Scientists identify new lethal virus in Africa

ATLANTA – Scientists have identified a lethal new virus in Africa that causes bleeding like the dreaded Ebola virus. The so-called "Lujo" virus infected five people in Zambia and South Africa last fall. Four of them died, but a fifth survived, perhaps helped by a medicine recommended by the scientists.

It's not clear how the first person became infected, but the bug comes from a family of viruses found in rodents, said Dr. Ian Lipkin, a Columbia University epidemiologist involved in the discovery.

"This one is really, really aggressive" he said of the virus.

A paper on the virus by Lipkin and his collaborators was published online Thursday on in PLoS Pathogens.

The outbreak started in September, when a female travel agent who lives on the outskirts of Lusaka, Zambia, became ill with a fever-like illness that quickly grew much worse.

She was airlifted to Johannesburg, South Africa, where she died.

A paramedic in Lusaka who treated her also became sick, was transported to Johannesburg and died. The three others infected were health care workers in Johannesburg.

Investigators believe the virus spread from person to person through contact with infected body fluids.

"It's not a kind of virus like the flu that can spread widely," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which helped fund the research.

The name given to the virus — "Lujo" — stems from Lusaka and Johannesburg, the cities where it was first identified.

Investigators in Africa thought the illness might be Ebola, because some of the patients had bleeding in the gums and around needle injection sites, said Stuart Nichol, chief of the molecular biology lab in the CDC's Special Pathogens Branch. Other symptoms include include fever, shock, coma and organ failure.

Genetic extracts of blood and liver from the victims were tested at Columbia University in New York, and additional testing was done at CDC in Atlanta. Tests determined it belonged to the arenavirus family, and that it is distantly related to Lassa fever, another disease found in Africa.

The drug ribavirin, which is given to Lassa victims, was given to the fifth Lujo virus patient — a Johannesburg nurse. It's not clear if the medicine made a difference or if she just had a milder case of the disease, but she fully recovered, Nichol said.

The research is a startling example of how quickly scientists can now identify new viruses, Fauci said. Using genetic sequencing techniques, the virus was identified in a matter of a few days — a process that used to take weeks or longer.

Along with Fauci's institute, the National Heart, Lung, and Blood Institute and Google also helped fund the research.

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PLoS Pathogens: http://www.plospathogens.org/home.action

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Stroke group expands time for clot-busting drugs

DALLAS – A change to stroke treatment guidelines is expanding the time that some patients can get clot-busting drugs. Current recommendations limit the use of the medicine to within three hours after the start of stroke symptoms. That treatment window is now being lengthened to 4 1/2 hours for some patients.

But the committee that made the change stressed that the earlier the treatment, the better for stroke victims.

"They should call the ambulance straight away and get moving," said Dr. Gregory del Zoppo, of the University of Washington School of Medicine in Seattle, who headed the committee for the American Heart Association Stroke Council.

The update, published online Thursday in the heart group's journal Stroke, comes after a European study last fall found stroke sufferers still benefited from getting the medicine an hour or so beyond the three-hour window.

The new guideline is expected to increase the number of people who get the treatment. Only about a third of stroke sufferers get help within three hours, and only about 5 percent get the drug now. Many people don't recognize the signs of a stroke: numbness or weakness in the face, arm or leg; trouble speaking, seeing or walking; a sudden, severe headache.

Stroke is the third leading cause of death in the U.S., with about 795,000 people suffering a new or recurrent stroke each year and more than 140,000 people dying. Strokes caused by blood clots are the most common; the clot blocks an artery supplying blood to the brain, which starves brain cells of oxygen. The drug TPA breaks up the clot and opens the artery.

Another member of the committee, Dr. Jeffrey Saver, of the University of California at Los Angeles, said some hospitals extended the time for using the clot dissolver after the European study, while many have been waiting for national guidelines.

He said the change could increase the number of people who get the drug by a third, to 7 or 8 percent of stroke victims.

Dr. Mark D. Johnson, a stroke specialist at the University of Texas Southwestern Medical Center in Dallas, said that the expanded time frame is good news but the emphasis is still on getting treatment sooner rather than later.

"If you were to arrive in 30 minutes, the chances of a better outcome are higher than if you arrive in four hours," said Johnson.

The new guideline notes that some patients should still be restricted to treatment within the three-hour period: people older than 80, those suffering from a severe stroke or with a history of stroke and diabetes or those taking anti-clotting drugs.

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On the Net:

American Stroke Association: http://www.strokeassociation.org

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CDC says October soonest for swine flu shots

ATLANTA – A U.S. health official said a swine flu vaccine could be available as early as October, but only if vaccine production and testing run smoothly this summer.

Dr. Anne Schuchat (Shook-it) of the U.S. Centers for Disease Control and Prevention said the agency began shipping virus samples to manufacturers in the past several days. The government will have to review the safety and effectiveness of what's produced, and decide if a vaccination campaign is warranted. October is about the time seasonal flu vaccine campaigns generally get rolling.

CDC officials reported more than 8,500 probable and confirmed cases in the U.S., including 12 deaths and more than 500 hospitalizations.

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Congress can learn from Mass., Tenn. health plans

Laid off from her job in Massachusetts, Danielle Marks thought immediately about losing her health insurance. How could she afford the medication and physical therapy she needed to heal after shoulder surgery?

Valerie Nash, laid off in Tennessee, thought about her diabetes. Could she stock up enough test strips and insulin before her coverage expired?

The two women, both briefly uninsured, got covered again thanks to their home states' 3-year-old experiments in expanding health insurance coverage. And while both are mostly pleased with the coverage and low cost of their new state-backed plans, their futures hold plenty of doubt.

Congressional lawmakers can look north to Massachusetts and south to Tennessee for guidance as they craft a national plan to restrain costs and cover the nation's estimated 50 million uninsured.

In Massachusetts, nearly every resident has health insurance, but doctors are turning away new patients, costs to the state are climbing and thousands have paid tax penalties for being uninsured. In Tennessee, that state's much smaller program hasn't cramped the budget, but few people are buying the new insurance even though premiums are as cheap as a monthly cell phone bill.

"The belief that we should all have health insurance coverage is broadly held," said Alan Weil of the nonpartisan National Academy for State Health Policy. "But there are tremendous differences around the country in beliefs on how to achieve that goal."

A Massachusetts-style requirement for individuals to obtain health insurance is likely to emerge as part of the health overhaul taking shape in Congress, although details remain unsettled. A variation of Tennessee's practice of charging higher premiums to smokers and those who are overweight also may emerge; some in Congress are discussing a lifestyle tax on alcohol and sugar-sweetened drinks to help finance the national plan.

In Plymouth, Mass., Marks and her husband, Tad, now pay just $78 a month for state-subsidized insurance that covers doctor visits, prescriptions and hospital stays. Because she's pregnant, Marks, who worked as an administrative assistant until her layoff, pays nothing for her checkups, medicine and vitamins.

But pared-down benefits may lie ahead in Massachusetts because throngs of the newly insured swelled costs of Commonwealth Care to $628 million last year.

And the demand for care is outstripping the number of doctors. One in five Massachusetts adults said a doctor's office or clinic told them they weren't taking new patients with their type of insurance, or they weren't accepting new patients at all, according to a new study published Thursday in the journal Health Affairs.

Massachusetts chose to cover virtually everyone. It set high standards for minimum health insurance and decided to deal with costs later. Soon a state commission expects to call for fundamental changes in the way doctors and hospitals are paid, a plan that amounts to putting them on a financial diet.

"Once you start down the moral path to universal coverage, you inevitably confront costs," said Jon Kingsdale, who directs the board that oversees the state's plan. He and others said Congress can learn the Massachusetts way: coverage first, then cost control.

"If you get everybody covered first, it's easier to deal with costs," Kingsdale said. "If you're going to hold the uninsured hostage to containing costs, you have more than doubled the height to get up this hill."

Tennessee, on the other hand, chose to get just a few more people bare-bones insurance at a budget price with limits on how much plans would pay for hospital stays.

In Chattanooga, Tenn., Nash, who had worked at a car dealership, and her husband, Larry, now pay $193 a month for their state-subsidized coverage, called CoverTN. Their doctor visits and generic drugs are covered, but the plan pays only $10,000 a year on hospital bills. A serious medical crisis could bankrupt them.

"My husband and I barely squeak by as it is now," Valerie Nash said. "It would be a devastating blow."

Compared to Massachusetts, Tennessee is similar in population size, but has more uninsured adults of working age and higher rates of diabetes, childhood obesity, low birth weight and smoking.

What set the stage for Tennessee's go-slow approach was the state's history with expanding health insurance during the 1990s, said Gov. Phil Bredesen.

A state program built around Medicaid, called TennCare, "got totally out of control. It was growing at 15 percent a year. Tennessee had the most expensive Medicaid program in the country," Bredesen said. "Our experience with trying to do universal coverage ended up being a disaster."

When Bredesen took office in 2003, he inherited soaring state health care spending. In 2005, he cut 170,000 adults from TennCare. He reduced benefits for thousands more.

His new initiative, CoverTN, takes "baby steps" toward covering more people. It targets workers at small businesses, the self-employed and the recently unemployed. The cost of monthly premiums is shared by the state, the individual and employers. No one is forced to participate.

Bredesen said the plan design reflects what uninsured Tennesseans want — primary care, not catastrophic care — in a trimmed-down package. Only eight people have exceeded the annual maximum for inpatient hospital costs since the program began.

"This is not the insurance for someone who's going to get into a motorcycle accident," Bredesen said.

The program costs less than anticipated and a fraction of Massachusetts' cost — $10.9 million last year, in part because only about 19,000 have signed up so far.

"I've dreamed about 100,000," Bredesen said. "I'm always amazed, however, when you actually charge someone for health insurance, how many fewer people are willing to sign up for it, than are willing to demand affordable health care."

Mostly it's the "young invincibles" who are staying away. Those are young adults who "don't feel like they're going to get sick," said Laurie Lee, who directs CoverTN and other state health benefits programs. "We've been surprised by that," she said. Older people with chronic conditions are signing up.

Massachusetts officials boast of adding 432,000 to the insured population; 187,000 of those got insurance through their employers or individual purchase. A state survey last year found fewer than 4 percent of working age adults remained uninsured.

Tennessee's uninsured rate for working-age adults probably is not much lower than it was before CoverTN, roughly 20 percent. New census data on the uninsured comes out later this year.

"We learn from Massachusetts that a bold objective matters. If it can be sustained, that's terrific," said Weil, who's lived in both states and said the plans reflect the states' different political cultures. "It would be nice if you had a southern state that had achieved universal coverage and did it in a different way, but we don't have that."

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Associated Press writers Bill Poovey in Chattanooga, Tenn., and Steve LeBlanc in Boston contributed to this report.

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