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Measles cases highest in 15 years, at 212 and counting

BY Michael Johnsen

BOSTON — This year’s jump in measles in the United States and Canada was costly and occurred among unvaccinated children and adults, suggested several studies being presented at the 49th Annual Meeting of the Infectious Diseases Society of America here Thursday.

In 2011 to date, 212 people with measles have been reported in the United States, 68 were hospitalized and at least 12 of them had pneumonia, reported the Centers for Disease Control and Prevention. This is the largest number of measles cases since 1996. Rapid public health response efforts prevented measles cases and outbreaks from becoming much larger by isolating cases and vaccinating those who were unvaccinated.

Of those infected, 183 (86%) were unvaccinated or their vaccination status was unknown, and 27 (13%) were less than 1 year old. Most of the imported measles cases occurred among U.S. residents traveling overseas to Western Europe (47%), Africa or Asia, where vaccination rates are significantly lower and measles is an ongoing problem.

An outbreak of measles in spring 2011 in Salt Lake County, Utah, began when an unvaccinated local high school student returned home after traveling in Europe, where he was infected. Rapid response to control the outbreak limited it to nine people in Salt Lake County, yet managing the outbreak cost approximately $300,000 for infection control measures by two local hospitals and the local and state health departments. That cost includes physician and staff time, vaccines, immunoglobulin and blood tests, according to the Utah Department of Health.

When a child or adult with measles goes to school, everyone in the school is exposed, and Utah state law dictates that unvaccinated children and teachers — including those who cannot locate their vaccination records — must stay home for 21 days after the exposure. To contain the outbreak, 12,000 people were contacted about possible exposure and 184 people were quarantined, including 51 students. Costs to the schools associated with these actions — such as the hiring of substitute teachers and state money that is withheld from the schools when kids stay home — were not factored into the study.

“Forest fires start with sparks, but unless there is sufficient dry tinder, they won’t roar out of control,” stated James Hughes, IDSA president. “The same is true of outbreaks. The occasional case is not an issue, but when it occurs in a community where a fair number of people are not vaccinated it can cause serious problems," he said.

Thanks to a successful infant measles, mumps and rubella vaccination program, measles has been declared eliminated in the United States — meaning the illness hasn’t had continuous spread — since 2000. But outbreaks can occur when the infection is imported, typically by unvaccinated Americans who are infected while traveling to Europe or other continents and then return home, or by foreign tourists who are infected and travel to this country.

Before measles vaccination was available in the 1960s, about 3 million to 4 million people were infected with measles in the United States every year — 48,000 were hospitalized, 1,000 were permanently disabled and about 500 died, according to the CDC.

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Study: Risk of breast cancer more apparent among women with Type 2 diabetes

BY Allison Cerra

NEW YORK — A study conducted by the University of Alberta found that women with Type 2 diabetes have an increased risk of developing breast cancer.

The study, which was published in the Oct. 4 issue of Diabetes Care, examined 170,000 premenopausal (under the age of 55 years) and postmenopausal women (ages 55 years and older), half of which were diagnosed with Type 2 diabetes. After following up with them four to five years later, 1.4% of all women were diagnosed with breast cancer; however, postmenopausal women diagnosed with Type 2 diabetes were more likely to develop breast cancer.

Commenting on the results, study author Jeffrey Johnson told Reuters Health that "the relationship that we see (between diabetes and cancer), we wondered if it was something about the fact that people with diabetes go to the doctor’s office more often. When a new diagnosis of diabetes is made, people undergo a lot of tests and general health exams."

"I think there are so many things going on in the relationship that this is maybe only one part of it. We’re really early on in understanding this relationship," he said.

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Research may provide insight to cause of birth defects among babies born to diabetic mothers

BY Allison Cerra

NEW YORK — A new study conducted by a team at the Joslin Diabetes Center suggested that a certain enzyme could cause birth defects among babies born to women with diabetes.

The enzyme, known as AMP kinase, could cause babies to be at an increased risk of developing neural tube effects (i.e., such conditions as spinal bifida) and certain heart defects, because it blocks the expression of a gene known as Pax3, which helps the neural tube form.

"The stimulation of a metabolism-sensing enzyme that can regulate specific genes explains how oxidative stress, which is generated throughout the embryo during maternal hyperglycemia, causes malformation of specific embryo structures," said Mary Loeken, who headed the study. "We now know that we must do whatever we can to prevent AMPK from being stimulated."

The results were published Monday in Diabetologia.


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