Friday, October 20, 2017

TGIF HCV Rewind - Seasonal Flu, Liver Disease & Blog Updates Around The Web

Seasonal Flu & You
Welcome folks, the weather here in Michigan is quickly changing, soon we'll be enjoying our beautiful autumn foliage. The flu season is here as well, with experts tracking flu cases outside the US.

Australia is reporting more cases this year, far more than the last two flu seasons, according to the latest Australian Influenza Surveillance Report.

Australians over the age of 80 and children between the ages of 5 and 9, have been the hardest hit with A(H3N2). Experts say influenza A virus may cause complications for older people and those with weakened immune systems. How the flu season plays out in the southern hemisphere, may indicate what we see here in the northern hemisphere, a few months later.

Worldwide, the World Health Organization (WHO) reported that influenza A(H3N2) and B viruses accounted for the majority of influenza detections. Here in the US, the CDC found low influenza activity, with influenza A the most frequently identified strain reported.

The current seasonal influenza vaccine covers both A(H3N2) and B viruses.
Excerpt from the CDC web site:

What viruses will the 2017-2018 flu vaccines protect against?
There are many different flu viruses and they are constantly changing. The composition of U.S. flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on vaccine) that research suggests will be most common. For 2017-2018, three-component vaccines are recommended to contain:
  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus
Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to be produced using the same viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

Watch - 2017-2018 Influenza Vaccination Recommendations
Medscape - CDC Expert Commentary
Lisa Grohskopf, MD, MPH
In this video, available online at Medscape, Dr Lisa Grohskopf, medical officer in the Influenza Division at the Centers for Disease Control and Prevention, will discuss CDC's influenza vaccination recommendations for the 2017-2018 influenza season.

People at High Risk of Developing Flu–Related Complications
People older than 65, those with certain chronic medical conditions, such as liver disease, COPD, diabetes, weakened immune systems, pregnant women and young children are most vulnerable for developing flu-related complications.

Liver Disease
Baby boomers, that is people born from 1945–1965, are 5 times more likely to have hepatitis C than other adults. Many baby boomers are over the age of 65, and living with chronic liver disease, for instance cirrhosis, making them more susceptible to complications related to the flu. Two reasons to protect yourself from the influenza virus.

Recently, a multicenter study published in the journal Eurosurveillance, concluded that people over the age of 65, who received influenza vaccination reduced their risk of being hospitalized for influenza-associated symptoms by 36 %. The study investigated hospitalization of the elderly in two influenza seasons (2013-2014 and 2014-2015).

So, if you’re over 65, you should absolutely get the flu shot. I feel compelled to add, the closer I get to that cut-off, 65, the more I hate the word elderly. Really. Hate it. Read more about the study here, or review the full-text article published in Eurosurveillance.

 How long is the flu contagious? What is the difference between a cold and the flu?
How long is a person with flu virus contagious?
The period when an infected person is contagious depends on the age and health of the person. You may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and 5 to 7 days after becoming sick. Some people, especially young children and people with weakened immune systems, might be able to infect others for an even longer time.

What is the difference between a cold and the flu?
The flu and the common cold are both respiratory illnesses but they are caused by different viruses. Because these two types of illnesses have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

How can you tell the difference between a cold and the flu?
Because colds and flu share many symptoms, it can be difficult (or even impossible) to tell the difference between them based on symptoms alone. Special tests that usually must be done within the first few days of illness can be carried out, when needed to tell if a person has the flu.

More information about Flu: The Disease.

In The News
British Liver Trust
Last year, fewer than half (46.9%) of people in clinical risk groups were protected against influenza, a virus, which can and does kill every year. People particularly ‘at risk’ of influenza, such as liver disease, and its complications are given the vaccine at no cost as part of NHS care. However last winter more than half (57.7%) of people under the age of 65 with a liver condition missed out on getting a free influenza (flu) vaccination in Wales.

Newly discovered viral marker could help predict flu severity in infected patients
Influenza is particularly dangerous for infants, the elderly, and people with underlying medical issues, but otherwise-healthy people sometimes experience severe infection, too. This suggests that, among the multiple strains that circulate yearly, some are more virulent than others. Markers of severity have been found for specific strains, but a general marker that applies to multiple strains would be more useful to inform treatment and policy

High-dose influenza vaccine better for solid organ transplant recipients
Transplant recipients are at particular risk of developing complications from an influenza virus, namely influenza-associated pneumonia. A study presented at IDWeek, held October 4, 2017 - October 8, 2017, reported that in adult solid organ transplant recipients, a high-dose influenza vaccine is preferable to a standard-dose vaccine. Read the summarized results published over at Healio, full-text study is available in Clinical Infectious Diseases.

The Infectious Diseases Society of America (IDSA) has published detailed guidance for the selection and timing of vaccines for persons with specific immunocompromising conditions, including solid organ transplant.

October 18, 2017
Patients with HIV receiving care at a hospital in Malawi were nearly three times more likely to have an influenza-like illness and five times more likely to develop severe influenza disease than patients without HIV, according to data from two recent observational studies.

October 9, 2017
With predictions calling for a potentially bad flu season this year, doctors are urging people -particularly those with diabetes - to get vaccinated

Cochrane Review Essay
In a new paper, experts in the field of Gastroenterology & Hepatology, expressed concern over the highly debated Cochrane systematic review which concluded that patients who achieved SVR (cure) using hepatitis C direct-acting antivirals (DAAs) showed no long term benefits. The new essay titled: Benefits of Direct-Acting Antivirals for Hepatitis C, was published in Annals of Internal Medicine this week.

Since June, when the Cochrane DAA review was published, updated in September with a somewhat "changed" conclusion, Henry E. Chang has tweeted out each rebuttal written about the misleading, failed, review. Read them all here, and make sure to follow Henry E. Chang for daily updates about viral hepatitis on Twitter. 

Conference Coverage - Coming Soon
The liver meeting starts today!

Oct 19, 2017
AASLD Liver Meeting Covers a Lot of Ground
New science could 'potentially change the field
There remains a great deal of interest in HCV, evidenced by dozens of posters and oral presentations on new therapeutics, as well as on other aspects of the disease..

Liver Meeting® 2017 - Gilead Announces Multiple Presentations Demonstrating High Cure Rates in Difficult-to-Cure HCV Patients
Gilead Sciences, Inc. (NASDAQ: GILD) today announced results from Phase 2 and Phase 3 studies of its approved medicines for chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, adding to the body of evidence supporting Gilead’s viral hepatitis therapies in diverse patient populations. These and other data from more than 25 abstracts will be presented this week at The Liver Meeting® 2017, which begins today in Washington, D.C.

The Liver Meeting® 2017 - The Frequency of Herbal and Dietary Supplement Mislabeling
Washington, D.C. – Herbal and dietary supplement mislabeling is common and should be evaluated as a potential cause for liver damage, according to research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases.

Liver Meeting - Updates on this blog, if you are a patient in search of easy to understand information click on this (LINK) for a collection of great HCV sites covering this years Liver Meeting.

The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD)
AASLD Website - The Liver Meeting
MedPage Today
Clinical Care Options
GI & Hepatology News
Updates on this blog

In The Journals
Alimentary Pharmacology & Therapeutics
Direct medical costs associated with the extrahepatic manifestations of hepatitis C virus infection in France
Cacoub,M. Vautier,A. C. Desbois,D. Saadoun,Z. Younossi
First published: 18 October 2017
The following extrahepatic manifestations of HCV infection were analysed: mixed cryoglobulinemia vasculitis, glomerulonephritis (increased creatininemia), end-stage renal disease, porphyria cutanea tarda, lichen planus, type 2 diabetes, depression, rheumatoid-like arthritis, lymphoma, Sjögren-like syndrome, stroke, heart failure and myocardial infarction.

On This Blog
Categorized article directory on the extrahepatic manifestations of hepatitis C.

Michael Carter / 16 October 2017

Blog Updates Around The Web
Hep Blogs
The Liver Disease That Threatens Us All
Lucinda K. Porter, RN
A few months ago, I reviewed Skinny Liver, a book about the most common liver disease in the United States—nonalcoholic fatty liver disease (NAFLD). Some studies estimate that up to 30 percent of Americans have fatty liver disease...

Daryl Luster
In recalling the early days of my hep C experience, I am reminded of just how awful I felt for years before I knew it was caused by hep C.

Hepatitis C and Breastfeeding
Carleen McGuffey
Did you also know that it’s perfectly safe and recommended for mothers with hepatitis C to breastfeed their infants? You need to know this, Mama. You probably even need to print this information from the CDC out to take with you to the delivery room and prenatal appointments, since many healthcare professionals are unaware regarding this science. HIV is different than HCV. HIV can be passed from mom to baby through breastfeeding and many providers falsely assume the same rules apply. They don’t.

The Weekly Bull
How HCV hides in the body; a new blood test to find liver cancer; rapid fibrosis in co-infected MSM, inadequate hospice care for people with chronic liver disease, efficacy of Maviret in chronic kidney disease ……..


HIV and ID Observations
Paul E. Sax, MD
Price’s “Quarantine” Comment a Startling Example of Remaining HIV Stigma and Ignorance
The stigma, fear, and ignorance associated with HIV are still very strong; those of us who do this work on a daily basis might forget this sad fact.

The Best Antiretroviral Therapy for Pregnant Women? The Controversy Continues
Paul E. Sax, MD
There’s considerable controversy in an area of HIV medicine that one would think should be all but solved by now. It’s what HIV treatment we should give pregnant women. The issue isn’t how to prevent the virus from being transmitted to the newborn — suppress the virus in mom, baby doesn’t get it — it’s what’s safest for the pregnancy outcome.

Harvard Health Publications
Robert H. Shmerling, MD
Statin drugs are among the most widely prescribed medications in the world. They lower cholesterol, reduce inflammation, and have been proven to reduce the risk of heart attack and stroke in those at high risk for these conditions. However, a limiting side effect is...

Dos and don’ts for patients who consult Dr. Google

Dear patient, I meet people several like you on a daily basis. It is always a pleasure to meet you since you come much more prepared compared to the average patient. I have seen you with several sheets of paper or even a notebook, a list of questions and an extra sheet of paper on which to write recommendations. You may even have printed research papers and articles off the Internet. I ...

Why are you seeing the gastroenterologist?
The decision to forego proven cancer treatment is an alarming trend, not unique to billionaire tech moguls. In fact, it’s a decision that I have witnessed with some frequency.  I’ve seen patients decline surgery, chemotherapy, and/or radiation — cancer therapies that have been proven to be beneficial. I have also witnessed these and other cancer patients return with cancers that had grown and spread because of a delay in evidence-based treatment.  This led our team to conduct a research study in order to determine whether the patients who chose alternative medicine in lieu of conventional cancer therapy were putting themselves at risk.

Healthy You
Drug-induced Liver Injury Remains Under-reported, Poorly Understood
Healio Gastroenterology, October 2017
Understanding of the causes and outcomes of drug-induced liver injury remains low not only among clinicians and patients, but also among the experts who study this phenomenon. There are emerging data showing that antibiotics and herbal and dietary supplements, or HDS, are the most important culprits of hepatotoxicity in the U.S. Beyond that, less frequent associations with other drug classes have been reported, but interesting and provocative genetic signals and immune factors are starting to emerge from ongoing studies that require further follow-up.

At the heart of the problem is that most clinicians still do not report DILI, according to Robert J. Fontana, MD, Medical Director of Liver Transplantation and professor of medicine at the University of Michigan. Fontana is co-chair of the Drug-Induced Liver Injury Network (DILIN), which aims to tackle the problem head-on. “Our network is important because these injuries are both under-recognized and under-reported,” he said. “We currently have six sites right now studying the problem in the U.S., but awareness is increasing.”...

Healio Gastroenterology, October 2017
Nancy S. Reau, MD, FAASLD, AGAF
Common medical perception of drug-induced liver injury, or DILI, associates it with stigmatized drugs and well-known injurious medications such as acetaminophen, but today, the picture can look quite different.

Fatty liver disease fastest-growing reason for transplants in young U.S. adults
By Carolyn Crist
About 18% of transplants were for acute liver failure, and other important causes were hepatitis C and B as well as liver cancers. Nonalcoholic steatohepatitis, also called NASH, accounted for just 3.3% of transplants across the entire study period, but it was the fastest-growing reason for transplant.

Harvard study: It’s not too late to start a healthy diet
Changing to one of three scientifically developed healthy eating programs is associated with improved longevity.

HEALTHbeat - Harvard University
If you're having the occasional twinge of joint pain when you go for a walk or climb stairs, or you're worried about arthritis because a parent had it, one step toward prevention is to check your weight.

Hope you get that flu shot, I'm not elderly, but I sure did get mine.
Enjoy the upcoming weekend everyone.

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