Is It Too Soon to Get the Flu Vaccine?

Costco, CVS, and Walgreens have started advertising the flu vaccine in the summer months, but for some, it might pay to wait before you vaccinate

Consumer Reports / Julia Calderone / September 09, 2016

If you’ve visited your local Costco, CVS, Walgreens, or other stores recently, you might have noticed advertisements for this year's flu vaccines.

Is it a good idea to get the shot now, before flu arrives? Or will that undermine its effectiveness in January and February, when flu season is in full swing?

The Centers for Disease Control and Prevention recommend that most people get vaccinated as soon as the shot becomes available (which can be as early as late July). That way, you’ll be protected when flu season typically starts around mid-October, and when it peaks from December through February. 

Early vaccination is an especially good idea for children six months to 8 years old because, unlike the rest of us, they need two doses of the flu vaccine given 28 days apart, says William Schaffner, M.D., a professor of medicine at Vanderbilt University School of Medicine and a consultant to the CDC’s Advisory Committee on Immunization Practices. So if they get their first shot in early September and their second in early October, they’ll likely be protected by the time the flu arrives.

On the the other hand, two groups of people might benefit from waiting a little bit before getting the shot: people 60 and older and those who have a compromised immune system due to conditions such asautoimmune disease, HIV, or those undergoing chemotherapy treatment.

That’s because in those people, research suggests there’s about a four-month window after getting the vaccine when the body is best able to fight the virus. 

After that, for at least some people in those groups, the immune system’s virus-fighting ability begins to wane.

Schaffner emphasizes that this evidence is not definitive, and that even with declining protection the flu vaccine still seems to provide some protection after four months. Still, he says, people who are older or have underlying chronic diseases might want to wait until late September or early October to be sure that their protection will cover the entire influenza season, which can extend into March, or even dribble into early April.

It doesn't matter whether you get the flu vaccine from your primary care doctor or your local pharmacy, Schaffner says. They’re both perfectly safe places to get it. The most important thing is that you get it. 

A New Way to Catch Zika

Women may also transmit the disease sexually, a new study finds
Consumer Reports / By Jeneen Interlandi / July 15, 2016

The Centers for Disease Control and Prevention has reported the first case of Zika involving female-to-male sexual transmission. A New York woman returning from a Zika-affected country (the report did not specify which country) passed the virus to her sexual partner.

Until now, all cases of sexually-transmitted Zika have involved men passing the disease to their sexual partners. Because the virus is known to live for months in semen, making infected men chronic carriers, the CDC advises men who have been infected with or exposed to Zika to wait at least six months before having unprotected sex, especially if their partner is or is hoping to become pregnant.

By contrast, women who may have been exposed to Zika are advised to wait just eight weeks before having unprotected sex because until now, the virus has not been detected in vaginal swabs and no cases of female sexual transmission have been documented.

Today's report, combined with one earlier this week in the Lancet Infectious Disease, may soon lead to changes in those guidelines. 

As the Lancet reported, the virus was also detected in the vaginal tract of a 27-year-old French woman, where it persisted for at least 11 days after it disappeared from her blood and urine. The report's authors say that they have not tested to see how infectious the vaginal virus might be, but their findings indicate that it’s at least possible for women to harbor Zika as men do. “Our findings raise the threat of a woman potentially becoming a chronic Zika virus carrier,” the authors wrote.

The CDC and others are working to answer a long list of questions about sexually transmitted Zika infection, including how long the virus can live in semen, how long in vaginal fluid, and whether sexually transmitted Zika presents a greater or lesser risk of birth defects than transmission via mosquito.

“We have been looking at our transmission guidelines,” says CDC spokesperson Candice Hoffman, “It’s possible that they may change in the next few weeks based on recent findings.”

In most people, Zika infection is asymptomatic and largely inconsequential. But in pregnant women, it can be devastating. The virus can cross the placenta, infect the unborn fetus, and cause a range of serious problems, including congenital microcephaly, and in some cases, miscarriage.

Both Florida and New York have seen more than 200 cases of travel-related Zika infection. And Texas, New Jersey, and other states have witnessed their first cases of Zika-related microcephaly, all among travelers recently returned from Zika-affected areas. So far, no cases have been reported from mosquito bites received in the continental U.S., but experts at the CDC and elsewhere say it’s only a matter of time until such locally acquired cases emerge.

Congress is heading into recess today, and so far has not passed a Zika funding bill.

Read more about how you can, and can't catch Zika.

C. Diff: Deadly Infection on the Rise in U.S. Hospitals

Consumer Reports' new Ratings show many teaching hospitals fail to prevent this deadly disease

By Hallie Levine
Last updated: March 04, 2016
consumerreports.org

A life-threatening bacterial infection is gaining ground in America’s hospitals, according to a new report from the Centers for Disease Control and Prevention. And a Consumer Reports analysis finds that even some of the nation’s largest and most prestigious medical institutions are having a hard time getting it under control.

The infection, called C. diff (Clostridium difficile) sickened 101,074 hospital patients in 2014, the most recent data available, according to a March report from the CDC. Other research shows that overall about 450,000 people a year, inside and out of hospitals, are sickened by the infection, and it contributes to the death of about 29,000 people.

"New data show that far too many patients are getting infected with dangerous bacteria in healthcare settings,” said CDC director Tom Frieden, M.D. “Doctors and healthcare facilities have the power to protect patients—no one should get sick while trying to get well," he said.

While several serious hospital-acquired infections, such as those caused by central-line catheters, have declined in recent years, C. diff. rates increased by 4 percent between 2013 and 2014, according to the CDC.

And Consumer Reports’ updated Ratings of more than 3,200 hospitals across the country show that many are doing a poor job of reining in the infection. Overall, about a third of them received a low Rating in combating the infection. That means they have C. diff infection rates that are worse than the national benchmark.

That includes 24 of the nation’s largest teaching hospitals, including familiar ones such as Baylor University Medical Center in Dallas, the Cleveland Clinic in Cleveland, Cedars-Sinai Medical Center in Los Angeles, Johns Hopkins Hospital in Baltimore, and Mount Sinai Hospital in New York City. “Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” said Lisa McGiffert, director of Consumer Reports' Safe Patient Project. “But even they seem to be struggling against this infection,” she said.

While about 28 percent of hospitals nationwide earned one of our top two scores in preventing the infection, only four of them were large teaching hospitals: Harris Health System in Houston, Maine Medical Center in Portland, Maimonedes Medical Center in Brooklyn, N.Y., and Mount Sinai St. Luke’s - Mount Sinai West in New York City.

(See the chart below for a complete list of low-scoring large teaching hospitals. And check our free hospital Ratings to see how your local hospitals score on infection prevention for five different types of infections and other key safety measures.)

How C. Diff Spreads

There are two important reasons why C. diff is hard to control in U.S. hospitals.  

First is the misuse of antibiotics in hospitals, said Erik Dubberke, M.D., associate professor of medicine in the Division of Infectious Diseases at Washington University in St. Louis and a spokesman for the Infectious Diseases Society of America. “Those drugs are obviously lifesaving when used appropriately, but they can also make you vulnerable to C. diff,” he said. That’s because those drugs can kill off the “good” bacteria that normally grow in your stomach, allowing bad bacteria, including C. diff, to spread.

About half of all hospitalized patients receive antibiotics during their stay—even though up to 50 percent of such prescriptions are unnecessary or inappropriate, according to the CDC. Particularly worrisome is when patients are given powerful “broad-spectrum” antibiotics, such as ciprofloxacin (Cipro and generic) and levofloxacin (Levaquin and generic), which are meant to act against a variety of disease-causing bacteria at once, instead of drugs that target specific bacteria. That increases the chance of developing C. diff, because those drugs are more likely to kill off the body’s good bacteria along with the bad.

The second reason is poor hygiene. C. diff, which is found in fecal matter, is easily passed from person to person on the hands of healthcare workers—and can survive on door knobs, bed rails, and other surfaces for weeks.

Proper hygiene—including washing hands and, especially, wearing gloves—can cut the spread of the disease. But less than a third of healthcare workers in intensive care units always wash their hands, according to a 2014 University of Iowa study. And a Consumer Reports survey of 1,200 recently hospitalized people found that only about half always saw their doctor or nurse wash their hands.

“Doctors and nurses get busy, and they sometimes simply forget to rewash their hands every time they walk into a new patient’s room,” said Louise-Marie Dembry, M.D., professor of medicine and epidemiology at Yale University and president of the Society for Healthcare Epidemiology of America.

What Hospitals Say

Representatives of some of the low-scoring teaching hospitals in our Ratings say that institutions like theirs face special challenges in combating C. diff.

For example, they may see sicker patients than non-teaching hospitals, said Craig Civale, a spokesman for Baylor University Medical Center. “As a major academic hospital in an urban setting, BUMC routinely admits very complex patients with multiple conditions,” he said. A spokeswoman for Cedars-Sinai Medical Center offered a similar explanation for its hospital's C. diff infection rate, and also notes that it sees an unusually large number of older patients, who are at increased risk of the infection.

Another factor may simply be that teaching hospitals detect more cases of the disease than do other hospitals, because they test and report more carefully, said Lisa Maragakis, M.D., senior director of health care epidemiology and infection control for the Johns Hopkins Health System.

Still, hospital officials acknowledge that C. diff. is a serious problem, and that they are responding by changing their practices. “The results reported by Consumer Reports are disappointing to us,” said a spokeswoman for Mount Sinai Hospital in a statement. Mount Sinai also said that it has recently established a task force to look into the hospital’s infection rates, and is investigating “evidence-based practices targeted to reduce all healthcare-associated infections.”

At Baylor, the hospital is developing new protocols to ensure that antibiotics are prescribed appropriately, Civale said. Johns Hopkins is taking similar steps, and is also instituting “rigorous hand hygiene and environmental cleaning initiatives,” Maragakis said. In addition to to those steps, Cedars-Sinai now tests all patients with diarrhea for C. diff, a spokeswoman for the hospital said. And in a statement to Consumer Reports, the Cleveland Clinic noted that the hospital is “committed to continuous improvement in quality and safety.”

What You Can Do

If you (or family members or friends) are in the hospital, here’s what you can do to reduce your risk of developing a C. diff infection:

• Make sure you really need that antibiotic. If your doctor wants to give you an antibiotic, ask why. If he suspects an infection, he should do a rapid culture, if possible, to quickly pinpoint the possible bacteria so that he can prescribe the most effective antibiotic at the lowest dose. 
• Watch out for heartburn drugs. Hospital patients are sometimes prescribed heartburn drugs called proton-pump inhibitors such as omeprazole (Prilosec and generic) and esomeprazole (Nexium and generic) to ease stomach pain. But those medications can also increase the risk of C. diff infections taking hold in your stomach. So if your doctor suggests you take one of those drugs while in the hospital, ask why. 
• Insist on hand-washing and gloves. Ask everyone who walks into your room whether they’ve washed their hands—if they’re doing it at your sink, make sure they scrub for 40 to 60 seconds. Also check that they are wearing gloves. Rubbing on alcohol-based hand sanitizer is not strong enough to destroy C. diff, Dembry said. 
• Ask about the hospital’s protective measure: Hospitals should order a C. diff test for any patient who has diarrhea (three loose stools within 24 hours), said the CDC. Anyone with diagnosed C. diff should be put in a single room, and healthcare providers should wear gloves and gowns when treating that patient.

Consumer Report's Hospital Ratings Receive National Attention

Consumer Reports released their most recent analysis of hospital infection data last week showing that many well-known teaching hospitals are performing poorly in CR's Ratings and putting patients at risk. (Their hospital Ratings are now free to all consumers.) CR released the story in conjunction with a CDC press conference about antibiotic resistance, which included Tom Frieden, M.D., CDC director, and Peter Pronovost, M.D., from Johns Hopkins Hospital. CR's timely and relevant content was referenced in the first question from the media when an NBC News reporter asked about Johns Hopkins' low score in preventing the hospital-acquired infection, C. diff. This story is part of CR's ongoing hospital safety coverage.

Why Where You Store Prescription Painkillers Is So Important

Consumer Reports / Lisa Gill/ December 2015

Deaths due to these powerful drugs are on the rise, 

but our poll finds most people don’t secure them

Americans have a lot of painkillers sitting around in their homes, and some of these unused drugs can pose dangers to children and others.

In fact, of those who take any kind of prescription medication, more than 80 percent of people in a recent Consumer Reports poll said that they don’t lock up their narcotic painkillers, such as Oxycontin, Percocet, and Vicodin—and nearly three-quarters said they had children living at home. That translates to more than 16 million households across the U.S. where powerful opioid painkillers sit unsecured in medicine cabinets, closets, and kitchen drawers. 

The Consumer Reports National Research Center conducted the telephone poll of a nationally representative sample of more than 2,000 U.S. adults in June 2015.

The results are concerning because too many of those potentially deadly drugs wind up in the wrong hands. Pain relievers are by far the most commonly abused prescription drugs, with more than half of people who abuse them reporting that they got the drugs for free from family and friends, according to the National Institute on Drug Abuse. 

The results can be tragic. More than 47,000 Americans died of a drug overdose in 2014—more than during any other year on record, according to a new report released last week from the Centers for Disease Control and Prevention.

The number one culprit? The same painkillers that some people don't keep locked up. In fact, the CDC report found that overdose deaths from prescription pain relievers, which have skyrocketed in the last decade, also reached record highs—up 9 percent in 2014 alone.

“Leaving narcotic drugs unsecured is like having a loaded gun lying around,” says Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser, noting that when it comes to prescription pain relievers, there’s little margin for error. Using someone else’s medication, taking too much, or combining it with the alcohol or certain other medications can be a fatal mistake. 

Safer Strategies for Dealing With Prescription Painkillers

“You may not think anyone would get into your medication, but you’d be surprised,” says Lipman. “It could be anyone from an inquisitive youngster to someone seeking the drugs to sell or for recreational use.”

Teens who have abused prescription medications, for example, cite friends and their parents' medicine cabinet as the most common sources for the drugs.

Lipman advises taking two steps for safer, more responsible handling of narcotic drugs at home.

Lock them up. Secure prescription pain relievers and all other medications up and out of sight of visitors and children in a locked cabinet or container. Don’t keep loose pills in bags or containers in your purse, luggage, or office drawer and, when you travel, keep medications in a locking case.

Discard unused pills properly. You can take unwanted medication to drop-off spots at pharmacies, hospitals, clinics, and long-term care centers any time of the year, with no appointment needed. Or you can mail it in to collection centers in special envelopes that are available from pharmacies and other designated locations. To find out where to drop off pills or pick up a mailer, call the DEA’s Registration Call Center at 800-882-9539 or go to deadiversion.usdoj.gov and search for “drug disposal.”

If there’s no drop-off spot in your area and you don’t want to use the mail-back option, the Food and Drug Administration recommends flushing them down the toilet. That’s usually a bad idea because of the possibility of contaminating the water supply and possibly harming aquatic life. But the danger of someone accidentally getting his or her hands on opioids make flushing an acceptable option if you have no other choice.

Taking leftover pills from an old prescription can be dangerous. Read more surprising facts about prescription pain relievers.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

A Brief History Of Antibiotic Resistance

The Grapevine

A Brief History Of Antibiotic Resistance: How A Medical Miracle Turned Into The Biggest Public Health Danger Of Our Time

Feb 17, 2016 09:30 AM By Lecia Bushak

The discovery of penicillin marked the advent of the age of antibiotics, 

an era where previously deadly infectious diseases could be cured in days. Wikimedia

Antibiotics, also known as antibacterials and antimicrobials, revolutionized medicine during the later half of the 20th century. But as time goes on, the success of antibiotics may be completely cancelled out by their combative counterparts: resistant bacteria.

Humans have overused antibiotics simply by harnessing them to treat all sorts of infections from pneumonia to strep throat — but also by sometimes taking too much of them, or infusing them into agricultural systems, animals, and food products, as the CDC illustrates . This overuse has opened the door for bacteria to evolve into resistant strains to beat out drugs. We’re now in a place where changes desperately need to be made in order to prevent millions of deaths from antibiotic resistance in the coming decades. These microscopic microbes seem to be smarter than us.

The authors of a 2010 report on the evolution of resistance note that microbes have “extraordinary genetic capabilities” that benefit “from man’s overuse of antibiotics to exploit every source of resistance genes... to develop [resistance] for each and every antibiotic introduced into practice clinically, agriculturally, or otherwise.” Here’s how antibiotics went from being a revolutionizing medical breakthrough to a massive public health concern.

Which Came First, The Antibiotic Or The Resistance?

The antibiotic era, as it’s called, may not have begun until the 21st century, but antibiotics were still in use in ancient folk medicine. The term “antibiotic” has an extremely broad definition, describing the activity of any compound or chemical that can be applied to kill or inhibit bacteria that cause infectious diseases.

350-550 CE. The earliest traces of antibiotic use date back thousands of years. Tetracycline — a common antibiotic still used today — has been found in skeletons from Sudanese Nubia, an area that included ancient Egypt. Researchers believe that ancient Nubians were actually brewing tetracycline into their beers or otherwise incorporating it into their diets over a long period of time because the compound was found embedded deep in their bones and the population’s documented infectious diseases seem to be quite low. This discovery overturned the commonly-held belief that antibiotics didn’t exist before 1928.

It’s tough to detect other ancient antibiotics aside from tetracyclines, however, as most didn’t settle into bones and tooth enamel in the same way. Only documentation and anecdotes remain to give us insights into the use of other ancient antibiotics. What is now known to be an antimalarial drug, artemisinin, was used in ancient Chinese medicine, and it’s possible that herbalists also used moldy bread to prevent wounds from getting infected. There’s also historical evidence that, in Jordan, red soils rich in antibiotic-producing bacteria were used to treat skin infections like rashes.

And for as long as antibiotics have existed, bacterial resistance has existed alongside them — but never on such a large scale. “The natural history of antibiotic resistance genes can be revealed through the phylogenetic reconstruction,” the authors of one study write, “and this kind of analysis suggests the long-term presence of genes conferring resistance to several classes of antibiotics in nature well before the antibiotic era.” In short, bacteria have always been doing what they’re good at: finding ways to survive.

Alexander Fleming, who discovered penicillin, was also one of the first scientists
to warn about the perils of antibiotic resistance. Wikimedia

1928. Alexander Fleming, a Scottish biologist, took the fight against infections to a new level when he identified penicillin, making this the year that the modern antibiotic era began.

The discovery had apparently been an accident. Fleming had left an uncovered Petri dish of Staphylococcus bacteria near an open window in his basement lab, and in the morning found that mold growth had inhibited the bacteria. Penicillin, which comes from a type of fungi known as Penicillin rubens , became the first compound to be used officially as an antibiotic.

Penicillin was popular in the public during the 1940's and 50's due to its ability to treat a variety
of infectious diseases quickly; this also led to an increased build-up of antimicrobial resistance. Wikimedia

1943. Penicillin was on its way to mass production and was used heavily to treat Allied troops fighting in Europe during World War II. Considered a miracle drug, it was soon available to the public, despite warnings from Alexander Fleming that overuse could lead to mutant bacteria. Because bacteria can transfer genes horizontally — from one bacteria to another immediately — its ability to share resistance was adding to a growing threat unheeded by many scientists and doctors of the day.

1948. Transferring antibiotic use from medicine to agriculture also happened in a rather accidental way. Robert Stokstad, an animal nutritionist, and Thomas Jukes, a biochemist, were working at the company Lederle to develop an “animal protein factor” that could enhance chicken growth and boost poultry profits. The researchers were initially experimenting with vitamin B12, which was believed to boost animal growth, but eventually found that the cellular remains of Streptomyces aureofaciens bacteria — from which tetracyclines are extracted — contained a lot of the vitamin. As the Lederle labs had also discovered the first tetracycline, the researchers had access to plenty of these bacterial remains. Chicks that received supplements including Streptomyces auerofaciens grew 24 percent more than those receiving liver extract, which also contained high levels of B12. The bacteria shells, which still contained traces of the antibiotics, were more effective in making them grow (and much cheaper than liver extract). This discovery jump started the process of routinely injecting antibiotics into animals.

Meanwhile, resistant staph bacteria were growing in hospitals. According to Harvard Magazine, resistant staph infections in hospitals had risen from 14 percent in 1946 to 59 percent in 1948.

1952. By this time, doctors were somewhat aware of the possibility of antibiotic resistance, but overall they remained hopeful and optimistic about the success of these new drugs, which could defeat diseases that had long plagued humanity, like cholera and syphilis. A study on antibiotic resistance published that year concluded that syphilis could be treated “without any indications of an increased incidence of [resistant] infections, and this work gives grounds for hoping that the widespread use of penicillin will equally not result in an increasing incidence of infections resistant to penicillin.”

1950s–1970s. The next couple decades were considered the golden era of antibiotics, due to the sheer number of new drugs that were being developed: streptomycin, to treat serious infections like endocarditis and the plague; ampicillin, which treats respiratory tract infections and meningitis; and dozens of others. In the excitement surrounding the success of these antibiotics, they were made readily available to the public, like penicillin, ultimately paving the way for resistance to develop more easily.

The Tide Turns, The Superbugs Arrive

1955. As Fleming had predicted, resistance to penicillin gradually built up due to the accessibility of the drug. By 1955, many countries had attempted to slow this resistance by limiting penicillin use to prescription only, but it was too little too late: many bacterial strains had already defeated the antibiotic, including staphylococci.

1960. In an attempt to defeat penicillin-resistant strains, scientists developed methicillin, a different antibiotic in the penicillin class that could work against resistance. But within a year, bacterial strains developed resistance to methicillin too — eventually called MRSA , methicillin-resistant Staphylococcus aureus , or S. aureus . Now, MRSA can resist most antibiotics, and infections are common in hospitals — making it one of the biggest forerunners of multiple-drug resistant (MDR) bacteria.

For decades, poultry and other animal farms utilized antibiotics
freely in feed to promote growth. Reuters

1976. At Tufts University, a physician and researcher named Stuart Levy became one of the first to identify antibiotic resistance due to their use in animals, and to clamor for greater awareness of the problem. He worked on a study that year that examined how small amounts of antibiotics in animal feed could cause resistance in humans. On a farm in Massachusetts, Levy fed tetracycline to chickens, and found that tetracycline-resistant bacteria began to populate the chickens’ gut flora within a week. Despite this, rampant use of antibiotics like vancomycin (which had previously been considered a “last resort” drug) throughout the 1980’s led to an epidemic of resistant strains on farms and among humans.

1990s. A stronger resistant strain of MRSA began sickening normal, healthy people in the 1990s. This perhaps created a greater public awareness of the danger of antimicrobial resistance.

In the midst of emerging superbugs and MDR bacteria, the CDC and other
public health organizations began issuing public service announcements
to curb the liberal use of antibiotics. CDC / Wikimedia

By 2002 , up to 60 percent of S. aureus cases in hospitals were resistant to methicillin. In 2005, over 100,000 Americans were stricken with MRSA infections and some 20,000 died, more than the amount of people who were dying from HIV and tuberculosis combined, according to Harvard Magazine.

2012. As more researchers began working on the impending antibiotic-resistant epidemic, they had to tackle the classification of multidrug-resistant bacteria, which were multiplying by the minute. In a 2012 study, a team of scientists proposed adding the terms extensively drug-resistant (XDR) and pandrug-resistant (PDR) to multidrug-resistant (MDR) bacteria to better help them classify and potentially defeat these superbugs. It was the first time that researchers had a unified set of definitions for MDR bacteria to better understand them.

2013. After decades of certain researchers calling for action, the FDA finally implemented aplan to phase out certain antibiotic use in animals. But the extent to which this plan is effective at reducing the massive damage already done is difficult to identify.

2014. In response to major superbug outbreaks like Klebsiella pneumoniae (which causes pneumonia and bloodstream infections in the hospital) and gonorrhea strains all over the world, the World Health Organization (WHO) released a statement noting that “this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.”

2015. McDonald's announced that it would phase out all meat sources that contained antibiotics, marking the first step of a major fast food company to heed the public health warnings and take action.

Since the 70s, very few new antimicrobial agents have been discovered, and the only way for researchers to combat resistant bacteria has been to modify already existing antibiotics. This has led to a standstill of sorts between current antibiotics and the rapidly adjusting “superbugs.”

Today, from farms to hospitals to everyday workplaces, animals and humans are likely teeming with different forms of resistant bacteria. In 2013, a Consumer Reports investigation showed that over half of ground turkey meat sold in the U.S. contained strains of drug-resistant bacteria. According to the CDC , some 2 million people in the U.S. are infected with drug-resistant bugs every year, and 23,000 of them die from these infections. Those numbers are likely to get worse in the coming decades, according to recent reports.

The danger of the situation is mainly in its complexity, Rustav Aminov writes in a 2010 report on antibiotic resistance: “It is not a single grand challenge; it is rather a complex problem requiring concerted efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with. In fact, this should be of everyone's concern, because, in the end, there is always a probability for any of us at some stage to get infected with a pathogen that is resistant to antibiotic treatment.”

Zika: The Dangerous Mosquito Virus You Must Know About

Insect repellents aren't enough to stay safe from this disease

Consumer Reports / Sue Byrne / January 28, 2015 / aired on GMA February 9, 2015

A mosquito-borne illness called the Zika virus is now spreading rapidly in South and Central America and the Caribbean, and it could arrive in the U.S. soon. It can make anyone sick for up to a week with symptoms like fever, rash, joint pain, and red eyes. But it's especially dangerous for women of childbearing age who are pregnant or considering pregnancy because it has been linked to microcephaly, a serious birth defect that causes an abnormally small head and incomplete brain development.

The outbreak has prompted the Centers for Disease Control and Prevention to issue a warning to take precautions for anyone traveling to 24 destinations in the Americas, but, most important, the CDC is recommending that all pregnant women should consider postponing their trip altogether. Here's what you should know to protect yourself and your family.

Why Zika Is So Concerning

The Zika virus normally does not cause illness that requires hospitalization or leads to death. Roughly one in five people infected with the virus develop symptoms, which are usually mild. The time from getting bitten to getting sick is likely to be a few days.

The Pan American Health Organization (PAHO) reports more than 16,000 Zika illnesses since the first cases were confirmed in Brazil in October 2015. Local transmission of the virus has been confirmed through lab testing in several countries in the Americas.

"The number of cases being reported is significantly lower than the actual number of cases." says Candice Burns Hoffmann, a CDC spokeswoman. "Many countries do not regularly test for Zika virus. Also, once the outbreak becomes common in an area, most people will not go to the doctor or get tested for the virus."  

Brazil has reported 4,180 cases of microcephaly, according to The New York Times, and Colombia has reported Zika infections in 1,090 pregnant women, a spokeswoman for PAHO told Consumer Reports. In addition, Guillain-Barré syndrome, which causes muscle weakness and sometimes paralysis, has been reported in patients with a probable Zika infection in French Polynesia and Brazil. The CDC says it is examining the link between Zika and the disorder.

Because there is neither a vaccine nor medication available to prevent a Zika virus infection, the American College of Obstetricians and Gynecologists recommends that women who are pregnant or considering pregnancy follow CDC guidelines and delay travel to those regions where Zika outbreaks are occurring.

"There is much that we do not yet know about the Zika virus," Mark S. DeFrancesco, M.D., president of the ACOG, said in a statement. "However, because of the associated risk of microcephaly, avoiding exposure to the virus is best." Women who have traveled to South and Central America and the Caribbean should be evaluated for Zika virus infection.  

How to Prevent Bites

For those who are planning to travel in spite of the warnings, the CDC asks that pregnant women, women who are trying to become pregnant, and everyone else should strictly follow steps to protect themselves. Because the mosquitoes that spread Zika are aggressive daytime biters and live indoors and outdoors, it's especially important to follow the CDC's precautions during daylight hours.

That includes using insect repellent containing deet, picaridin, lemon eucalyptus, or IR3535. All have been approved by the Environmental Protection Agency for use during pregnancy. Also wear long-sleeved shirts and pants, the CDC says. At night, CDC recommends sleeping in a screened-in or air conditioned room or under a mosquito bed net.

Consumer Reports' recent tests of insect repellents found that the most effective product, Sawyer Fishermen's Formula with 20 percent picaridin, was also one of the safest, helping to keep away Aedes mosquitoes—the same type that transmit Zika—for at least 8 hours. Off Deepwoods VIII with 25 percent deet also kept Aedes mosquitoes at bay for 8 hours. Our tests showed that repellents containing natural plant oils, such as citronella and lemongrass, did not work against mosquitoes.

Two types of mosquitoes that are capable of transmitting the Zika virus live primarily 

in the southeastern U.S. Photo: Courtesy of the Centers for Disease Control and Prevention

More Actions to Take

All cases of Zika virus in the U.S. so far have been found in returning travelers to the regions mentioned above. No one has gotten sick from being bitten in the U.S. But that may be changing as the two mosquito types known to carry the disease, Aedes aegypti and Aedes albopictus, can be found here (see maps above). If a homegrown mosquito bites an infected returning traveler it could pick up the virus and then pass it along to other people in the U.S.  

For this reason, it’s wise to use insect repellent, as noted above. You can also make it harder for mosquitoes to set up shop in your backyard. Female mosquitoes lay several hundred eggs on the walls of water-filled containers. The eggs stick like glue and remain attached until they are scrubbed off. If water covers the eggs, they hatch and become adults in about a week. To prevent them from hatching:
• Empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers. Do this once a week.
• Tightly cover water storage containers (buckets, cisterns, rain barrels) so that mosquitoes cannot get inside to lay eggs.
• Use wire mesh with holes smaller than an adult mosquito if you don't have lids.

If you have a septic tank, repair cracks or gaps, and cover open vents or plumbing pipes.

For more info go to ConsumerReports.org:

http://www.consumerreports.org/insect-repellent/zika-the-dangerous-mosquito-virus-you-must-know-about?loginMethod=auto

Dangerous infections...

Dangerous infections that are resistant to antibiotics are spreading and growing stronger, with dire consequences

CONSUMER REPORTS

Jul. 2, 2015, 4:42 PM

The next time you’re offered a prescription for antibiotics and ask yourself, “What harm could it do?” think about Peggy Lillis.

Five years ago, the 56-year-old kindergarten teacher from Brooklyn, N.Y., was given the antibiotic clindamycin, which was supposed to prevent a dental infection.

Instead, the drug wiped out much of the “good” bacteria in her gut that normally keeps “bad” bacteria in check.

Without that protection, harmful bacteria in her belly ran rampant, triggering an intestinal infection so severe that doctors had to perform emergency surgery to remove her colon.

Despite that desperate, last-ditch effort, “within 10 days of taking those pills, my mother was dead,” says Lillis’ son, Christian.

Or consider Zachary Doubek, a rambunctious 12-year-old from New Brunswick, N.J. After a baseball game, Zachary came home complaining of knee pain that worsened overnight and quickly escalated.

His doctor initially prescribed an antibiotic that failed to bring the problem under control. Zachary had the bad luck of running into a strain of bacteria that, after repeated exposure to antibiotics, had evolved, developing defenses against the drugs. Zachary’s infection raced through his body, forcing doctors to put him in a medically induced coma until they could rein it in with vancomycin, a powerful antibiotic that, luckily, still worked against the germ.

Zachary survived, but a year and six surgeries later, he still walks with a limp from the ordeal. “We may never know how he got infected,” says his mother, Marnie Doubek, M.D., a family physician, “but we know that the antibiotic that should have first helped him didn’t work.”

Scary new superbugs

Peggy Lillis’ and Zachary Doubek’s stories are all too common. Though antibiotics have saved millions of lives since penicillin was first prescribed almost 75 years ago, it’s now clear that unrestrained use of the drugs also has unexpected and dangerous consequences, sickening at least 2.25 million Americans each year and killing 37,000.

That harm comes in two main ways. First, as in Lillis’ case, antibiotics can disrupt the body’s natural balance of good and bad bacteria, which research shows is surprisingly important to human health. Lillis was killed by one such bad bug, the bacteria C. difficile. At least 250,000 people per year now develop C. diff infections linked to antibiotic use, and 14,000 die as a result.

Second, overuse of antibiotics breeds “superbugs”—bacteria that often can’t be controlled even with multiple drugs. Doubek was a victim of MRSA (methicillin-resistant staphylococcus aureus), a bacteria once confined to hospitals that has now spread into the community, including nail salons, locker rooms, and playgrounds—where Doubek may have picked up his infection. MRSA and other resistant bacteria infect at least 2 million people in the US annually, killing at least 23,000.

As alarming as those numbers are, experts say things could get much worse, and fast. The Centers for Disease Control and Prevention has sounded the alarm about two threats: CRE (carbapenem-resistant enterobacteriaceae), which—when it gets into the bloodstream—kills almost 50 percent of hospital patients who are infected; and shigella, a highly contagious bacteria that overseas travelers often bring home and that is now resistant to several common antibiotics, raising fears of an outbreak in the U.S.

The World Health Organization and the European Union call the rise of resistant bacteria one of the world’s most serious health crises, putting us on the verge of a “post-antibiotic era.” In June, President Obama convened a forum on the crisis at the White House attended by 150 organizations, including Consumer Reports. And his 2016 proposed budget included $1.2 billion for combatting resistant infections.

Miracle Drugs Gone Awry


The CDC estimates that up to half of all antibiotics used in this country are prescribed unnecessarily or used inappropriately.

“We have to act now to reverse this problem,” says Thomas R. Frieden, M.D., director of the CDC. “If we lose the ability to treat infection, we lose the ability to safely do much of what we take for granted in modern medicine.”

Part of the solution may come from developing new antibiotics. But experts say it’s even more important that doctors, hospitals, and consumers develop a new attitude to the drugs, learning when antibiotics should—and shouldn’t—be used.

That applies even to how the drugs are employed on farms: 80 percent of the antibiotics in the U.S. are actually fed to chickens, cows, and other food animals, mostly to speed their growth and to prevent disease.

Frieden and others say the problem, although complex, is fixable—if we act now. Here, what you need to know about antibiotic overuse and its consequences, and how to protect yourself and your family.

“Antibiotics really are miracle drugs. Patients believe that. I believe that,” says Lauri Hicks, D.O., head of the CDC’s program Get Smart: Know When Antibiotics Work.

Ask anyone who has had a brush with bacterial meningitis. About 85 percent of people treated with antibiotics for that infection survive; without the drugs, almost all die. In fact, many of the advances of modern medicine—organ transplants, invasive surgery, cancer therapy, among others—depend on antibiotics. For example, without the drugs up to 40 percent of people undergoing total hip-replacement would develop an infection and almost one-third of those would die.

But antibiotics have become a victim of their own success. The drugs seemed so effective that we started using them even in cases when they shouldn’t be,” Hicks says. Overall, in fact, the CDC estimates that up to half of all antibiotics used in this country are prescribed unnecessarily or used inappropriately.

How doctors misuse antibiotics



One recent study of 204 doctors suggested some physicians may be more likely to prescribe antibiotics for viral infections toward the end of their office hours—a sign they may be taking the easy route to handling patients’ complaints.

Antibiotic misuse happens in many ways:

Using the drugs to treat illnesses caused by viruses, not bacteria. Doctors know, of course, that antibiotics don’t work against viruses, like those that cause the common cold or the flu. But in some cases tests can’t help distinguish between the two. Or doctors may feel that they just don’t have the time to determine the cause, and figure “it’s better to be safe than sorry.” One recent study of 204 doctors suggested some physicians may be more likely to prescribe antibiotics for viral infections toward the end of their office hours—a sign they may be taking the easy route to handling patients’ complaints.

Prescribing the drugs just to satisfy patient demand. Doctors may also just want to make their patients happy—and patients often want antibiotics. For example, in a recent Consumer Reports poll of 1,000 adults, one in five people who got an antibiotic had asked for the drug. “I often have patients who ask for antibiotics,” says Marnie Doubek, who sees many sick children in her practice. “So I understand the pressure to just say OK. But now, especially with Zachary’s experience, no way.”

Rushing to drugs too quickly. Even when infections are caused by bacteria, doctors sometimes prescribe antibiotics when it might be wise to wait a few days to see whether mild symptoms clear up on their own. One example: ear infections in children older than 6 months. When mild, those infections often improve untreated. But as many parents know, a crying child can be a powerful motivator to seek a quick fix even if, in the long run, repeated use of antibiotics may be more likely to cause problems than solve them.

Abusing broad-spectrum drugs. When antibiotics are called for, doctors often reach too quickly for “broad spectrum” ones that attack multiple bacteria types at once. That shotgun approach is not only more likely to breed resistance but also to wipe out protective bacteria. The drug that triggered Lillis’ C. diff infection, clindamycin, is one such drug.

Those drugs were developed with the thought that “killing as many bugs as you possibly can in every patient” was a good idea, says John Powers, M.D., former lead medical officer of Antimicrobial Drug Development and Resistance Initiatives at the Food and Drug Administration.

Doctors loved the broad-spectrum antibiotics and, spurred by aggressive marketing from drug companies, began using them for common problems such as ear and sinus infections. Given that widespread use, “it’s hardly a shock that we now have a problem with resistance and C. diff,” Powers says.

The danger of new drugs

Many of those broad-spectrum drugs were introduced 30 years ago, when antibiotic development was in its heyday. More than 50 antibiotics were introduced in the 1980s and 1990s. But that once-steady drug pipeline has slowed to a trickle, for several reasons.

One is that coming up with new classes of antibiotics that target superbugs is proving to be a tough scientific puzzle. Most of the new antibiotics introduced since 2000 have been minor tweaks to existing drugs, not major breakthroughs.

The other big reason? Money. “Developing antibiotics is not that profitable,” says Henry Chambers, M.D., an infectious disease specialist at the University of California San Francisco School of Medicine. Drug companies would rather focus on medications that many people take for a long time, he explains, because the market, and profit potential, is larger.

The government is trying to sweeten the economic incentive. In 2012, the FDA began to fast-track certain antibiotics and told drugmakers that patent protection on the drugs would last an additional five years. Since then, 49 new drugs have entered the pipeline’s fast lane and six have been approved.

The FDA has proposed further streamlining—allowing companies to test drugs using smaller, shorter, or fewer studies—for antibiotics that are meant to treat serious infections in patients with no other options. Legislation now with Congress would also lower the requirements needed to get new antibiotics on the market.

When Big Pharma pushes drugs

That approach means the FDA “is willing to accept less safety and efficacy data,” acknowledges Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. But he says that’s a trade-off that many doctors are willing to make.

Still, some researchers and patient advocates worry about fast-tracking drugs. “We absolutely need new antibiotics,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. “But that doesn’t justify lowering the bar on the standards for drug approval. These can be dangerous drugs, so they should be thoroughly tested for safety and efficacy before we unleash them on the public.”

Perhaps the biggest concern is that even if effective new antibiotics make it to market, they may not provide much long-term help if health care professionals and patients continue to misuse the drugs. And, Chambers says, there may be pressure on doctors to use the drugs widely, despite the growing threat of antibiotic resistance.

Some pressure may come from drug companies, which have a history of marketing new drugs aggressively, and even illegally. Pfizer agreed to pay $1 billion in 2009 to settle allegations that the company illegally promoted four drugs, including the antibiotic linezolid (Zyvox), which was pushed to treat forms of MRSA for which it was not approved.

The real antibiotic solution


Avoid infections in the first place by staying up to date on vaccinations.

With education and a little prodding, doctors have shown that they can do better.

One study, in the Journal of the American Medical Association, found that doctors who attended a 1-hour session on guidelines for treating common upper-respiratory tract infections and then received feedback on their prescribing habits, cut their use of broad-spectrum antibiotics almost in half. Inappropriate prescriptions for sinus infections and pneumonia were cut by 50 to 75 percent.

Several medical organizations, such as the American Academy of Family Physicians and the American Academy of Pediatrics, have distributed guidelines on appropriate antibiotic use to their members. In some cases, that advice is incorporated into electronic medical records, so doctors are alerted if they prescribe a drug inappropriately.

Still, patients play a key role, too, by helping to make sure those drugs are used only when necessary, and by avoiding infections in the first place. Here are a few guidelines to follow:

Don’t push for antibiotics. If your doctor says you don’t have a bacterial infection, don’t insist. Ask about other treatments that can help you feel better, such as a pain reliever, throat soother, antihistamine, or decongestant.

Ask whether you can fight it off on your own. If bacteria are the cause but your symptoms are mild, ask about trying to fight off the infection without drugs.

Request targeted drugs. When possible, your doctor should order cultures to identify the bacteria that caused your infection and prescribe a drug that targets that bug.

Use antibiotic creams sparingly. Even antibiotics applied to the skin can lead to resistant bacteria. So use over-the-counter ointments containing bacitracin and neomycin only if dirt remains after cleaning with soap and water.

Avoid infections in the first place. That means staying up to date on vaccinations. And it means washing your hands thoroughly and regularly, especially before preparing or eating food, before and after treating a cut or wound, and after using the bathroom, sneezing, coughing, and handling garbage. Plain soap and water is best. Avoid antibacterial hand soaps and cleaners, which may promote resistance.

Read more: http://www.consumerreports.org/cro/health/the-rise-of-superbugs/index.htm#ixzz3fQgA6mIC