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If you’ve been taking vitamin E supplements, you’re not
alone. The positive results of early studies on the antioxidant led many
to take it in hopes of preventing or slowing everything from respiratory
infections to macular degeneration. But what proves hopeful in early,
preliminary studies doesn’t always pan out in larger research settings,
and vitamin E is a case in point.
Age- Related Macular Degeneration
Age- Related Macular Degeneration (AMD) is the breakdown of cells of
the macula, the small part of the eye that allows us to see
things sharply and in color. Little is known about what causes AMD, which
is the leading source of vision loss in people older than 55.
Early observational studies showed vitamin E might help prevent macular
degeneration. To test this theory, researchers recruited close to 1,200
participants between the ages of 55 and 80 to receive either a daily
vitamin E supplement or a placebo for four years. Participants underwent
annual eye exams to detect signs of development or progression of AMD
and changes in visual function.
The results of this study showed the incidence of AMD was similar among
participants in the two groups. In the vitamin E group 8.6% developed
AMD, whereas 8.1% in the placebo group did. Though this study clearly
indicates that vitamin E does not help prevent or slow the progression
of AMD, the study period was short, so it doesn’t prove that vitamin
E doesn’t help in the long run.
(British Journal of Medicine, July 6, 2002)
Early studies showed that vitamins and minerals, particularly vitamin
E, may boost immune response in healthy elderly people. With this in
mind, Dutch researchers set out to investigate whether either of the
supplements lessens the rate and severity of respiratory infections in
The researchers enlisted 652 participants over the age of 60 and broke
them randomly into four groups. Each day, they either took a multivitamin
with minerals and a placebo, a vitamin E pill and a placebo, both a multivitamin
with minerals and vitamin E pill, or two placebos. After fifteen months
of follow-up, the researchers found that the rate of respiratory infections
did not differ among the groups. However, those who took vitamin E supplements
actually had respiratory infections that were more severe — they
were longer, caused more symptoms, and restricted more of the sufferer’s
(Journal of the American Medical Association, August 14, 2002)
February 2003 Update
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The Spread of West Nile
West Nile virus is a viral disease — spread by the bite of infected
mosquitoes — that can cause encephalitis, an infection of the brain
and spinal cord. It first appeared in the United States in 1999, when
55 people became seriously ill and another 7 died.
There was a total of 66 human cases of West Nile Virus in 2001 —
mostly in New York, New Jersey, and Florida — nine of which were
fatal. Almost all cases occurred in August and September, but a few were
diagnosed between October and early December.
Since 1999, the geographic boundaries of the disease have spread as
far north as Maine; as far west as Montana, Wyoming, Colorado, and New
Mexico; and as far south as Florida and Texas. This is a dramatic change
from 2000, when it was only detected in New York, New Jersey, and Connecticut.
And 2002 has seen at least 480 human cases and 22 deaths from West Nile
in the country's worst outbreak since the virus first was first detected
Most likely, the disease will continue to move west. To slow its progress,
the CDC is concentrating on teaching people to avoid mosquitoes and their
bites as much as possible. When in places where there is risk of mosquito
- Use insect repellent containing DEET.
- Try to wear long-sleeved clothes and long pants treated with repellents
containing permethrin or DEET; mosquitoes can bite through thin clothing.
Do not apply permethrin repellants directly to skin.
- Whenever possible, stay indoors at dawn, dusk, and in the early
evening, which are peak mosquito biting times.
- Eliminate standing water sources from around your home. These are
popular places for mosquitoes to lay eggs.
Most people who become infected with West Nile virus will have either
no symptoms or only mild ones. The risk of severe disease is higher for
people over 50. There is no evidence that West Nile virus can be spread
from person to person or from animal to person.
September 2002 Update
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Hepatitis A Vaccine is Safe and Effective
Hepatits A is a virus transmitted by contaminated food and is a common
cause of inflammation of the liver (hepatitis). This illness may be associated
with fever, yellowing of the skin and eyes (jaundice), loss of appetite,
nausea, vomiting, and tiredness. In many parts of the world, hepatitis
A is so common that almost every adult has been infected at some point
in his or her life. A vaccine to protect against hepatitis A infection
was licensed in the United States by the Food and Drug Administration
in 1995 for individuals 212 years of age.
A recent study published in the Journal of the American Medical Association showed
that the hepatitis A vaccine was highly effective in preventing hepatitis
A outbreaks among a large group of children who received it. The study
also found the vaccine to be quite safe. Out of the nearly 30,000 children
who received the vaccine, no serious side effects were reported. Mild
adverse reactions were reported in a small percentage of cases, including
injection site reactions, fever, and rash.
Should your child be immunized? In the United States, there actually
are certain areas of the country with higher than average rates of hepatitis
A. Speak with your child's pediatrician because the hepatitis A vaccine
is currently recommended for:
- Children living in areas with consistently higher rates of hepatitis
A. This includes 11 states where the prevalence of hepatitis A is
greater than twice the national average: Alaska, Arizona, California,
Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah,
and Washington. (Routine vaccination can also be considered in six
states where the prevalence of the disease is less than double but
greater than the national average: Arkansas, Colorado, Texas, Missouri,
Montana, and Wyoming.)
- Children traveling to countries where the disease is highly prevalent.
This includes all countries other than Canada, Japan, Australia, New
Zealand, Scandinavia, and those in Western Europe.
- Children with chronic liver disease or blood-clotting disorders.
April 2002 Update
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Vaccine safety: no link between thimerosal
and neurodevelopmental disorders
Parents should feel confident and safe when having their children immunized.
No evidence exists that proves a link between thimerosal-containing vaccines
and neurodevelopemental disorders, such as autism, attention deficit-hyperactivity
disorder, or speech and language delay. The Institute of Medicine recently
reported these findings, consistent with the recommendations of the American
Academy of Pediatrics.
Thimerosal, a mercury-containing preservative, was used for many years
in vaccines to prevent contamination. Taking in a high dose of mercury
is toxic to the human nervous system. But because of the increasing number
of vaccines routinely recommended for infants, concern was raised in
1999 by the Food and Drug Administration that the total amount of mercury
contained in the vaccinations could be exceeding the recommended mercury
levels for infants.
Although there's no data to suggest thimerosal caused any harm, the American
Academy of Pediatrics and the U.S. Public Health Service have requested
manufacturers remove thimerosal from vaccines. As a result, most, if
not all, childhood vaccines are now thimerosal-free.
The Institute of Medicine's recommendations emphasized the importance
and continued safety of childhood vaccination. Parents should definitely
be reassured that all routine childhood immunizations are in their children's
best interests, as they clearly have been shown to prevent potentially
November 2001 Update
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H. pylori Infection May Aggravate GI
Injury in Patients Taking Low-dose Aspirin
Doctors commonly prescribe low-dose aspirin for the prevention of heart
disease, but it may also be responsible for some potentially serious
side effects when taken frequently. Among the most common of these are
gastrointestinal erosions and ulcers.
A recent study in The American Journal of Gastroenterology sought
to determine whether certain people taking low-dose aspirin
specifically, people infected with Helicobacter pylori, a common
bacterium that can cause ulcers are more susceptible to gastrointestinal
erosions and ulcers than people who are not infected with H. pylori.
Researchers from the University of Texas Southwestern Medical
School and Baylor College of Medicine recruited 61 healthy volunteers
between the ages of 18 and 61. Of these, 29 volunteers were infected
with H. pylori. Forty-six of the volunteers were then randomly
selected to receive low-dose aspirin (either 81 mg daily or 325 mg every
three days), while 15 received a placebo.
After 46 days of treatment, an upper GI endoscopy was performed
on each subject to determine the extent of gastrointestinal injury. The
researchers did not detect any injury in the stomach or duodenum (upper
intestine) of the patients taking placebo. In the subjects taking aspirin,
those patients who were infected with H. pylori were significantly
more likely to have gastrointestinal injury than those who were not infected
(50% vs. 16%).
However, there was no difference between the groups in
complaints of pain, nausea, vomiting, indigestion, or heartburn. In addition,
the difference in outcomes between patients taking 81 mg of aspirin daily
and 325 mg every three days was not statistically significant.
The researchers caution that the results of this study may not hold for
older people or those with gastrointestinal diseases such as peptic ulcer
disease, because the volunteers were healthy and aged 61 or younger.
However, this study does suggest eradicating H. pylori infection
may help prevent gastrointestinal erosions and ulcers in patients taking
low-dose aspirin on a long-term basis.
October 2001 Update
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Lyme Disease Update
Can antibiotics catch Lyme disease before it develops? Do antibiotics
alleviate the lingering symptoms after the infection is cured? Two recent
studies published in The New England Journal of Medicine shed
light on these two controversial questions.
In the first study, conducted in Westchester County, New York, an area
with high rates of Lyme disease, researchers gave a single dose of either
an antibiotic or a placebo to patients who were bitten by deer ticks
in the previous 72 hours.
The researchers found the antibiotic doxycycline prevented the disease
form developing. However, only 3.2% of the untreated patients developed
the characteristic bull's eye rash around the tick bite. This suggests
the risk of Lyme disease is low even in Westchester County. The study
also found the infection was more likely to develop from bites by ticks
in the nymph stage, and if the tick was attached for 72 hours or more.
This study suggests preventive treatment is only worthwhile in areas
with a particularly high incidence of the disease or if you are bitten
by a nymphal deer tick that has been attached for three days or more.
You should save the tick in a jar of alcohol so it may be identified
to help you and your physician make that decision.
In the second study, researchers investigated whether prolonged treatment
with antibiotics reduces the fatigue, muscle and joint pain, and mood
or memory disturbances that some people experience even after the infection
has cleared. But the study was discontinued early when preliminary results
showed prolonged antibiotic treatment was no more effective than a placebo
at improving the persistent symptoms.
If you are experiencing post-Lyme disease symptoms, long-term use of
antibiotics is unlikely to help. But there is hope your condition will
the study found symptoms improved in 36% of the untreated patients.
September 2001 Update
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Flu Vaccine and Recurrent Heart Attack
Late each fall, the call goes out to remind people to get
their flu vaccinations. Most healthy people equate the flu with a week
of being miserable. However for the elderly or people with chronic illnesses,
the complications of influenza, such as pneumonia, can be life threatening.
Good enough reason to get the shot, but now research suggests the vaccination
may also lower heart attack risk.
The study, conducted by researchers at the University of Texas-Houston,
questioned whether getting a flu shot could reduce the risk of a second
heart attack in people with coronary artery disease. Scientists have
been studying a potential link between cardiovascular disease and infection,
and some of their work suggests upper respiratory infections, such as
the flu, might be a risk factor for heart attack.
The investigators evaluated 218 individuals with previous heart attacks
who were seen in the university's cardiology outpatient clinic during
the 1997-98 flu season. Of the patients who met the study criteria, 109
experienced a heart attack during the study period. These volunteers
were matched with 109 controls with coronary artery disease, but had
not experienced a second heart attack during the same period.
Of those who had had new myocardial infarctions, the rate of flu vaccination
during the current season was 47%, versus 71% among those who did not
have new heart attacks. After adjusting for differences between these
groups, the researchers found the risk of heart attack was reduced by
two-thirds among patients who had gotten a flu shot that season. This
study showed no evidence that use of multivitamins or physical exercise
changed risk for recurrent heart attack.
No one knows how flu vaccination might reduce a person's risk of heart
attack. Perhaps exposure to the flu might cause atherosclerotic plaques
to become less stable or the stress of this illness might dangerously
increase the heart's workload for people with cardiovascular disease.
Other theories include an increased tendency for blood clots during the
flu or that the flu may contribute to poor blood vessel function. Whatever
the cause and effect, people with coronary artery disease (and who are
not allergic to the vaccine) should strongly consider getting a flu shot
September 2001 Update
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The Benefits of Surgery for Ear Infection are Unclear
Every year thousands of young children undergo surgery to alleviate
chronic middle ear infections (otitis media). The demand for these
procedures is driven by the concern that persistent bouts of ear infection
will cause hearing loss and long-term effects on their child's speech
and language development. However, the benefits of surgery are unclear even
after two recent new studies.
The most common operation involves inserting tubes through the eardrums
to drain fluid that collects in the middle ear. Whether or not prompt
implementation of this surgery actually protects against the development
of infection was the subject of the first study in which 6,350 children
were checked regularly for ear infections. By the age of 3, 429 of them
were diagnosed with chronic ear infections. About half received the surgery
as soon as possible, while the others waited up to nine months. The researchers
found the children who had the surgery promptly had fewer subsequent
ear problems than those who waited. But there was no significant difference
in their speech, language, cognition or psychosocial development as measured
by standardized tests and parental assessments. In fact the mean scores
for all of the children fell with the average range for that age.
The second study examined hospital discharge records for children in
Ontario to determine whether removing adenoids and/or tonsils at the
same time as the insertion of tubes helped reduce the likelihood of subsequent
ear problems. Of the 37,316 cases who received tubes, 28% also involved
the removal of adenoids and/or tonsils. About one quarter of those who
didn't undergo adjuvant surgery were re- hospitalized within two years
after their initial surgery for subsequent ear problems. But those who
did nearly halved their risk of re-hospitalization. Having both adenoids
and tonsils out provided additional benefit.
So should children with chronic ear infections have tubes inserted, and
should they also have their adenoids and tonsils taken out? Because of
limitations in these and previous studies, we still don't know. More
research is needed to weigh the long-term risks of hypothetical development
impairment verses the not fully understood risk of the different surgeries.
August 2001 Update
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Killing H. Pylori Helps Prevent Gastrointestinal
Bleeding in Patients Taking Low-Dose Aspirin
Many people take low-dose aspirin on a daily basis to help prevent heart
attacks. Others take larger doses of stronger nonsteroidal antiinflammatory
drugs (NSAIDs), such as naproxen (Anaprox, Aleve, others), to relieve
musculoskeletal pain such as that caused by arthritis. When taken on
a regular basis, however, NSAIDs often cause ulcers and gastrointestinal
(GI) bleeding. Ulcers, which are raw, crater-like breaks in the mucosal
lining of the digestive tract, may also be caused by excess acid production
and a bacterium known as Helicobacter pylori (H. pylori).
In a study published in the New England Journal of Medicine, researchers
enrolled 400 patients with a history of GI bleeding who were taking aspirin
or other NSAIDs to prevent heart disease or to control musculoskeletal
pain. They set out to find whether eradicating H. pylori infection
reduces the risk of recurrent GI bleeding in these patients. For six
months, 250 patients were given an 80 mg "baby" aspirin once
per day, while the remaining 150 patients received 500 mg of naproxen
twice per day. Within each of the two groups, patients were randomly
assigned to take either a daily dose of omeprazole (Prilosec), an acid-suppressing
medication, or a one-week antibiotic treatment to eradicate H. pylori infection,
followed by placebo for the remainder of the trial.
The researchers found that in patients taking aspirin, those who were
treated for H. pylori had a 1.9% risk of GI bleeding while the
risk for those taking omeprazole was 0.9%. In other words, for patients
on low-dose aspirin, the treatments were almost equal.
The results were very different for patients taking naproxen. 19% of
the naproxen patients who had H. pylori treatment suffered from
recurrent bleeding. In contrast, only 4% of the omeprazole group did.
The study suggests that patients with a history of GI bleeding who take
low-dose aspirin to prevent heart attacks should be tested for H.
pylori infection and treated if the infection is found to be present.
Patients taking non-aspirin NSAIDs and who have experienced GI bleeding
are more likely to benefit from acid-suppressing therapy.
April 2001 Update
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Warfarin and Vaginal Cream Drug Interaction Warning
The Food and Drug Administration (FDA) has issued a warning stating
that women taking the prescription blood thinner warfarin (Coumadin)
should consult their doctor or pharmacist before using over-the-counter
vaginal creams containing the antifungal drug miconazole because of an
increased risk of bleeding or bruising. Miconazole is an active ingredient
in many over-the-counter creams and suppositories used to treat vaginal
Doctors were already aware of adverse reactions between warfarin and
systemically administered miconazole. This warning urges women to beware
of creams and suppositories as well.
The warning was issued in response to two reports of abnormal blood clotting
tests in women taking the anticoagulant warfarin who used vaginal miconazole.
In addition to the abnormal blood-clotting test, one of the two women
also developed bruises, bleeding gums, and a nosebleed. Two journal articles
also warned of a possible interaction between warfarin and vaginal miconazole.
The FDA warning will appear on miconazole-containing product labels and
April 2001 Update
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Pneumonia: How Long Before You Feel Better?
Pneumonia is a serious infection or inflammation of the lungs. Uncomplicated
pneumonia may be successfully treated with antibiotics in one or two
weeks, but many patients continue to experience the symptoms of pneumonia,
including cough, chest pain, fatigue, shortness of breath, and fever,
for some time after that. A team of Canadian researchers set out to determine
how long after treatment it should take for pneumonia patients to be
The scientists asked a group of 535 adults who had undergone a course
of antibiotic treatment for pneumonia to complete questionnaires about
persisting symptoms at two and six weeks after the completion of their
The average age of these patients was 62 years. Fifty-four percent of
the patients were admitted to the hospital for treatment of their pneumonia,
and a minority had a coexisting chronic illness such as chronic obstructive
pulmonary disease, asthma, or congestive heart failure.
At two weeks after therapy, 67% of patients reported fatigue, 56% were
coughing, 50% were short of breath, and 35% were producing sputum. Six
weeks after therapy, more than 60% of patients reported continuing symptoms.
Forty-five percent still had fatigue, 35% continued to cough, and 16%
had gastrointestinal symptoms. Older patients, those who were sickest
at onset of treatment, patients with chronic obstructive pulmonary disease,
and patients with asthma suffered the most persistent symptoms.
Although hospitalizations are shorter and antibiotic treatments briefer,
complete recovery still takes time. Pneumonia patients should be reassured
that a "normal" period of recuperation may vary from several
weeks to several months.
March 2001 Update
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Good News for Breast-Fed Babies
Breast-feeding has been linked to many advantages, including fewer earaches,
colds, and asthma attacks. Now, a large trial involving almost 16,500
mother-infant pairs has shown even more benefits of breast-feeding. The
study demonstrated that long-term, exclusive breast-feeding significantly
decreases the risk of gastrointestinal tract infections and atopic eczema
during a childs first year of life.
Published in the Journal of the American Medical Association,
the study involved mothers from the former Soviet republic of Belarus.
To avoid a conflict of interest, given the advantages of breast-feeding
that are already established, the program studied mothers who breast
fed for a long time compared to mothers who breast fed for a short time
then switched to bottle feeding. Some hospitals were randomly chosen
to promote breast- feeding, through programs involving counseling from
doctors and midwives; other hospitals, which served as a control group,
provided the usual obstetric care. After 12 months, nearly 20% of the
infants who were part of the breast-feeding program were still nursing,
compared to 11.4% of the control group.
In the first year, only 9% of the infants in the breast-feeding program
had one or more gastrointestinal infection compared to about 13% of the
control group. In addition, 3% of the breast-fed infants developed atopic
eczema (a scaly, allergy-associated skin irritation), compared with 6%
of the other babies.
The World Health Organization recommends only breast milk for the first
four to six months, and recommends that breast-feeding (in combination
with formula) continue until 2 years of age. The American Academy of
Pediatrics recommends breast milk alone until 6 months, and breast-feeding
plus formula until 12 months old. This study suggests that breast-feeding
exclusively for the first year could provide greater health benefits
to the child.
February 2001 Update
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Meningococcal Disease Prevention for College Students
Meningococcal disease is an inflammation of the membranes that encase
and protect the brain and spinal cord. When caused by a bacterial infection,
meningococcal disease can be fatal. Survivors can suffer significant
lifelong impairments, including permanent brain damage or hearing loss.
In recent years, the incidence of meningococcal disease has been on the
rise in 15- to 24-year-olds in the United States. And the Centers for
Disease Control and Prevention (CDC) has revealed that U.S. college students
living in a dormitory setting are more than three times as likely to
contract meningococcal disease than those in the same age group who do
not live in a dormitory setting. Freshmen face the greatest risk.
Sixty percent or more of these cases could be prevented with an existing,
available vaccine. Adverse reactions to the vaccine have been shown to
be mild, and serious reactions are rare. Based on findings from recent
studies and on input from expert committees, the American Academy of
Pediatrics advises physicians to inform college-bound patients who intend
to live in a dormitory of the increased risk for meningococcal disease
and of the benefits and limitations of the vaccine. Physicians are also
advised to make the vaccine available to those patients who then request
U.S. military recruits have been routinely vaccinated against meningococcal
disease since 1971, in response to a high incidence of the disease in
February 2001 Update
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Treating Chronic Hepatitis C
An estimated 3.9 million people in the United States are
infected with the hepatitis C virus (HCV). Hepatitis C affects the liver.
In many but not all cases, hepatitis C progresses from
mild to moderate inflammation (hepatitis), to scarring (fibrosis), to
severe fibrosis with loss of liver function (cirrhosis), and finally
liver failure. It is the leading cause of chronic liver disease and liver
transplantation. But not all cases of hepatitis C progress to cirrhosis
and the rate of progression of the disease is often unpredictable.
The standard of care for treating hepatitis C is a combination of the
antiviral drugs interferon-alpha and ribavirin. However, these drugs
are not completely effective, they cause side effects, and they are expensive.
Given the drugs' limitations and the unpredictable nature of disease
progression, doctors remain in disagreement about whether treatment should
begin at the onset of mild inflammation, or whether it should be delayed
until a moderate amount of inflammation or cirrhosis exists.
Using information from recent studies about the natural progression of
HCV, researchers created a computer model that would help determine the
optimal time to start combination antiviral drug therapy with interferon-alpha
and ribavirin. The simulation projected that 18 percent of patients who
had a liver biopsy every three years and started treatment at the onset
of moderate inflammation would progress to cirrhosis after 20 years.
This strategy avoided the need for treatment in 50 percent of patients,
and increased life expectancy by 1.2 years. In patients who began treatment
at the onset of mild inflammation, only 16 percent would progress to
cirrhosis after 20 years, increasing life expectancy by another 0.4 years.
In comparison, the computer model predicted that 27 percent of patients
in the control group, which was left untreated, would have cirrhosis
after 20 years.
This study illustrated that beginning antiviral treatment at the onset
of mild inflammation is the most effective treatment strategy. However,
for patients with HCV and mild inflammation of the liver who do not wish
to receive drug treatment or hope to delay it, biopsy management is also
a reasonably effective option that could avoid treatment altogether.
A Promising New Drug: Peginterferon
In January 2001, the FDA approved Peg-Intron (peginterferon) to treat
hepatitis C. Peginterferon is a form of interferon-alpha that stays
active in the immune system longer than interferon-alpha. As a result,
it can be taken once a week, as opposed to three times a week.
Two recent studies published in the New England Journal of Medicine compared
the effects of another brand of peginterferon, called Pegasys, with interferon-alpha
on patients with chronic hepatitis C. Both studies revealed that peginterferon
is significantly more effective in managing the virus. It was also better
tolerated and had fewer side effects.
In the clinic, interferon-alpha is usually given in combination with
ribavirin, which has been shown to double the effectiveness of interferon-alpha.
Researchers regard testing a combination of peginterferon and ribavirin
the next logical step in determining how to treat this disease more successfully.
February 2001 Update
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Zinc Lozenges Have No Beneficial Effect on the Common
Over the past few years, more and more people have begun to reach for
zinc lozenges at the first sign of a cold. But a study published in the
journal Clinical Infectious Diseases suggests that there is little
scientific evidence of zinc's effectiveness to support the treatment's
In a study funded by Warner Lambert Consumer Healthcare, a company that
manufactures zinc lozenges, researchers conducted two clinical trials
to test zinc's efficacy. One trial involved 273 people who were exposed
to a specific cold virus, called rhinovirus, to induce a cold. The other
trial involved 281 subjects with natural colds. Both groups were broken
up into four subgroups that received one of the following treatments:
13.3 milligrams (mg) of zinc gluconate, 11.5 mg of zinc acetate, 5 mg
of zinc acetate, or a placebo. Zinc gluconate and zinc acetate are different
formulations of zinc; zinc gluconate is more commonly found in lozenges.
Treatment was started within a day of the onset of cold symptoms and
continued every 2-3 hours (up to 6 lozenges per day) until the cold symptoms
disappeared, or up to 14 days.
The researchers measured the effects of the treatments on both the duration
and severity of the colds. Patients self-scored the severity of seven
cold symptoms: sneezing, runny nose, nasal obstruction, sore throat,
cough, headache, and hoarseness.
At the end of the study, researchers found that zinc gluconate had a
small but significant effect on the duration of induced cold symptoms.
People who had taken zinc gluconate had cold symptoms for about 2.5 days
as opposed to 3.25 for high-dose zinc acetate and 3.5 days for low-dose
zinc acetate and placebo. None of the treatments, including zinc gluconate,
reduced the severity of cold symptoms for the first three days of the
cold. And none of the zinc preparations or placebo had a significant
effect on the duration or severity of symptoms in people with natural
Overall, the study suggests that zinc lozenges have little, if any, beneficial
effect on the treatment of the common cold.
January 2001 update
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Pet Reptiles and Salmonella
Between 1996 and 1998, approximately 16 state health departments reported
salmonella infections in persons who had direct or indirect contact with
reptiles (i.e., lizards, snakes, or turtles) to the Centers for Disease
Control and Prevention.
Salmonella infection can result in severe illness and even death, particularly
in infants, young children, and anyone with a compromised immune system.
The CDC issued the following recommendations to reduce the chances of
anyone in your family contracting this potentially deadly infection from
these increasingly popular exotic pets:
- Pet store owners, veterinarians, and pediatricians should provide
information to owners and potential purchasers of reptiles about
the risk of acquiring salmonellosis from reptiles.
- People should always wash their hands thoroughly with soap and water
after handling reptiles or reptile cages.
- People at increased risk for infection or serious complications
of salmonellosis (e.g., children younger than age 5 and immunocompromised
persons) should avoid contact with reptiles.
- Pet reptiles should be kept out of households where children younger
than age 5 and immunocompromised persons live. Families expecting a
new child should remove the pet reptile from the home before the infant
- Pet reptiles should not be kept in childcare centers.
- Pet reptiles should not be allowed to roam freely throughout the
home or living area.
- Pet reptiles should be kept out of kitchens and other food-preparation
areas to prevent contamination.
- Kitchen sinks should not be used to bathe reptiles or to wash their
dishes, cages, or aquariums. If bathtubs are used for these purposes,
they should be cleaned thoroughly and disinfected with bleach.
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Symptomless Genital Herpes Infections
Recent research tested a potential vaccine against genital herpes only
to find it ineffective. But study investigators did learn something very
important about this infection. During the course of the trial, 63% of
study volunteers who developed antibodies to the virus (indicating exposure)
never developed symptoms. Women were about equally likely to develop
symptoms or not.
Perhaps the most important message here is that while a newly acquired
genital herpes infection may cause no symptoms, new symptoms of genital
herpes may in fact result from an old infection. If you or your sexual
partner develop symptoms of genital herpes, it is very possible that
this is ancient history coming to light in the context of a new relationship.
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Lyme Disease Vaccine
Should you get the Lyme disease vaccine? Experience so
far has shown that the vaccine, which is called LYMErix, is safe and
effective. The side effects include a couple of days of soreness in the
upper arm where the vaccine was injected, short-term headache, and flu-like
symptoms. The largest study of the vaccine, published in the July 23,
1998, New England Journal of Medicine and the basis for its FDA
approval, showed no difference in long-term, arthritis-like side effects
between the treatment group and the placebo group. That finding reassures
those concerned that the vaccine might provoke an autoimmune response
(when a persons immune system attacks his or her own body). The
same clinical trial showed that when the full, three-shot series of the
vaccine was given, it was 76% effective that is, the people who
received all three shots were 76% less likely to come down with Lyme
disease than people who received three placebo shots. As with other vaccines,
however, its effectiveness is probably lower among older people because
as the immune system ages, it gets less responsive.
But just because it is safe and it works doesnt mean its
necessary. Lyme disease is transmitted by deer ticks infected with the Borrelia
burgdorferi bacteria. Your risk of getting Lyme disease comes down
to primarily three factors: the number of infected deer ticks in the
environment; what you do in that environment; and how much of an effort
you make to keep ticks off you in the first place and remove them if
they do bite you.
Infected deer tick territory is concentrated in southern New England,
New York, New Jersey, Pennsylvania, Maryland, and a few counties of Minnesota
and northeastern Wisconsin. Even in these hotbeds, only 1530% of
ticks are infected with the disease-causing bacteria. Also, the number
of ticks is very sensitive to local conditions and can vary tremendously
from town to town or even from block to block. Deer ticks favor moist,
bushy, leafy places not the wide expanse of your lawn, the beach,
or even grass-covered dunes. Do you need to get the Lyme disease vaccine
if youre going to Marthas Vineyard this summer to swim, play
and lounge on the beach, and shop? Probably not. But if you plan on clearing
brush and doing some gardening in a high-risk area, you might be a good
candidate for the Lyme disease vaccine. Even then, some doctors question
whether the vaccine is warranted, partly due to lingering doubts about
how long protection lasts. Booster shots may be necessary. Also, deer
ticks carry other diseases that the vaccine does not protect against.
People who garden in tick-infested areas can (and should) take other
precautions, like wearing high rubber boots. Hikers and birdwatchers
can cut down on their risk by sticking to the center of well-traveled
The time of year also makes a big difference. Lyme disease season starts
around May on the East Coast and in the Upper Midwest. It continues through
June and July when the deer ticks are in their nymphal stage. It is not
so much that these nymphs are super-infectious. Rather, they are so small
that people cant spot them easily especially because these
tiny pests favor hard-to-spot places on the body. By August, most of
these young ticks have either died or satisfied their appetite. Adult
ticks are still active and infected, but their size (about that of an
apple seed) makes them easier to see.
About 12,500 cases of Lyme disease are reported to health authorities
every year, and many more go unreported. Because they play outside, children
are vulnerable, and approval of a child version of LYMErix could come
later. No one questions the value of the vaccine, but it isnt for
everyone even where infection rates are relatively high.
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Starve a Cold, Feed a Fever, Take a Pill for the
The height of the flu season is starting to wane, but we seem to be
at the peak of print and television ads promoting new treatments. Late
in 1999, the U.S. Food and Drug Administration approved two new anti-influenzal
drugs zanamivir (Relenza) and oseltamivir (Tamiflu). Both work by interfering
with an enzyme needed for the flu virus to reproduce. Both offer an option
for treating uncomplicated cases of the flu.
In clinical trials, when taken within two days of the onset of flu
symptoms, Relenza was shown to make people feel better a little (about
36 hours) sooner. This drug is administered in an inhaler twice daily
for five days. Relenza has not been proved effective for people who
have severe asthma or chronic breathing problems, and in fact may
cause bronchial spasms in these individuals. Tamiflu comes in pill
form (taken twice a day for five days) and can reduce the length
and severity of flu symptoms if it is taken within two days of the
onset of symptoms, but not by much.
Patients participating in two clinical trials reported feeling better
about one day sooner than patients taking a placebo. The most common
side effects of Tamiflu included upset stomach, vomiting, trouble
sleeping, and dizziness. Neither drug can prevent people from passing
the flu on to others. These medications may offer some relief to
flu sufferers, but getting a flu vaccine remains the best way to
minimize your chances of getting this virus in the first place. This
is true for healthy people and especially for people at high risk
for complications from the flu (the elderly and people with compromised
immune systems or chronic lung diseases).
In fact, the safety and effectiveness of these new flu treatments
are unproven in these populations. What's more, Tamiflu and Relenza
are effective only against influenza types A and B, but not type
C (a very common, less severe flu) and many upper respiratory infections
caught during the winter are viral, and not the flu.
The bottom line is that these medications are helpful in only a handful
of situations. An extra day of fluids and bed rest may be all you
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A New Approach to Testing for Cervical Cancer
Most women know that regular Pap smears can almost eliminate the chances
of developing invasive cervical cancer. By examining the cervix for abnormal
(and potentially precancerous) cells, treatment can be started before
a real problem develops.
What many women may not know is that human papilloma viruses (HPVs) (which
cause genital warts) are responsible for the majority of cases of cervical
cancer. Two recent studies suggest that regular screening for HPV may
prove even more effective than the traditional Pap smear in preventing
The first study included 8,554 women who lived in the Gaunacaste Province
of Costa Rica, where there is a very high rate of cervical cancer. Researchers
found that HPV testing picked up 17% more high-grade cervical cell abormalities
The second study compared the Pap smear with testing vaginal samples
for HPV. 1,415 women in South Africa (who had not had any cervical cancer
screening) participated. The first HPV test was done by a doctor during
a routine physical exam. The HPV test was done on samples of vaginal
fluid the women collected themselves using a cotton swab. All the women
had Pap smears done as well. The HPV testing on samples taken by the
doctor detected far more cervical disease than the Pap smear (84% vs.
68%). The HPV testing done on the self-collected samples was not equivalent
to the HPV tests done on the physician-collected samples, but was just
as good as the Pap smear. And did not require a trip to the doctors
What are the important take-home messages from these studies? First,
each year in the United States there are an estimated 15,000 new cases
of cervical cancer. Each year, about 5,000 women will die needlessly
of the disease. Regular Pap smears are the most effective way to screen
for this disease. Second, although HPV is one of the most common sexually
transmitted infections, only a small number of women suffer complications,
including cervical disease. There are over 70 types of HPV, but only
13 are known to cause cervical cancer.
Still, screening techniques that include HPV testing may not only increase
the ability to detect abnormal cell changes early, but can also let a
woman know whether or not she carries one of the more dangerous viruses
(and therefore needs to be extra vigilant about screening). Finally,
self-collected samples for testing may take us a big step forward in
preventing this disease in places where women do not get regular visits
to the doctor.
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New Pneumococcal Vaccine for Children Less Than
Two Years Old
A new vaccine called Prevnar is the first vaccine to protect children
less than two years old against the bacteria Streptococcus pneumoniae,
which is the leading cause of pneumonia, bacterial meningitis, bacteremia,
sinusitis, and acute otitis media, or middle-ear infections, in young
children. In addition to protecting children from pneumococcal infection,
vaccination with Prevnar also decreases transmission of pneumococci from
one child to another, an effect known as "herd immunity." Furthermore,
since middle-ear infections are the leading reason that children need
to take antibiotics, vaccination with Prevnar could reduce the need for
antibiotics in this age group. This, in turn, should slow or reverse
the trend of antimicrobial resistance. A different pneumococcal vaccine,
known generically as PPV23, has been available to adults for years, but
it has not been effective in children less than two years old.
The Centers for Disease Control and Prevention's (CDC's) Advisory Committee
on Immunization Practices (ACIP) recommends that all children less than
two years old should be vaccinated with Prevnar. Children aged two to
five years old should receive a two-shot series of Prevnar followed by
one dose of PPV23 if they are high-risk, a category that includes children
with HIV, immunocompromising conditions, chronic illness, or sickle cell
disease. Prevnar may also be considered for children between two to five
years with priority given to those who are between the ages of 24 and
35 months, of African-American, American Indian, or Alaska Native descent,
or who attend group day care centers.
Since Prevnar has not been studied sufficiently in children older than
five years who are at high risk for serious pneumococcal disease, ACIP
continues to recommend that children five and older receive PPV23.
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Tamiflu (Oseltamivir) for Flu Prevention
Until recently, there wasnt much a person could do once he or
she was hit with the flu. However, the Food and Drug Administration approved
two medications that could be added to the usual routine of fluids, bedrest,
and fever-reducing analgesics. Both drugs interfere with an enzyme (neuraminidase)
that is crucial for the flu virus to multiply. Taken within two days
of symptom onset, zanamivir (Relenza) and oseltamivir (Tamiflu) can reduce
the severity and duration of a bout with this winter menace. Now, the
FDA has also approved Tamiflu for the prevention of influenza in adults
and children 13 and older.
The FDAs approval was based on several recent studies. One trial
followed healthy, unvaccinated adults and adolescents who took 75 mg
of Tamiflu or a placebo once a day for 42 days during a community outbreak
of the flu. The flu rate among study subjects taking the placebo was
4.8%, while only 1.2% of the Tamiflu group came down with the virus.
In a second study, researchers assigned elderly nursing home residents
to either a placebo or 75 mg of Tamiflu daily for 42 days. Of the placebo
group, 4.4% developed the flu, compared with only 0.4% of the treatment
group. (It is important to note that in this study, 80% of the elderly
population had gotten a flu shot.) A third investigation evaluated whether
Tamiflu could prevent the spread of the virus within a household. Family
members received either 75 mg of Tamiflu or a placebo within two days
of the onset of symptoms in the flu sufferer. In placebo households,
the flu rate was 12%. In the Tamiflu households, only 1%.
Note that Tamiflu is not a substitute for the flu shot and those at high
risk for complications of the flu should get their yearly vaccination.
None of these studies tested Relenza (zanamivir), so it is unclear whether
this drug offers similar benefits. Keep in mind, both Tamiflu and Relenza
are effective only against type A and type B flu viruses, and although
many upper respiratory infections and severe colds caught during the
winter are viral, that doesnt mean they are "the flu."
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