FWC biologists began tracking the kittens’ mother in February. She was captured, collared and released. In May, they examined and marked her three kittens on private land in Lee County.

On Sept. 14, a mortality signal from the mother’s collar was detected during a routine telemetry flight. Her skeletal remains were located later that day. The cause of death is unknown.

Knowing orphaned kittens cannot survive long in the wild without their mother, biologists worked quickly to capture the kittens. Remote cameras and traps were set. Several days went by with no activity, and hope the kittens would be found alive was fading.

That is until Thursday. FWC biologists checked the cameras and found pictures of two panther kittens.

This morning, two kittens were trapped together in a single trap. It is believed that only two of the three kittens survived to this age. They were successfully rescued and transported via private plane to White Oak Conservation Center, where they will be raised and conditioned for a future return to the wild.

“Losing a mother panther in the prime of her life is tough,” said Darrell Land, FWC biologist and panther team leader. “But we hope we can finish the job she started by raising her kittens so they can be returned to the wild. With only 100-160 adult panthers remaining in South Florida, every individual is important.”

The public can support panther conservation efforts. Funds generated through the purchase of a panther license plate go directly to supporting the research and management of Florida panthers, including the care of these two kittens.

Most Floridians or visitors to the state will never get to see the reclusive long-tailed cat. But they can attend the first annual Florida Panther Festival on Saturday, Oct. 29, from 10 a.m. to 4 p.m. at North Collier Regional Park in Naples. The purpose of the free festival is to raise awareness of the endangered Florida panther, while promoting safe coexistence of people, pets, livestock and panthers. To learn more about the panther, go to FloridaPantherNet.org.

September brings the change of seasons. Football players return to the gridiron. New television programs replace summer reruns. In Washington, legislators gear up for another season of legislative brinkmanship.

What distinguishes such brinkmanship from ordinary legislating? Hard deadlines.

Such deadlines force Congress to address policy issues that might otherwise languish due to partisan differences or legislative inertia.

Last spring, for example, the repeated threat of a government shutdown forced Congress to decide how much to spend on government agencies in fiscal 2011. This summer, the debt limit forced Republicans and Democrats to reach a budget compromise before Aug. 3, the day we would have discovered what happens if America can’t pay all its bills.

Hard deadlines thus can force Congress to address major issues. But they also invite that brinkmanship.

Like students who put off writing term papers until the night before they’re due, legislators often drag out negotiations until the very end. As we saw with the debt-limit debate, the ensuing uncertainty – will the United States really default? – can damage consumer, business, and international confidence. Hard deadlines also give leverage to those legislators who are least concerned about going over the brink.

So get ready for the new season. The fall legislative season is full of deadlines that could invite such brinkmanship. Here are five.
Number 1

The first up was the Federal Aviation Administration, whose short-term funding expired Sept. 16. Congress averted a partial shutdown by extending the agency’s funding for four months, avoiding the thousands of furloughs and layoffs that occurred when FAA funding briefly ran out in July.
Number 2

Second is for a much larger item: funding for highways and mass transit. Current authority for these programs expires on Sept. 30. If Congress doesn’t act by then, new federal spending on surface transportation projects will grind to a halt, putting tens of thousands of jobs at risk.

Number 3

Sept. 30 also marks the end of the fiscal year – an especially important deadline. Congress has made woefully little progress in deciding next year’s funding. So we again face the prospect of temporary funding bills being negotiated in the shadow of threatened government shutdowns.

Number 4
The fourth deadline comes on Nov. 23, the day the new “super committee” has to deliver a plan to address government debt and cut the deficit by at least $1.2 trillion over the next decade. If any seven committee members agree by that date, their plan will get special, expedited consideration in the House and Senate.

If the committee fails to reach agreement or Congress fails to enact it by Dec. 23, however, then automatic budget cuts go into effect for a range of programs, including defense, domestic programs, and Medicare, starting in 2013.
Number 5

A final deadline comes at the end of the year, when several economic initiatives are set to expire, including the 2 percent payroll tax holiday and extended unemployment insurance benefits.

Each of these deadlines will command congressional attention. The downside of inaction will be tangible and visible. With renewed concern about jobs, policymakers will feel extra pressure to continue any funding or tax cuts that can be directly linked to employment.

These deadline-driven policy issues will thus dominate the fall legislative season. That will leave little space for any new initiatives that don’t come with a deadline.

~ National report ranks Florida’s reading proficiency standards higher than the majority of other states ~

TALLAHASSEE – A new report from the National Assessment of Educational Progress (NAEP) indicates that Florida has some of the strongest reading standards in the country. The Mapping State Proficiency Standards onto the NAEP Scales report compares each state’s reading and mathematics proficiency standards against national proficiency standards to see how closely they match up. According to the report, Florida’s eighth grade reading proficiency standards are the second highest in the nation, and only 12 states have higher proficiency standards in fourth grade.

“Florida set a high bar for reading very early on and this latest NAEP report helps to reflect the positive impact of that decision,” said Education Commissioner Gerard Robinson. “With our Next Generation reading standards now firmly in place we should expect even greater things in the years ahead.”

The report uses a method called “mapping” to take each state’s proficiency standards and place them on a common scale so they can be accurately compared. The common scale in this report is the NAEP reading and mathematics proficiency standards, widely considered the gold standard for the nation.

Florida experienced more moderate rankings in mathematics, primarily due to newly updated mathematics standards not being fully captured in this NAEP report. In fourth grade, Florida’s mathematics proficiency standards were ranked 15th in the nation, and its eighth grade ranking was 26th.

Florida continues to be a national leader in setting high standards for student achievement. Over the past several years the state has been involved in developing, adopting and implementing Next Generation curriculum standards designed to prepare students for college and career. Florida’s commitment to higher standards and increased expectations for students has resulted in significant academic progress as measured by both state and national assessments.

NIH-funded study finds dietary supplement does not alleviate BPH

Are These Berries the Cure for Prostate Problems?

Saw palmetto, a widely used herbal dietary supplement, does not reduce urinary problems associated with prostate enlargement any better than a placebo, according to research funded by the National Institutes of Health. The study was published Sept. 28 in the Journal of the American Medical Association.

Prostate enlargement, also called benign prostatic hyperplasia (BPH), can cause frequent urination, a weak or intermittent urine stream and an inability to empty the bladder completely. More than half of men in their 60s, and up to 90 percent in their 70s and 80s, have symptoms of BPH.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements (ODS) supported the study. All are part of the NIH.

According to Robert A. Star, M.D., director of the NIDDK’s Division of Kidney, Urologic and Hematologic Diseases, the current study met an important need for rigorous evaluation of standard and higher doses of saw palmetto. The trial also confirmed results of the earlier NIDDK- and NCCAM-sponsored Saw Palmetto Trial for Enlarged Prostates (STEP), which found that a standard daily dose of 320 milligrams provided no greater symptom relief than placebo.

“Investigators designed the current trial to determine whether daily doses of up to 960 milligrams — three times the standard daily dose — would prove better than a placebo at improving lower urinary tract symptoms in men due to BPH,” said Star. “We were disappointed to find that higher doses of saw palmetto did not improve symptoms more than placebo.”

Josephine P. Briggs, M.D., director of NCCAM, added that this study further illustrates the importance of conducting research on botanical products that are used extensively by the general public.

“This was a well-designed study that addressed limitations of earlier, smaller trials — it was a multicenter study with a larger sample size and tested different doses of a carefully analyzed saw palmetto product,” Briggs said. “The NIH is committed to bringing rigorous science to the study of natural products and to building the evidence base that can guide consumer decisions.”

The study was a double-blind randomized placebo-controlled clinical trial conducted at 11 North American clinical sites from June 2008 to October 2010. A cohort of 369 men aged 45 years or older participated, each with a peak urine flow rate of at least four milliliters per second at the beginning of the study — which is less than normal. Also, all had an American Urological Association Symptom Index (AUASI) score of between eight and 24 — a lower score is better. The AUASI score ranges from zero to 35. Escalating doses of saw palmetto or placebo were given, starting at one, then two, and then three pills of 320 milligrams per day, with dose increases at 24 and 48 weeks.

The study measured the differences between the AUASI score at the start of the trial and after 72 weeks of treatment. Secondary measures included improvements in frequency, nocturia (nighttime urination), peak urine flow, prostate-specific antigen (PSA) level, sexual function, incontinence and sleep quality.

Between baseline and 72 weeks, mean AUASI scores decreased from 14.4 to 12.2 points with saw palmetto extract and from 14.7 to 11.7 points with placebo. The group average change in AUASI score from baseline to 72 weeks between the saw palmetto and placebo groups was 0.79 points, favoring placebo. Saw palmetto was not more effective than placebo in reducing urinary symptoms for any of the secondary outcomes.

According to Joseph M. Betz, Ph.D., director of the Analytical Methods and Reference Materials program at ODS and a study co-author, the study used a very well-characterized saw palmetto product. Through batch testing, study investigators took extreme care to ensure that the composition of the supplement was consistent over the whole study.

“Saw palmetto and other herbs are often manufactured in different ways, so no two brands are likely to have the same composition,” Betz said.

Rottapharm/Madaus, Cologne, Germany, donated the saw palmetto extract and matching placebo used in the study.

New Understanding Into the Causes of ALS and Dementia

National Institutes of Health scientists and worldwide teams of researchers have identified the most common genetic cause known to date for two neurological diseases, amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). The discovery offers clues to underlying mechanisms of these diseases, and may eventually contribute to the design and testing of possible therapies. The research results appeared online in Neuron on Sept. 21, 2011.

Researchers found that a mutation on a single gene, C9ORF72 on the short arm of chromosome 9, accounts for nearly 50 percent of the directly inherited, familial ALS and FTD in the Finnish population, and more than a third of familial ALS in other groups of European ancestry. The mutation, called a hexanucleotide repeat expansion, is an unusual one that involves repeating a DNA sequence over and over again. The researchers also found these mutations in Finnish people with the more common, sporadic form of ALS.

Bryan Traynor, M.D., of the Laboratory of Neurosciences at the NIH’s National Institute on Aging (NIA), led the NIH work with support from NIH’s National Institute of Neurological Disorders and Stroke (NINDS). NIA and NINDS also funded work by a team from the Mayo Clinic in Florida, reported by Mayo investigator Rosa Rademakers, Ph.D., and colleagues, which independently identified the same repeat DNA sequence as a genetic cause of FTD/ALS.

“Identifying this defective gene common to both the inherited forms of ALS and FTD and the sporadic form of ALS provides important new insights into the development of these neurodegenerative diseases,” said NIA Director Richard J. Hodes, M.D. “We still have much to learn about the complex interplay between genetic risk for a disorder and the other factors that determine disease onset and progression. But finding these types of mutations is critically important to a better understanding of disease mechanisms so that we can ultimately target disease biology to develop therapeutics.”

“This finding highlights the importance of studying isolated populations with high rates of a specific disease. Finland has the highest rates of ALS in the world. By collecting virtually every case within the Finnish population, Traynor and colleagues were able to definitively show that this particular gene mutation plays a role in ALS development—a discovery relevant not just to that population, but critical to our basic understanding of the disorder,” said NINDS Director Story Landis, Ph.D.

Both ALS, often referred to as Lou Gehrig’s disease, and FTD are rapidly progressive, fatal neurological disorders that attack and kill brain cells, or neurons. People with ALS lose strength and the ability to move their arms, legs, and body, and eventually, the ability to breathe without support. About 5 percent of people with ALS have the directly inherited form of the disease. People with FTD develop erratic behavior, emotional problems, trouble communicating, or difficulty with walking and other basic movements. About 20 to 40 percent of those with FTD have a family history of the disorder. ALS and FTD can sometimes occur together in the same individual, but they also occur independently of each other.

There is growing scientific evidence that the pathologies of ALS and FTD somehow overlap. To date, a number of mutated genes have been identified as playing a role in the development of familial FTD and ALS, but not to the level of significance as the discovery of the 9p21 gene mutation. The five major genes previously identified for ALS account for approximately 25 percent of familial cases. The new discovery increases this figure to around 65 percent.

“Until now, the gene alteration responsible for the chromosome 9p-linked inherited forms of these diseases remained elusive,” said Traynor. “Investigators around the world worked together to identify a common genetic cause of these fatal disorders. At NIH, our state of the art DNA sequencing facilities enabled us to rapidly generate the data needed to identify this repeat expansion.”

The findings reported by Traynor and the team resulted from an international collaboration involving scientists in the United States, Canada and Europe. In the United States, participating institutions included the University of Washington School of Medicine, Seattle; Johns Hopkins University, Baltimore; Georgetown University, Washington, D.C.; and the Miller School of Medicine, University of Miami. The European collaborators included Cardiff University School of Medicine, Wales; VU University Medical Centre, Amsterdam, and Erasmus MC – University Medical Center, Rotterdam, The Netherlands; University of Manchester and University College London, England; University of Oulu and University of Helsinki, Finland; the University of Toronto; University of Würzburg, Germany; and the University of Turin, Catholic University Rome, and the University of Modena Cagliari, Italy.

Research project will focus on doctors, communities and families to help children make healthy choices

The Centers for Disease Control and Prevention (CDC) today launched a new effort to address childhood obesity using successful elements of both primary care and public health. Funding made available through the Affordable Care Act will support a four year Childhood Obesity Demonstration Project.  Supported by $25 million in funding awards, the project will build on existing community efforts and will work to identify effective health care and community strategies to support children’s healthy eating and active living and help combat childhood obesity.

The project will target children ages 2–12 years covered by the Children’s Health Insurance Program (CHIP), which provides low cost health insurance to over 7 million children from working families.  Rates of childhood obesity are high overall, but for minority and low–income communities in particular, they are even higher. Using innovative approaches to reach low–income and minority families to tackle childhood obesity prevents the onset of many diseases associated with childhood obesity, including type 2 diabetes, asthma, and heart disease.

These innovative approaches include combining changes in preventive care at doctor visits with supportive changes in schools, child care centers, and community venues such as retail food stores and parks. Community health workers will provide a bridge between families and resources in their communities in order to inform and educate hard–to–reach, limited English proficiency, and minority communities about disease prevention (including obesity), health insurance enrollment opportunities, and disease management.  Overall, the grantees’ work will focus on strategies that improve children’s health behaviors by involving the children themselves, their parents and other family members and the communities in which they live.

“Over the last three decades, obesity rates among children and adolescents have nearly tripled,” said CDC Director Thomas R. Frieden, MD, MPH.  “Obese children are more likely to have asthma, depression, diabetes, and other serious and costly health problems.  This project will help figure out ways our children can grow up to lead long, healthy and productive lives.”

The project grantees include three research facilities, each of which will receive approximately $6.2 million over four years, to identify effective childhood obesity prevention strategies. The evaluation center will receive about $4.2 million over four years and will determine successful strategies and share lessons and successes.

Research Facilities:

• University of Texas Health Science Center at Houston
• San Diego State University
• Massachusetts State Department of Public Health

Evaluation Center:

• The University of Houston

At the end of the project in September 2015, CDC will disseminate the findings and provide recommendations for successful strategies to prevent obesity among underserved children throughout the United States.

The number of fatal crashes involving 16- and 17-year old drivers dropped by more than a third between 2004 and 2008, but this doesn’t mean that parents and teens should be satisfied with the progress, according to a report by the Centers for Disease Control and Prevention.

Crashes still remain the leading cause of death for teens in the United States, though most are preventable, the report says. Graduated driver licensing (GDL) programs, which help new drivers gain skills under low-risk conditions, are widely credited with contributing to the drop in deadly crashes involving teens, it says.

The report shows wide variations from state to state, with teens in some states more likely than teens in others to be involved in fatal crashes.

Nationally, the number of 16- and 17-year-old drivers involved in fatal crashes decreased by 36 percent, from 2,230 in 2004 to 1,437 in 2008, said the study in CDC’s Morbidity and Mortality Weekly Report.

The overall decline in young drivers’ fatal crash involvement is an extension of a longer-term downward trend. Rates of fatal crash involvement for 16- and 17-year-old drivers have fallen by more than 50 percent since 1996 (from 36 per 100,000 persons in 1996 to 16.7 per 100,000 in 2008). Despite this downward trend, young drivers’ fatal crash rates are still high in some areas of the country.

This study, which examined national and state-based data from the Fatality Analysis Reporting System (FARS) also found that, from 2004 to 2008:

• Of 16- and 17-year-old drivers involved in fatal crashes, 6,280 (65 percent) were male and 3,364 (35 percent) were female.
• Across all states, the rates of 16- and 17-year-old drivers involved in fatal crashes varied widely, ranging from 9.7 per 100,000 (New York and New Jersey) to 59.6 per 100,000 (Wyoming).

Of the 11,019 persons who died in crashes involving 16- and 17-year-old drivers, 4,071 (37 percent) were the young drivers themselves, 3,428 (31 percent) were passengers of young drivers, 1,987 (18 percent) were drivers of other vehicles, and 805 (7 percent) were passengers of the other drivers. Another 728 (7 percent) were other road users such as bicyclists or pedestrians.

“These trends show both how much progress we have made—and how much more we can make—to reduce motor vehicle crashes, which remain the number one cause of death for teens in the United States,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “This is a call to action to teen drivers, parents and communities. It’s not right that teens would lose their lives on U.S. roads when there are proven methods for helping teens be safer drivers.”

The study reports that graduated driver licensing programs can be partially credited with the recent decline in fatal crashes involving these young drivers. GDL programs, which are used in 49 states and the District of Columbia, limit driving under conditions such as at night and while transporting other teen passengers. An earlier evaluation of GDL programs found that these systems can reduce crash risk by up to 40 percent among newly licensed drivers.

There is a wide variability in GDL programs among states, and the more comprehensive programs are associated with the higher reductions in crashes. No state has a GDL program which incorporates all the effective means of reducing risk to teens and others.

Parental involvement is also a key factor that can protect teen drivers. Parents should set and enforce their rules of road, restricting their teens’ nighttime driving and the number of teen passengers they are allowed to drive with. They should also put these rules into writing with a parent-teen safe driving agreement.

CDC is launching a new campaign, “Parents Are the Key,” to inform parents across the nation about the key role they can play in keeping teen drivers safe.

“Teen drivers are nearly four times more likely than more experienced drivers to crash, largely due to teens’ lack of driving experience,” said Dr. Grant Baldwin, director of the CDC’s Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control. “Proven measures, including GDL and parental involvement, can reduce the toll of deaths and injuries among teen drivers and protect the lives of others who share the road with these new drivers”.

CDC is also releasing “Policy Impact: Teen Driver Safety,” the first in a series of briefs highlighting a key public health issue and important, science-based policy actions that can be taken to address it.

By making these new resources available, CDC hopes to provide parents, policymakers, and others with proven ways to keep teen drivers safe.

From Britain’s National Health Services

Scientists have discovered how to switch off the pain of migraines, The Daily Telegraph reported. The newspaper said that new drugs may soon be able to counteract the debilitating headaches.

The study behind the news analysed the DNA of over 1,200 people to look for mutations within a gene known to play a role in the working of nerve cells. The analysis found a particular mutation in a woman who had migraines with “aura” (visual disturbances that accompany a migraine). When the mutation was traced back through the woman’s family, it was found that all those who carried the mutation also had migraines with aura. Further testing of the mutation showed that it affects the way cells in the spinal cord and brain chemically transfer signals to each other.

As yet, we do not know how commonly people with migraine and aura are affected by the mutation, or whether mutations in the gene might play a role in migraine without aura. Also, there is likely to be a variety of genetic and environmental factors that increase the risk of getting migraines. While this genetic discovery may eventually help migraine sufferers, the media have been overly optimistic in interpreting this research as it is too soon to anticipate it leading directly to a treatment.

Where did the story come from?

The study was carried out by researchers from Université de Montréal in Canada and other research organisations across the world. It was funded by Genome Canada, Genome Quebec, Emerillon Therapeutics, the Wellcome Trust and the Pfizer pharmaceutical company. It was published in the peer-reviewed medical journal Nature Medicine.

This genetic study is an important but early step in the investigation of potential genetic causes of typical migraines with aura. It is unclear whether it will have an application for migraine treatments and it is too soon to claim that scientists have discovered how to “switch off” the pain of migraines. This study did not investigate a treatment.

What kind of research was this?

This was a type of genetic study called a “candidate gene study”. This is where researchers investigate a particular gene for mutations that may be linked with a condition, in this case migraines. It is a form of case-control study, in which the DNA sequences found in that particular gene are compared between people with the condition (cases) and a group of people without the condition (controls).

When communicating with each other, nerve and brain cells use ions (atoms or a group of atoms with an electrical charge) to transfer tiny electrical impulses from cell to cell. As part of this process, ions pass through “channel proteins”, which are complex proteins that act as gates and will only let specific substances through. Problems with channelling ions across cells have previously been linked to other types of migraine, although not to migraines with aura. Here, researchers were interested in a gene called KCNK18. This gene contains the code for producing a protein called TRESK K2P, which channels potassium ions in the spinal cord. TRESK K2P is known to have a role in the “excitability” of nerve cells, i.e. their ability to generate nerve impulses. The protein is also thought to play a role in pain.

Researchers assessed whether mutations in this particular gene were linked with migraine with aura. Some people experience aura before the onset of migraine, which often involves visual disturbances. For example, some people see black spots or flashing shapes before a migraine.

What did the research involve?

The study enrolled 110 people who experienced typical migraine with aura and determined the DNA sequence of their KCNK18 genes. This was then compared to the KCNK18 sequence in a group of 80 people who did not have migraines.

To verify their findings from the initial phase of the study, the researchers replicated their analysis in a group of 511 Australians with migraine and a group of 505 people, matched for ethnicity, who did not have migraines. The researchers investigated the genetics of one mutation, which they identified further by assessing DNA samples of family members of an individual with the mutation.

As well as looking at mutations of the KCNK18 gene, the researchers investigated where the TRESK protein it coded for was concentrated. Tissue from mice and humans was used to determine whether the TRESK protein was produced in regions of the brain that were relevant to migraine. The researchers also used frog cells to investigate how the mutations they identified might cause functional changes within the TRESK potassium channel.

What were the basic results?

The candidate gene analysis identified four variants in the KCNK18 gene that were present in migraine sufferers but not in people without migraines. Of the four variants, one would not have caused any change in the TRESK protein and one was already known to be common in African populations. These were unlikely to be involved in migraines. Another variant was identified in only one migraine sufferer, but no DNA samples were available from the family members of this individual, so the researchers did not study this variation further.

The final variant, called F139WfsX24, involved the deletion of two “letters” in the code of the DNA. This meant that the full-length TRESK protein could not be made. This was likely to have an impact on the protein’s function, and could possibly lead to migraines. When this mutation was subject to further study in a detailed family analysis, it was found to be present only in the eight family members who were migraine sufferers. This fitted with the idea that this mutation could cause migraine with aura in this family.

By tracing the family’s history, the researchers found that this mutation acted in a dominant way (i.e. people carrying just a single copy of the mutation were affected by migraine with aura). The mutation was also found to have “full penetrance”, which means that all people in the family with the mutation suffered from migraines.

The phase of the study which looked at mouse and human tissue found that the TRESK protein was present in mouse spinal cord and brain regions and in the trigeminal ganglion neurons (a group of nerve cells outside the central nervous system) of humans. As expected, during functional studies in frog cells, the mutation completely suppressed the appropriate functioning of TRESK potassium channels.

How did the researchers interpret the results?

The researchers say that they have identified a mutation in TRESK that is associated with typical migraine with aura in a large multigenerational family. They say that the results support the possibility that TRESK is involved in typical migraines with aura and that these channels may be a target for treatments.

Conclusion

The study was well conducted and well described, but the media’s interpretation of the results was overly optimistic. The study did not investigate a treatment for migraine or a method to “switch off” the pain of migraines. Several important details are still unknown, including the number of people whose migraines may be caused by this faulty gene. It appears that the key mutation identified (F139WfsX24) was found in only one person out of the 600 or so who had migraines in this study (although it was also found in their family members). Further research will be needed to see whether these findings can be generalised to a larger population. Even if they can be, treatments based on these findings will be a long way off. The findings also only apply to people who have auras with their migraines, while most sufferers do not.

Such research can be a first step in the development of drugs. The researchers have not only identified genetic variations associated with migraine, but they have also gone some way to investigating the functional consequences of the mutation in rat, human and frog cells. Additionally, they have attempted to clarify the complex biochemical pathways behind it.

It will now take further research to determine whether these findings will have a direct application to most migraine sufferers. Drug development is a long process, and few drugs make it all the way through to being a successful human treatment.

NIH Scientists Consider Fate of Pandemic H1N1 Flu Virus

From the National Institutes of Health

Whither pandemic H1N1 virus? In a new commentary, scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, review the fates of previous pandemic influenza viruses in the years following a pandemic and speculate on possible future courses for the 2009 pandemic H1N1 (pH1N1) virus during the upcoming flu season and beyond.

The authors estimate that at least 183 million Americans (about 59 percent of the total U.S. population) have some immunity to pH1N1 because they were exposed to related viruses or vaccines prior to 2009, were immunized against pH1N1 or developed immunity following infection with the pandemic virus.

To stay in circulation in the face of such high levels of population immunity, the pH1N1 virus must adapt either through abrupt or gradual changes. The authors briefly examine a number of earlier pandemics and trace paths taken by the causative viruses. Some—for reasons not well understood—died out, while others, like those of 1889 and 1918, returned in an explosive fashion. Such an explosive return of pH1N1 virus is unlikely, note the authors, because global levels of immunity are already high and will increase further through immunization with 2010-2011 seasonal influenza vaccines, which contain the pH1N1 strain.

In light of what is known about pH1N1, the NIAID authors express a cautious optimism that unless it disappears entirely the virus will follow a route like that of 1968 pandemic virus, that is, it will persist in a form that causes relatively few deaths.

Nevertheless, the authors caution against complacency. As they acknowledge, many gaps remain in understanding how a given pandemic influenza virus adapts to increased immunity in humans. For that reason, influenza vaccination for everyone older than six months is a wise public health measure to maintain high levels of population-wide immunity. Immunization with 2010-2011 seasonal flu vaccine is particularly urged for babies older than six months, children, teens and young adults as the best way to protect individuals in those potentially more susceptible age groups from illness.

Approximately one in five (19 percent) men who have sex with men (MSM) in a study of 21 major U.S. cities is infected with HIV, and nearly half (44 percent) of those men are unaware of their infection, according to a new analysis from the Centers for Disease Control and Prevention.  In the study, young MSM and MSM of color were least likely to know their HIV status.  The findings were published today in CDC’s Morbidity and Mortality Weekly Report.

“This study’s message is clear:  HIV exacts a devastating toll on men who have sex with men in America’s major cities, and yet far too many of those who are infected don’t know it,”  said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  “We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among men who have sex with men.”

The study’s results bolster key themes in the President’s National HIV/AIDS Strategy for the United States.  The recently released strategy states that “the United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men,” and MSM are listed among a few priority populations to focus HIV prevention efforts.  The President’s strategy also sets targets for reducing the number of individuals living with HIV who are unaware of their HIV status.

The CDC study tested 8,153 MSM in 21 cities participating in the 2008 National HIV Behavioral Surveillance System (NHBS), and examined HIV prevalence and awareness of HIV status among this group.  NHBS monitors HIV testing, risk behaviors, and access to prevention services among at-risk populations in cities with high numbers of persons living with AIDS.

While MSM of all races and ethnicities were severely affected, black MSM were particularly impacted:  28 percent of black MSM were HIV-infected, compared to 18 percent of Hispanic and 16 percent of white MSM.

The study also found a strong link between socioeconomic status and HIV among MSM: prevalence increased as education and income decreased, and awareness of HIV status was higher among MSM with greater education and income.  These findings echo similar disparities found in recent NHBS research among heterosexuals.

Low awareness of HIV infection a major concern, particularly for younger men

The study provided additional insight into the populations of MSM most in need of HIV testing and prevention:

• Among racial/ethnic groups, black MSM with HIV were least likely to be aware of their infection (59 percent unaware, vs. 46 percent for Hispanic MSM and 26 percent for white MSM).
• While young MSM (under age 30) had lower HIV prevalence than older men, they were far more likely to be unaware of their HIV infection.  Among MSM aged 18-29 who had HIV, nearly two-thirds (63 percent) were unaware, versus 37 percent for men age 30 and older.
• Among young MSM, young MSM of color were less likely than whites to know they were HIV-infected.  Among HIV-infected black MSM under age 30, 71 percent were unaware of their infection; among HIV-infected Hispanic MSM under age 30, 63 percent were unaware.  This compares to 40 percent of HIV-infected white MSM under age 30.

CDC officials note that low awareness of HIV status among young MSM likely reflects several factors:  they may have been infected more recently, may underestimate their personal risk, may have had fewer opportunities to get tested, or may believe that advances in HIV treatment minimize the threat of HIV.  For young MSM of color, discrimination and socioeconomic factors – such as poverty, homophobia, stigma, and limited health-care access – may be especially acute and pose particular challenges.

“For young men who have sex with men – including young men of color who are least likely to know they may be infected – the future is truly on the line,” said Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention.  “It is critical that we reach these young men early in their lives with HIV prevention and testing services and continue to make these vital services available as they become older.”

CDC estimates that the majority of new sexually transmitted infections are transmitted by individuals who are unaware of their infection, and studies show that once people learn they are HIV-infected, most take steps to protect their partners.  Therefore, because undiagnosed infection likely plays a major role in HIV transmission, reaching younger MSM with regular HIV testing is critical.

CDC recommends that MSM of all ages get tested for HIV at least annually, or more often (every three to six months) if they are at increased risk (e.g., those with multiple or anonymous sex partners, or who use drugs during sex).  Notably, only 45 percent of HIV-infected MSM who were unaware of their infection had been tested in the past year, underscoring the importance of more frequent testing among those at highest risk.

While HIV prevention for MSM remains a top CDC priority, agency officials note that a renewed national commitment to HIV prevention is needed to reduce the toll of HIV on MSM and increase access to prevention.