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The norovirus, best known for causing diarrhea and vomiting on board cruise ships, can cause problems on airplanes as well, researchers have found.

On October 8, 2008, a flight from Boston to Los Angeles was diverted to Chicago shortly after take off after multiple passengers suffered acute gastrointestinal illness, including vomiting and diarrhea, thought to be caused by the highly contagious norovirus. The ill passengers were members of a tour company’s New England fall foliage bus tour who were returning home to California.

In Chicago, the airline passengers not from the tour group boarded a different plane and continued their trip west, while the tour group remained in Chicago overnight. Several were hospitalized.

A subsequent investigation by the U.S. Centers for Disease Control and Prevention in Atlanta and the New Hampshire Department of Health in Concord found 6 confirmed and 9 probable cases of norovirus infection among tour group members on the plane, as well as 1 confirmed and 6 probable cases of norovirus infection in the non-tour group airline passengers.

“The symptoms and timing of illness” (within 48 hours of the flight) among non-tour group passengers was consistent with norovirus transmission on the airplane, Dr. Daniel Fishbein, the CDC researcher who led the investigation, told Reuters Health. The same strain of norovirus was recovered from stool samples of both the tour group members and one of the ill non-tour group passengers.

Sitting in an aisle seat or near a tour group member were strong risk factors for becoming ill, which suggests to investigators that transmission occurred either directly through person-to-person contact or indirectly via contamination of armrests, tray tables, or seat controls.

“This is the first time passenger-to-passenger transmission (of norovirus) has been documented on an airplane,” Dr. Aron Hall, a CDC epidemiologist involved in the investigation, told Reuters Health by email. Hall said only three other norovirus outbreaks on airplanes have been reported in the medical literature.

In an email to Reuters Health, Dr. John Holmes, of the University of Otago in Dunedin, New Zealand, who last year published a paper on a norovirus outbreak on an airplane, noted that the compact layout of bathroom facilities on aircraft hinder good hand-washing techniques that can prevent spread of norovirus and also pose problems for crew cleaning up after contamination from vomiting or diarrhea.

He said travelers can avoid mid-air infection by carrying a small vial of alcohol hand sanitizer to be applied while using aircraft toilets and before eating. “Do not put your fingers into your mouth after you have touched aircraft seats, fittings or other surfaces that may be contaminated,” he advised.

Holmes, an official with the New Zealand Health Ministry, said people who feel nauseated should postpone travel. He said ill travelers often are unwilling to postpone trips because airlines and tour companies are reluctant to rebook without extra charges.

Fishbein and colleagues suggest that travelers buy traveler’s insurance, so ill people might feel less compelled to travel. Motion-sensing or foot-operated faucets, soap dispensers and drains in plane lavatories could reduce spread of disease.

SOURCE: Clinical Infectious Diseases.

Cocoa-rich dark chocolate could be prescribed for people with liver cirrhosis in future, following the latest research to show potential health benefits of chocolate.

Spanish researchers said on Thursday that eating dark chocolate capped the usual after-meal rise in abdominal blood pressure, which can reach dangerous levels in cirrhotic patients and, in severe cases, lead to blood vessel rupture.

Antioxidants called flavanols found in cocoa are believed to be the reason why chocolate is good for blood pressure because the chemicals help the smooth muscle cells of the blood vessels to relax and widen.

A study of 21 patients with end-stage liver disease found those given a meal containing 85 percent-cocoa dark chocolate had a markedly smaller rise in blood pressure in the liver, or portal hypertension, than those given white chocolate.

“This study shows a clear association between eating dark chocolate and (lower) portal hypertension and demonstrates the potential importance of improvements in the management of cirrhotic patients,” said Mark Thursz, a professor of hepatology at London’s Imperial College.

The results were presented at the annual meeting of the European Association for the Study of the Liver in Vienna and follow a number of earlier scientific studies suggesting that dark chocolate also promotes heart health.

Cirrhosis is scarring of the liver as a result of long-term damage. It is caused by various factors, including hepatitis infection and alcohol abuse.

(Reporting by Ben Hirschler; editing by Philippa Fletcher)

U.S. officials report a continuing decline in food-related illnesses caused by several common bacteria, including the most virulent form of E. coli.

But Vibrio, a pathogen most often acquired from oysters which can cause severe illness or even death, is on the rise, while rates of Salmonella infection have remained flat in recent years.

“Overall, this year’s report shows a reduction in the number of illnesses due to many of these important pathogens over the past 10 to 15 years,” said Dr. Chris Braden, acting director of the Division of Foodborne, Waterborne and Environmental Diseases at the U.S. Centers for Disease Control and Prevention (CDC).

“This reflects the impact of measures to prevent foodborne illness, but additional measures are needed,” he said at a Thursday press conference.

The preliminary 2009 data comes from the interagency FoodNet system, which tracks laboratory-confirmed illness from nine bacteria in 10 states. The findings are published in the April 16 issue of the CDC journal Morbidity and Mortality Weekly Report.

Infections caused by Campylobacter, Listeria, Salmonella, Shiga-toxin-producing E. coli (STEC) 0157, Shigella and Yersinia, have declined overall since 1996.

But decreases in the incidence of infections caused by Salmonella, Listeria and Campylobacter have essentially plateaued since 2004, causing some concern.

“Salmonella continues to be a challenge. It is the most commonly diagnosed foodborne illness,” Braden said. “Its incidence has declined by 10 percent since 1996, but it is the furthest of any of the pathogens for the goals we have set for reduction.”

Not all Salmonella infections are transmitted by food. Some occur from direct contact with baby chicks, turtles, frogs or their environment and from drinking contaminated water, Braden added.

Shigella and E.coli infections have decreased significantly since 2006.

“Infections of STEC 0157 [E. coli] , which causes one of the most severe forms of illness, showed an early decline, then plateaued,” Braden said. “Then, in 2009, it decreased by 25 percent compared with the previous three years and has reached its lowest level since 2004. The decrease may be due to continuing efforts to decrease contamination of ground beef and leafy green vegetables consumed raw.”

Although the incidence of Vibrio-related illness is up, the pathogen causes only a small percentage of overall foodborne illness, Braden said.

“The illnesses are typically attributed to temperature exposure of the shellfish after they’re harvested so we have been trying to improve the practices in the industry in that regard,” said Donald Kraemer, deputy director of the U.S. Food and Drug Administration’s Office of Food Safety. “States have, within the last couple of years, implemented some controls but unfortunately we haven’t seen the numbers come down so we are taking a look at why that is.”

But officials emphasized that consumers can implement protective measures in their own homes.

“Consumers can always protect themselves if they follow our four safe-handling guidelines: clean, separate, cook and chill,” said Dr. David Goldman, assistant administrator of the Office of Public Health Science, part of the U.S. Department of Agriculture’s Food Safety and Inspection Service. “This provides some extra measure of safety.”

SOURCES: 2010 press teleconference with Chris Braden, M.D., acting director, Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention; David Goldman, M.D., assistant administrator, Office of Public Health Science, U.S. Department of Agriculture Food Safety and Inspection Service; Donald Kraemer, deputy director, Office of Food Safety, U.S. Food and Drug Administration;

Death and disease rates vary widely among distinct groups of Asian Americans, Native Hawaiians and Pacific Islanders, but these groups can benefit from culturally appropriate prevention and care programs, new studies show.

Among the findings:
The breast cancer death rate among Asian-born women in the United States is up to four times higher than among U.S.-born Asian women.
While heart disease is the leading cause of death for most women in the United States, among Asian-American women cancer is the leading cause of death. Breast cancer has the highest incidence and is the second-leading cause of cancer death in these women.
Lung and bronchial cancer are leading causes of death among Asian-American men. But a culturally sensitive approach to community health led to large reductions in smoking among Vietnamese, Cambodian and men of several other Asian ethnicities in four U.S. communities.
Vietnamese Americans have lower rates of colorectal cancer screening than other Asian-Americans or whites. But the use of Vietnamese language public health education campaigns about colorectal cancer increased the screening rate.
Rates of liver and cervical cancer among the Hmong in California (refugees who came to the U.S. from Laos after the Vietnam War) are three to four times higher than those of other Asian-American and Native Hawaiian and Pacific Islander groups.

The studies were published online March 18 in a special issue of the American Journal of Public Health devoted to Asian-American and Native Hawaiian and Pacific Islander populations.

“We are failing to adequately address cancer in our communities,” Marguerite Ro, deputy director of the Asian & Pacific Islander American Health Forum, said in a news release. “Simple measures, such as cancer screening and immunization, along with the delivery of culturally appropriate care in languages understandable to the people who need care, would reduce costly, serious illnesses and lower death rates.”

SOURCE: Burness Communications, news release

The drug Carbaglu (carglumic acid) has been approved by the U.S. Food and Drug Administration to treat a rare genetic disorder called N-acetylglutamate synthase (NAGS deficiency), which results in elevated blood levels of ammonia, the agency said Thursday.

The drug’s safety and effectiveness were evaluated in 23 people with NAGS. Carbaglu reduced blood ammonia within a day and lowered levels to a normal range within three days, the FDA said.

The most common side effects included vomiting, abdominal pain, fever, inflamed tonsils, anemia, ear infection, diarrhea, nasal and throat inflammation, and headache.

The drug should only be administered by a doctor with experience in treating metabolic problems, the agency said. The medication is manufactured by Orphan Europe.

The U.S. Food and Drug Administration today approved Carbaglu (carglumic acid) Tablets to treat a condition that results in too much ammonia in the blood.

The condition, N-acetylglutamate synthase or NAGS deficiency, is an extremely rare, genetic disorder that can be present in babies soon after birth. NAGS deficiency and the resulting elevated levels of ammonia (hyperammonemia) can be fatal if it is not detected and treated rapidly. DNA testing can confirm the diagnosis of NAGS.

“We are very excited that more drugs are being developed to treat very rare but often devastating genetic disorders” said Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research. “We hope to see continuing progress in this area.”

The safety and efficacy of Carbaglu was studied in 23 patients with NAGS who received the treatment for times ranging from six months to 21 years. In these patients, Carbaglu reduced blood ammonia levels within 24 hours and normalized ammonia levels within three days. The majority of those in the study appeared to maintain normal plasma ammonia levels with long-term Carbaglu treatment.

Side effects experienced by those using Carbaglu included vomiting, abdominal pain, fever, tonsillitis, anemia, ear infection, diarrhea, inflammation of the nose and throat, and headache. As with all FDA-approved products, the agency will continue to monitor Carbaglu as it is used to treat hyperammonemia.

Carbaglu should only be administered by a physician experienced in treating metabolic disorders. The recommended initial dose of Carbaglu is 100 to 250 mg/kg/day for treatment of acute hyperammonemia. Use of other ammonia-lowering therapies with Carbaglu during episodes of acute hyperammonemia is recommended. Dosing should be adjusted based on a patient’s ammonia levels and symptoms.

Elderly adults with poor vision, particularly untreated vision problems, may have a higher risk of developing dementia than those with better vision, a new study suggests.

Researchers found that among 625 older Americans with initially normal cognition, those who said they had poor vision even with corrective lenses were more likely to develop dementia over the next 8.5 years.

During the study period, 168 participants developed Alzheimer’s disease or other forms of dementia. Of those men and women, less than 10 percent had rated their vision as “excellent” at the start of the study. That compared with almost 31 percent of participants who maintained normal brain function over the study period.

On the other hand, about one-quarter of the study participants who went on to develop dementia had rated their vision as “fair” or “poor” at the outset, versus 11 percent of those whose memory and thinking remained intact.

When the researchers looked at the effects of treatment, they found that the highest odds of dementia were among people with poor vision left untreated. The risk was lower when they received some form of eye care.

The findings, published in the American Journal of Epidemiology, do not prove that vision problems contribute to dementia — or that eye care can help slow cognitive decline.

But they do suggest that could be the case, according to lead researcher Dr. Mary A.M. Rogers, a research assistant professor of internal medicine at the University of Michigan in Ann Arbor.

It has long been known that there is an association between dementia and vision disorders, Rogers noted in an interview with Reuters Health. But in practice those problems are often detected and treated after a dementia diagnosis.

The current findings, Rogers said, show that vision problems may precede a dementia diagnosis by years.

It’s not clear why eye disorders and poor vision would contribute to dementia. One possibility, Rogers explained, is the fact that limited vision could keep older adults from being active — whether it’s getting out and walking, reading, doing crosswords or socializing. All of those things, she noted, have been linked to a decreased risk of dementia in older adults.

The findings are based on 625 older U.S. adults who were part of a larger health study begun in 1992.

Overall, Rogers’ team found, study participants who reported “very good” or “excellent” vision were 63 percent less likely to develop dementia over the next 8.5 years than those with poor vision.

The researchers then looked at the combined effects of vision problems with or without treatment on the risk of Alzheimer’s disease specifically. Compared with people who had good vision and at least one visit to an ophthalmologist during the study period, those with poor vision and no visits were more than nine times as likely to be diagnosed with Alzheimer’s.

By comparison, among study participants who had poor vision and at least one ophthalmologist visit, the risk of Alzheimer’s was not significantly increased.

Similarly, men and women with poor vision who had received no eye procedures, such as cataract removal, had a five-fold increase in the risk of Alzheimer’s. That risk was elevated by 2.5 times among people with poor vision who had received such procedures.

According to Rogers, the findings imply that older adults with vision problems should seek treatment — if for no other reason than to improve their sight.

“If you have poor vision, don’t sit on it. Go and see your doctor,” she said. It’s best, Rogers added, to see an ophthalmologist, a medical doctor who can diagnose the range of problems common in elderly adults, such as cataract, glaucoma, macular degeneration and diabetes-related retinopathy.

More studies are needed to replicate the current findings and determine whether vision problems are an actual risk factor for dementia, according to Rogers. With the number of people with Alzheimer’s disease increasing, she said, it is becoming even more important to “take a look at the things we can do to either delay or prevent dementia.”

SOURCE: American Journal of Epidemiology

Women who experience depression during pregnancy may have another treatment option, new research suggests.

The study found that women treated with depression-specific acupuncture had a 63 percent response rate compared to a 44 percent response rate in women treated with control acupuncture or massage.

“We tested acupuncture as a standalone treatment, and the results are very positive,” said study author Rachel Manber, a professor at the Stanford University School of Medicine Sleep Medicine Center in Redwood City, Calif. But, she added, because this is the first study of its kind, and the acupuncture protocol used was specifically designed for this study, “you always need replication of the findings.”

Dr. Shari Lusskin, director of reproductive psychiatry at the New York University Langone Medical Center, echoed that sentiment. “It’s encouraging to see alternative treatments being studied in a scientific manner, and this study should generate further studies. It needs to be replicated on a larger scale,” she noted.

“This is one treatment, and perhaps it will become another possible treatment tool in our therapeutic toolbox,” said Lusskin. But, she cautioned that “acupuncture is not a substitute for the appropriate use of antidepressant therapy especially in women with a prior history of response to antidepressants.”

As many as 20 percent of women may experience depression during pregnancy, according to the March of Dimes. Symptoms include sad, hopeless feelings that persist, generally for more than two weeks, Lusskin said. Women may also experience severe anxiety or feel disconnected from the baby. And, she cautioned, suicidal thoughts are never normal and are a sign that you should seek help.

Many women are cautious about using medications during pregnancy, reports the study. Interpersonal psychotherapy is an option for women who are depressed during pregnancy, but this type of therapy isn’t always available, according to the study.

For the study, Manber and her colleagues recruited 150 pregnant women who were diagnosed with a major depressive disorder. All were between 12 and 30 weeks of gestation.

The women were randomly assigned to one of three groups: depression-specific acupuncture (52 women), control acupuncture (49 women) or massage (49 women). The depression-specific protocol was designed just for this study, and the control acupuncture was specifically designed to avoid using acupuncture needles in any areas known to affect depression.

The treatments lasted for eight weeks. Women received treatment twice a week for the first four weeks, and then once a week for the next four weeks. The treatments lasted an average of 25 minutes.

The researchers found a 63 percent response rate in women who received the depression-specific acupuncture, while the response rate was 44.3 percent in the control acupuncture and massage groups. A response rate was defined as a 50 percent reduction in depression symptoms, Manber said.

Results of the study are scheduled to be published in the March issue of Obstetrics & Gynecology.

“We found our acupuncture protocol was helpful, but that does not mean that any acupuncture for depression treatment will be effective. The quality of what you get can differ from one practitioner to another,” said Manber.

“Our goal is always to find treatments that have the maximum benefits and minimum risk,” said Lusskin. “Many women think it’s safer for the baby to go off antidepressants, but there’s a real risk to the baby for untreated depression in pregnancy. And, we have enough safety data about antidepressant use in pregnancy that we can make informed choices about managing treatment during pregnancy.”

The bottom line, she said, is to talk with your doctor to find the right combination of treatments that can help you. “Depression is not a one-size-fits-all illness, and treatment won’t be one-size-fits-all either. If acupuncture ends up being helpful for you, that’s great, but make sure you’re treated into remission.”

SOURCES: Rachel Manber, Ph.D., professor, Stanford University School of Medicine Sleep Medicine Center, Redwood City, Calif.; Shari Lusskin, M.D., director, reproductive psychiatry, New York University Langone Medical Center, and clinical associate professor, psychiatry and obstetrics and gynecology, New York University School of Medicine, New York City;