to test the implants in people within the next
five years. The material is cheap and appears to be useful for a range of
bone injuries, including for the spine, skull and jaw, they said.
Currently, the best option is a bone graft from the patient, which can be
painful and which doesnât always work well, or donated bone from someone who
has died. These transplants often do not heal well. Artificial bone grafts
currently in development are often brittle and risk being rejected, also.
Jakus and assistant professor Ramille Shah developed a mixture of materials
including hydroxyapatite, the main mineral component of natural bone tissue,
which also lends itself to ink-jet printing.
âDespite the fact that it is majority ceramic, which is usually very
brittle, it possesses very unique nano and micro-structural properties that
makes it highly elastic,â Shah said. âThe first time that we actually 3-D
printed this material, we were very surprised to find that when we squeezed
or deformed it, it bounced right back to its original shape.â It can be
âeasily cut, rolled, folded, and sutured to tissue. And since it is elastic,
it can be pressed, fit into a defect, and expand to mechanically fix itself
into a space without glue or sutures,â she added.
They stuck some under the skin of a mouse and it acted like natural tissue.
Cells grew on it and blood vessels made their way into it, much like natural
Visit Counton for the study.
rule preserves patients' rights to sue nursing homes in court
The federal government has announced a new rule that guarantees the rights
of patients and families to sue long-term care facilities.
The rule, released Wednesday by the Centers for Medicare & Medicaid
Services, bans so-called pre-dispute binding arbitration clauses in nursing
home contracts, which require patients and families to settle any dispute
over care in arbitration, rather than through the court system.
The rule applies to facilities that receive money from Medicare or Medicaid
- which is nearly all of them. It is scheduled to go into effect in
The change was originally proposed in July 2015, and the agency "received
and reviewed almost 10,000 comments from the public."
The rule would address cases like that of Dean Cole, who NPR reported on in
2015. Just two weeks after Cole's wife arranged for him to move into a
Minnesota nursing home, he was rushed to the hospital, severely dehydrated
and in a coma, a lawyer for the family told NPR's Ina Jaffe.
Cole died a short while later. His wife, Virginia, could not sue the
facility because she had signed a binding agreement to pursue arbitration
for any dispute. Although she won the arbitration hearing before three
judges, the fees for the proceedings amounted to more than $60,000, leaving
her with a final settlement amount of only $20,000, her lawyer said.
The new rule will allow people like Virginia Cole to sue a nursing home in
court. It also leaves the door open to arbitration in individual cases if
both sides agree to it.
2009 study commissioned by the American Health Care Association, which
represents most nursing homes, found the average awards after arbitration
were 35 percent lower than if the plaintiff had gone to court.
The American Health Care Association opposed the arbitration rule change
when it was proposed in 2015. Clifton Porter II, the AHCA's senior vice
president for government relations, defended arbitration in a 2015 interview
with NPR, saying "it actually allows consumers to get an expedited award."
In addition to the litigation changes, the new rule also includes expanded
regulations regarding the food, medical treatment and personnel requirements
for long-term care facilities. Nursing homes must provide "nourishing,
palatable" food for residents and develop a care plan for each resident
within 48 hours of their admission to the facility.
Amid increased fears of institutionally-spread infection and antibiotic
resistance, the new rules also require nursing homes to develop an
"infection prevention and control program," and a plan for monitoring the
use of antibiotics.
Visit NPR for the article.
Large majorities favor wide range of policy changes to curb prescription
drug costs, including government role in negotiating or limiting prices
Amid news reports about increases in the price for EpiPen and other drugs,
the vast majority of Americans â including majorities of Democrats,
Republicans and independents â support several policy changes to control the
costs of prescription drugs, including some that would expand governmentâs
role in drug pricing, the latest Kaiser Family Foundation tracking poll
About eight in 10 Americans say they favor allowing the federal government
to negotiate with drug companies to get a lower price on medications for
people on Medicare (82%) and limiting the amount drug companies can charge
for high-cost drugs for illnesses like hepatitis or cancer (78%). In
addition, two-thirds (66%) favor creating an independent group that oversees
the pricing of prescription drugs, as Democratic presidential candidate
Hillary Clinton recently proposed. Majorities also support requiring drug
companies to release information to the public on how they set drug prices
(86%) and allowing Americans to buy prescription drugs imported from Canada
majority of Democrats, Republicans and independents support each of these
five policy changes and also think each of them would be effective in
keeping drug costs down.
Fewer overall and across parties favor two other potential policy changes:
eliminating drug advertisements (47%) and encouraging consumers to buy
lower-cost drugs by requiring them to pay more for similar but higher-cost
The survey probes the publicâs views and experiences with prescription drugs
more broadly. It finds a large majority (77%) perceive drug costs as
unreasonable, while one in five (21%) say they are reasonable. The share who
say drug costs are unreasonable is up somewhat from 72 percent a year ago in
At the same time, relatively few Americans say they personally are having
trouble paying for their medication. The survey finds about half (55%) of
the public report currently taking prescription drugs, and the vast majority
(73%) of them say paying for their medications is easy; far fewer (26% of
those taking prescription drugs, or 14% of the total population) say it is
difficult to pay for their drugs. Larger shares of those who report being in
âfairâ or âpoorâ health and those taking four or more medications say it is
difficult to afford their prescriptions.
The survey finds the public remains divided in its view of the Affordable
Care Act (ACA), with 47 percent reporting an unfavorable view and 44 percent
reporting a favorable one. As in the past, Democrats largely support the
law, Republicans largely oppose it, and independents are in the middle,
though leaning unfavorable. These divisions persist on other questions about
views and facts related to the lawâs impact.
For example, about half of the public (48%) say the ACA marketplace in their
own state is working well, while 43 percent say it is not working well. When
asked how well they think the marketplaces are working in the nation
overall, perceptions shift slightly with about half (49%) saying they are
not working well and 44 percent say they are working well.
Majorities of Democrats perceive the marketplace in their state and
marketplaces nationally as working well, while Republicans are more likely
to say they are not working well. People living in states that have
developed their own state-based marketplace are more likely to say the
health insurance marketplace in their own state is working well - even when
controlling for party identification and other demographic factors that tend
to predict support for the ACA.
Visit Kaiser for the report.
Dengue vaccine may cause disease, hospitalization in low, moderate
Routine administration of the Dengvaxia dengue vaccine in low-transmission
areas could increase the number of patients hospitalized with severe
secondary infections, according to study data, and led the researchers to
recommend patients undergo serological testing before vaccination.
âSuccessful licensing of the first vaccine against a major global pathogen
is a significant achievement,â Neil M. Ferguson, DPhil, director of the MRC
Centre for Outbreak Analysis and Modeling, Imperial College London, and
colleagues wrote in the journal Science. âHowever, the dependence of vaccine
efficacy on prior immunity presents challenges to planning large-scale use.â
Using mathematical models of dengue transmission, the researchers simulated
the effect of routine Dengvaxia (CYD-TDV, Sanofi Pasteur) administration
with 80% coverage to examine the result of vaccinating children aged 2 to 18
years, although the vaccine is not approved for use in children aged younger
than 9 years.
The researchers reported a modest benefit in high-transmission areas: 20% to
30% reductions in symptomatic disease and hospitalization. In
low-transmission areas, however, they reported longer-term (30 years)
effects of vaccination on symptomatic disease and hospitalization may be
positive or negative, despite mostly positive short-term (10 years) effects.
They also reported a more than 90% reduced risk for hospitalization among
seropositive patients who received the vaccine, although they wrote that
vaccination put seronegative patients in low-transmission areas at a higher
risk for being hospitalized with a secondary infection.
âIn places with high transmission intensity, most people have been already
exposed to dengue at the time of vaccination, and the vaccine has higher
efficacy on average,â researcher Derek A.T. Cummings, PhD, biology professor
at the University of Florida, said in a press release. âHowever, in places
with lower transmission intensity, where individuals havenât been previously
exposed, the vaccine can place people at risk of severe disease and overall
increase the number of hospitalized cases.â
Ferguson, Cummings and colleagues predicted that routine vaccination would
reduce overall incidence of the disease by only 10% to 20%, and wrote that
serological testing could help maximize the benefits of the vaccine.
âOur model refines estimates of which places would see a decline in dengue
incidence with large-scale vaccination programs, and which places should not
implement programs at this point in time,â Ferguson said in the release.
âThese results present the first published, independent predictions of the
potential impact of vaccination that take account of recent data showing
that the vaccine can increase the risk of severe dengue disease in young
Visit Healio for the story.
Tissue, implant and consumable tracking software solutions available to
Intalere members through agreement with TrackCore, Inc.
Intalere announces a new agreement with TrackCore, Inc. for tissue and
implant tracking and compliance software solutions.
Through this agreement, Intalere members will receive negotiated pricing on
TrackCoreâs full suite of products for managing tissue, implants and
consumables in all hospital departments. Among the products available to
Intalere members is TrackCore Operating Room, the industry-leading tissue
and implant tracking software clinically proven to cut operational costs and
ensure full regulatory compliance.
Other solutions include TrackCore Interventional (implant and consumable
tracking), fully integrated RFID-enabled enclosures, and TrackCore SameDay
(bill-only implant tracking) which will be available in early 2017.
This contract is currently effective through July 31, 2019.
Learn more at
Halyard Health launches âFist Bump For Heroesâ to celebrate first responders
Halyard Health has launched its âFist Bump for Heroesâ campaign to
recognize and show support of first responders across the United States.
The âFirst Bump for Heroesâ program recognizes first responders â those
heroes who work on the front lines, pulling double duty, to protect our
communities. The program was inspired by the new, dual purpose BLACK-FIRE
Nitrile Exam Glove that provides protection for the variety of jobs required
of first responders.
Who do you consider a hero? Halyard invites you to nominate first
responders, including firefighters, emergency medical technicians and law
enforcement officials, who go above and beyond both on and off the job.
Nominate your heroes now through December 31, 2016. All entries will be
reviewed by a panel of judges and a winner will be announced in January
To nominate a hero, submit a photo of the individual you would like to
recognize along with a few sentences about how he or she not only exceeds
expectations while on the job, but how they give back outside the job. You
can enter at
www.halyardhealth.com/info/ems/fist-bump-for-heroes.aspx or by posting a
public photo on Facebook, Twitter or Instagram using the hashtag #HeroFistBump.
decision memo for screening for Hepatitis B Virus (HBV) Infection
The Centers for Medicare & Medicaid Services (CMS) has determined that the
evidence is sufficient to conclude that screening for Hepatitis B Virus (HBV)
infection, consistent with the grade A and B recommendations by the U.S.
Preventive Services Task Force (USPSTF), is reasonable and necessary for the
prevention or early detection of an illness or disability and is appropriate
for individuals entitled to benefits under Part A or enrolled under Part B,
as described below.
Therefore, CMS will cover screening for HBV infection with the appropriate
U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests,
used consistent with FDA approved labeling and in compliance with the
Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the
beneficiary's primary care physician or practitioner within the context of a
primary care setting, and performed by an eligible Medicare provider for
these services, for beneficiaries who meet either of the following
screening test is covered for asymptomatic, nonpregnant adolescents and
adults at high risk for HBV infection. "High risk" is defined as persons
born in countries and regions with a high prevalence of HBV infection (i.e.,
â„ 2%), US-born persons not vaccinated as infants whose parents were born in
regions with a very high prevalence of HBV infection (i.e., â„ 8%),
HIV-positive persons, men who have sex with men, injection drug users,
household contacts or sexual partners of persons with HBV infection. In
addition, CMS has determined that repeated screening would be appropriate
annually only for beneficiaries with continued high risk (i.e., men who have
sex with men, injection drug users, household contacts or sexual partners of
persons with HBV infection) who do not receive hepatitis B vaccination.
screening test at the first prenatal visit is covered for pregnant women and
then rescreening at time of delivery for those with new or continuing risk
factors. In addition, CMS has determined that screening during the first
prenatal visit would be appropriate for each pregnancy, regardless of
previous hepatitis B vaccination or previous negative hepatitis B surface
antigen (HBsAg) test results.
The determination of "high risk for HBV" is identified by the primary care
physician or practitioner who assesses the patient's history, which is part
of any complete medical history, typically part of an annual wellness visit
and considered in the development of a comprehensive prevention plan. The
medical record should be a reflection of the service provided.
Visit CMS for more information.