Study suggests UN force brought cholera to Haiti (AP)

PORT-AU-PRINCE, Haiti � Evidence "strongly suggests" that a United Nations peacekeeping mission brought a cholera strain to Haiti that has killed thousands of people, a study by a team of epidemiologists and physicians says.

The study is the strongest argument yet that newly-arrived Nepalese peacekeepers at a base near the town of Mirebalais brought with them the cholera, which spread through the waterways of the Artibonite region and elsewhere in this impoverished Caribbean country.

The disease has killed more than 5,500 people and sickened more than 363,000 others since it was discovered in October, according to the Haitian government.

"Our findings strongly suggest that contamination of the Artibonite (river) and 1 of its tributaries downstream from a military camp triggered the epidemic," said the report in the July issue of Emerging Infectious Diseases, a journal of the U.S. Centers for Disease Control and Prevention.

The article says there is "an exact correlation" in time and place between the arrival of a Nepalese battalion from an area of its South Asian homeland that was experiencing a cholera outbreak and the appearance of the first cases in the Meille river a few days later.

The remoteness of the Meille river in central Haiti and the absence of other factors make it unlikely that the cholera strain could have come to Haiti in any other way, the report says.

In an email U.N. mission spokeswoman Sylvie Van Den Wildenberg didn't comment on the findings of the article published in the CDC journal, referring only to a study released in May by a U.N.-appointed panel.

That panel's report found that the cholera outbreak was caused by a South Asian strain imported by human activity that contaminated the Meille river where the U.N. base of the Nepalese peacekeepers is located. The study also found that bad sanitation at the camp would've made contamination of the water system possible.

But the U.N. report refrained from blaming any single group for the outbreak. While no other potential source of the bacteria itself was named, the report attributed the outbreak to a "confluence of circumstances," including a lack of water infrastructure in Haiti and Haitians' dependence on the river system.

The panel's report was ordered by U.N. Secretary-General Ban Ki-moon as anti-U.N. protests spread in Haiti and mounting circumstantial evidence pointed to the troops.

Before that, for nearly two months after the outbreak last October, the United Nations, CDC and World Health Organization refused to investigate the origin of the cholera, saying that it was more important to treat patients than to try to figure out the source.

The article published in the CDC journal comes as health workers in Haiti wrestle with a spike in the number of cholera cases brought on by several weeks of rainfall. The aid group Oxfam said earlier this month that its workers were treating more than 300 new cases a day, more than three times what they saw when the disease peaked in the fall.

Cholera is caused by a bacteria that produces severe diarrhea and is contracted by eating or drinking contaminated food or water.

The disease has spread to the neighboring Dominican Republic, where more than 36 deaths have been reported since November.

Epidemiologist Renaud Piarroux, the lead author of the CDC journal article, was initially sent by the French government in late 2010 to investigate the origins of Haiti's outbreak. He authored a report for U.N. and Haitian officials that said the Nepalese peacekeepers likely caused the outbreak, a copy of which was obtained at the time by the AP.

The latest study was more complete and its methodology was reviewed by a group of scientists.

The new study argues it is important for scientists to determine the origin of cholera outbreaks and how they spread in order to eliminate "accidentally imported disease."

Moreover, the study says, figuring out the source of a cholera epidemic would help health workers better treat and prevent cholera by minimizing the "distrust associated with the widespread suspicions of a cover-up of a deliberate importation of cholera."

It also argues that demonstrating an imported origin would compel "international organizations to reappraise their procedures."

After cholera surfaced last fall, many Haitians believed the Nepalese peacekeepers were to blame, straining relations between the population and U.N. personnel and sparking angry protests. On the streets, cholera has become slang for something that must be banished from Haiti.

The new study is acknowledged in a commentary by a pair of public health experts affiliated with the CDC.

"However it occurred, there is little doubt that the organism was introduced to Haiti by a traveler from abroad, and this fact raises important public health considerations," wrote Scott Dowell, director of the CDC's Division of Global Disease Detection and Emergency Response, and Christopher Braden, a medical epidemiologist with the CDC.

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Associated Press writer Trenton Daniel reported this story from Port-au-Prince and Jonathan M. Katz reported from Mexico City.

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Trenton Daniel can be followed at http://twitter.com/trentondaniel; Jonathan M. Katz can be followed at http://twitter.com/KatzOnEarth.

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E. coli outbreak may be traced to Egypt seeds (AP)

ROME � European food and disease prevention authorities said Wednesday they are investigating whether the E. coli outbreak in Germany and France may be traced back to fenugreek seeds imported from Egypt either in 2009 or last year.

The European Center for Disease Prevention and Control and the European Food Safety Authority said in a joint report that "there is still much uncertainty about whether this is truly the common cause of all the infections."

The report said "fenugreek seeds imported from Egypt either in 2009 and/or 2010 are implicated in both outbreaks." Fenugreek seeds are commonly used in the preparation of pickles and curry powders as well as Indian, Ethiopian and Yemeni cuisine.

However, further investigation was necessary, said the report.

The death toll in Europe's E. coli outbreak has risen by three to at least 47, according to German authorities. Germany's disease control center said earlier this week that 46 deaths have now been reported in the country. One person has died in Sweden.

In France, eight case have been reported so far. Seven people have been hospitalized in the Bordeaux region and another person was released.

The report said that a 2009 lot of fenugreek seeds appeared to be implicated in the outbreak in France and a 2010 lot in the German outbreak. But it said this possible link does not explain the case in Sweden, where no consumption of sprouts has been implicated.

Many questions were still unanswered about the source of the E. coli.

A further 119 cases have been reported in a total of 15 other countries. The source has been traced to a vegetable sprout farm in northern Germany.

The World Health Organization said it considers an outbreak in France separate. But it also said that, of the eight French cases, three of them carried the same bacterial strains as in Germany.

The report said the clinical picture of the French cases was similar to that of German cases.

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Lung cancer scans: False alarms amid lives saved (AP)

Full results of a big study that showed some smokers' lives could be saved by screening with lung scans now reveal more clearly what the risks are: There's a good chance of a false alarm.

Of those who got the recommended annual scans for three years, 4 out of 10 had a suspicious finding on at least one scan and were advised to have a follow-up test or biopsy. And more than 95 percent of them turned out to have nothing wrong.

The results out Wednesday give the first detailed look at the benefits and risks of screening longtime current or former smokers with special X-rays called CT scans. The government stopped the study last fall after seeing the scans were saving lives.

Most insurers don't cover the scans because no major groups currently recommend them.

"No one should rush off and get one of these scans for screening until we've thought more about it," said Dr. Christine Berg of the National Cancer Institute, the study's main sponsor.

But guidance on smoker screening is likely to change with the study's results, which may help the nation's 94 million current and former smokers decide whether to be screened.

"The question has changed to how are we going to do this," not whether we should, said Dr. Harold "Hal" Sox, a Dartmouth professor who used to head the government task force that shapes policy on screening tests. He wrote an editorial with the results, published online Wednesday by the New England Journal of Medicine.

The study tested CT scans versus ordinary chest X-rays in 53,454 people over 55 with more than 30 pack-years of smoking: a pack a day for 30 years or two packs for 15 years. No one knows if younger or less frequent smokers would benefit from screening.

The study used top medical centers around the nation and low-radiation-dose machines. It involved skilled doctors who did less invasive tests in place of many biopsies and had far lower death rates when they did operate for lung cancer than is usual. The lower risk of death among those screened with scans in the study reflects all these things.

"This is what happens when people get screened in the best of centers. When people start getting screened anyplace ... the results may not be, and are likely not to be, as good," warned Dr. Otis Brawley, chief medical officer of the American Cancer Society.

Numbers to know:

_Three. The number of scans, one each year, that showed benefit in this study. No one knows if a single scan or testing less often would help.

_Twenty percent. The reduction in the risk of dying from lung cancer among those given CT scans (356 deaths versus 443 in the X-ray group).

_Seven percent. The reduction in the risk of dying from any cause during the study (1,877 deaths in the CT group versus 2,000 in X-ray group).

_About 320. The number of people who would have to be scanned for three years to prevent a single death from lung cancer. That's impressive when compared to the 1,339 women in their 50s who would need to have mammograms for several years to avoid one breast cancer death. However, mammograms are cheaper and involve less radiation so the risks and benefits aren't quite the same.

_One percent. The odds of dying from surgery for lung cancer among those in the study. In general practice, it's 4 percent.

_$300 to $1,200. The average range of charges for a scan. At some private practices it's up to $2,500 and "there's a group in Hollywood that's charging more than that," said Berg, of the National Cancer Institute.

Researchers plan a cost-effectiveness study and may compare the benefit from scans to smoking cessation efforts.

"People should not take this positive study as `now it is safe to smoke,'" because it isn't, and quitting remains the best way to lower cancer risk, Brawley said.

The cancer society and other medical groups expect to have screening advice for the public "in a matter of months," said Dr. Bruce Johnson, a lung cancer expert at the Dana-Farber Cancer Institute in Boston and a board member of the American Society of Clinical Oncology, doctors who treat the disease.

"Can society afford it? This comes with a substantial cost," he said of screening.

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Online:

New England Journal: http://www.nejm.org

Study Q&A: http://www.cancer.gov/newscenter/qa/2002/nlstqaQA

Video discussion: http://www.youtube.com/watch?vhY6GQnO75Mo

Screening info: http://www.cancer.gov/cancertopics/types/lung

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Researchers analyze gene changes in ovarian cancer (AP)

LOS ANGELES � Researchers analyzing the genetic makeup of ovarian cancer tumors have found a gene mutation that is surprisingly frequent, suggesting it plays a key role in driving the cancer.

The finding, appearing in Thursday's issue of the journal Nature, may eventually lead to tests for earlier diagnosis of the disease and to better treatment. Ovarian cancer kills nearly 14,000 women in the United States each year. It's usually not spotted until at an advanced stage.

The gene sequencing was carried out by The Cancer Genome Atlas, a federally funded network of medical centers that analyzed 316 ovarian tumors.

Scientists found that 96 percent of the tumors had mutated TP53 genes. The mutations were not present in normal tissue from the patients, showing they arose within the tumors. Normally, the gene directs the cell how to make a protein that acts as a tumor suppressor, keeping cells from growing and dividing uncontrollably.

Alterations in nine other genes also played a role in ovarian cancer, though to a much lesser extent, the researchers reported. Among them were the BRCA1 and BRCA2 genes, which increase the risk of breast and ovarian cancer.

"In other cancers, there are usually several genes that are involved" on almost equal footing, said one of the study authors, Dr. David Wheeler of Baylor College of Medicine. "This is an unusual pattern."

The new work "is producing impressive insights into the biology" of ovarian cancer, Dr. Francis Collins, who heads the National Institutes of Health, said in a statement.

Among cancers, ovarian is the fifth leading cause of death among women. A regular pelvic exam is considered the best way to detect ovarian cancer early.

The Cancer Genome Atlas was launched in 2006 to unravel the genetic underpinning of cancer. The group mapped the genome of the most common form of brain cancer in 2008 and plans to do the same for 20 other types of cancers.

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Online:

Nature journal: www.nature.com/nature

The Cancer Genome Atlas: http://cancergenome.nih.gov

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Report: More than 100 million suffer lasting pain (AP)

WASHINGTON � A new report finds at least 116 million U.S. adults experience long-lasting pain � the kind that lingers for weeks to months. Too often, they feel stigma rather than relief from a health care system poorly prepared to treat them.

The Institute of Medicine report shows chronic pain costs the nation even more than heart disease in medical bills, sick days and lost productivity.

The report calls effective pain management a moral imperative, and urges a series of steps to transform the field.

Barriers include health workers not properly trained to handle pain, and insurance that doesn't cover complex care. Law enforcement's fight against abuse of narcotic painkillers plays a role, too, but the report found that those medicines are safe and effective for the right patient.

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AIDS drug supplies dwindling in Swaziland (AP)

MBABANE, Swaziland � Cash-strapped Swaziland's state hospitals have only two months' supplies of AIDS drugs, the country's health minister has told parliament in an assessment that AIDS patients and activists took as a death sentence.

State media on Tuesday quoted Health Minister Benedict Xaba as making the remarks to parliament a day before. He blamed the country's economic crisis, linked to a drop in customs revenues amid a worldwide recession.

More than 60,000 Swazis depend on anti-retroviral AIDS drugs, known as ARVs, distributed free at government hospitals.

Swaziland, with a population of about 1 million, has the world's highest percentage of people living with the virus that causes AIDS. More than a quarter of Swazis between the ages of 15 and 49 are believe to carry HIV.

Swaziland is seeking international loans to cope with its budget crisis. Xaba says AIDS patients should not lose hope, but news of dwindling drug supplies has worried patients.

Without AIDS drugs, "we shall die," said Patrick Mngometulu, an AIDS patient who has been on government-supplied drugs since 2003.

"Mothers who take ARVs will be worse affected. ARVs help children not to get HIV infection from their mothers. So if mothers stop taking the ARVs their children are in danger. We lose hope, and the situation will decrease productivity of the infected," Mngometulu said.

Thembi Nkambule, director of the Swaziland National Network of People Living with HIV and AIDS, said the government has made strides in combating AIDS, moving from 15,000 people on ARVs in 2005 to 60,000 today. But now, she fears gains will be lost.

"Swazis will die in numbers. Hope will be lost," Nkambule said.

A pro-democracy movement in Swaziland, southern Africa's last absolute monarchy, has gained some ground since the government announced in March its plan to freeze civil service salaries and sell off state-run companies. But the government has cracked down hard on protests, and reformists have had to contend with reverence for the monarchy among many Swazis.

Activists have criticized King Mswati III of living lavishly while most Swazis live in poverty, and of harassing and jailing pro-democracy activists.

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