Flu drug advised for pregnant women with swine flu

ATLANTA – Pregnant women should take prescription flu medicines if they are diagnosed with the new swine flu, health officials said Tuesday. So far, the swine flu has not proven to be much more dangerous than seasonal influenza, and it's not clear whether or not pregnant women catch swine flu more often than other people. But in general, flu poses added risks for pregnant women, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

Pregnancy weakens a woman's immune system, so that she's more likely to suffer pneumonia when she catches the flu. In earlier flu pandemics, infection also raised the risk of a premature birth, said Schuchat.

Risks from the virus are greater than the unknown risks to the fetus from the drugs Tamiflu and Relenza, Schuchat said at a press conference Tuesday.

"We really want to get the word out about the likely benefits of prompt antiviral treatment" for pregnant women, she said.

Still, the flu medicines' effectiveness is somewhat limited, studies have shown. They can relieve symptoms and shorten the disease by about a day. They only work if started within 48 hours of first symptoms, and little is known about whether they cut the chances of serious flu complications. Most people recover from the flu with no medical treatment.

But a pregnant Texas woman who had swine flu died last week, and at least 20 other pregnant women have swine flu, including some with severe complications.

In total, about 3,000 U.S. cases of swine flu have been confirmed through lab testing so far, most of them ages 18 and under. Officials think the actual number of infections is much higher, and that infections are still occurring.

CDC officials said the swine flu may seem to be mild now, but they worry the virus will mutate into something more dangerous. One concern is that it will combine with the more deadly but less easily spread bird flu virus that has been circulating in Asia and other parts of the world.

Another concern is that it will combine with the seasonal H1N1 virus that went around over the winter. That virus was not unusually virulent, but it was resistant to Tamiflu — the current first-line defense against the new swine flu. If the two virus strains combine, it's possible the swine flu will become resistant to Tamiflu as well, health officials worry.

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On the Net:

CDC swine flu web site: http://www.cdc.gov/h1n1flu/

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As swine flu spreads, who should get Tamiflu?

MEXICO CITY – The swine flu epidemic may seem mild now, with relatively few deaths even as the virus infects thousands in at least 33 countries. But experts worry it could mutate into something more dangerous — making the question of who should get antiviral therapy ever more important.

The World Health Organization said Tuesday that countries should save antiviral drugs for those patients most at risk, and the U.S. Centers for Disease Control and Prevention added that pregnant women in particular should take the drugs if they are diagnosed with swine flu — even though the effects on the fetus are not completely known.

European countries have been using antiviral drugs such as Tamiflu and Relenza much more aggressively than the United States and Mexico — administering it whenever possible in an attempt to contain the virus before it spreads more widely.

Instead, the WHO recommends that antivirals be targeted mainly at people already suffering from other diseases or complications — such as pregnancy — that can lower a body's defenses against flu, WHO medical expert Dr. Nikki Shindo said.

Pregnant women are more likely to suffer pneumonia when they catch flu, and flu infections raised the risk of premature birth in past epidemics. A pregnant Texas woman who had swine flu died last week, and at least 20 other pregnant women have swine flu, including some with severe complications.

For all these reasons, risks from the virus are greater than the unknown risks to the fetus from Tamiflu and Relenza, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

"We really want to get the word out about the likely benefits of prompt antiviral treatment" for pregnant women, she said.

Mexico is now giving Tamiflu to anyone who has had direct contact with a person infected with swine flu, Health Secretary Jose Angel Cordova said. And now that schools are back in session, authorities plan to give Tamiflu to any children who show symptoms and are suspected of being infected.

CDC officials said the swine flu may seem to be mild now, but they worry the virus will mutate into something more dangerous — perhaps by combining with the more deadly but less easily spread bird flu virus circulating in Asia and Africa.

Another concern is that it will combine with the northern winter's seasonal H1N1 virus. While not unusually virulent, it was resistant to Tamiflu, and health officials worry that it could make the new swine flu resistant to Tamiflu as well.

The nearly 6,000 confirmed cases worldwide so far have included 63 deaths, and Mexico's death toll rose by two on Tuesday to 58, with 2,282 confirmed infections. But Cordova said the worst appears over — and the more cases the country confirms, the less deadly the virus appears. The increasing toll reflects a testing backlog, Cordova said, with the last confirmed case on May 8.

The U.S. has the world's highest caseload, at more than 3,000 infections in 45 U.S. states, but many countries have focused their energy on containing the spread from Mexico, rather than the U.S. Cuba, Thailand and Finland reported their first cases Tuesday, all in people who had returned from Mexico, and criticism of Mexico's handling of the crisis continues.

Cuba's first case — a Mexican student attending a Cuban medical school — came despite strict restrictions on flights and travelers, prompting former president Fidel Castro to accuse Mexico of hiding the epidemic until after President Barack Obama visited last month.

Mexico has denied hiding anything — and the timeline supports this: Obama's April 16 visit came a week before Canadian and U.S. scientists identified swine flu in Mexican patients, at which point Mexico quickly imposed an unprecedented shutdown of most aspects of public life for days.

"The response by Mexico's health care system and the country's transparency in the way it conducted itself has allowed all nations ... to be able to take preventive measures in a timely manner so they could combat this illness," President Felipe Calderon said Tuesday.

China said it has tracked down and quarantined most passengers who shared flights with the mainland's first known swine flu sufferer — a Chinese graduate student from the U.S. who is said to be improving.

"We must attach great importance to the fact that the flu epidemic is still spreading in some countries and regions, and that China has discovered one case," said President Hu Jintao.

About 260 people were quarantined in Beijing, including 70 foreigners, the China Daily reported. In Sichuan province, the government said another 95 people were being isolated.

With the virus now spreading worldwide, Swiss pharmaceuticals company Roche Holding AG announced it is donating enough Tamiflu for 5.65 million more people to WHO. A further 650,000 packets containing smaller doses of the drug will be used to create a new stockpile for children.

At the start of the outbreak, Mexico had enough Tamiflu for 1 million people, and has since received more, building reserves of 1.5 million courses.

Each country's health experts must decide if infected people should immediately be treated with antivirals, Shindo said — a decision that also must take into account how many antivirals are available.

"As part of pandemic preparedness plans, we urge countries to plan for prioritization," Shindo said.

Mexico's overburdened health system has been strained. Dozens of government doctors and nurses marched and blocked streets in the Gulf coast city of Jalapa to demand higher pay and better working conditions.

Mexico also is trying to revive its economy after the epidemic pummeled tourism, the country's third-largest source of legal foreign income. Cordova said there have been no swine flu cases in five top Mexican vacation spots, including Los Cabos, Puerto Vallarta, Cozumel, Mazatlan and Zihuatanejo.

But with incoming flights virtually empty of tourists, Tourism Secretary Rodolfo Elizondo said a $90 million publicity campaign would focus on encouraing Mexicans to vacation at home.

Promoting trips by foreigners now, he said, "would be like throwing money away."

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Associated Press writers Michael Stobbe in Atlanta; Maria Cheng in London; and Gillian Wong in Beijing contributed to this report.

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Senators weigh tax hikes to pay for health care

WASHINGTON – Senators are considering limiting — but not eliminating — the tax-free status of employer-provided health benefits to help pay for President Barack Obama's plan to provide coverage to 50 million uninsured Americans.

Finance Committee Chairman Max Baucus, D-Mont., said Tuesday that there are no easy options. Senators began grappling with how to finance guaranteed coverage, a cornerstone of Obama's plan to overhaul the health care system. Independent experts put the costs at about $1.5 trillion over 10 years.

Obama sees a world in which doctors and hospitals compete to offer quality service at lower costs, and the savings help cover the uninsured. Turning that vision into reality remains the biggest challenge for the president and his backers, because hard cash — not just ideas — is required to cover upfront costs of expanding coverage.

The president put health care industry leaders on notice Tuesday that he expects them to fulfill their dramatic offer of $2 trillion in savings over 10 years. "I will hold you to your pledge to get this done," Obama said in a letter released by the White House that went to groups representing insurers, hospitals, doctors, drug makers and others.

But those savings — even if the industry delivers every penny — won't all accrue to the government. So the financing package for Obama's plan is likely to include a mix of tax increases and spending cuts in federal health programs.

Among the possibilities: tax increases on alcoholic beverages, tobacco products and sugary soft drinks, and restrictions on other health care-related tax breaks, such as flexible spending accounts.

But some taxes don't seem to be on the table, such as a federal sales levy to pay for health care or a new payroll tax.

Congressional leaders say they want to pass legislation in the Senate and House this summer.

On the controversial question of taxing health benefits, Baucus is staking out a position that could put him at odds with Obama.

The president adamantly opposed such taxes during the campaign, arguing they would undermine job-based coverage. Obama's aides now say he's open to suggestions from Congress, even if he criticized Republican presidential rival John McCain for proposing a sweeping version of the same basic idea.

Baucus said he wants to modify the tax break, not abolish it.

"We are not going to repeal it," he said.

Baucus suggested that the benefit could be limited by taxing health insurance provided to high-income individuals, although he did not specify at what income levels. He also said that plans offering rich benefits — for example, no co-payments or deductibles — might be taxed once their value exceeded a yet-to-be-determined threshold.

White House press secretary Robert Gibbs resisted being drawn into the congressional debate. "We're not going to get into a daily scorekeeping of each idea and proposal," he said.

Employer-provided health insurance is considered part of workers' compensation, but unlike wages, it is not taxed. The forgone revenue to the federal government amounts to about $250 billion a year.

Proponents of repealing the benefit say it encourages lavish health insurance plans that only add to waste in the health care system. And they argue that the benefit is unfair, since self-employed people don't get as big a tax break for health care.

Many experts say that Congress won't be able to come up with the kind of money needed to provide coverage for all unless limitations on the health care tax break are part of the mix.

"I don't see how you're going to put a package together ... unless you touch the exclusion," said Robert Greenstein, director of the Center on Budget and Policy Priorities, which advocates for low-income people. In government jargon, the tax-free status of health insurance is called the "tax exclusion."

Obama has proposed to pay for the plan with a 50-50 mix of tax increases and spending cuts. On the tax side, the president would limit income tax deductions for families making more than $250,000 a year, raising $267 billion over 10 years. Baucus said Tuesday that idea deserves consideration.

The ranking Republican on the Finance Committee, Sen. Charles Grassley of Iowa, said lawmakers should try to squeeze wasteful spending out of the system before imposing new taxes. But Grassley ridiculed the health care industry's pledge of $2 trillion in savings through voluntary efforts to hold down costs.

"I'm sure we will be waiting for some time before this fairy dust becomes real gold," he said.

One option for lawmakers would be to codify the industry's cost reduction offer in federal law, giving it some teeth by applying it to federal health insurance programs.

Protesters who back government-run health care disrupted the Finance Committee hearing. Police ejected five doctors and nurses after they interrupted Baucus and Grassley at the start of the session.

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Associated Press writer Erica Werner contributed to this report.

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Miami VA: Steps taken to prevent contamination

MIAMI – The top Veterans Affairs official in Miami said Tuesday she has taken steps locally to prevent the kind of problems that exposed patients to contaminated medical equipment at VA hospitals in three states.

Mary D. Berrocal, director of the Miami VA Healthcare System, told The Associated Press she has hired someone in Miami to supervise training, make sure biomedical equipment works properly there and ensure the problems aren't repeated.

"We have truly scrutinized our systems to ensure that doesn't happen," she said. "We truly, truly are on it ... We've really, really, really expended every effort possible to make sure that this is an isolated situation."

But she declined to discuss specifics about the contamination problems or say how they went undetected for so long.

Five patients have tested positive for HIV — three of them in Miami — and 33 have tested positive for hepatitis since February, when the VA started notifying more than 11,000 people treated at three VA medical centers to get follow-up blood checks because they could have been exposed to infectious body fluids. The equipment is used for colonoscopies and ear, nose and throat procedures.

The hospitals are in Miami, Murfreesboro, Tenn., and Augusta, Ga.

Berrocal, who has been praised by some Miami veterans in the aftermath of the scandal, said that when she first heard about the situation: "I was heartbroken, you know."

The problems with cleaning equipment — and possibly co-mingling infectious body fluids — went on for five years at the Miami and Murfreesboro hospitals and about a year in Augusta.

Berrocal said she couldn't discuss the specifics because of a continuing investigation by the VA and its inspector general.

U.S. Rep. Kendrick Meek, D-Fla., was informed Monday that the VA inspector general's report will be issued within weeks or days to the House Veterans' Affairs Committee, Meek's spokesman Adam Sharon said.

Meek called for congressional hearings when the scandal broke out. Sharon said those hearings are expected to take place shortly after the report is issued.

North Carolina Sen. Richard Burr, the top Republican on the Senate Veterans' Affairs Committee, has also called for hearings on the subject.

The endoscopic equipment is made by Center Valley, Pa.-based Olympus American Inc., and the company has said its recommended cleaning procedures are clear. Berrocal said it's "very complicated equipment."

She said a series of experts have reviewed the processes and the systems and improved them.

She added, "I think our quest has to be about doing everything possible, everything that we can to minimize the potential for error and to take care of our patients. We have to constantly be vigilant"

The VA has stressed that the positive tests are "not necessarily linked" to medical treatment at its hospitals, and infections don't always cause symptoms and can go undetected for years.

No matter where the patients contracted the illnesses, Berrocal said the VA will treat them.

"Miami has a very high percentage of those illnesses anyway. It is very hard to tell whether they contracted it from this or not," she said. "To me, it just doesn't matter how they got it. If we found it, we are going to treat it."

Berrocal said the discovery of the problems at the VA may have helped improve health care nationwide.

"It's really unfortunate that this happened, however, I believe that it has increased awareness across the country about this piece of equipment. It's not only used in VA," she said.

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FDA takes issue with Cheerios health claims

WASHINGTON – Federal regulators are scolding the maker of Cheerios, saying it made inappropriate claims about the popular cereal's ability to lower cholesterol and treat heart disease.

The Food and Drug Administration says in a warning letter to General Mills that language on the Cheerios box suggests the cereal is designed to prevent or treat heart disease. Regulators say that only FDA-approved drugs are allowed to make such claims.

Among other claims, the labeling states: "you can lower your cholesterol 4 percent in six weeks."

General Mills said the health claims on Cheerios have been approved for 12 years and the FDA's complaints deal with how the language appears on the box. The company said in a statement that the science was not in question.

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