Showing posts with label hav. Show all posts
Showing posts with label hav. Show all posts

Saturday, June 23, 2018

Ohio have officially declared a statewide hepatitis A outbreak

Authorities in Ohio have officially declared a statewide hepatitis A outbreak following the confirmation of 79 hepatitis A cases this year, which is already almost double the number of confirmed cases the entire previous year. Montgomery County has the most cases in the state with 17 confirmed cases, followed by Lawrence with 12 cases, and Lucas with 10.
Continue reading..

Links
CDC
Hepatitis A Questions and Answers for the Public
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

Immunization Action Coalition
Read how hepatitis A is spread, the symptoms, how serious the virus is, when and who should get vaccinated. 

Wednesday, May 30, 2018

Hepatitis A is usually not a problem to recover from. But in Michigan, 27 people died since this outbreak began.

USA Today Network
May 29, 2018
Kristen Jordan Shamus, Detroit Free Press

Hepatitis A is usually not a problem to recover from. But in Michigan, 27 people died since this outbreak began.
WARREN, Mich.— Michigan is in the throes of the largest hepatitis A outbreak in the USA, a flareup that began in August 2016 and has killed 27 people, state health officials say.

The hepatitis A virus, which attacks the liver, is highly contagious. Just ask Christopher Larime ,46, of Grosse Pointe Park, who goes out to lunch most days with co-workers from the General Motors Tech Center here.
Read the article: https://www.usatoday.com/story/news/nation-now/2018/05/29/hepatitis-outbreak-michigan/651732002/ 

May 29, 2018

Wednesday, May 9, 2018

Hepatitis Awareness Month - What is hepatitis C? What about hepatitis B or A?


Featured on the blog today in honor of Hepatitis Awareness Month, is a look at three common viruses that cause hepatitis, brought to you by Centers of Disease Control and Prevention (CDC), health experts, advocates, and patient bloggers, who work hard to spread information and awareness about viral hepatitis.

Hepatitis C
Lets start with the hepatitis C virus (HCV), a virus that once caused serious damage to my liver, putting me at risk for liver-related complications. The good news is after testing; it all starts with getting tested for HCV, I went on to successfully treat the virus. The bad news is close to 50% of people who have HCV have not yet been diagnosed. Why not take this opportunity to learn more about viral hepatitis, or better yet, have a long frank discussion with "yourself" about getting tested.

Young Or Not So Young - The Risk 
Today we have two different groups of people that are at risk for hepatitis C, young people who have injected drugs and well, older people. We know that the hepatitis C epidemic peaked between 1940 and 1965 due in part because of hospital transmissions caused by the practice of reusing needles. So if you are at risk for HCV, rather you are young or part of the baby boomer generation; people born between 1945 and 1965, I hope you consider getting tested for HCV.

Hepatitis C Risk Factors
-IV drug use, sharing needles and syringes; Spike in HCV Linked to Opioid Injection Hits Young Adults Hardest
-Vertical transmission from mother to baby; HCV in Pregnant Women on Rise Increased risk of HCV infected infants.
-You were born from 1945 through 1965
-Extensive surgical procedures
-Needlestick injuries in health care settings
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
-People who received a blood product for clotting problems made before 1987
-Hemodialysis patients or persons who spent many years on dialysis for kidney failure
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine
-Sexual transmission, rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship - Unless you also have human immunodeficiency virus (HIV).
-Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
-Unknown--up to 5% of patients have no identifiable risk factors

May 19th is Hepatitis Testing Day! 

Are You At Risk For Viral Hepatitis?
Find out if you should get tested or vaccinated by taking a quick, online Hepatitis Risk Assessment, developed by the CDC and get a personalized report.

Hepatitis C - A Few Facts
Of every 100 people infected with hepatitis C, 75 to 85 will develop chronic disease and 10-20 will go on to develop cirrhosis over a period of 20-30 years. Early on HCV doesn't always have noticeable symptoms but overtime and with certain co-factors the virus can lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Almost 80 percent of cases of hepatocellular carcinoma (HCC) are due to underlying chronic hepatitis B and C infection, and 80 to 90 percent of people with HCC have liver cirrhosis. According to the recent EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma; Vaccination against hepatitis B reduces the risk of HCC and is recommended for all new-borns and high-risk groups. In patients with chronic hepatitis, antiviral therapies leading to maintained HBV suppression in chronic hepatitis B and sustained viral response in hepatitis C are recommended, since they have been shown to prevent progression to cirrhosis and HCC development.

Show Me The Guidelines

Current EASL Clinical Practice Guidelines
During The International Liver Congress 2018, The European Association for the Study of the Liver (EASL) released updated practice guidelines to help physicians, as well as patients manage and treat HCV. (Link) EASL Practice Guidelines - Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E.

Current AASLD Clinical Practice Guidelines
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV. The guidelines break down treatment according to liver damage and HCV genotype, updated when new HCV drugs are approved, or new real world data is established.

Help - Where Do I Begin?

Talk To Someone
Help‑4‑Hep is a non-profit, peer-to-peer helpline where counselors work with patients to meet the challenges of hepatitis C head-on. Callers talk one-to-one with a real person, typically someone who's had hepatitis C touch their own life. And they talk about the specifics of their particular situation. The phone call, support and information are all provided free of charge. Let us help you cut through the clutter and confusion. Call toll-free: 877‑Help‑4‑Hep (877‑435‑7443).
Begin here.......

Where To Get Tested - Hepatitis C and Hepatitis B

Find A HCV Specialist 
Find a Specialist In Your Area

Hepatitis B 
More than 2 million Americans are chronically infected with hepatitis B virus (HBV), to learn more about HBV visit The Hepatitis B Foundation, for patients it's the best site for easy to understand information, here are a few links to get you started: 

What Is Hepatitis B?
Facts and Figures
Symptoms
Transmission
Acute vs. Chronic Infection
Commonly Asked Questions
The ABCs of Viral Hepatitis
Liver Cancer and Hepatitis B
Hepatitis Delta Coinfection
Hepatitis C Coinfection
HIV/AIDS Coinfection

AASLD 2018 hepatitis B guidance
Update on prevention, diagnosis, and treatment of chronic hepatitis B

ACIP Hepatitis B Vaccine Recommendations | CDC
You may have questions about the hepatitis A virus (HAV) after reading about HAV outbreaks across the US; Michigan, California, Indiana, Kentucky and Utah. The outbreak began in California in 2017, this year Michigan, Utah, and Kentucky have reported outbreaks with a high number of cases. Here is a Public Service Announcement from San Diego County Health & Human Services Agency on HAV prevention.


Immunization Action Coalition

Hepatitis A: Questions and Answers Information about the disease and vaccines
Read how hepatitis A is spread, the symptoms, how serious the virus is, when and who should get vaccinated.

CDC
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

What is postexposure prophylaxis (PEP)?
Postexposure prophylaxis (PEP) refers to trying to prevent or treat a disease after an exposure. For hepatitis A, postexposure prophylaxis is an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure.
Begin here.......

Blog Updates: The ABCs Of Viral Hepatitis

Swedish Medical Center
What is hepatitis C, and how does it differ from hepatitis A or B?
By 2030, the World Health Organization wants to have hepatitis C eliminated from the planet. A key to reaching that goal is to create awareness of the disease among baby boomers, who suffer from it in larger numbers compared to the rest of the population, as well as those with increased lifestyle risks. But what is hepatitis C, and what can be done to reduce its numbers? Kris Kowdley, MD, director of the Liver Care Network and Organ Care Research at Swedish Medical Center in Seattle, WA, discusses hepatitis C in detail.
View the article here: https://www.swedish.org/blog/2018/05/ask-the-expert-all-about-hepatitis-c

HEP Blogs
Go-to online source for educational and social support for people living with hepatitis. The website is devoted to combating the stigma and isolation surrounding hepatitis.

What are the Different Types of Hepatitis?
May 9, 2018 • By Connie M. Welch
Viral hepatitis is a liver infection that causes inflammation and damage. There are 5 viruses that cause viral hepatitis, Hepatitis A, B, C, D, and E. Hepatitis A and E viruses can cause acute infections (infections that last less than 6 months). Hepatitis B, C, and D viruses can cause acute and chronic (lasting longer than 6 months and typically ongoing) liver infections.

Awareness
Get Organized for Hepatitis Awareness Month 
By Lucinda K. Porter, RN
Raising hepatitis awareness is a great deal more fun if you participate with others. Here are some tips.


HepatitisC.net
Hep C Daily Blog, Experts & Community

By Karen Hoyt · May 7, 2018
So, you are hanging out with the same crowd that you always have. They’re like your family. In many ways, they are closer to you than your own family.

The Fallout Guide for Hep C: Support Network
By Rick Nash · May 2, 2018
I am lucky after my transplant, I carry that reminder on my stomach. Because when someone hears you have a condition, they may not initially understand the reality of how that affects you.
This is part two of a six-part series, view part one here.

All updates: https://hepatitisc.net/community/

Hep B Blog
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.

May is Hepatitis Awareness Month
Hepatitis Awareness Month is dedicated to increasing awareness of hepatitis in the United States and to encourage high risk populations to get tested. If you’re not sure how you can get involved in the hepatitis B community this month, here are some ways you can!

Information On Hep B Blog:
Hepatitis B Diagnosis & Monitoring
Hepatitis B Prevention
Hepatitis B Treatment
Liver Cancer
Living with Hepatitis B
News

    Al D. Rodriguez Liver Foundation
    The Al D. Rodriguez Liver Foundation is a 501(c)(3) non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.

    A New York Post article about an unsafe “pizza joint manager” — who was reported to have sparked hepatitis C scare — made a few rounds on the panicked social media circuit earlier this year.


    Healio
    Healio features the industry’s best news reporting, dynamic multimedia, question-and-answer columns, CME and other educational activities in a variety of formats, quick reference content, blogs, and peer-reviewed journals. A quick free registration may be required.

    Hepatitis Awareness Month: 10 recent reports on viral hepatitis
    May 8, 2018
    The Centers for Disease Control and Prevention have designated May as Hepatitis Awareness Month to raise public awareness of viral hepatitis including the most common strains: hepatitis A, hepatitis B and hepatitis C. Additionally, the CDC designated May 19th as Hepatitis Testing Day. The following recent reports, many from recent meetings including the International Liver Congress 2018, include new research data on hepatitis prevalence and outbreaks, transmission risks and treatment outcomes...

    May 9, 2018
    Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a…

    Viral Hepatitis - An Overview
    By Osmosis
    What is the hepatitis virus? Well, the hepatitis virus invades liver cells and causes inflammation in the liver tissue. There are five known hepatitis viruses—hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E, all of which have slightly different presentations, symptoms and severity.


    Do you want to know your status? If you fall under any of the above mentioned risk groups please consider getting tested.

    Tina

    Thursday, April 12, 2018

    Liver Congress™ 2018 Ongoing hepatitis A virus outbreak among men who have sex with men is linked to current outbreaks in Europe

    Italy: Ongoing hepatitis A virus outbreak among men who have sex with men is linked to current outbreaks in Europe

    European Association for the Study of the Liver
    12 April 2018, Paris, France: Hepatitis A viruses (HAVs) circulating in an ongoing outbreak among men who have sex with men (MSM) in the Lombardy region of Italy are predominantly attributable to strains linked to two other recent outbreaks in Europe, according to a study presented today at The International Liver Congress™ 2018 in Paris, France. The study found that earlier cases in the Lombardy outbreak were related to an HAV strain reported in the Netherlands, while later cases were more frequently linked to a strain seen in the UK.

    Although HAV is rarely fatal, 10-15% of symptomatic patients experience an illness lasting several months, and comorbidities increase the chance of serious liver complications.11 HAV is generally transmitted through the faecal/oral route, although sexually transmitted outbreaks of HAV have occurred among MSM.11,12 Genetic sequencing of the HAV circulating in a particular outbreak can help determine its source and potentially help identify at-risk populations.13 Effective vaccines have become available within the last 25 years and routine vaccination is widely recommended.14

    'We wanted to understand the ongoing HAV outbreak within a large group of patients including MSM from seven hospitals in the Lombardy region', explained Dr Massimo Iavarone from the Fondazione IRCCS Ca' Granda Maggiore Hospital in Milan, Italy, and lead author of the study. 'We used viral phylogenetic analysis to see if this outbreak was linked to other recent European outbreaks'.

    The study prospectively analyzed 244 cases of acute HAV between January and May 2017 (median age 33 years, range 18-76; 94% male; 59% MSM). The incidence rate of HAV in Lombardy was also analyzed and was found to be 9.512 per 100,000 inhabitants during the study period, compared with 1.069 in 2016 and 0.750 in 2015. The phylogenetic correlation between the viruses currently circulating in Lombardy and other HAV strains was assessed by sequencing the VP1/2A region.

    Hospitalization was required by 80% of patients (median stay 7 days, range 2-44), and the median (range) alanine aminotransferase and bilirubin peak levels were 2,652 (47-8,914) IU/mL and 6.6 (0.4-18) mg/dL, respectively. Severe liver injury according to the EASL definitions occurred in 14% of patients, with no cases requiring liver transplants.

    The molecular phylogenetic analyses revealed that 93% of patients were infected by HAV genotype IA and 7% with genotype IB. All of the genotype IA infections matched strains from one of three European outbreaks (UK, 54%; The Netherlands, 45%; Germany, 1%). Interestingly, the proportion of cases infected by each strain varied with time; the strain from the Netherlands accounted for 100% of the January cases, but the strain from the UK dominated the later months of the outbreak (May 68%, June 70%). 'There is a high hospitalization rate for the patients in these linked HAV outbreaks involving young active workers, which may impact admissions to liver and infectious disease units and have significant direct and indirect economic consequences', said Dr Iavarone. 'Efforts to increase hepatitis A vaccine coverage in high-risk groups must be taken to strengthen population protection from HAV'. 'This study emphasizes the risk of acute HAV infection via sexual transmission in risk groups such as MSM', said Prof. Markus Cornberg from the Hannover Medical School, Germany, and EASL Governing Board Member. 'Awareness campaigns for the prevention of sexually transmitted infections are important, and in this case of HAV, vaccination can prevent infections'.

    References
    11. Matheny SC, Kingery JE. Hepatitis A. Am Fam Physician. 2012;86(11):1027-34.
    12. Stene-Johansen K, et al. Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe. J Med Virol. 2007;79(4):356-65.
    13. Bruni R, et al. Hepatitis A virus genotypes and strains from an endemic area of Europe, Bulgaria 2012-2014. BMC Infect Dis. 2017;17(1):497.
    14. Stuurman AL, et al. Impact of universal mass vaccination with monovalent inactivated hepatitis A vaccines - A systematic review. Hum Vaccin Immunother. 2017;13(3):724-36.

    Tuesday, September 26, 2017

    California Scrambles To Contain ‘Unprecedented’ Hepatitis A Outbreaks


    California Scrambles To Contain ‘Unprecedented’ Hepatitis A Outbreaks
    By Stephanie O'Neill September 26, 2017

    Health officials in California are struggling to contain fierce outbreaks of hepatitis A among homeless people and drug abusers in three counties, including San Diego, where at least 17 people have died.

    Hundreds more have become ill and been hospitalized, mostly in the San Diego area, often not far from tourist destinations. The disease also has cropped up farther north in Los Angeles and Santa Cruz counties. Poor access to restrooms and sinks in homeless encampments is largely to blame.

    Public health officials say the crisis has caught them off guard because it’s rare for the disease to spread so rampantly when it isn’t tied to a common source, such as a tainted food product. Meanwhile, as cases mount with no end in sight, critics fault authorities’ response as lethargic.

    Continue reading...

    Saturday, June 29, 2013

    FDA Investigates Multistate Outbreak of Hepatitis A Illnesses Potentially Associated with a Frozen Fruit Blend

    FDA Investigates Multistate Outbreak of Hepatitis A Illnesses Potentially Associated with a Frozen Fruit Blend

    Posted June 29, 2013
    Available En Español1
    Source - FDA

    Related - CDC-Multistate outbreak of Hepatitis A infections linked to pomegranate seeds from Turkey
     
     

    Updates

    June 29, 2013 
    The U.S. Food and Drug Administration (FDA) will detain shipments of pomegranate seeds2 from Goknur Gida Maddeleri Ithalat Ihracat Tic (Goknur Foodstuffs Import Export Trading) of Turkey when they are offered for import into the United States.
     
    This action results from the investigation by the FDA, the Centers for Disease Control and Prevention, and state and local health authorities into a multi-state outbreak of Hepatitis A illnesses associated with Townsend Farms Organic Antioxidant Blend, a frozen food blend containing pomegranate seed mix.

    By combining information gained from the FDA’s traceback and traceforward investigations and the CDC’s epidemiological investigation, the FDA and CDC have determined that the most likely vehicle for the Hepatitis A virus appears to be a common shipment of pomegranate seeds from Goknur used by Townsend Farms to make the Townsend Farms and Harris Teeter Organic Antioxidant Blends that were recalled in June.   These seeds were also used by Scenic Fruit Company to make their recently recalled Woodstock Frozen Organic Pomegranate Kernels.
    “This outbreak highlights the food safety challenge posed by today’s global food system,” said Michael R. Taylor, Deputy Commissioner for Foods and Veterinary Medicine. “The presence in a single product of multiple ingredients from multiple countries compounds the difficulty of finding the cause of an illness outbreak.  The Hepatitis A outbreak shows how we have improved our ability to investigate and respond to outbreaks, but also why we are working to build a food safety system that more effectively prevents them.”

    The FDA reviewed records and determined that the pomegranate seeds from this shipment were the only ingredient common to all of the recalled Townsend Farms and Harris Teeter Organic Antioxidant Blend. 

    FDA will be working with the firms that have distributed pomegranate seeds from this shipment from Turkey to help ensure that all recipients of these seeds are notified.
    The CDC reports that as of June 27, 2013, 127 people have been confirmed to have become ill with Hepatitis A after eating Townsend Farms Organic Antioxidant Blend.  The illnesses have been reported from 8 states: Arizona, California, Colorado, Hawaii, Nevada, New Mexico, Utah, and Wisconsin.  The people who were reported ill in Wisconsin were exposed to the product in California.

    The CDC reports that the outbreak strain of hepatitis A virus, belonging to genotype 1B, was found in clinical specimens of 56 people in seven states: AZ (6), CA (15), CO (22), HI (4), NM (4), NV (4) and WI (1; the person was exposed in California). This subtype is rarely seen in the Americas but circulates in North Africa and the Middle East.



    The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multi-state outbreak of Hepatitis A illnesses potentially associated with a frozen food blend. We are moving quickly to learn as much as possible and prevent additional people from becoming ill. We recognize that people will be concerned about this outbreak, and we will continue to provide updates and advice. 

    What is the Problem and What is Being Done About It? 
    The FDA, the CDC, and state and local officials are investigating a multi-state outbreak of Hepatitis A illnesses potentially associated with Townsend Farms Organic Antioxidant Blend, a frozen blend containing pomegranate seed mix.
     
    As of June 27, 2013, 127 people infected with Hepatitis A have been reported from 8 states: Arizona, California, Colorado, Hawaii, Nevada, New Mexico, Utah, and Wisconsin. The cases from Wisconsin were exposed to the product in California.

    The CDC reports that the outbreak strain of Hepatitis A virus (HAV), belonging to genotype 1B, was found in clinical specimens of 56 people in 7 states.  This strain is rarely seen in the Americas but circulates in North Africa and the Middle East.

    On June 4, 2013, Townsend Farms, Inc. of Fairview, Oregon, recalled certain lots of its frozen Organic Antioxidant Blend3, because it has the potential to be contaminated with Hepatitis A virus.  No other Townsend Farms products, frozen or fresh, are covered by this voluntary recall or linked to the illness outbreak at this time.
     
    The product was sold at Costco warehouse stores under the product name Townsend Farms Organic Antioxidant Blend4, 3 lb. bag and UPC 0 78414 404448. The recalled codes are located on the back of the package with the words “BEST BY”; followed by the code T012415 sequentially through T053115, followed by a letter. All of these letter designations are included in this recall for the lot codes listed above.
     
    The product was also sold at Harris Teeter stores from April 19 until May 7, 2013, under the product name Harris Teeter Organic Antioxidant Berry Blend5, 10 oz. bag and UPC 0 72036 70463 4, with Lot Codes of T041613E or T041613C and a “BEST BY” code of 101614.
     
    On June 28, 2013, Townsend Farms, Inc. expanded its recall6 to include Townsend Farms Organic Antioxidant Blend, 3 lb. bag with UPC number 0 78414 40444 8. The recall codes are located on the back of the package with the words “BEST BY” followed by the code T122114 sequentially through T053115, followed by a letter. All letter designations are included in the recall.
    On June 14, 2013, the Jackson County Oregon Health Department warned customers of Evo’s Coffee Lounge, in Ashland, Oregon, that they may have been exposed to Hepatitis A in the coffee shop's "Radically Free" smoothie served between May 17 and June 12, 2013.  The coffee shop used Townsend Farms Organic Antioxidant Blend to produce this menu item. The Jackson County Health Department also alerted those who may have been exposed in the last 14 days of the availability of Hepatitis A vaccine in the local area.

    On June 19, 2013, the Mendocino County Public Health Department warned customers of A Frame Espresso in Fort Bragg Calif. that they may have been exposed to Hepatitis A in the coffee shop's "Mixed Berry" smoothie served between March 4 and June 8, 2013.  The smoothies may have contained Townsend Farms Organic Antioxidant Blend.

    On June 26, 2013, Scenic Fruit Company of Gresham, Oregon recalled specific lots of Woodstock Frozen Organic Pomegranate Kernels7 because they have the potential to be contaminated with the Hepatitis A virus.

    Woodstock Organic Pomegranate Kernels are sold in eight-ounce (227 gram) resealable plastic pouches (see image8) with UPC Code 0 42563 01628 9. Specific coding information to identify the product can be found on the back portion of these pouches below the zip-lock seal. The following lots are subject to this recall:

      C 0129 (A,B, or C) 035 with a best by date of 02/04/2015
      C 0388 (A,B, or C) 087 with a best by date of 03/28/2015
      C 0490 (A,B, or C) 109 with a best by date of 04/19/2015
     
    The recalled Scenic Fruit products  were shipped from February 2013 through May 2013 to United Natural Foods, Inc. (UNFI) distribution centers in California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, New Hampshire, Pennsylvania, Rhode Island, Texas, and Washington State. UNFI distribution centers may have further distributed products to retail stores in other states.
    The FDA has finalized a protocol to test berries for the Hepatitis A virus (HAV), and is testing samples related to the outbreak for the presence of HAV.

    The FDA has also inspected the processing facilities of Townsend Farms of Fairview, Oregon. By combining information gained from the FDA’s traceback and traceforward investigations and the CDC’s epidemiological investigation, the FDA and CDC have determined that the most likely vehicle for the Hepatitis A virus appears to be a common shipment of pomegranate seeds from Goknur used by Townsend Farms to make the Townsend Farms and Harris Teeter Organic Antioxidant Blends that were recalled in June.   These seeds were also used by Scenic Fruit Company to make their recently recalled Woodstock Frozen Organic Pomegranate Kernels.
    The FDA reviewed records and determined that the pomegranate seeds from this shipment were the only ingredient common to all of the recalled Townsend Farms and Harris Teeter Organic Antioxidant Blend. 

    FDA will be working with the firms who have distributed pomegranate seeds from this shipment from Turkey to help ensure that all recipients of these seeds are notified.
    The FDA is working closely with the CDC and state and local agencies and will provide updates as soon as they become available.  

    What is Hepatitis A?
    Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces, or stool, of an infected person.

    What are the Symptoms of Hepatitis A?
    Illness occurs within 15 to 50 days of exposure and includes fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine and pale stool.

    Who is at Risk?
    Hepatitis A is a human disease and usually occurs when an infected food handler prepares food without appropriate hand hygiene.  However, food contaminated with HAV, as is suspected in this outbreak, can cause outbreaks of disease among persons who eat or handle food.

    In rare cases, particularly in patients with pre-existing severe illness or immune compromise, HAV infection can progress to liver failure and death.  Persons with underlying liver conditions should be vaccinated.

    What is being Recalled?
    On June 4, 2013, Townsend Farms, Inc. of Fairview, Oregon, recalled certain lots of its frozen Organic Antioxidant Blend9 on June 4, 2013, because it has the potential to be contaminated with Hepatitis A virus.  No other Townsend Farms products, frozen or fresh, are covered by this voluntary recall or linked to the illness outbreak at this time. The product was sold at Costco warehouse stores under the product name Townsend Farms Organic Antioxidant Blend10, 3 lb. bag and UPC 0 78414 404448. The recalled codes are located on the back of the package with the words “BEST BY”; followed by the code T012415 sequentially through T053115, followed by a letter. All of these letter designations are included in this recall for the lot codes listed above.The product was also sold at Harris Teeter stores from April 19 until May 7, 2013, under the product name Harris Teeter Organic Antioxidant Berry Blend11, 10 oz. bag and UPC 0 72036 70463 4, with Lot Codes of T041613E or T041613C and a “BEST BY” code of 101614.

    On June 28, 2013, Townsend Farms, Inc. expanded its recall12 to include Townsend Farms Organic Antioxidant Blend, 3 lb. bag with UPC number 0 78414 40444 8. The recall codes are located on the back of the package with the words “BEST BY” followed by the code T122114 sequentially through T053115, followed by a letter. All letter designations are included in the recall.

    On June 26, 2013, Scenic Fruit Company of Gresham, Oregon recalled specific lots of Woodstock Frozen Organic Pomegranate Kernels13 because they have the potential to be contaminated with the Hepatitis A virus.

    Woodstock Organic Pomegranate Kernels are sold in eight-ounce (227 gram) resealable plastic pouches (see image14) with UPC Code 0 42563 01628 9. Specific coding information to identify the product can be found on the back portion of these pouches below the zip-lock seal. The following lots are subject to this recall:

      C 0129 (A,B, or C) 035 with a best by date of 02/04/2015
      C 0388 (A,B, or C) 087 with a best by date of 03/28/2015
      C 0490 (A,B, or C) 109 with a best by date of 04/19/2015
     
    The recalled Scenic Fruit products were shipped from February 2013 through May 2013 to United Natural Foods, Inc. (UNFI) distribution centers in California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, New Hampshire, Pennsylvania, Rhode Island, Texas, and Washington State. UNFI distribution centers may have further distributed products to retail stores in other states.

    On June 26, 2013, Scenic Fruit Company of Gresham, Oregon recalled specific lots of Woodstock Frozen Organic Pomegranate Kernels15 because they have the potential to be contaminated with the Hepatitis A virus.

    Woodstock Organic Pomegranate Kernels are sold in eight-ounce (227 gram) resealable plastic pouches (see image16) with UPC Code 0 42563 01628 9. Specific coding information to identify the product can be found on the back portion of these pouches below the zip-lock seal. The following lots are subject to this recall:

      C 0129 (A,B, or C) 035 with a best by date of 02/04/2015
      C 0388 (A,B, or C) 087 with a best by date of 03/28/2015
      C 0490 (A,B, or C) 109 with a best by date of 04/19/2015
     
    The recalled Scenic Fruit products  were shipped from February 2013 through May 2013 to United Natural Foods, Inc. (UNFI) distribution centers in California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, New Hampshire, Pennsylvania, Rhode Island, Texas, and Washington State. UNFI distribution centers may have further distributed products to retail stores in other states.

    What Do Consumers and Retailers Need To Do?
    Consumers should not eat the recalled products and should discard any remaining product from their freezers. Even if some of the product has been eaten without anyone in your home becoming ill, the rest of the product should be discarded.

    Retailers and other food service operators should not sell or serve the recalled products.

    See the CDC's recommendations concerning vaccination for Hepatitis A in regard to this outbreak here17.

    Who Should be Contacted?
    For more information on the Townsend Farms recall, consumers may contact a Townsend Farms Customer Service Representative by phone or e-mail at 1-800-875-5291; townsendfarms5148@stericycle.com.  Customer service representatives will be available Monday through Friday, 7 a.m. to 4 p.m. PDT to respond to inquiries.

    For more information on the Scenic Fruit Company recall, consumers may contact the Scenic Fruit Company at 877-927-3434 or email to info@scenicfruit.com from Monday through Friday, 8 a.m. to 8 p.m. PDT

    For information on Hepatitis A and the vaccine, consumers may call the CDC information line at 1-800-CDC INFO between 8 a.m. and 8 p.m. Eastern time.

    The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the fda.gov website: www.fda.gov18.



    The information in this release reflects the FDA’s best efforts to communicate what it has learned from the manufacturer and the state and local public health agencies involved in the investigation. The agency will update this page as more information becomes available. For more information:

     

    Friday, June 28, 2013

    CDC-Multistate outbreak of Hepatitis A infections linked to pomegranate seeds from Turkey

    CDC-Multistate outbreak of Hepatitis A infections linked to pomegranate seeds from Turkey
    Posted June 28, 2013 2:00 PM ET

    CDC is collaborating with public health officials in several states and the US Food and Drug Administration (FDA) to investigate a multistate outbreak of Hepatitis A illnesses. Results from the ongoing investigation are highlighted below.

    Highlights

    Epidemiologic Investigation:

    Read the Advice to Consumers »
    As of June 27, 2013, 127 people have been confirmed to have become ill from Hepatitis A after eating ‘Townsend Farms Organic Anti-oxidant Blend’ in 8 states: Arizona (17), California (64), Colorado (25), Hawaii (7), New Mexico (5), Nevada (5), Utah (2), and Wisconsin (2).
    [Note: The cases reported from Wisconsin resulted from exposure to the product in California.]

    71 (58%) ill people are women

    Ages range from 2 – 84 years;
    74 (61%) of those ill were between 40 – 64 years of age.
    6 children under age 18 were also ill. None were previously vaccinated.
    Illness onset dates range from 3/31/2013 – 6/15/2013
    55 (45%) ill people (all over 18 years of age) have been hospitalized, and no deaths have been reported

    All those who reported eating this product purchased it from Costco markets; however, the product was also sold at Harris Teeter stores. No cases have been identified that bought the product at Harris Teeter at this time.

    Laboratory Investigation:

    The outbreak strain of hepatitis A virus, belonging to genotype 1B, was found in clinical specimens of 56 people in seven states: AZ (6), CA (15), CO (22), HI (4), NM (4), NV (4) and WI (1; the person was exposed in California). This subtype is rarely seen in the Americas but circulates in North Africa and the Middle East.

    This genotype was identified in a 2013 outbreak in Europe linked to frozen berries and another 2012 outbreak in British Columbia related to a frozen berry blend with pomegranate seeds from Egypt. However, there is no evidence at this time that these outbreaks are related to the ongoing U. S. outbreak.

    Regulatory Investigation:

    On June 3, 2013, Townsend Farms, Inc. of Fairview, Oregon voluntarily recalled certain lots of its frozen Organic Antioxidant Blend because it has the potential to be contaminated with hepatitis A virus.

    FDA is inspecting the processing facilities of Townsend Farms of Fairview, Oregon.
    By combining information gained from the FDA’s traceback and trace forward investigations and the CDC’s epidemiological investigation, FDA and CDC have determined that the most likely vehicle for the Hepatitis A virus is appears to be a common shipment of pomegranate seeds from Turkey used by Scenic Fruit Company to make the recalled Woodstock Frozen Organic Pomegranate Kernels and by Townsend Farms to make the recalled Townsend Farms and Harris Teeter Organic Anti-Oxidant Blend.

    The FDA reviewed records and determined that the pomegranate seeds from this shipment were the only ingredient common to all of the recalled Townsend Farms and Harris Teeter Organic Anti-Oxidant Blend.

    On June 26, 2013, Scenic Fruit Company of Gresham, Oregon recalled specific lots of Woodstock Frozen Organic Pomegranate Kernels.
    Combining information gained from the FDA’s traceback and trace forward investigations and the CDC’s epidemiological investigation, it has been determined that the vehicle for the Hepatitis A virus is a common shipment of pomegranate seeds from Turkey used by Scenic Fruit Company in making the recalled Woodstock Frozen Organic Pomegranate Kernels and by Townsend Farms in making Townsend Farms Organic Anti-Oxidant Blend

    FDA will be working to identify and contact other food processors who may have also received pomegranate seeds from this shipment from Turkey, so that products using these seeds may be recalled.

    FDA has finalized a protocol to test berries for the Hepatitis A virus, and is testing samples related to the outbreak for the presence of the virus.

    According to the label, the “Townsend Farms Organic Anti-Oxidant Blend” frozen berry and pomegranate mix associated with illness contained products originating from the U.S., Argentina, Chile, and Turkey.

    At a Glance:
    *The cases reported from Wisconsin resulted from exposure to the product in California

    Vaccine and IG Information:
    Hepatitis A Vaccine Schedule
    Postexposure Prophylaxis - Use of vaccine and IG
    Source for IG

    More Information:
    Advice to Consumers & Retailers
    Hepatitis A Information
    Key Resources
     

    Wednesday, July 25, 2012

    Patients with HCV may not benefit from HAV vaccination

    Rowe IA. Hepatology. 2012;doi:10.1002/hep.25683.

    July 24 2012

    Routine HAV vaccination in patients with HCV may not be cost-effective or beneficial to patients, according to recent study results.

    In a meta-analysis of 10 studies, researchers evaluated the mortality risk from HAV superinfection among 22,371 patients with HCV who were vaccinated against HAV. Incorporated data included the type of study, data collection methods, diagnostic criteria, study length, the number of patients involved and the number of deaths attributed to HAV.

    Investigators established a pooled OR of 7.23 (95% CI, 1.24-42.12) for mortality risk from HAV superinfection, which was equated with 1.4 deaths for every one million susceptible patients with HCV annually. Heterogeneity between studies was determined (I2=56%, P=.03), and this analysis excluded three studies reporting zero deaths. A subsequent analysis that incorporated all 10 studies and used a random effects model and continuity correction resulted in an OR of 6.88 (95% CI, 1.32-36.01).

    Publication bias toward increased mortality risk was observed, with studies submitted as original articles reporting a higher mortality risk (OR=38.75; 95% CI, 7.33-204.84) while those published as correspondence suggested rates similar to the population risk (OR=0.86; 95% CI, 0.15-4.90).

    Assuming an incidence rate of five cases of HAV superinfection for every 100,000 patients with HCV, researchers calculated the number needed to vaccinate (NNV) patients with HCV against HAV was 23,565 to prevent one case. The NNV to prevent one death annually was calculated at 814,849, with an estimated cost of $162 million for the vaccine, or $80.1 million per death prevented. Both calculations assumed a 94.3% efficacy rate and 90% uptake for the vaccine.

    “These data challenge the use of routine HAV vaccination in HCV-infected persons and its incorporation into clinical practice guidelines,” the researchers wrote. “These findings highlight several key issues in the development of both guidelines and quality measures. Firstly, the assessment of the evidence and the benefit of interventions need occur in light of relevant prevalence data. Secondly, changes in prevalence need to be considered when guidelines or quality measures are revised or reassessed. Physicians otherwise run the risk of exposing many patients to interventions that are ultimately of no benefit to them.”

    http://www.healio.com/hepatology/chronic-hepatitis/news/online/%7B908A09AD-8877-473A-B4BE-91C6FC423E14%7D/Patients-with-HCV-may-not-benefit-from-HAV-vaccination

    Friday, September 16, 2011

    Hepatitis News Ticker;Does antiviral therapy prevent hepatocellular carcinoma?

    New On The Blog;

    New Hepatitis C Drugs Offer Options but With Added Complications

    In This Weeks News

    Telaprevir-Shorter treatment



    Todays HCV News

    Does antiviral therapy prevent hepatocellular carcinoma?
    Kwon H, Lok AS; Antiviral Therapy 16 (6), 787-95 (2011)
    Source: Antiviral Ther

    Chronic infection with HBV or HCV can lead to the development of hepatocellular carcinoma (HCC). The major risk factors for HBV-related HCC are persistent presence of hepatitis B e antigen (HBeAg) and/or high serum HBV DNA levels, and cirrhosis.

    The major risk factor for HCV-related HCC is cirrhosis. One randomized double blind controlled trial of lamivudine in patients with HBeAg and/or high serum HBV DNA levels showed that antiviral therapy prevented disease progression and reduced the incidence of HCC.

    A beneficial effect of antiviral therapy on the risk of HCC has also been shown in cohort studies and meta-analyses, particularly among responders. Several randomized controlled trials of interferon in patients with HCV-related cirrhosis showed that treated patients had a lower incidence of HCC.

    A greater effect was observed in patients who achieved sustained virological response, while the benefit in non-responders is unclear. Antiviral therapies for hepatitis B and hepatitis C can prevent but not completely eliminate HCC.

    Improvement in identification of infected persons, accessibility of care and affordability of treatment is needed for antiviral therapy to have a major impact on the global incidence of HCC.

    Ribavirin priming improves the virological response to antiviral treatment in transplanted patients with recurrent hepatitis C: a pilot study
    Merli M, Giannelli V, Gentili F, Giusto M, Simmaco M, Lionetto L, Corradini SG, Biliotti E, Attili AF, Rossi M, Taliani G; Antiviral Therapy 16 (6), 879-85 (2011)

    INTRODUCTION
    Patients with hepatitis C recurrence after liver transplantation represent a clinical challenge. Antiviral treatment in transplant patients has usually poor tolerability and limited efficacy, with a mean sustained virological response (SVR) of 30%. Our pilot study was aimed at evaluating whether 8-week ribavirin pre-treatment could increase either adherence or antiviral effect of a 48-week combination therapy.

    METHODS
    Ribavirin pre-treatment (8 weeks) was started with 600 mg daily and increased to 10.4 mg/kg/day. After pre-treatment, 1.5 μg/kg/week pegylated interferon-α2b was added for 48 additional weeks of combination therapy. Blood count, liver function tests and plasma HCV-RNA were examined monthly. Ribavirin plasma concentrations were determined by HPLC.

    RESULTS
    Thirteen patients (mean age 53 ±2 years, 11 males) were treated: eight were HCV genotype 1/4; five were genotype 2/3. The median baseline HCV RNA level was 6.5 log (10) (range 5.84-7.42 log (10) ). During ribavirin pre-treatment the median HCV RNA levels decreased significantly (5.7 log (10) ; P=0.023). During combination therapy 6/13 (46%) patients exhibited a rapid virological response (RVR) and 10/13 (77%) patients a complete early virological response, two were non-responders. A decline of 0.5 log (10) HCV RNA during pre-treatment predicted RVR. SVR occurred in six patients (46%): four were genotype 2/3. Stable ribavirin dose reduction was required in only two patients (15%) in whom transient interferon reduction was also required.

    CONCLUSION
    This proof-of-concept study indicates that ribavirin pre-treatment increased the tolerability of the antiviral treatment, and improved its efficacy in liver transplant patients. Moreover, the degree of HCV RNA decline during pre-treatment allowed one to predict on-treatment response.

    Analysis of the Complete Open Reading Frame of Genotype 2b Hepatitis C Virus in Association with the Response to Peginterferon and Ribavirin Therapy
    Patients infected with genotype 2b hepatitis C virus (HCV) generally can achieve favorable responses to pegylated-interferon plus ribavirin therapy (PEG-IFN/RBV). However, a proportion of patients show poorer responses and the correlation between viral sequence variation and treatment outcome remains unclear.The pretreatment complete open reading frame (ORF) sequences of genotype 2b HCV determined by direct sequencing were investigated for correlation with the final outcome in a total of 60 patients...Full Text

    Related; RSS From PLoS ONE Blog

    From Expert Review of Anti-Infective Therapy
    Management of Viral Infections in Solid Organ Transplant Recipients
    Raymund R Razonable
    Authors and Disclosures
    Posted: 09/16/2011; Expert Rev Anti Infect Ther. 2011;9(6):685-700. © 2011 Expert Reviews Ltd.

    Introduction Only
    Click Here For Full Text
    Viruses are major pathogens that cause morbidity and mortality after solid organ transplantation (SOT). Some of these infections generally follow a stereotypical temporal pattern. The first month after SOT represents the period when herpes simplex virus (HSV)-seropositive transplant recipients are at highest risk of HSV-1 and HSV-2 infection.[1] Other viruses that present during this time are often donor derived, such as the rare transmission of West Nile virus, rabies virus and lymphocytic choriomeningitis virus.[2–4] The classic 'opportunistic' viral pathogens typically occur during the second to the sixth months after SOT, when impairment in cell-mediated immunity is most intense; primary or reactivated cytomegalovirus (CMV) disease is most common during this period.[5–9] During the 'late period,' which begins more than 6 months after SOT, Varicella zoster virus (VZV) may reactivate to cause mono- or multidermatomal zoster or disseminated disease. Liver recipients with chronic viral hepatitis B and C may have an accelerated course that progresses to allograft failure.[10–14]


    Late-onset CMV disease, with either classic or atypical presentation, may also occur.[15–21] Adenoviruses and community-acquired respiratory viruses such as respiratory syncytial virus (RSV), influenza virus and parainfluenza virus occur anytime after SOT, but with the risk of severe illness and outcome during the first 3 months.[22,23]

    Epstein–Barr virus infection may occur anytime after SOT to cause post-transplant lymphoproliferative disorders (PTLDs).[9,24] In endemic regions, human herpesvirus 8 (HHV-8) reactivation may lead to the development of Kaposi's sarcoma (KS). In this article, the current management of virus infections after SOT are discussed, with particular focus on herpes, hepatitis, polyoma and RNA viruses causing respiratory diseases... Continue Reading..

    Ask the Doctor: What is Hepatitis and HIV co-infection?
    Hepatitis is a viral infection that attacks liver cells. There are three main types of hepatitis: A, B and C. Hepatitis A is a liver infection caused by a virus that does not produce long-term or chronic liver problems... Continue Reading..

    T cells making brain chemicals may lead to better treatments for inflammation, autoimmune diseases
    MANHASSET, NY -- Scientists have identified a surprising new role for a new type of T cell in the immune system: some of them can be activated by nerves to make a neurotransmitter (acetylcholine) that blocks inflammation. The discovery of these T cells is novel and suggests that it may be possible to treat inflammation and autoimmune diseases by targeting the nerves and the T cells. The study was published this week in Science.

    "The discovery that 2 percent of T cells can make acetylcholine under the control of nerves gives a new insight into how the nervous system regulates immunity," said Kevin J. Tracey, MD, president and chief executive officer of The Feinstein Institute for Medical Research, and principal investigator of the study. "The arrival of electrical signals from nerves activates these specialized T cells to produce the acetylcholine necessary to block inflammation, and protect against damage. It is possible to transfer these cells to cross-protect mice from inflammation, and to control these T cells by electrically stimulating the nerves directly."

    The present study followed years of work from Dr. Tracey's lab that identified the role of the vagus nerve, named for its wandering course from the base of the brain to the liver, spleen and other organs, in blocking inflammation. Applying electrodes to stimulate the vagus nerve blocked the release of tumor necrosis factor (TNF) and other cytokines that underlie the tissue damage in arthritis, inflammatory bowel disease and other syndromes. Stimulating this nerve pathway led to increased production of acetylcholine, a neurotransmitter that binds to the alpha 7 nicotinic acetylcholine receptor. Activating this receptor on macrophages blocked the release of immune molecules (the cytokines,) suggesting a novel strategy for developing anti-inflammatory agents.

    But these results raised an important question because the nerve fibers in spleen release norepinephrine, another neurotransmitter, but not acetylcholine. The search for the cells that produce acetylcholine led these investigators to use "nude" mice, devoid of T cells. Then they examined the spleen cells that make acetylcholine and that led them to a subset of T cells. Transferring these acetylcholine producing T-cells into nude mice restored the vagus nerve circuit that blocked inflammation.

    "Our results point to a population of acetylcholine-synthesizing memory T cells in spleen that is integral to the function of the inflammatory reflex, the nerve circuit that regulates inflammation and immunity," said Dr. Tracey. "It is as if these T cells occupy a nerve-like function in this important circuit."

    It should be possible to target these T cells and to modulate this neural circuitry to develop therapeutic modalities for inflammatory and autoimmune diseases. In the future, it may be possible to isolate these T cells and exploit their anti-inflammatory activity. In the meantime, there is a more direct route to use this discovery for therapy. Rheumatoid arthritis patients in Europe are being studied in clinical trials where vagus nerve stimulators are implanted and turned on to stimulate this circuit and suppress inflammation.
    ###
    About The Feinstein Institute for Medical Research Headquartered in Manhasset, NY, The Feinstein Institute for Medical Research is home to international scientific leaders in Parkinson's disease, Alzheimer's disease, psychiatric disorders, rheumatoid arthritis, lupus, sepsis, inflammatory bowel disease, diabetes, human genetics, leukemia, lymphoma, neuroimmunology, and medicinal chemistry. The Feinstein Institute, part of the North Shore-LIJ Health System, ranks in the top 6th percentile of all National Institutes of Health grants awarded to research centers. For more information: http://www.feinsteininstitute.org/

    This video covers Hepatitis A after exposure

    *Remember that chronic liver disease puts you at risk for serious complications if you get infected with the hepatitis A virus.

    Dr. Ron Warner answers viewers questions about Hepatitis A
    Ron Warner, Ph.D., is an Infectious Disease Specialist and Professor at the Texas Tech Health Sciences Center. He has provided this information to our viewers in addition to the questions he answered in our segment on NewsChannel 11 at Ten.
    -Karin McCay







    Media

    37 students stabbed with needle in Puerto Rico
    By Danica Coto, Associated Press
    SAN JUAN, Puerto Rico — A 14-year-old girl went on a playground rampage with a hypodermic needle, stabbing 37 classmates, Puerto Rican officials said Thursday."She would stab one, run, stab another, run, like it was some sort of joke," Education Secretary Jesus Rivera Sanchez said about Tuesday's lunchtime attack on 12- to 14-year-olds at the Jose de Choudens middle school in the southern coastal town of Arroyo.Health Department spokeswoman Margarita Casalduc said it was unclear if the syringe contained anything and further tests were needed to determine if it was contaminated.But the victims, accompanied by their shaken parents, gathered at a convention center to be tested for HIV and hepatitis C and to be given preventive medications.Sanchez said counselors also were helping the victims and their parents.

    Social workers were interviewing the alleged attacker to try to determine a motive, Justice Department spokesman Fidel Rodriguez said. He said no charges had yet been filed, but officials said she had been suspended from school.Rivera said the girl first told investigators she found the syringe, but later said she stole an unused one while visiting a relative at a hospital and had planned to pierce her ear with it. He said it was not clear why she decided to attack her classmates.A woman who answered the phone at the school said the director, Gloria Ramos, was not available for comment.

    Pharmaceutical

    Teva bets $7.5M on hep C program at upstart Cocrystal
    As the generic drug giant pushes to capitalize on more novel therapies, Teva Pharmaceutical ($TEVA) has invested an initial $7.5 million in Bothell, WA-based developer Cocrystal Discovery to advance its work on new drugs targeting the hepatitis C virus. If it likes what it sees, Teva has the option to pump more money into the upstart, which is focused on small-molecule antiviral drugs.
    Hep C has attracted lots of pharma investment due to the white-hot market opportunity for developing oral drugs that home in on viral replication enzymes. Upping its bet on the hep C game after Vertex ($VRTX) and Merck ($MRK) hit the market this year with protease inhibitors against the liver-wrecking virus, Teva has gained an option for exclusive development rights to Cocrystal's drug. The generic drugmaker also has the option to back Cocrystal's development of antiviral drugs for other diseases. The start-up now has programs in influenza and the common cold... Continue Reading...

    Will the UN backtrack on accessible medicine?
    The US and Europe are pushing the UN to flout the Doha Declaration, which improves poorer countries' access to drugs.
    The term "compulsory license" is used to describe cases in which governments or courts set aside the exclusive rights of a patent, and allow others to use inventions, normally in return for a royalty payment to the patent owner. In such cases, the patent is no longer an absolute monopoly to use the invention, but does ensure that patent owners are paid when the inventions are used by third parties.
    The use of compulsory licenses are as old as the patent system itself (a 1474 Venetian statute and an English law passed in 1623 both sanctioned compulsory licenses), and are used in a wide range of cases. While maintaining an active trade policy to prevent developing countries from using compulsory licenses for patents on medicines, at home the United States has used compulsory licenses to expand access to patented inventions to treat cancer, diagnose the Hepatitis C virus, manufacture contact lenses, and treat aortic valve heart disease.

    Health Insurance

    Helping the uninsured sign up for health insurance
    As you may have heard, a new nonprofit group launched yesterday to help get Americans – specifically those who, beginning in 2014, will be eligible for coverage under the Affordable Care Act – signed up for insurance. Enroll America, a coalition of 42 companies and organizations, is planning a state-by-state publicity campaign and will launch an effort to help state leaders “put in place procedures to simplify enrollment.” (Its website also offers resources for people currently looking for coverage.) Over at Wonkblog, Sarah Kliff tells readers they should keep an eye on the group:
    Enroll America is taking on a challenging issue on in a big way. The majority of uninsured Americans don’t think the health reform law will help them, the most recent Kaiser Family Foundation report found.As the Hill’s Sam Baker smartly pointed out, polling data seems to show Americans forgetting what the reform law does as we move further away from its passage. “Our biggest hurdle is most people don’t even know this is coming,” says Rachel Klein, director of Enroll America. How much a multi-million campaign can change that will be a key factor to watch in the health law’s success... Continue Reading...

    FYI

    Tempest In A Lunch Box: Arsenic Traces In Apple Juice
    A lot of parents might be worried about what's in their kids' sippy cups if they caught a recent report by TV talk show host Dr. Mehmet Oz about high levels of arsenic in popular brands of apple juice.
    But the Food and Drug Administration and medical experts are attacking Oz's report, saying it's inaccurate and needlessly panics parents.

    Monday, August 15, 2011

    What Factors Determine the Severity of Hepatitis A-related Acute Liver Failure?

    From Journal of Viral Hepatitis
    What Factors Determine the Severity of Hepatitis A-related Acute Liver Failure?
    V. Ajmera; G. Xia; G. Vaughan; J. C. Forbi; L. M. Ganova-Raeva; Y. Khudyakov; C. K. Opio1, R. Taylor; R. Restrepo; S. Munoz; R. J. Fontana; W. M. Lee
    Authors and Disclosures
    Posted: 08/15/2011; J Viral Hepat. 2011;18(7):e167-e174. © 2011 Blackwell Publishing

    Abstract and Introduction
    Abstract
    The reason(s) that hepatitis A virus (HAV) infection may progress infrequently to acute liver failure are poorly understood. We examined host and viral factors in 29 consecutive adult patients with HAV-associated acute liver failure enrolled at 10 sites participating in the US ALF Study Group. Eighteen of twenty-four acute liver failure sera were PCR positive while six had no detectable virus. HAV genotype was determined using phylogenetic analysis and the full-length genome sequences of the HAV from a cute liver failure sera were compared to those from self-limited acute HAV cases selected from the CDC database. We found that rates of nucleotide substitution did not vary significantly between the liver failure and non-liver failure cases and there was no significant variation in amino acid sequences between the two groups. Four of 18 HAV isolates were sub-genotype IB, acquired from the same study site over a 3.5-year period. Sub-genotype IB was found more frequently among acute liver failure cases compared to the non-liver failure cases (chi-square test, P < 0.01). At another centre, a mother and her son presented with HAV and liver failure within 1 month of each other. Predictors of spontaneous survival included detectable serum HAV RNA, while age, gender, HAV genotype and nucleotide substitutions were not associated with outcome. The more frequent appearance of rapid viral clearance and its association with poor outcomes in acute liver failure as well as the finding of familial cases imply a possible host genetic predisposition that contributes to a fulminant course. Recurrent cases of the rare sub-genotype IB over several years at a single centre imply a community reservoir of infection and possible increased pathogenicity of certain infrequent viral genotypes.

    Introduction
    Hepatitis A virus (HAV), a single stranded RNA virus, is endemic throughout most of the world and is also highly genetically conserved.[1,2] In the United States, rates of infection have dropped significantly with increased use of the hepatitis A vaccine, however the estimated incidence is still above 30 000 new infections per year.[3] The infection usually follows an innocuous course, remaining sub-clinical in most children, while appearing as acute self-limited hepatitis in adults. Less than 1% of acute hepatitis A cases result in acute liver failure.[4,5] HAV infection currently accounts for only 3% of adult acute liver failure (ALF) cases in the United States.[4,6] Although hepatitis A-related ALF patients experience a relatively high spontaneous survival rate (69%), the remaining patients either die or require emergency liver transplantation.[7]

    The relationship between self-limited hepatitis A cases and those HAV infections resulting in ALF (HAV ALF) is poorly understood. Host factors including age and underlying liver disease are thought to increase the likelihood of a fulminant course.[8,9] Viral factors including low viral load and a higher rate of substitution in the 5' untranslated region (UTR) of the viral RNA have also been correlated with increased frequency of HAV-related ALF.[10,11] Another potential viral factor is genotype. Epidemiologic studies in the United States have demonstrated that sub-genotype IA is most common, comprising 98% of infections, while sub-genotype IB is found in only 2%; most IB infections have been associated with international travel.[12] To date, no correlation between ALF and HAV genotype has been evident but this has not been systematically examined. Previous studies have focused on the 5' UTR and VP1-P2B regions, while only small case series have evaluated the entire HAV genome of HAV ALF cases.[13] This study aimed to further explore both host and viral factors, including genotype and nucleotide sequence variation in the entire HAV genome among consecutive adult cases of HAV ALF from the multicentre adult US acute liver failure registry. To identify factors contributing to variation in outcomes, full genome sequences of 18 HAV ALF cases were compared to geographically matched controls: patients with self-limited acute HAV identified in the CDC database.

    Patients and Methods
    The adult US Acute Liver Failure Study Group (ALFSG) is a cooperative effort of 23 tertiary liver centres to study the aetiology and outcomes of ALF.[14] Twenty-nine patients from the ALFSG registry were diagnosed with HAV ALF between January 1998 and May 2004 and all of these patients were included in this study. ALF was defined as the onset of encephalopathy and coagulopathy within 26 weeks of first symptoms of hepatic illness with no prior history of liver disease.[15] Encephalopathy was defined as any degree of altered mentation while coagulopathy was defined by an international normalized ratio (INR) ≥1.5. ALF was attributed to acute HAV infection when a positive IgM anti-HAV antibody test was obtained in conjunction with consistent clinical findings by the site investigator and the data-coordinating centre. All patients tested negative for other markers of acute viral infection including HBsAg, anti-HBc IgM, anti-HCV with the exception of two patients. One had typical acute HAV infection but was hepatitis C virus (HCV) antibody positive without detectable HCV RNA on repeated testing, unlikely to represent acute hepatitis C. One patient had evidence of both chronic hepatitis B and C with detectable HBsAg, anti-HCV, HBV DNA and HCV RNA detected but was shown to be anti-HAV IgM positive and recovered fully from ALF.

    Informed consent, approved by the Institutional Review Board of each of the respective centres, was obtained from the next of kin due to the patients' altered mental status and all cases were coded to maintain anonymity. Detailed data including the patients' demographics, history, laboratory results, and outcome were obtained. Sera were collected daily for up to 7 days, stored at −80 °C and shipped to the central repository for continued storage prior to testing.
    A series of randomly selected sera from US and Mexican patients with acute hepatitis A infection in the CDC database was used as controls for the HAV whole-genome analysis. These control sera included 20 sub-genotype IA and 8 sub-genotype IB specimens obtained over a similar time frame from a comparable US geographic distribution as the HAV ALF cases.

    HAV RNA Amplification and Sequencing
    Serum samples (collected on day 1 or no later than day 4) were available from 24 of 29 patients. These samples were used for HAV whole-genome amplification. HAV surveillance databases at the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA were accessed to form a demographically comparable control group of acute hepatitis cases for comparison of the entire viral RNA genome. RNA was extracted using the Total Nucleic Acid Isolation kit in conjunction with a MagNAPure LC system (Roche Applied Science, Indianapolis, IN, USA). Extracted RNA was used as a template in a one step RT-PCR reaction (QIAGEN, Valencia, CA, USA) to amplify 14 different overlapping fragments encompassing the entire length of the HAV genome. Nested PCR was carried out for each amplicon to generate fragments suitable for sequencing. Sequencing of both DNA strands was carried out with the corresponding internal primers using BigDye v3.1 chemistry (Applied Biosystems, Foster City, CA, USA). The resulting products from the sequencing reaction were cleaned using the Millipore Montage SEQ96 Cleanup Kit (Millipore, Billerica, MA, USA) and later run on 3130xl Genetic Analyzer (Applied Biosystems). All reactions were performed on a Biomek 3000 Laboratory Automation Workstation (Beckman Coulter, Fullerton, CA, USA). Sequences were assembled and preliminarily analysed using SeqMan and MegAlign programs from the Lasergene DNA & Protein analysis package v8.0.2 (DNASTAR Inc., Madison, WI, USA) The Accelrys GCG Package v11.0 (Accelrys Inc. San Diego, CA, USA) was used for phylogenetic analysis. Shannon entropy was expressed as mean + standard deviation (SD). Differences in Shannon entropy and viral genetic identity were tested by ANOVA. sas for Windows version 9.2 (SAS Institute Inc., Cary, NC, USA) was used for statistics analysis.

    Measurement of Acetaminophen Protein Adducts
    Adducts in sera were measured using a high-performance liquid chromatography method with electrochemical detection as previously described.[16,17]

    Results
    Epidemiological Data
    The 29 patients were obtained from 10 of the 23 ALFSG sites; demographic and laboratory data are shown in Table 1. Four patients with sub-genotype IB were from the same site (site 23, University of Michigan) and presented over the course of 3.5 years. That same site demonstrated one sub-genotype IA case during the study period as well. Site 35, Albert Einstein Medical College, recorded two related HAV ALF patients admitted within 1 month of each other, a mother and son. The mother's infection preceded the son's. Although they did not live together they had shared meals during the mother's period of infection. There were no other known interactions between patients or common risk factors other than geographic location and none of the patients had migrated from an endemic area outside of the United States.

    Patient Outcomes
    Sixteen of twenty-nine (55%) patients recovered spontaneously (e.g. without transplantation). Nine of twenty-nine (31%) received a liver transplant and eight survived at least 3 weeks post transplant. Four of twenty-nine patients (14%) died from renal failure, brain oedema, respiratory failure or cardiac arrest.

    HAV Genetic Analyses
    Eighteen of twenty-four (75%) samples were RT-PCR positive (Table 1). To confirm the PCR negative results, we repeated testing on later (day 3) samples. Five of the six remained negative. The entire genome of 15 of the 18 initially PCR positive cases was sequenced. Within the three cases that could not be completely sequenced; the VP1-P2B (nt 2912–3277) region and 5' UTR were sequenced successfully. Based on phylogenetic analysis of the VP1-P2B region 14 cases were classified as sub-genotype IA and 4 cases as sub-genotype IB. The complete HAV-genome sequences of the 15 ALF cases were compared with a control group of sequences of sub-genotype IA (n = 20) and sub-genotype IB (n = 8) retrieved from the CDC surveillance databases of acute hepatitis A cases (Fig. 1). The nucleotide and amino acid sequences were compared between ALF cases and controls within the same sub-genotype. There were no apparent sequence differences or specific nucleotide/amino acid substitutions between ALF cases and controls. Also, no significant differences by ANOVA were observed in the Shannon entropy and genetic similarity between the ALF case and control sequences among sub-genotype IA. The mean nucleotide identity among ALF cases and control sequences were 96.8 per 100 nucleotides (SD = 1.78) and 96.6% (SD = 1.81) among the sub-genotype IA (ANOVA, P = 0.447; Table 2).

    However, similar analyses of the HAV sub-genotype IB sequences showed a higher nucleotide and amino acid identity among HAV variants from ALF cases than controls (ANOVA, P < 0.01; Table 2). Rates of spontaneous survival were not significantly different between the two sub-genotypes (chi-square test, Table 3).

    PCR Negative Cases
    The six PCR negative samples had viral loads below the lower limit of detection of the assay of 0.1 plaque forming units/100 μL.[18] PCR negative patients experienced worse outcomes than those who were PCR positive (Table 3); transplant free survival amongst PCR positive cases was 77.8% while PCR negative cases experienced a transplant free survival of 16.7% (chi-square test, P < 0.01). Being PCR positive was associated with a decreased risk of death or transplant with an odds ratio of 0.057 (95% confidence interval 0.005–0.641, P = 0.02). Of interest, the PCR negative cases as a group had lower mean peak ALT levels: 1414 IU/L compared to 3113 IU/L for the PCR positive ALF patients. Prothrombin time/international normalized ratio (INR) values were slightly more prolonged: 3.9 in the PCR negative patients vs 2.9 for PCR positive cases.

    HAV Genotype IB
    Four out of eighteen (22%) of the PCR positive ALF patients were infected with sub-genotype IB, which is rare in the United States. Though not identical, the sequences were remarkably similar although the cases occurred over a three and a half year period. None of the patients were born abroad nor had they visited countries where genotype IB is more common. During the same observation period (1998–2004), only 19 (2.2%) sub-genotype IB cases were detected in the United States among 834 hepatitis A cases identified through different surveillance projects and this was also highly significant (P < 0.01) by chi-square test.

    Patient Co-factors
    Case report data revealed that 12 of 29 patients (41.4%) reported having taken more than 1g of acetaminophen/day for at least 3 days preceding hospital admission (Table 1), therapeutic dosing that might indicate possible toxicity in the setting of viral hepatitis. Four patients reported regular alcohol consumption (>2 drinks per night), one of whom also took acetaminophen. There was no correlation between a history of acetaminophen use and poorer outcomes. Acetaminophen adducts were measured in all 24 for whom sera were available; 20 were undetectable and four demonstrated levels below 1.0 nmol a-cys adducts/mL (range 0.18–0.34). None were considered compatible with liver toxicity due to acetaminophen.[16] A more detailed clinical description of these cases has been published recently. As in our prior report of the same 29 cases, subject age, gender, and MELD score were not predictive of patient outcomes.[19]

    Discussion
    Since prior studies had suggested a possible difference in viral substitutions between HAV ALF patients and other patients with acute HAV, we were interested in further exploring whether unique viral genome patterns might predispose hepatitis A patients to liver failure. We did not find a clear difference in genomic sequences between patients with HAV ALF and those with self-limited hepatitis A.

    The rates of single nucleotide substitutions in the complete HAV genome including both the 5' UTR and the VP1-P2B regions showed no significant variation between those with HAV ALF and patients with uncomplicated acute hepatitis A infection. This finding suggests that variation in severity of hepatitis A infection is not dependent upon rates of substitution in the internal ribosomal entry site of the 5' UTR or elsewhere in the genome. Furthermore, the differences in rates of substitution in the transcribed amino acid residues were also not significant in the two groups (Table 2).

    Only a small fraction (8%) of acute HAV sera from a previous large CDC cohort study was shown to be PCR negative during the acute illness.[12] Among our HAV ALF study patients, 25% (6/24) were PCR negative and this status correlated with significantly worse outcomes defined by a lower rate of spontaneous survival. The inability to obtain PCR products in our study corresponds with an undetectable or very low viral load. Low or undetectable viral load at presentation has been previously cited as a significant factor differentiating fulminant from non-fulminant cases for both hepatitis A[11] and hepatitis B.[20] In vitro studies suggest that the immunologic response is primarily responsible for the liver disease in HAV infections.[21] In our study, undetectable viral load not only correlated with more severe disease, but also indicated a worse outcome amongst the ALF cases. However, the small number of patients with undetectable HAV RNA may limit the generalizability of this finding. Quantitative PCR was not available for this study.

    With regard to use of acetaminophen, 12 of 29 patients gave a history of acetaminophen ingestion of at least 1 g/day for a minimum of 3 days (Table 1). We could not relate a history of acetaminophen ingestion to poorer outcomes or to more severe disease in this small case series, nor could we identify other demographic or clinical factors such as age or gender to be associated with poor outcome (Table 1).

    Additional data were obtained on two clusters of HAV ALF cases with highly conserved viral RNA genomes. The first revealed a mother and son, both of whom presented with HAV ALF within 1 month of each other to the same clinical centre and without pre-existing liver disease. Although they did not live together, they shared meals together during the time of the first patient's infection and the close genetic similarity of their viruses confirms that infection appears to have been transmitted from mother to son. HAV ALF cases transmitted between family members have been reported in the literature, specifically the occurrence of HAV ALF among siblings.[22,23] Often the virus was transmitted to the family via a community outbreak of routine HAV infections, suggesting that host factors contributed to these more severe outcomes. Furthermore, all reported inter-familial occurrences of HAV ALF have been among patients with no pre-existing liver condition. In both previously reported studies of siblings, the infections occurred in young patients whose age ranged from 16 to 24 years. Genetic predisposition to a fulminant course could be a factor considering the inter-familial HAV ALF outbreak we observed in our study, emphasizing the possible importance of the immunological response to outcome.
    A second cluster of HAV ALF cases came from a single centre. Four of five cases from this site were sub-genotype IB, which occurs very infrequently in the United States. This finding coincides with epidemiological data from typical acute hepatitis A cases that suggest that community reservoirs of infection may be present for long periods of time under certain circumstances.[12] The near identity of all four IB sequences, coupled with the rarity of genotype IB, suggest ongoing transmission of this one strain within the community and that it may be somewhat more virulent than other subtypes but this remains highly speculative.
    Our study was limited in that we had serum samples on only 24 of the 29 patients with HAV ALF in the study. In addition, we could not perform phylogenetic analysis on five of the six patients because they were PCR negative repeatedly during the study period. Finally, the case controls used in this analysis of whole genome sequencing were not obtained from the same local hospital as the ALF index case due to the limited number of annual HAV cases that the CDC has access to. Nonetheless, matching based upon medical centre location and year of infection was undertaken. The small number of cases in this study of acute liver failure provides further evidence of the declining incidence of HAV infection in the United States.[19]

    In conclusion, viral factors including substitution rate in the entire genome do not seem to differ between HAV ALF patients and those with uncomplicated hepatitis A infection in North America. While this study is limited in the number of cases presented, the rapidly declining rate of HAV and HAV associated ALF make it unlikely that larger studies will be possible in the future at least in the United States. However, further analysis of genotype I should be performed, particularly in locations where HAV is still endemic. An undetectable viral load at the onset of liver failure correlated in our study with worse outcomes. HAV RNA testing by PCR, if it were readily obtainable, might help determine prognosis but should not be used to preclude referral and listing for transplantation. The association of undetectable viral load with poor outcome suggests a genetic predisposition to a 'excessive' host immune response contributes to the more severe disease observed. This is further supported by the occurrence of familial ALF case clustering. Whole genome sequence analyses of patients with ALF of diverse aetiologies compared to ethnically matched controls may prove useful in identifying the genetic basis for differences in outcomes with hepatotrophic viruses.[24]

    Abstract and Introduction
    Patients and Methods
    Results
    Discussion
    References