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CDC Recommends Vaccination for Prospective Families In Overseas Adoptions
Hepatitis A is a highly contagious liver infection that causes inflammation and affects the function of the liver. However, it is not commonly as serious as other types of viral hepatitis such as Hepatitis B and C, which develop into potentially fatal conditions including chronic hepatitis and cirrhosis.
In a recent Atlanta-based meeting of the Advisory Committee on Immunization Practices, members voted to recommend hepatitis A vaccinations for people who will come into contact with children from countries where infection is prevalent. Among countries targeted are Guatemala, China, Russia and Ethiopia as they are key sources of current international adoptions. Federal guidelines already call for vaccinations against Hepatitis A for all U.S. children as well as for adults traveling to countries where the illness is common.
The advisory committee makes recommendations to the Centers for Disease Control and Prevention (CDC) and held that people expecting to have close contact with children within 60 days of their arrival into the U. S. should be vaccinated. This includes not only family members, but also anyone who may be affected, including caregivers and babysitters. The recommendation comes after a 51-year-old adoptive grandmother of twins was hospitalized in California for hepatitis A in 2007 and an incident leading to the hospitalization of two adults and school vaccination clinics in Maine in 2008.
According to Dr. Cindy Weinbaum, a medical epidemiologist with the CDC, “Recently, there have been cases of family members who have gotten sick after kids have been adopted.” She said there had been about 20 cases. Dr. Weinbaum explained that the new recommendations pertain to adoptions from countries having a high or intermediate infection risk. She said, “That includes most of the world. All that excludes is North America, Western Europe, Australia, New Zealand and Japan.”
Of the estimated 32,000 annual occurrences of hepatitis A infection within the U. S., it is estimated by federal officials that 100 to 1,000 cases are linked to international adoptees, with a few cases ending tragically. Children coming from other countries often do not receive recommended vaccinations when they first arrive into the U.S. They are given a physical examination yet often do not exhibit any telltale symptoms of the disease, such as jaundice. To complicate matters, non-traveling members of a new adoptee’s family are also not commonly vaccinated. The two-dose vaccination has a total cost of about $140 per person. This is a small price to pay for protection when one considers that the costs of international adoptions are between $20,000 and $40,000. According to the CDC, the first dose of hepatitis A vaccine should be administered as soon as adoption is planned. A statement from the agency said, “Ideally, the first of two doses of hepatitis A vaccine should be administered at least two weeks prior to the arrival of the adoptee.”
Kansas Gov. Kathleen Sebelius Accepts Nomination to HHS Secretary
By Michael A. Fletcher and Ceci Connolly
Washington Post Staff Writers
Saturday, February 28, 2009; 7:18 PM
Kansas Gov. Kathleen Sebelius this afternoon accepted President Obama’s request to become his Health and Human Services secretary, stepping into a central role in the new administration’s ambitious effort to overhaul the nation’s health care system.
Sebelius’s nomination comes just days before the White House is scheduled to convene a summit on health reform, an early step in the president’s ambitious plan to vastly expand the reach of the nation’s health care system. A formal announcement of her nomination will come on Monday.
The summit, which is expected to be the first in a series of open meetings around the country, is intended to spotlight the challenges spawned by the nation’s balkanized health care system — including soaring costs and gaping holes in coverage. It is also aimed at rallying public support for an overhaul certain to draw ideological and industry opposition. Similar to last week’s “fiscal responsibility” summit, the health session will open with remarks by Obama and then divide into working groups run by administration officials.
In his budget proposal unveiled last week, Obama set aside $634 billion for a new health reform reserve fund that over the next decade would serve as a substantial downpayment on the cost of moving the country closer to universal health coverage. Currently, about 46 million Americans lack health care coverage, a number likely to grow as the economic downturn throws more people out of work.
If confirmed by the Senate, Sebelius would fill a vital Cabinet position originally slated to go to former Sen. Thomas A. Daschle, who withdrew from consideration last month over his failure to pay $146,000 in back taxes and interest until he had already been nominated for the post. The controversy prompted Obama to acknowledge that he had “screwed up.”
Steering the costly changes through Congress promises to be a complicated and politically-charged task that will be a big part of Sebelius’s portfolio. The withdrawal of Daschle, a former Senate majority leader steeped both in the byzantine ways of Congress and the intricacies of the nation’s $2.3 trillion health care system, delivered a significant blow to the administration as it prepared to launch its ambitious health reform agenda.
Sebelius would inherit a sprawling department of 65,000 employees responsible for public health, food safety, scientific research and the administration of the Medicare and Medicaid, which serve 90 million Americans. The solvency of those programs is yet another worry confronting the administration, which has vowed to take on entitlement reform. The department’s budget, consumed largely by those two programs, exceeds $700 billion.
The Kansas governor’s health care experience stems primarily from her eight years as state insurance commissioner and her work as governor overseeing the Medicaid health program for the poor. She tried unsuccessfully to expand health coverage in the state through higher cigarette taxes. Still, under her watch, Kansas has added tens of thousands of low-income children to state health programs.
As insurance commissioner, she rejected the sale of Blue Cross Blue Shield to an Indiana company, citing the prospect as higher premiums as the reason. The job, however, had less to do with the delivery of health care and achieving the sort of quality improvements and efficiencies that Obama and policy experts speak of when they describe a high-performing health system of the future.
More than a month into the administration, few Obama appointees have been placed in the health agency and the president has yet to name a chief for the major health agencies such as the Food and Drug Administration or the National Institutes of Health.
“This evening, the President asked Kansas Governor Kathleen Sebelius to serve as his Secretary of Health and Human Services, and she accepted,” an administration official said this afternoon.
An administration source said it is likely that Obama would nominate someone else for a second post Daschle had created for himself: director of a new White House Office of Health Reform. One name mentioned for the job is former Clinton administration adviser Nancy-Ann DeParle, who would take over the effort to create, sell and implement a wide-ranging health care overhaul.
Sebelius, the 60-year-old daughter of a former Ohio governor, served as state Insurance Commissioner before winning the 2002 governor’s race. She is halfway through a second term.
Though she lacks Washington experience, Sebelius is a veteran politician who learned the craft from her father, John J. Gilligan, and later her father-in-law, a Kansas Republican who spent six years in Congress. A graduate of Trinity College in Washington, Sebelius served eight years in the state legislature and at one time worked as a lobbyist for the Kansas Trial Lawyers Association.
She is known for reaching across the aisle in her Republican-dominated state, and in her first gubernatorial bid, she chose a former Republican businessman as her running mate.
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Coffee Brown, University of New Mexico, Talk Radio News
The president’s National Commission on Children and Disasters met to continue planning for the special needs of children in the worst of times.
Existing standards and guidelines do not account for pediatric differences.
Irwin Redlener, MD, Commissioner, noted that it would be relatively easy to come up with good recommendations, but relatively hard to get them approved by all parties.
Mark Shriver, Chairman, responded, “If disaster hits and your child dies because federal agencies can’t see eye to eye, that’s just unacceptable.”
Several problems illustrate the difficulty: Mandating minimum shelter standards could inhibit emergent, improvised solutions, or impose unrealistic burdens on smaller communities. Often there are no evidence based medical plans, so groups of experts will need to provide consensus opinions. What may strike one person as “comfort measures,” and thus of lower priority, may strike another parent as basic, minimal childcare; Shriver mentioned bathing children in sinks as an example. While victims need shelter from day one, cached supplies may not make to the sites for 72 to 96 hours after the state’s governor makes a request.
An attendee from Columbia University pointed out that the international community has generally had more experience with modern disaster management, and might provide some useful templates, citing the Sphere Project (http://www.sphereproject.org/content/view/146/84/lang,English/) as an example.
Perhaps the most difficult problem for children is recovery. Dr. Redlener said recovery isn’t just infrastructure, it’s young psyches for whom things are not ever going to be “just like before.” He noted that we need to know what works and what doesn’t, that both psychological and material support are needed, and that current regulations are relatively arbitrary and limiting. The goal, he said, is to get these kids back onto a normal or better developmental and educational curve.
Shriver pointed out that when a city rebuilds, it upgrades, why not think that way about recovery for children?
For background on the Commission: http://www.uhhospitals.org/rainbowchildren/tabid/4354/Default.aspx
The National Commission on Children and Disasters was authorized under the Consolidated Appropriations Act of 2008, signed into law by President Bush on December 26, 2008.
The purpose of the Commission
to conduct a comprehensive study that examines and assesses childen’s needs as they relate to preparation for, response to, and recover from all hazards, including major disasters and emergencies.
to identify, review and evaluate existing laws, regulations, policies and programs relevant to such needs.
to identify, review and evaluate the lessons learned from past disasters relative to addressing such needs.
to report to the President and Congress on its findings and recommendations to address such needs, including the need for a national resource center on children and disasters, coordination of resources and services, administrative actions, policies, regulations and legislative changes.
The Commission is compromised of 10 members. The President and congressional leaders appoint 2 commissioners each. At present 6 of 10 have been appointed. President Bush and House Republican Leader Boehner are vetting their nominees.
The expertise represented on the Commission is diverse and drawn from multiple professions and disciplines related to serving the unique needs of children affected by disasters.
Timeline of Commission operations
The Commission may not officially meet until all 10 members are appointed. Once the Commission is fully constituted:
within 30 days, members meet to elect a Chairperson and Vice-Chairperson
within 120 days, the Commission shall meet and begin operations
within 1 year of the first meeting, the Commission shall issue an Interim Report to the President and Congress
within 2 years of the first meeting, the Commission shall issue its Final Report to the President and Congress
The Commission shall terminate 180 days after the Final Report is submitted
Powers of the Commission
hold hearings
request information from federal agencies
receive administrative support from the general services administration and other federal departments
enter into contracts
accept postal service in same manner as a federal department
Staffing
The Chairperson, in consultation with the Vice Chairperson, may appoint and fix the compensation of a staff director and other personnel
The Chairperson may request staff from federal agencies to assist the Commission
The Commission may procure the services of experts and consultants
Funding
Authorised at $1.5 million for each federal fiscal years of 2008 and 2009. A federal fiscal year is October 1st to September 30th of the following year.
COMMENT: Due to my interest in disaster management, especially the special needs or vulnerable populations and the fact that I have two friends from the InterAgency Board who sit on this commission….I have been monitoring their activities with great interest.
Cleaning and disinfection work on an Abbotsford, B.C. turkey farm has been completed to the Canadian Food Inspection Agency’s approval after the farm’s stock was culled for avian flu.
About 60,000 birds were gassed and composted in the farm’s barns after some birds in the flock were confirmed Jan. 24 to have what turned out to be a low-pathogenicity H5N2 strain of avian influenza.
A nearby second poultry farm in B.C.’s poultry-concentrated Fraser Valley, where what appears to be a similar “low-path” H5 strain of bird flu was confirmed in the flock on Feb. 11, has completed in-barn composting of its birds, to “inactivate” whatever virus they’re carrying.
Preparation for cleaning and disinfection has begun at that second site, CFIA said Friday.
The second site was detected through routine surveillance of properties within a three-km radius of the first infected site.
As per international guidelines, Canada can again claim its notifiable-avian flu-free status three months after all cleaning and disinfection activities on infected premises have been completed and approved by the CFIA — provided that surveillance has been carried out during that three-month period, the agency said.
Surveillance continues on the commercial poultry premises within three km of the first and second infected premises and any in-contact premises still under movement restriction outside of the three-km radius, CFIA said Friday.
As of Thursday, CFIA said it has 43 premises quarantined in relation to these two cases.
If the second case is also confirmed as “low-path,” Canada also gets its World Organization for Animal Health (OIE) status as free of “high-path” bird flu, which it regained in April 2008 after cleanup of an outbreak of H7N3 on a poultry farm near Regina Beach, Sask.
…London, 1975:The Moorgate Tube crash kills dozens and injures dozens more. The final death toll was 43. The cause of the crash remains a mystery.
BBC, 1975: A London Underground train has crashed at Moorgate, killing the driver and at least 29 passengers and injuring more than 70 in the worst-ever Tube disaster.
The 0837 train from Drayton Park to Moorgate was packed with commuters going to work when it overshot the platform and ploughed into a dead-end tunnel at 0846.
Passengers on platform nine said the train appeared to shudder and accelerate as it arrived at the station.
It failed to stop and carried on past the platform, into the tunnel and smashed through a sand barrier and into a brick wall at 30mph.
The driver, Leslie Newson, 55, was killed.
The front three carriages have been crushed together with the last three intact at the platform.
The crash left the station in total darkness and threw up a huge amount of soot and dust.
The rescue operation has involved several teams – police, London Underground staff, fire crews, doctors and nurses from St Bartholomew’s Hospital and members of the Salvation Army.
It was a horrible mess of limbs and mangled iron
Gerard Kemp, journalist
They have been working all day to free the dead and the injured from the tangled mass of metal in atrocious conditions.Only one journalist was allowed down into the tunnel – Gerard Kemp of the Daily Telegraph.
“It was a horrible mess of limbs and mangled iron,” he said.
“One of the great problems [for the rescue teams] was the intense heat down there. It must have been 120 degrees. It was like opening the door of an oven.”
Twelve hours after the tragedy, a young policewoman was brought out of the front carriage after her foot was amputated.
The last known survivor, a 26-year-old man, was brought out at 2200GMT.
It is feared many more bodies will be found over the next few days.
Baxter Sent Bird Flu Virus to European Labs by Error (Update2)
By Michelle Fay Cortez and Jason Gale
Feb. 24 (Bloomberg) — Baxter International Inc. in Austria unintentionally contaminated samples with the bird flu virus that were used in laboratories in three neighboring countries, raising concern about the potential spread of the deadly disease.
The contamination was discovered when ferrets at a laboratory in the Czech Republic died after being inoculated with vaccine made from the samples early this month. The material came from Deerfield, Illinois-based Baxter, which reported the incident to the Austrian Ministry of Health, Sigrid Rosenberger, a ministry spokeswoman, said today in a telephone interview.
“This was infected with a bird flu virus,” Rosenberger said. “There were some people from the company who handled it.”
The material was intended for use in laboratories, and none of the lab workers have fallen ill. The incident is drawing scrutiny over the safety of research using the H5N1 bird flu strain that’s killed more than three-fifths of the people known to have caught the bug worldwide. Some scientists say the 1977 Russian flu, the most recent global outbreak, began when a virus escaped from a laboratory.
The virus material was supposed to contain a seasonal flu virus and was contaminated after “human error,” said Christopher Bona, a spokesman for Baxter, in a telephone interview.
‘Sanitized’
Baxter “moved very quickly to sanitize and protect employees,” Bona said. “Labs have been sanitized, potentially contaminated materials have been destroyed and employees were tested and considered not to be at risk.”
Baxter gained 93 cents, or 1.6 percent, to $58.27 at 4 p.m. in New York Stock Exchange composite trading, and has lost 2.3 percent over the last 12 months.
The Austrian health ministry reported the incident to the European Union and is conducting its own audit, Rosenberger said. In response, Baxter said it has put in place “preventive and corrective” measures that the ministry found satisfactory. The vaccine has been destroyed, according to Rosenberger.
The World Health Organization “is aware of the situation and is consulting with the ministers of health of the countries involved to ensure that all public risks arising from this event have been identified and managed appropriately,” said Gregory Hartl, a spokesman in Geneva.
Vietnam said a 32-year-old man died of bird flu, the Southeast Asian nation’s second confirmed case of the fatal H5N1 virus strain this year, a health official said.
The victim, from Ninh Binh province, 58 miles south of Hanoi, had eaten a sick chicken before developing the illness early this month, according to Nguyen Huy Nga, director of the Health Ministry’s department of preventive medicine in Hanoi. He was hospitalized on Feb. 12 and died on Feb. 25, Nga said.
Vietnam outbreaks of the H5N1 virus have so far spread in poultry to 11 provinces, including Ninh Binh, according to Hoang Van Nam, deputy head of Vietnam’s animal health department.
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