Rabies
Health
insurance for children
Folic acid and cancer
obesity awareness
preventing lyme
disease
Rabies
First documented case of recovery from clinical rabies
without post-exposure prophylaxis.
A 15 year old girl in Wisconsin recovered from
clinical rabies without post-exposure prophylaxis (PEP).
She was diagnosed in early October, approximately one
month after an unreported bat bite. When serum and CSF
samples were found to be positive for antibodies specific
to rabies virus, the patient had already been ill for
about one week and had developed impaired muscle
coordination, difficulty speaking, double vision, tremors,
and hypersalivation requiring intubation. Before a
neuroprotective drug-induced coma was implemented, the
patient was noted to be obtunded but answered questions
appropriately and complied with commands. Intravenous
ribavarin was administered under an investigational
protocol. The patient was extubated after one month and
as of December 17 continues inpatient rehabilitation,
walking with assistance and feeding herself a solid diet.
She has solved math puzzles and was regaining the ability
to speak after prolonged intubation.
PEP
and other immune modulating interventions were not
administered because the patient had evidence of
rabies-neutralizing antibodies at the time of diagnosis.
Previously, five patients have been documented to recover
from clinical rabies; all had received some form of PEP.
Only one of these patients recovered without residual
neurologic deficit; long-term prognosis in the current
case is unknown.
Centers for Disease Control and Prevention. Recovery of a
Patient from Clinical Rabies – Wisconsin, 2004. MMWR. 24
December 2004; 53(50):1171-1173
December 2004 Index
Health insurance
for children
Data analysis reflects improvements in health insurance
eligibility and coverage among children, but being
uninsured continues to be a problem of participation, not
eligibility.
Using data from the Medical Expenditure Panel
Survey (MEPS) between 1996 and 2002, researchers found
that improved outreach and simplified enrollment have led
to improvements in health insurance coverage for
children. From an uninsurance rate of 23.0% among low
income children in 1996, expanded Medicaid eligibility and
the implementation of the State Children’s Health
Insurance Program (SCHIP) resulted in a decrease to 18.6%
in 2002. Among all children in 2002, 13.1% were
uninsured, compared with 16.4% in 1996. The proportion of
all children eligible for free or highly subsidized
coverage increased to 47.1% in 2002, from 28.6% in 1996.
Among children without insurance in 2002, more than 60%
were found to be eligible for public coverage. Although
progress has occurred, uninsurance is largely due to lack
of participation in available insurance programs.
Selden TM, Hudson JL, Banthin JS. Tracking Changes in
Eligibility and Coverage Among Children, 1996-2002.
Health Affairs. Sept/Oct 2004; 23(5):39-50
December 2004 Index
Folic acid and cancer
Preliminary results from a randomized controlled trial in
the United Kingdom detected a possible increased risk of
breast cancer mortality among women taking high doses of
folate.
Deborah Charles and colleagues published a
brief report that presents new data on folic acid intake
and cancer risk. The study is a follow up on a large
double blind RCT conducted in 1966-1967, with 210 deaths
as of 2002. Among these deaths, the hazard ratio for all
cancer deaths in the high-dose folate group (5 mg daily
for one year) compared to placebo was 1.70 (1.06 to 2.72,
P value 0.02). For breast cancer mortality, the hazard
ratio was 2.02 (0.88 to 4.72, P value 0.10). The authors
were cautious in drawing conclusions from these
observations due to the small number of deaths and wide
confidence intervals. Possible causal mechanisms were not
discussed, although a recent study demonstrated that rats
fed with high folate diets had levels of tumorigenesis
similar to rats that were deficient in folate; both were
elevated in comparison to rats with sufficient folate
diets.
Charles D, Ness AR, Campbell D, Davey Smith G, Hall MH.
Taking folate in pregnancy and risk of maternal breast
cancer. BMJ. 11 December 2004; 329:1375-1376
December 2004 Index
obesity awareness
Parents are unable to accurately identify obesity in
themselves or in their children.
Only 25% of parents accurately recognized
overweight in their child in a random cohort selected for
study in the United Kingdom. Among 277 randomly recruited
children, 8% were overweight and 11% obese, using 91st
and 98th centiles of body mass index reference
curves. Among parents of these children, mothers were
more accurate than fathers in assessing overweight, and
fathers were more affected by their own weight status:
overweight fathers were even less accurate in assessing a
child’s weight, while performance by mothers did not
change based on their own weight status. Both fathers and
mothers were more likely to recognize overweight in girls
than in boys. Lack of awareness of overweight is
correlated to lack of parental concern about their child’s
health, preventing formation of a critical link in public
health efforts to combat obesity.
Jeffrey AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ.
Parents’ awareness of overweight in themselves and their
children: cross sectional study within a cohort (EarlyBird
21). BMJ Online First. 26 November 2004;
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38315.451539.F7v1
accessed December, 2004.
December 2004 Index
preventing lyme disease
An
ecological approach is useful in reducing nymphal tick
vector infection with Borrelia burgdorferi.
Local health departments in the future may
combat Lyme disease using techniques borrowed from rabies
prevention. A recent study has established that
vaccinating animal reservoirs, in this case white-footed
mice, can decrease the prevalence of infectious agents and
may thereby decrease infection spread to humans.
Widespread implementation will have to wait until an oral
vaccine is developed for mice; injections of the type used
in the current study would not be feasible on a larger
scale. Although Borrelia burgdorferi prevalence
was reduced in the mouse populations, findings also showed
that nonmouse hosts account for a larger proportion of the
Lyme disease reservoir than previously expected. Even if
100% of mouse populations were vaccinated, it is projected
that only 55% of larval tick infection would be prevented
in a best-case scenario. Additional research will be
needed for vaccines for other suspected reservoirs, such
as deer, squirrels, and raccoons.
Tsao
JI, Wootton JT, Bunikis J, Gabriela Luna M, Fish D,
Barbour AG. An ecological approach to preventing human
infection: Vaccinating wild mouse reservoirs intervenes in
the Lyme disease cycle. PNAS. 28 December 2004; 101(52):
18159-18164
December 2004 Index
