Nigeria monitoring 400 contacts of doctor who died of Ebola

Thu Sep 4, 2014
Nigerian authorities are monitoring nearly 400 people for signs of Ebola after they came in contact with a Port Harcourt doctor who died of the disease but hid the fact that he had been exposed, a senior Nigerian health official said on Thursday.

Dr. Abdulsalami Nasidi, project director at Nigeria Centre for Disease Control, said there was a sense of "hopelessness" due to the lack of proven drugs or vaccines to treat Ebola that has infected 18 people in Africa's most populous nation.

In an interview with Reuters in Geneva, he said that more isolation wards were being opened in the oil industry hub but voiced confidence that there would not be "many cases" there.

After having contact with an Ebola patient and before his own death on Aug. 22, the Port Harcourt doctor, named by local authorities as Iyke Enemuo, carried on treating patients and met scores of friends, relatives and medics, leaving about 60 of them at high risk of infection, the World Health Organization said on Wednesday.

The doctor's wife, who is also a physician, and a patient in the same hospital have been infected with Ebola, the WHO said.

"Everything about this doctor was in secrecy, he violated our public health laws by treating a patient with a highly pathogenic agent who revealed to him that he had contact with Ebola and didn't want to be treated in Lagos because he might be put in isolation," Nasidi said.

"He treated him in secrecy outside hospital premises. When he became ill he did not reveal to his colleagues that he had contact with someone who contracted Ebola. He was taken to General Hospital, a private hospital that sees everybody.

"That is the only case that effectively escaped our surveillance network. We are paying now for it," Nasidi said.

He spoke on the sidelines of a two-day WHO experts meeting aimed at speeding development of Ebola drugs and vaccines.

The deadly virus can be spread by direct contact with body fluids and secretions of an infected person or during traditional burial rituals, the WHO says.

The latest outbreak has spread from Guinea to Liberia, Sierra Leone, Nigeria, and Senegal and, with the death toll at more than 1,900 people as of Wednesday, has killed more people than all outbreaks since Ebola was first uncovered in 1976.

"People are living in a state of hopelessness seeing the disease has no cure and no vaccine but has great potential to spread," Nasidi said.

"380 CONTACTS IN OUR DRAGNET"

Nasidi said the Port Harcourt doctor was visited by friends and family in hospital, including some who "laid hands" on him.

"As we are talking now, we have more than 380 of such contacts in our dragnet," he said. Those at high risk are being quarantined, and some 500 volunteers and health care workers are checking on all exposed people twice a day, he said.

A 28-bed isolation ward for Ebola patients has opened in the city, which is home to many expatriate workers in major international oil companies, but authorities did not forecast many more cases, Nasidi said.

He said most of the exposed contacts were near the end of the 21-incubation period for the disease, which starts with fever and muscle pain, followed by vomiting and diarrhea.

"So we are monitoring and are sure we shan't miss out on any contacts that come out with infection that could be transmitted. A contact who has no symptoms doesn't transmit even if he has the virus. So this is why we are hopeful," he said.

The United Nations said on Wednesday that $600 million in supplies would be needed to fight West Africa's Ebola outbreak.

"We must fight Ebola because there is huge anxiety for our populations along with significant social and economic consequences," Younoussa Ballo, secretary-general of Guinea's health ministry, told Reuters at Thursday's talks. "Research must be speeded up to have medicines to confront this epidemic."

Human safety trials are due to begin this week on a vaccine from GlaxoSmithKline Plc and later this year on one from NewLink Genetics Corp. Johnson & Johnson said on Thursday that clinical trials of its vaccine would commence in early 2015, accelerated from late 2015 or early 2016.

NewLink founder Charles Link told Reuters in Geneva: "The clinical trials do take some time. Everybody is trying as hard and furiously as possible to move those trials forward as rapidly as possible with the regulations, scientific and ethical constraints.

"Just because we have the drugs we haven't shown anything about their effectiveness so we have to do these initial studies before it would be appropriate to release them on any kind of broader scale," he said.

"So that is really what our group is here for and a number of other groups like ours, is to try to coordinate those activities to do things at speeds that haven't be done before."

The U.S. Department of Health and Human Services said this week a federal contract worth up to $42.3 million would help accelerate testing of an experimental Ebola virus treatment being developed by privately held Mapp Biopharmaceutical Inc.

Big pharmacies knock on door of oil-rich North Dakota

Thu Sep 4, 2014
North Dakota's oil boom has fueled a construction bonanza for new supermarkets, restaurants and clothing stores. But try finding a Rite Aid, Walgreens or other national pharmacy chain in the state, the fastest-growing economy in the nation, and you'll be largely out of luck.

That could all change with a controversial Nov. 4 ballot initiative in which voters will get to decide for the first time whether to abolish a 1963 state law designed to protect small businesses. The law requires North Dakota pharmacies to be owned by local pharmacists or run by hospitals with a local pharmacist on staff.

Supporters of the initiative argue it will remove an embarrassing anachronism, give consumers more choice and lower prescription drug costs.

Opponents say that allowing national chains would destroy North Dakota's tradition of personalized pharmacy care and be yet another example of how the state's neighborly way of life is changing too fast. Canada, Germany, France and many other countries, they also note, have similar laws requiring local pharmacy ownership.

"Independent pharmacies are more apt to focus on customer service," said Gabe Gretz, who bought Service Drug Pharmacy in Williston last year with his father. "This is our bread and butter. It's not just a hobby for us."

"North Dakota Nice" is a truism here, not an irony, and most retail stores are still prohibited from opening before noon on Sunday - a throwback to laws designed to encourage family time.

Yet since the oil boom began around 2010, drawing thousands of new residents to jobs where roughnecks can earn more than $100,000 a year, drug use, assault and other violent crimes have jumped.

Recent sex-trafficking charges brought against an oil field worker in Williston, a once quiet town that is now the epicenter of the boom, marked the first charges of that type ever filed in the area and has escalated tension between new and old residents.

CONVENIENCE VS. CUSTOMER CARE

Many newly arrived oil workers, and even some locals, say they hope the ballot measure passes so that they can use the same chains they've grown accustomed to elsewhere.

Rite Aid Corp has no outpost in the state, North Dakota's Walmarts have no in-store pharmacies and the state's lone Walgreens, on the Minnesota border, is prohibited from selling prescription drugs.

CVS is able to operate only a handful of pharmacies in North Dakota thanks to a 2006 buyout of several Osco Drug stores that operated before the 1963 law.

"Honestly, it's not convenient getting my prescriptions here," said Jan Anseth, a resident of Williston who spends winters in Arizona where she gets her medications from a national chain. In North Dakota, Anseth says, she runs into problems transferring prescriptions and getting anything more than a 30-day supply.

The ballot's primary sponsor, North Dakotans For Lower Pharmacy Prices, was funded with $168,000 in contributions from Walmart, Walgreens, Kmart and others.

In campaign materials, the group cites data the Kaiser Family Foundation compiled in 2009 showing North Dakota has one of the highest per capita costs for prescription drug and medical devices in the country.

Walmart says North Dakotans are missing out on its popular $4 prescription program, which makes many generic drugs available at the sharply discounted price.

Crying foul, the state's independent pharmacists say they're able to often meet or beat prices from national chains, most of whom lose money on pharmacy sales as a way to get customers in the door.

A random survey by Reuters of North Dakota's independent pharmacies showed that a 30-day supply of the generic blood thinning drug clopidogrel ranged in price between $10 and $59.95. A CVS in Bismarck, the state capital, quoted a price of $149.95 for the same dosage.

"I get to set the prices here at my pharmacy," said Jenna Wahlstrom, a pharmacist at Larsen Service Drug, which her grandfather founded in Watford City in 1952. "It's not a corporate decision."

Like the big chains, Wahlstrom offers her customers a smartphone app and online refill ordering. Her pharmacy has transferred hundreds of prescriptions from retail chains for workers who have moved to the state, she said.

Ahead of the vote, the state's top politicians are declining to take sides.

Governor Jack Dalrymple, a Republican who took office in 2010, says he shops at locally owned Aerohead Plaza Drug while in Bismarck and believes it has been able to compete effectively with the nearby CVS.

Yet in the 1990s, as a state legislator, Dalrymple voted to keep the pharmacy law intact.

"I don't know," he now says, "if that was the right vote."

Obesity rates reach historic highs in more U.S. states

Thu Sep 4, 2014
Rates of adult obesity increased in six U.S. states and fell in none last year, and in more states than ever - 20 - at least 30% of adults are obese, according to an analysis released on Thursday.

The conclusions were reported by the Trust for America's Health and the Robert Wood Johnson Foundation and were based on federal government data. They suggest the problem may be worsening despite widespread publicity about the nation's obesity epidemic, from First Lady Michelle Obama and many others, plus countless programs to address it.

From 2011 to 2012, by comparison, the rate of obesity increased in only one state.

The 2013 adult obesity rate exceeds 20% in every state, while 42 have rates above 25%. For the first time two states, Mississippi and West Virginia, rose above 35%. The year before, 13 states were above 30% and 41 had rates of at least 25%.

Adult obesity rates increased last year in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming.

Nationally, rates of obesity remained at about one-third of the adult population, according to The State of Obesity: Better Policies for a Healthier America (stateofobesity.org), while just over two-thirds are overweight or worse.

Rates of childhood obesity have leveled off, with about one in three 2- to 19-year-olds overweight or obese in 2012, comparable to rates over the last decade.

Continuing a years-long trend, nine of the 10 states with the highest rates of obesity are in the South. The West and Northeast had the healthiest BMIs, with Colorado boasting the lowest adult obesity rate, 21.3%.

Obesity also tracked demographics, with higher rates correlating with poverty, which is associated with lower availability of healthy foods and fewer safe neighborhoods where people can walk and children can play for exercise. For instance, more than 75% of African Americans are overweight or obese, compared with 67.2% of whites.

That pattern affects children, too. In 2012, just over 8% of African American children ages 2 to 19 were severely obese, with a BMI above 40, compared with 3.9% of white children. About 38% of African American children live below the poverty line, while 12% of white children do.

One-third of adults who earn less than $15,000 per year are obese, compared with one-quarter who earn at least $50,000.

"Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling," said Jeffrey Levi, executive director of TFAH.

WHO urges drug companies, regulators to speed Ebola work

Thu Sep 4, 2014
The World Health Organization (WHO) called on Thursday for pharmaceutical companies and regulatory agencies to work together to accelerate development of safe and efficient drugs and vaccines against Ebola.

Ten experimental treatments - eight drugs and "two promising candidate vaccines" - have shown potential against the virus but remain under investigation, the WHO said in a document distributed at the start of a two-day meeting in Geneva.

They include the antibody drug ZMapp made by U.S.-based Mapp Biopharmaceutical Inc., which has been given to several Ebola patients for "compassionate care" but whose clinical effectiveness is "still uncertain", it said. "Efforts to scale up production (of ZMapp) may yield increased supplies of potentially a few hundred doses by the end of 2014."

Evidence of the effectiveness of the medicines and vaccines is "suggestive but not based on solid scientific data from clinical trials," the WHO said. Existing supplies of all experimental medicines are extremely limited or exhausted.

The virulent disease, which has killed at least 1,900 people in West Africa since March, could affect 20,000 by the time it is contained in the next six to nine months, the WHO has said.

"Accelerating the development of experimental/not approved Ebola Virus Disease therapies and vaccines require a concerted effort by product developers and regulatory agencies, in cooperation with the WHO," the WHO paper said.

Decisions on which products go into accelerated development should be transparent and involve the West African countries affected by the epidemic, it said.

"While there is an urgent need for product to be used on a compassionate basis, the ultimate goal should be product approval so that countries affected by Ebola Virus Disease have products which have been demonstrated safe and effective at their disposal."

"THE HOPE OF WHAT WE ARE GOING TO HAVE"

Marie-Paule Kieny, WHO assistant director-general who is chairing the closed-door talks attended by more than 150 experts, said the meeting would focus on developing the most promising drugs in the quickest possible time.

"Developed in terms of getting them to registration and developed in terms of putting them in the treatment center as much as possible in order to make a difference in the lives of people," she said.

The WHO paper said that while supplies of experimental drugs are limited "the prospects of having augmented supplies of vaccines quickly look slightly better".

Human safety trials are due to begin this week on a vaccine from GlaxoSmithKline Plc and later this year on one from NewLink Genetics Corp. Johnson & Johnson said on Thursday that clinical trials of its vaccine would commence in early 2015, accelerated from late 2015 or early 2016.

NewLink Genetics Corp NLNK.O said the U.S. Food and Drug Administration (FDA) allowed the Iowa-based company to start testing an experimental Ebola vaccine in humans. [ID:nL3N0R53VM}

NewLink founder Charles Link told Reuters on the sidelines of the Geneva talks on Thursday: "The clinical trials do take some time. Everybody is trying as hard and furiously as possible to move those trials forward as rapidly as possible with the regulations, scientific and ethical constraints.

A treatment by Tekmira Pharmaceuticals of Vancouver, Canada, that targets two viral genes to stop the virus from replicating, may be available in limited supplies, the WHO said. "There is potential for the production of 900 courses by early 2015."

More U.S. households smoke-free, study says

Thu Sep 4, 2014
Nearly twice as many U.S. households are smoke-free compared to 20 years ago, reflecting an increased awareness of the health hazards from secondhand smoke, but too many people still are exposed, according to a federal study released Thursday.

In the early 1990s, 43 percent of U.S. homes were smoke-free, a figure that rose to 83 percent in 2010-2011, according to the study, issued by the Centers for Disease Control and Prevention.

More than 90 percent of homes without a smoker and nearly half of those with at least one adult smoker had smoke-free rules, the study said.

"It’s a shift in social norms," said Brian King, lead author of the CDC study. "People no longer see smoking around non-smokers as socially acceptable behavior."

Still, he said, more progress is needed, particularly in homes where smokers live, as secondhand smoke from cigarettes kills an estimated 41,000 non-smokers annually.

“We know there is no safe level of secondhand smoke,” King said. “The ultimate goal it to not expose people to a known carcinogen.”

The increased number of smoke-free homes is attributable in part to the diminishing segment of Americans who smoke.

Some 18 percent of Americans were smokers in 2012, down from 42 percent in 1965, the CDC said.

With smoking bans increasingly common at bars, restaurants and in private workplaces, homes are the primary source of secondhand smoke for children and non-smokers, the CDC said.

Roughly half of U.S. residents are now covered by laws that ban smoking in public places, the agency said.

Smoking bans are now expanding to apartments, public housing and even to cars with children inside, King said.

Among states, the percentage of smoke-free homes ranged from a low of 69.4 percent in Kentucky and West Virginia to 93.6% in Utah during 2010–2011, the CDC said.

The study did not ask respondents to specify whether they were referring to tobacco or marijuana smoke in the home, the CDC said.

Apple's smartwatch to have NFC technology: WSJ

Thu Sep 4, 2014
Apple Inc plans to include near-field communication (NFC), a technology that can be used to make payments wirelessly, in its upcoming smartwatch, the Wall Street Journal reported, citing people familiar with the matter.

The company is also expected to add the technology, which is used to transmit data wirelessly over short distances, to the next version of its iPhone, the paper reported.

The smartwatch will be offered in two sizes and will have sensors to track and monitor health, people familiar with the device told the paper.

However, the smartwatch is unlikely to go on sale this year, the people said.

Apple did not immediately respond to calls and emails for comment.

NFC will allow users to make payments for goods and services with credit cards stored with Apple's iTunes digital content store, the report said.

Apple has invited media to a "special event" in its hometown of Cupertino, California, on Sept. 9, when the iPhone maker is expected to unveil the latest versions of its best-selling smartphones.

Apple's shares were trading up 0.46 percent at $99.40 in early afternoon trading on the Nasdaq.

Google to refund $19 million in kids' in-app purchase case: U.S.

Thu Sep 4, 2014
Google Inc has agreed to refund at least $19 million to settle charges that it unfairly billed parents for purchases that their children made while playing video games such as Ice Age Village and Air Penguins on mobile devices.

Children sometimes put hundreds of dollars on their parents' credit cards without permission, the U.S. Federal Trade Commission said on Thursday in announcing the settlement.

The FTC said the Internet giant had also agreed to modify its billing practices to ensure that parents know, and agree to, purchases that their children make.

Google said that it implemented changes in March 2014 that made it clearer when real - as opposed to virtual - money was being spent. And it said that it allowed consumers to choose whether they wanted to be prompted to enter a password with each purchase, as a way to head off unauthorized charges by children.

"We're glad to put this matter behind us so we can focus on creating more ways for people to enjoy all the entertainment they love," said a Google spokeswoman.

The FTC settled a similar case with Apple Inc in January. Apple agreed to refund to customers at least $32.5 million in unauthorized charges made by children and to change its billing practices to require consent from parents for in-app spending.

The FTC sued Amazon.com in July on the same issue.

The FTC has alleged that the companies were too lax in allowing children playing some app games to ring up charges on their parents' credit cards to buy pricey digital goods.

In Air Penguins, for example, children can buy virtual fish costing $49.99 to feed virtual penguins living on virtual melting ice caps.

Google first began offering in-app charges, as the virtual purchases are known, in 2011 without requiring any password or taking other steps to ensure that the parent approved of the child's charges, the FTC said.

In 2012, Google began asking for the credit card holder's password before allowing the purchase. But, granting permission for one purchase would open a 30-minute window where children could make purchases without re-entering a password, the FTC said.

Initially, Google urged unhappy parents to take up the issue with the app developer, the FTC said.