Deepak Chitnis

Within the community of surgeons, chronic pain is a four-letter word, spoken about in hushed tones – if it’s spoken about at all, that is – and rarely ever discussed as something that urgently needs to be addressed.

But surgeons are susceptible to the same chronic conditions as are the patients they treat. In addition to the fatigue associated with conducting long, grueling surgical operations, surgeons can experience repetitive motion injury from using laparoscopic tools for minimally invasive procedures – injuries that can, if left untreated, lead to long-term consequences.

Razvan/ThinkStock

“There have been a few studies on this, but I think we’re just scratching the surface,” explained Dr. Adrian Park, chair of surgery at the Anne Arundel Medical Center in Annapolis, Md. Dr. Park was the lead author of a 2010 study that identified chronic pain among surgeons as a serious and underreported issue within medicine.

That study, which evaluated 317 surgeons using a 23-question survey, found that 86.9% of surgeons experience “physical symptoms or discomfort,” with the most significant indicator of such symptoms being a high case load. Subsequent studies from Europe and eastern Asia also found rates of 80% or higher among surgeons in those regions of the world.

With so pervasive a problem, however, the relative paucity of data and conversation among medical professionals is alarming. “As a surgeon leader, I can tell you surgeons complain about a lot of stuff, but one of the things they tend not to complain about is themselves and their own health and well-being,” said Dr. Park.

The reasons for that, Dr. Park explained, are plentiful. Most surgeons simply don’t find it acceptable to speak up about any pain they’re experiencing, while “some may have felt it was a sign of weakness to report these injuries, some may have felt it would affect their referral base and their work,” according to Dr. Park.

To that end, Dr. Mario Cerame is well aware of what a seemingly innocuous, relatively small chronic pain can do to a surgeon. A surgeon in North Carolina, Dr. Cerame began to experience symptoms of repetitive motion injury about 2 years ago, symptoms which he says “crept up on me.”

It began as simply numbness at the tips of his fingers, affecting the way he held laparoscopic tools during surgery and other, more menial, daily tasks. Initially suspecting it was carpel tunnel syndrome, Dr. Cerame brushed it off, until the numbness spread to three whole fingers and, eventually, his entire hand. His physician explained what was happening, instructing him that if he didn’t undergo orthopedic surgery immediately, he ran the risk of becoming quadriplegic.

“I got the diagnosis on Thursday, and had the operation on Tuesday,” said Dr. Cerame, explaining that the diagnosis was spinal stenosis. Two areas of his spinal column were pinching inward, causing the slow but steady paralysis he was experiencing. With physical therapy, Dr. Cerame could have some function back within 2 years of the operation – so far, it’s been just over 16 months. The point of the operation, however, was to prevent further damage and paralysis, not necessarily to restore Dr. Cerame’s motor function to 100%.

Dr. Cerame’s story, however, isn’t what usually happens. Because surgeons generally keep things to themselves, they have to find other ways of coping with chronic pain. Some choose noninvasive options: massages, physical therapy, and so on. Other do choose to go under the knife, but such surgeries don’t provide a permanent solution to the problem. With laparoscopic tools becoming increasingly ergonomic, and monitors allowing surgeons not to keep their heads bent at an angle for hours on end during surgery, things are improving – but more can be done.

“I’ve published an awful lot of papers, but the thing that struck me about [the 2010] paper is the response I got,” said Dr. Parks. “Surgeons, literally from around the country, would call me saying ‘I used to be able to do this operation, I no longer can do that,’ or ‘this used to be what my case list looked like, I can no longer do this, you can use me as an example.’ People came forward.”

Then there’s the darker side of coping with chronic pain: substance abuse. Tight-lipped surgeons who won’t talk about pain certainly won’t talk openly about using painkillers or narcotics to ease their muscle aches or joint stiffness, but with physicians having relatively easy access to such products, could substance abuse among surgeons be a problem?

“When livelihoods are at stake, I think folks will take opportunities to stay in the game,” admitted Dr. Parks, adding that “it’s not something that folks advertise, but in anonymous surveys [surgeons] respond amazingly to stuff like this.”

The bottom line, according to both Dr. Parks and Dr. Cerame, is for surgeons not to keep quiet about these issues if they ever do experience them. Asking for help and getting things checked right away is better, not only for a surgeon, but for his family and patients, too. While Dr. Cerame has gone back to work, he is unable to handle the case load he once had and isn’t sure if he’ll ever be able to.

“Surgeons and physicians in general have a tendency to get so consumed with other people’s health that they don’t focus on their own health issues,” said Dr. Cerame. “It took me almost 8 months from the time I had symptoms to actually get it checked out [because] I thought it would go away, [so] if you find something that’s not kosher or you feel something that isn’t normal, take care of it.”

The other side of this, Dr. Parks elaborated, is the overload of mental stress, leading to surgeon burnout. “There’s really a growing literature on surgeon burnout, and it is not a trifling issue; in studies from North American, Australasia, Europe, Great Britain, the rate of burnout among surgeons averages about 35%, and again, surgeons are very reluctant to talk about this sort of thing.”

Dr. Park and Dr. Cerame did not have any relevant financial disclosures.

dchitnis@frontlinemedcom.com

Within the community of surgeons, chronic pain is a four-letter word, spoken about in hushed tones – if it’s spoken about at all, that is – and rarely ever discussed as something that urgently needs to be addressed.

But surgeons are susceptible to the same chronic conditions as are the patients they treat. In addition to the fatigue associated with conducting long, grueling surgical operations, surgeons can experience repetitive motion injury from using laparoscopic tools for minimally invasive procedures – injuries that can, if left untreated, lead to long-term consequences.

Razvan/ThinkStock

“There have been a few studies on this, but I think we’re just scratching the surface,” explained Dr. Adrian Park, chair of surgery at the Anne Arundel Medical Center in Annapolis, Md. Dr. Park was the lead author of a 2010 study that identified chronic pain among surgeons as a serious and underreported issue within medicine.

That study, which evaluated 317 surgeons using a 23-question survey, found that 86.9% of surgeons experience “physical symptoms or discomfort,” with the most significant indicator of such symptoms being a high case load. Subsequent studies from Europe and eastern Asia also found rates of 80% or higher among surgeons in those regions of the world.

With so pervasive a problem, however, the relative paucity of data and conversation among medical professionals is alarming. “As a surgeon leader, I can tell you surgeons complain about a lot of stuff, but one of the things they tend not to complain about is themselves and their own health and well-being,” said Dr. Park.

The reasons for that, Dr. Park explained, are plentiful. Most surgeons simply don’t find it acceptable to speak up about any pain they’re experiencing, while “some may have felt it was a sign of weakness to report these injuries, some may have felt it would affect their referral base and their work,” according to Dr. Park.

To that end, Dr. Mario Cerame is well aware of what a seemingly innocuous, relatively small chronic pain can do to a surgeon. A surgeon in North Carolina, Dr. Cerame began to experience symptoms of repetitive motion injury about 2 years ago, symptoms which he says “crept up on me.”

It began as simply numbness at the tips of his fingers, affecting the way he held laparoscopic tools during surgery and other, more menial, daily tasks. Initially suspecting it was carpel tunnel syndrome, Dr. Cerame brushed it off, until the numbness spread to three whole fingers and, eventually, his entire hand. His physician explained what was happening, instructing him that if he didn’t undergo orthopedic surgery immediately, he ran the risk of becoming quadriplegic.

“I got the diagnosis on Thursday, and had the operation on Tuesday,” said Dr. Cerame, explaining that the diagnosis was spinal stenosis. Two areas of his spinal column were pinching inward, causing the slow but steady paralysis he was experiencing. With physical therapy, Dr. Cerame could have some function back within 2 years of the operation – so far, it’s been just over 16 months. The point of the operation, however, was to prevent further damage and paralysis, not necessarily to restore Dr. Cerame’s motor function to 100%.

Dr. Cerame’s story, however, isn’t what usually happens. Because surgeons generally keep things to themselves, they have to find other ways of coping with chronic pain. Some choose noninvasive options: massages, physical therapy, and so on. Other do choose to go under the knife, but such surgeries don’t provide a permanent solution to the problem. With laparoscopic tools becoming increasingly ergonomic, and monitors allowing surgeons not to keep their heads bent at an angle for hours on end during surgery, things are improving – but more can be done.

“I’ve published an awful lot of papers, but the thing that struck me about [the 2010] paper is the response I got,” said Dr. Parks. “Surgeons, literally from around the country, would call me saying ‘I used to be able to do this operation, I no longer can do that,’ or ‘this used to be what my case list looked like, I can no longer do this, you can use me as an example.’ People came forward.”

Then there’s the darker side of coping with chronic pain: substance abuse. Tight-lipped surgeons who won’t talk about pain certainly won’t talk openly about using painkillers or narcotics to ease their muscle aches or joint stiffness, but with physicians having relatively easy access to such products, could substance abuse among surgeons be a problem?

“When livelihoods are at stake, I think folks will take opportunities to stay in the game,” admitted Dr. Parks, adding that “it’s not something that folks advertise, but in anonymous surveys [surgeons] respond amazingly to stuff like this.”

The bottom line, according to both Dr. Parks and Dr. Cerame, is for surgeons not to keep quiet about these issues if they ever do experience them. Asking for help and getting things checked right away is better, not only for a surgeon, but for his family and patients, too. While Dr. Cerame has gone back to work, he is unable to handle the case load he once had and isn’t sure if he’ll ever be able to.

“Surgeons and physicians in general have a tendency to get so consumed with other people’s health that they don’t focus on their own health issues,” said Dr. Cerame. “It took me almost 8 months from the time I had symptoms to actually get it checked out [because] I thought it would go away, [so] if you find something that’s not kosher or you feel something that isn’t normal, take care of it.”

The other side of this, Dr. Parks elaborated, is the overload of mental stress, leading to surgeon burnout. “There’s really a growing literature on surgeon burnout, and it is not a trifling issue; in studies from North American, Australasia, Europe, Great Britain, the rate of burnout among surgeons averages about 35%, and again, surgeons are very reluctant to talk about this sort of thing.”

Dr. Park and Dr. Cerame did not have any relevant financial disclosures.

dchitnis@frontlinemedcom.com

Within the community of surgeons, chronic pain is a four-letter word, spoken about in hushed tones – if it’s spoken about at all, that is – and rarely ever discussed as something that urgently needs to be addressed.

But surgeons are susceptible to the same chronic conditions as are the patients they treat. In addition to the fatigue associated with conducting long, grueling surgical operations, surgeons can experience repetitive motion injury from using laparoscopic tools for minimally invasive procedures – injuries that can, if left untreated, lead to long-term consequences.

Razvan/ThinkStock

“There have been a few studies on this, but I think we’re just scratching the surface,” explained Dr. Adrian Park, chair of surgery at the Anne Arundel Medical Center in Annapolis, Md. Dr. Park was the lead author of a 2010 study that identified chronic pain among surgeons as a serious and underreported issue within medicine.

That study, which evaluated 317 surgeons using a 23-question survey, found that 86.9% of surgeons experience “physical symptoms or discomfort,” with the most significant indicator of such symptoms being a high case load. Subsequent studies from Europe and eastern Asia also found rates of 80% or higher among surgeons in those regions of the world.

With so pervasive a problem, however, the relative paucity of data and conversation among medical professionals is alarming. “As a surgeon leader, I can tell you surgeons complain about a lot of stuff, but one of the things they tend not to complain about is themselves and their own health and well-being,” said Dr. Park.

The reasons for that, Dr. Park explained, are plentiful. Most surgeons simply don’t find it acceptable to speak up about any pain they’re experiencing, while “some may have felt it was a sign of weakness to report these injuries, some may have felt it would affect their referral base and their work,” according to Dr. Park.

To that end, Dr. Mario Cerame is well aware of what a seemingly innocuous, relatively small chronic pain can do to a surgeon. A surgeon in North Carolina, Dr. Cerame began to experience symptoms of repetitive motion injury about 2 years ago, symptoms which he says “crept up on me.”

It began as simply numbness at the tips of his fingers, affecting the way he held laparoscopic tools during surgery and other, more menial, daily tasks. Initially suspecting it was carpel tunnel syndrome, Dr. Cerame brushed it off, until the numbness spread to three whole fingers and, eventually, his entire hand. His physician explained what was happening, instructing him that if he didn’t undergo orthopedic surgery immediately, he ran the risk of becoming quadriplegic.

“I got the diagnosis on Thursday, and had the operation on Tuesday,” said Dr. Cerame, explaining that the diagnosis was spinal stenosis. Two areas of his spinal column were pinching inward, causing the slow but steady paralysis he was experiencing. With physical therapy, Dr. Cerame could have some function back within 2 years of the operation – so far, it’s been just over 16 months. The point of the operation, however, was to prevent further damage and paralysis, not necessarily to restore Dr. Cerame’s motor function to 100%.

Dr. Cerame’s story, however, isn’t what usually happens. Because surgeons generally keep things to themselves, they have to find other ways of coping with chronic pain. Some choose noninvasive options: massages, physical therapy, and so on. Other do choose to go under the knife, but such surgeries don’t provide a permanent solution to the problem. With laparoscopic tools becoming increasingly ergonomic, and monitors allowing surgeons not to keep their heads bent at an angle for hours on end during surgery, things are improving – but more can be done.

“I’ve published an awful lot of papers, but the thing that struck me about [the 2010] paper is the response I got,” said Dr. Parks. “Surgeons, literally from around the country, would call me saying ‘I used to be able to do this operation, I no longer can do that,’ or ‘this used to be what my case list looked like, I can no longer do this, you can use me as an example.’ People came forward.”

Then there’s the darker side of coping with chronic pain: substance abuse. Tight-lipped surgeons who won’t talk about pain certainly won’t talk openly about using painkillers or narcotics to ease their muscle aches or joint stiffness, but with physicians having relatively easy access to such products, could substance abuse among surgeons be a problem?

“When livelihoods are at stake, I think folks will take opportunities to stay in the game,” admitted Dr. Parks, adding that “it’s not something that folks advertise, but in anonymous surveys [surgeons] respond amazingly to stuff like this.”

The bottom line, according to both Dr. Parks and Dr. Cerame, is for surgeons not to keep quiet about these issues if they ever do experience them. Asking for help and getting things checked right away is better, not only for a surgeon, but for his family and patients, too. While Dr. Cerame has gone back to work, he is unable to handle the case load he once had and isn’t sure if he’ll ever be able to.

“Surgeons and physicians in general have a tendency to get so consumed with other people’s health that they don’t focus on their own health issues,” said Dr. Cerame. “It took me almost 8 months from the time I had symptoms to actually get it checked out [because] I thought it would go away, [so] if you find something that’s not kosher or you feel something that isn’t normal, take care of it.”

The other side of this, Dr. Parks elaborated, is the overload of mental stress, leading to surgeon burnout. “There’s really a growing literature on surgeon burnout, and it is not a trifling issue; in studies from North American, Australasia, Europe, Great Britain, the rate of burnout among surgeons averages about 35%, and again, surgeons are very reluctant to talk about this sort of thing.”

Dr. Park and Dr. Cerame did not have any relevant financial disclosures.

dchitnis@frontlinemedcom.com

Officials at the Centers for Disease Control and Prevention reported that they are aware of at least nine cases of laboratory-confirmed Zika virus infection in pregnant travelers, and that in four of these cases, fetuses were either spontaneously lost or aborted.

Confirmed cases of Zika virus infection were reported among women who had traveled to one or more of the following nine areas with ongoing local transmission of Zika virus: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico, and Samoa, according to the CDC’s latest Morbidity and Mortality Weekly Report (2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e1er).

The agency is also investigating reports of 10 other cases of pregnant women with possible Zika virus infection.

Of the nine confirmed cases, six women were infected with Zika virus in their first trimester. In two cases, the pregnancies were terminated and two of the pregnancies resulted in stillbirths. Another woman gave birth to an infant with microcephaly, and one woman is still pregnant and has not experienced any complications so far.

Two of the nine women became infected with Zika virus during their second trimesters, one of whom has delivered a healthy infant and the other of whom is still pregnant with no known complications thus far. The last of the nine women, who became infected during her third trimester, gave birth to a healthy infant with no known complications.

There were no Zika virus–related hospitalizations or deaths among the nine women with Zika virus.

“To better understand the effects of Zika virus infection during pregnancy, CDC has established the U.S. Pregnancy Registry for Zika Virus Infection,” announced Dr. Denise J. Jamieson, colead of the Pregnancy and Birth Defects Team at the CDC. “This registry will provide information about the effects of Zika virus on pregnant women and their children.”

Participation in the registry is voluntary and information will be available on the CDC website soon, Dr. Jamieson added. Until then, the CDC maintains a 24/7 consultation hotline for both pregnant women and health care providers concerned about Zika virus infections, at 1-800-CDC-INFO. Patients and providers can also email zikamch@cdc.gov.

Additionally, CDC officials stated that they have received reports of at least 14 instances in which Zika virus may have been transmitted between individuals through sexual contact. Two of these cases are confirmed to have been transmitted to women from men who visited a Zika-endemic area, while another four are “probable cases” of sexual transmission, and another six are under investigation. Two reported cases were excluded after receiving additional information.

“Men who reside in or have traveled to an area of ongoing Zika virus transmission and have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex with their pregnant partner for the duration of the pregnancy,” said the CDC in a statement (MMWR. 2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e2er).

The World Health Organization also released a new situation report on Zika virus, microcephaly, and Guillain-Barré syndrome, saying that although Zika virus has been spreading to more geographic areas since the beginning of the crisis, cases of microcephaly and neonatal malformations are increasing only in Brazil and French Polynesia.

Additionally, the WHO released interim guidelines on psychosocial support for pregnant women who may be infected with Zika virus and families dealing with an infant born with either microcephaly or another neurologic disorder.

At a press briefing on Feb. 26, CDC Director Dr. Tom Frieden, noted that it has been 6 weeks since the CDC issued its first travel warning regarding Zika virus, and that the agency is “learning more about Zika everyday.” He added that the current state of the Zika virus outbreak is an “unprecedented situation.”

But Dr. Frieden also stressed that the exact link between Zika virus infection and microcephaly is still unknown, and it is not clear at what stage in the pregnancy Zika virus affects the fetus.

It’s also unknown whether infants born to mothers with Zika virus infection who don’t develop microcephaly will have any other health problems in the future. “Unfortunately, this is something we may not know for many years,” Dr. Frieden said.

dchitnis@frontlinemedcom.com

Officials at the Centers for Disease Control and Prevention reported that they are aware of at least nine cases of laboratory-confirmed Zika virus infection in pregnant travelers, and that in four of these cases, fetuses were either spontaneously lost or aborted.

Confirmed cases of Zika virus infection were reported among women who had traveled to one or more of the following nine areas with ongoing local transmission of Zika virus: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico, and Samoa, according to the CDC’s latest Morbidity and Mortality Weekly Report (2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e1er).

The agency is also investigating reports of 10 other cases of pregnant women with possible Zika virus infection.

Of the nine confirmed cases, six women were infected with Zika virus in their first trimester. In two cases, the pregnancies were terminated and two of the pregnancies resulted in stillbirths. Another woman gave birth to an infant with microcephaly, and one woman is still pregnant and has not experienced any complications so far.

Two of the nine women became infected with Zika virus during their second trimesters, one of whom has delivered a healthy infant and the other of whom is still pregnant with no known complications thus far. The last of the nine women, who became infected during her third trimester, gave birth to a healthy infant with no known complications.

There were no Zika virus–related hospitalizations or deaths among the nine women with Zika virus.

“To better understand the effects of Zika virus infection during pregnancy, CDC has established the U.S. Pregnancy Registry for Zika Virus Infection,” announced Dr. Denise J. Jamieson, colead of the Pregnancy and Birth Defects Team at the CDC. “This registry will provide information about the effects of Zika virus on pregnant women and their children.”

Participation in the registry is voluntary and information will be available on the CDC website soon, Dr. Jamieson added. Until then, the CDC maintains a 24/7 consultation hotline for both pregnant women and health care providers concerned about Zika virus infections, at 1-800-CDC-INFO. Patients and providers can also email zikamch@cdc.gov.

Additionally, CDC officials stated that they have received reports of at least 14 instances in which Zika virus may have been transmitted between individuals through sexual contact. Two of these cases are confirmed to have been transmitted to women from men who visited a Zika-endemic area, while another four are “probable cases” of sexual transmission, and another six are under investigation. Two reported cases were excluded after receiving additional information.

“Men who reside in or have traveled to an area of ongoing Zika virus transmission and have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex with their pregnant partner for the duration of the pregnancy,” said the CDC in a statement (MMWR. 2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e2er).

The World Health Organization also released a new situation report on Zika virus, microcephaly, and Guillain-Barré syndrome, saying that although Zika virus has been spreading to more geographic areas since the beginning of the crisis, cases of microcephaly and neonatal malformations are increasing only in Brazil and French Polynesia.

Additionally, the WHO released interim guidelines on psychosocial support for pregnant women who may be infected with Zika virus and families dealing with an infant born with either microcephaly or another neurologic disorder.

At a press briefing on Feb. 26, CDC Director Dr. Tom Frieden, noted that it has been 6 weeks since the CDC issued its first travel warning regarding Zika virus, and that the agency is “learning more about Zika everyday.” He added that the current state of the Zika virus outbreak is an “unprecedented situation.”

But Dr. Frieden also stressed that the exact link between Zika virus infection and microcephaly is still unknown, and it is not clear at what stage in the pregnancy Zika virus affects the fetus.

It’s also unknown whether infants born to mothers with Zika virus infection who don’t develop microcephaly will have any other health problems in the future. “Unfortunately, this is something we may not know for many years,” Dr. Frieden said.

dchitnis@frontlinemedcom.com

Officials at the Centers for Disease Control and Prevention reported that they are aware of at least nine cases of laboratory-confirmed Zika virus infection in pregnant travelers, and that in four of these cases, fetuses were either spontaneously lost or aborted.

Confirmed cases of Zika virus infection were reported among women who had traveled to one or more of the following nine areas with ongoing local transmission of Zika virus: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico, and Samoa, according to the CDC’s latest Morbidity and Mortality Weekly Report (2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e1er).

The agency is also investigating reports of 10 other cases of pregnant women with possible Zika virus infection.

Of the nine confirmed cases, six women were infected with Zika virus in their first trimester. In two cases, the pregnancies were terminated and two of the pregnancies resulted in stillbirths. Another woman gave birth to an infant with microcephaly, and one woman is still pregnant and has not experienced any complications so far.

Two of the nine women became infected with Zika virus during their second trimesters, one of whom has delivered a healthy infant and the other of whom is still pregnant with no known complications thus far. The last of the nine women, who became infected during her third trimester, gave birth to a healthy infant with no known complications.

There were no Zika virus–related hospitalizations or deaths among the nine women with Zika virus.

“To better understand the effects of Zika virus infection during pregnancy, CDC has established the U.S. Pregnancy Registry for Zika Virus Infection,” announced Dr. Denise J. Jamieson, colead of the Pregnancy and Birth Defects Team at the CDC. “This registry will provide information about the effects of Zika virus on pregnant women and their children.”

Participation in the registry is voluntary and information will be available on the CDC website soon, Dr. Jamieson added. Until then, the CDC maintains a 24/7 consultation hotline for both pregnant women and health care providers concerned about Zika virus infections, at 1-800-CDC-INFO. Patients and providers can also email zikamch@cdc.gov.

Additionally, CDC officials stated that they have received reports of at least 14 instances in which Zika virus may have been transmitted between individuals through sexual contact. Two of these cases are confirmed to have been transmitted to women from men who visited a Zika-endemic area, while another four are “probable cases” of sexual transmission, and another six are under investigation. Two reported cases were excluded after receiving additional information.

“Men who reside in or have traveled to an area of ongoing Zika virus transmission and have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex with their pregnant partner for the duration of the pregnancy,” said the CDC in a statement (MMWR. 2016 Feb 26. doi: http://dx.doi.org/10.15585/mmwr.mm6508e2er).

The World Health Organization also released a new situation report on Zika virus, microcephaly, and Guillain-Barré syndrome, saying that although Zika virus has been spreading to more geographic areas since the beginning of the crisis, cases of microcephaly and neonatal malformations are increasing only in Brazil and French Polynesia.

Additionally, the WHO released interim guidelines on psychosocial support for pregnant women who may be infected with Zika virus and families dealing with an infant born with either microcephaly or another neurologic disorder.

At a press briefing on Feb. 26, CDC Director Dr. Tom Frieden, noted that it has been 6 weeks since the CDC issued its first travel warning regarding Zika virus, and that the agency is “learning more about Zika everyday.” He added that the current state of the Zika virus outbreak is an “unprecedented situation.”

But Dr. Frieden also stressed that the exact link between Zika virus infection and microcephaly is still unknown, and it is not clear at what stage in the pregnancy Zika virus affects the fetus.

It’s also unknown whether infants born to mothers with Zika virus infection who don’t develop microcephaly will have any other health problems in the future. “Unfortunately, this is something we may not know for many years,” Dr. Frieden said.

dchitnis@frontlinemedcom.com

Live attenuated influenza vaccine (LAIV) is likely to be an option for all individuals with egg allergies, regardless of allergy severity, because the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to approve proposed amendments to the existing recommendations regarding administration of LAIV in individuals with egg allergies.

With 11 members voting “yes” and three choosing to abstain, the committee agreed to leave sections 1, 2, and 3 as they currently are, with a slight change to section 1 so that it will now include the latter half of recommendations that were previously placed under section 4. Therefore, section 1 of the recommendations for influenza vaccination of persons with egg allergy – which already states that “Regardless of a recipient’s allergy history, all vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available” – will now also include text stating that the vaccine should be administered in a medical setting and supervised by a health care provider with “experience in the recognition and management of severe allergic conditions,” or that such a medical professional should be “immediately available.”

©pressdigital/iStock

Sections 2 and 3 will remain the same. Section 2 states that a previous allergic reaction to the influenza vaccine is a contraindication to ever receiving the vaccine again in the future. Section 3 states that individuals with egg allergy who have only experienced hives due to eggs still should be administered the influenza vaccine.

The committee voted to strike section 5 of the existing recommendations, which calls for a 30-minute postvaccination observation period. However, the committee still advises that health care providers monitor all patients, particularly adolescents, for 15 minutes immediately after vaccination, and that individuals should be seated or lying down “to decrease the risk for injury should syncopy occur.”

The CDC generally follows ACIP’s recommendations.

Live attenuated influenza vaccine (LAIV) is likely to be an option for all individuals with egg allergies, regardless of allergy severity, because the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to approve proposed amendments to the existing recommendations regarding administration of LAIV in individuals with egg allergies.

With 11 members voting “yes” and three choosing to abstain, the committee agreed to leave sections 1, 2, and 3 as they currently are, with a slight change to section 1 so that it will now include the latter half of recommendations that were previously placed under section 4. Therefore, section 1 of the recommendations for influenza vaccination of persons with egg allergy – which already states that “Regardless of a recipient’s allergy history, all vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available” – will now also include text stating that the vaccine should be administered in a medical setting and supervised by a health care provider with “experience in the recognition and management of severe allergic conditions,” or that such a medical professional should be “immediately available.”

©pressdigital/iStock

Sections 2 and 3 will remain the same. Section 2 states that a previous allergic reaction to the influenza vaccine is a contraindication to ever receiving the vaccine again in the future. Section 3 states that individuals with egg allergy who have only experienced hives due to eggs still should be administered the influenza vaccine.

The committee voted to strike section 5 of the existing recommendations, which calls for a 30-minute postvaccination observation period. However, the committee still advises that health care providers monitor all patients, particularly adolescents, for 15 minutes immediately after vaccination, and that individuals should be seated or lying down “to decrease the risk for injury should syncopy occur.”

The CDC generally follows ACIP’s recommendations.

Live attenuated influenza vaccine (LAIV) is likely to be an option for all individuals with egg allergies, regardless of allergy severity, because the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to approve proposed amendments to the existing recommendations regarding administration of LAIV in individuals with egg allergies.

With 11 members voting “yes” and three choosing to abstain, the committee agreed to leave sections 1, 2, and 3 as they currently are, with a slight change to section 1 so that it will now include the latter half of recommendations that were previously placed under section 4. Therefore, section 1 of the recommendations for influenza vaccination of persons with egg allergy – which already states that “Regardless of a recipient’s allergy history, all vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available” – will now also include text stating that the vaccine should be administered in a medical setting and supervised by a health care provider with “experience in the recognition and management of severe allergic conditions,” or that such a medical professional should be “immediately available.”

©pressdigital/iStock

Sections 2 and 3 will remain the same. Section 2 states that a previous allergic reaction to the influenza vaccine is a contraindication to ever receiving the vaccine again in the future. Section 3 states that individuals with egg allergy who have only experienced hives due to eggs still should be administered the influenza vaccine.

The committee voted to strike section 5 of the existing recommendations, which calls for a 30-minute postvaccination observation period. However, the committee still advises that health care providers monitor all patients, particularly adolescents, for 15 minutes immediately after vaccination, and that individuals should be seated or lying down “to decrease the risk for injury should syncopy occur.”

The CDC generally follows ACIP’s recommendations.

Studies of two-dose and three-dose 9-valent human papillomavirus (HPV) vaccines in youth aged 9-14 years and in those up to age 26 found the vaccines to be “generally well tolerated in all vaccination groups,” according to a report at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

There were no vaccine-related severe adverse events, deaths, or discontinuations due to an adverse event.

©xrender/Thinkstock

The key points for ACIP to consider were the time interval between the first and second vaccine doses, the duration of protection provided by a two-dose regimen, and that it is imperative for patients to complete the entire series of vaccinations. A longer-term follow-up is planned, explained Dr. Alain Luxembourg, who spoke about the studies on behalf of Merck. “9-valent [vaccine] has now been licensed in more than 30 countries, [and] the ACIP recommended gardasil-9 for vaccination in 2015, so we continue to look at further developments in terms of licensure and recommendations,” he said.

The first of two 9vHPV two-dose studies was an open-label trial that examined five cohorts of 300 children; cohorts 1-3 and 5 were of children ages 9-14 years, and cohort 4 – the control – was of children and adults aged 16-26 years. All individuals in cohorts 1, 4, and 5 were female, all children in cohort 2 were male, and cohort 3 comprised males and females.

Children in cohorts 1 and 2 were put on dosing regimens lasting either 0 or 6 months. Children in cohort 3 were placed in regimens lasting either 0 or 12 months, while those in cohorts 4 and 5 were in regimens of either 0, 2, or 6 months. Vaccine administration was done over two or three visits, within a 4-week window of month 6 and month 12; those who were on a 2-month regimen were vaccinated within 3 weeks of reaching 2 months. In addition, one dose of 9vHPV was administered at 36 months to “assess immune memory.”

The second study was a 37-month trial that examined noninferiority of measured geometric mean titer (GMT) concentrations – the metric used for both studies to determine HPV concentration – at 1 month after last dose in both girls and boys who were on a two-dose regimen, and compared them with young women who received a three-dose regimen.

The results indicated that noninferior HPV concentrations at 1 month after administration of the final dose in both girls and boys “supports extending efficacy findings in women who received three doses to girls and boys who received two doses.” Furthermore, lower measure GMTs were found in girls who received only two doses versus three, although Dr. Luxembourg said the clinical significance of this finding is as yet unknown.

Dr. Luxembourg is an employee of Merck.

dchitnis@frontlinemedcom.com

Studies of two-dose and three-dose 9-valent human papillomavirus (HPV) vaccines in youth aged 9-14 years and in those up to age 26 found the vaccines to be “generally well tolerated in all vaccination groups,” according to a report at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

There were no vaccine-related severe adverse events, deaths, or discontinuations due to an adverse event.

©xrender/Thinkstock

The key points for ACIP to consider were the time interval between the first and second vaccine doses, the duration of protection provided by a two-dose regimen, and that it is imperative for patients to complete the entire series of vaccinations. A longer-term follow-up is planned, explained Dr. Alain Luxembourg, who spoke about the studies on behalf of Merck. “9-valent [vaccine] has now been licensed in more than 30 countries, [and] the ACIP recommended gardasil-9 for vaccination in 2015, so we continue to look at further developments in terms of licensure and recommendations,” he said.

The first of two 9vHPV two-dose studies was an open-label trial that examined five cohorts of 300 children; cohorts 1-3 and 5 were of children ages 9-14 years, and cohort 4 – the control – was of children and adults aged 16-26 years. All individuals in cohorts 1, 4, and 5 were female, all children in cohort 2 were male, and cohort 3 comprised males and females.

Children in cohorts 1 and 2 were put on dosing regimens lasting either 0 or 6 months. Children in cohort 3 were placed in regimens lasting either 0 or 12 months, while those in cohorts 4 and 5 were in regimens of either 0, 2, or 6 months. Vaccine administration was done over two or three visits, within a 4-week window of month 6 and month 12; those who were on a 2-month regimen were vaccinated within 3 weeks of reaching 2 months. In addition, one dose of 9vHPV was administered at 36 months to “assess immune memory.”

The second study was a 37-month trial that examined noninferiority of measured geometric mean titer (GMT) concentrations – the metric used for both studies to determine HPV concentration – at 1 month after last dose in both girls and boys who were on a two-dose regimen, and compared them with young women who received a three-dose regimen.

The results indicated that noninferior HPV concentrations at 1 month after administration of the final dose in both girls and boys “supports extending efficacy findings in women who received three doses to girls and boys who received two doses.” Furthermore, lower measure GMTs were found in girls who received only two doses versus three, although Dr. Luxembourg said the clinical significance of this finding is as yet unknown.

Dr. Luxembourg is an employee of Merck.

dchitnis@frontlinemedcom.com

Studies of two-dose and three-dose 9-valent human papillomavirus (HPV) vaccines in youth aged 9-14 years and in those up to age 26 found the vaccines to be “generally well tolerated in all vaccination groups,” according to a report at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

There were no vaccine-related severe adverse events, deaths, or discontinuations due to an adverse event.

©xrender/Thinkstock

The key points for ACIP to consider were the time interval between the first and second vaccine doses, the duration of protection provided by a two-dose regimen, and that it is imperative for patients to complete the entire series of vaccinations. A longer-term follow-up is planned, explained Dr. Alain Luxembourg, who spoke about the studies on behalf of Merck. “9-valent [vaccine] has now been licensed in more than 30 countries, [and] the ACIP recommended gardasil-9 for vaccination in 2015, so we continue to look at further developments in terms of licensure and recommendations,” he said.

The first of two 9vHPV two-dose studies was an open-label trial that examined five cohorts of 300 children; cohorts 1-3 and 5 were of children ages 9-14 years, and cohort 4 – the control – was of children and adults aged 16-26 years. All individuals in cohorts 1, 4, and 5 were female, all children in cohort 2 were male, and cohort 3 comprised males and females.

Children in cohorts 1 and 2 were put on dosing regimens lasting either 0 or 6 months. Children in cohort 3 were placed in regimens lasting either 0 or 12 months, while those in cohorts 4 and 5 were in regimens of either 0, 2, or 6 months. Vaccine administration was done over two or three visits, within a 4-week window of month 6 and month 12; those who were on a 2-month regimen were vaccinated within 3 weeks of reaching 2 months. In addition, one dose of 9vHPV was administered at 36 months to “assess immune memory.”

The second study was a 37-month trial that examined noninferiority of measured geometric mean titer (GMT) concentrations – the metric used for both studies to determine HPV concentration – at 1 month after last dose in both girls and boys who were on a two-dose regimen, and compared them with young women who received a three-dose regimen.

The results indicated that noninferior HPV concentrations at 1 month after administration of the final dose in both girls and boys “supports extending efficacy findings in women who received three doses to girls and boys who received two doses.” Furthermore, lower measure GMTs were found in girls who received only two doses versus three, although Dr. Luxembourg said the clinical significance of this finding is as yet unknown.

Dr. Luxembourg is an employee of Merck.

dchitnis@frontlinemedcom.com

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

dchitnis@frontlinemedcom.com

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

dchitnis@frontlinemedcom.com

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

dchitnis@frontlinemedcom.com

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

dchitnis@frontlinemedcom.com

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

dchitnis@frontlinemedcom.com

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – For patients who want to get rid of scars, consider using laser treatment for speedy and effective removal, said Dr. Joel L. Cohen, a dermatologist practicing in Englewood, Colo.

“I do spend a fair amount of my time doing [laser treatments] and I do use a lot of these laser modalities,” Dr. Cohen said at the Orlando Dermatology Aesthetic and Clinical Conference. “We have them in aesthetic practices, and we have them for other things we can do, such as trying to minimize scars.”

For laser removal of a recent surgical scar, Dr. Cohen recommended the 585-nm pulsed dye laser, citing a 2010 study of 20 adults, which found that both long- and short-pulse dye lasers had no significant difference in their ability to effectively improve the appearance of surgical scars. After sutures were removed, sections of the postoperative scar of each patient were treated with the short-pulse 585-nm laser and the long-pulse 585-nm laser once a month for 3 months, and one section was left untreated to serve as controls. The investigators found that the sections treated with the laser demonstrated a statistically significant overall average improvement in appearance, as measured by the Vancouver Scar Scale, of 92% and 89%, vs. 67% for the untreated areas (Lasers Med Sci. 2010 Jan;25[1]:121-6).

For atrophic scars, fractional laser photothermolysis is considered the preferred method in a number of studies. In a 2007 study of 53 patients with mild to moderate atrophic facial acne scars, a 1,550-nm erbium-doped fiber laser was found to improve the appearance of scars safely and effectively in most of the patients (Dermatol Surg. 2007 Mar;33[3]:295-9). After three monthly treatments, almost 90% of the patients has clinical improvements averaging 51%-75%, according to the study results.

In addition, for traumatic scars, optimal treatment is via use of ablative fractional laser resurfacing, Dr. Cohen said. This approach was also mentioned in a 2014 consensus statement, which said that laser scar therapy, particularly ablative laser resurfacing, was a promising but underused tool (JAMA Dermatol. 2014;150[2]:187-93).

Importantly, Dr. Cohen advised that laser treatment can be used after traditional grafting, if surgeons and their patients are not satisfied with the aesthetic outcome of an operation.

“We don’t always get great closures,” said Dr. Cohen. “I think we’ve seen some really nice reconstructions done [but] things don’t always go great, and so this is an option” when more traditional approaches, like flaps, are simply not viable.

Preventing or minimizing scar formation

Dr. Cohen also referred to data on preventing or minimizing scar formation with approaches that include botulinum toxin.

“There are some data about using botulinum toxin to chemo-immobilize the area,” he noted, pointing to a 2006 blinded, prospective, randomized clinical trial of 31 patients, which found that botulinum toxin-induced immobilization enhanced healing of forehead wounds and improved the eventual appearance of scars (Mayo Clin Proc. 2006 Aug;81[8]:1023-8). In the study, botulinum toxin or placebo injections were administered into the muscle surrounding the wound within 24 hours after the wound was closed.

Another study, a retrospective chart review of 18 patients published in 2009, had similar results, showing that in patients who undergo facial reconstructions, botulinum toxin can help with wound healing regardless of which type (A or B) is used. When administered intraoperatively during reconstruction post Mohs micrographic surgery, botulinum toxin types A and B were effective in helping wound healing, according to the researchers (Dermatol Surg. 2009 Feb;35[2]:182-8).

Botulinum toxin type A also has been scrutinized in preclinical studies, including one that looked at its effects on the synthesis of cytokines, “in a cell culture model of cutaneous scarring.” This study found no effect of botulinum type A on cell proliferation or on cytokines and growth factors. The researchers concluded that the results did not provide evidence “to suggest a significant therapeutic role of botulinum toxin A injections for cutaneous wound healing beyond chemoimmobilization” (Arch Facial Plast Surg. 2012 Mar-Apr;14[2]:122-6).

Results of another study that looked at the effect of botulinum type A on transforming growth factor beta-1 on fibroblasts that were isolated from a hypertrophic scar suggested that it may be worth studying further as a treatment for hypertrophic scars. (Aesthetic Plast Surg. 2010 Aug;34[4]:424-7).

Dr. Cohen did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – For patients who want to get rid of scars, consider using laser treatment for speedy and effective removal, said Dr. Joel L. Cohen, a dermatologist practicing in Englewood, Colo.

“I do spend a fair amount of my time doing [laser treatments] and I do use a lot of these laser modalities,” Dr. Cohen said at the Orlando Dermatology Aesthetic and Clinical Conference. “We have them in aesthetic practices, and we have them for other things we can do, such as trying to minimize scars.”

For laser removal of a recent surgical scar, Dr. Cohen recommended the 585-nm pulsed dye laser, citing a 2010 study of 20 adults, which found that both long- and short-pulse dye lasers had no significant difference in their ability to effectively improve the appearance of surgical scars. After sutures were removed, sections of the postoperative scar of each patient were treated with the short-pulse 585-nm laser and the long-pulse 585-nm laser once a month for 3 months, and one section was left untreated to serve as controls. The investigators found that the sections treated with the laser demonstrated a statistically significant overall average improvement in appearance, as measured by the Vancouver Scar Scale, of 92% and 89%, vs. 67% for the untreated areas (Lasers Med Sci. 2010 Jan;25[1]:121-6).

For atrophic scars, fractional laser photothermolysis is considered the preferred method in a number of studies. In a 2007 study of 53 patients with mild to moderate atrophic facial acne scars, a 1,550-nm erbium-doped fiber laser was found to improve the appearance of scars safely and effectively in most of the patients (Dermatol Surg. 2007 Mar;33[3]:295-9). After three monthly treatments, almost 90% of the patients has clinical improvements averaging 51%-75%, according to the study results.

In addition, for traumatic scars, optimal treatment is via use of ablative fractional laser resurfacing, Dr. Cohen said. This approach was also mentioned in a 2014 consensus statement, which said that laser scar therapy, particularly ablative laser resurfacing, was a promising but underused tool (JAMA Dermatol. 2014;150[2]:187-93).

Importantly, Dr. Cohen advised that laser treatment can be used after traditional grafting, if surgeons and their patients are not satisfied with the aesthetic outcome of an operation.

“We don’t always get great closures,” said Dr. Cohen. “I think we’ve seen some really nice reconstructions done [but] things don’t always go great, and so this is an option” when more traditional approaches, like flaps, are simply not viable.

Preventing or minimizing scar formation

Dr. Cohen also referred to data on preventing or minimizing scar formation with approaches that include botulinum toxin.

“There are some data about using botulinum toxin to chemo-immobilize the area,” he noted, pointing to a 2006 blinded, prospective, randomized clinical trial of 31 patients, which found that botulinum toxin-induced immobilization enhanced healing of forehead wounds and improved the eventual appearance of scars (Mayo Clin Proc. 2006 Aug;81[8]:1023-8). In the study, botulinum toxin or placebo injections were administered into the muscle surrounding the wound within 24 hours after the wound was closed.

Another study, a retrospective chart review of 18 patients published in 2009, had similar results, showing that in patients who undergo facial reconstructions, botulinum toxin can help with wound healing regardless of which type (A or B) is used. When administered intraoperatively during reconstruction post Mohs micrographic surgery, botulinum toxin types A and B were effective in helping wound healing, according to the researchers (Dermatol Surg. 2009 Feb;35[2]:182-8).

Botulinum toxin type A also has been scrutinized in preclinical studies, including one that looked at its effects on the synthesis of cytokines, “in a cell culture model of cutaneous scarring.” This study found no effect of botulinum type A on cell proliferation or on cytokines and growth factors. The researchers concluded that the results did not provide evidence “to suggest a significant therapeutic role of botulinum toxin A injections for cutaneous wound healing beyond chemoimmobilization” (Arch Facial Plast Surg. 2012 Mar-Apr;14[2]:122-6).

Results of another study that looked at the effect of botulinum type A on transforming growth factor beta-1 on fibroblasts that were isolated from a hypertrophic scar suggested that it may be worth studying further as a treatment for hypertrophic scars. (Aesthetic Plast Surg. 2010 Aug;34[4]:424-7).

Dr. Cohen did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – For patients who want to get rid of scars, consider using laser treatment for speedy and effective removal, said Dr. Joel L. Cohen, a dermatologist practicing in Englewood, Colo.

“I do spend a fair amount of my time doing [laser treatments] and I do use a lot of these laser modalities,” Dr. Cohen said at the Orlando Dermatology Aesthetic and Clinical Conference. “We have them in aesthetic practices, and we have them for other things we can do, such as trying to minimize scars.”

For laser removal of a recent surgical scar, Dr. Cohen recommended the 585-nm pulsed dye laser, citing a 2010 study of 20 adults, which found that both long- and short-pulse dye lasers had no significant difference in their ability to effectively improve the appearance of surgical scars. After sutures were removed, sections of the postoperative scar of each patient were treated with the short-pulse 585-nm laser and the long-pulse 585-nm laser once a month for 3 months, and one section was left untreated to serve as controls. The investigators found that the sections treated with the laser demonstrated a statistically significant overall average improvement in appearance, as measured by the Vancouver Scar Scale, of 92% and 89%, vs. 67% for the untreated areas (Lasers Med Sci. 2010 Jan;25[1]:121-6).

For atrophic scars, fractional laser photothermolysis is considered the preferred method in a number of studies. In a 2007 study of 53 patients with mild to moderate atrophic facial acne scars, a 1,550-nm erbium-doped fiber laser was found to improve the appearance of scars safely and effectively in most of the patients (Dermatol Surg. 2007 Mar;33[3]:295-9). After three monthly treatments, almost 90% of the patients has clinical improvements averaging 51%-75%, according to the study results.

In addition, for traumatic scars, optimal treatment is via use of ablative fractional laser resurfacing, Dr. Cohen said. This approach was also mentioned in a 2014 consensus statement, which said that laser scar therapy, particularly ablative laser resurfacing, was a promising but underused tool (JAMA Dermatol. 2014;150[2]:187-93).

Importantly, Dr. Cohen advised that laser treatment can be used after traditional grafting, if surgeons and their patients are not satisfied with the aesthetic outcome of an operation.

“We don’t always get great closures,” said Dr. Cohen. “I think we’ve seen some really nice reconstructions done [but] things don’t always go great, and so this is an option” when more traditional approaches, like flaps, are simply not viable.

Preventing or minimizing scar formation

Dr. Cohen also referred to data on preventing or minimizing scar formation with approaches that include botulinum toxin.

“There are some data about using botulinum toxin to chemo-immobilize the area,” he noted, pointing to a 2006 blinded, prospective, randomized clinical trial of 31 patients, which found that botulinum toxin-induced immobilization enhanced healing of forehead wounds and improved the eventual appearance of scars (Mayo Clin Proc. 2006 Aug;81[8]:1023-8). In the study, botulinum toxin or placebo injections were administered into the muscle surrounding the wound within 24 hours after the wound was closed.

Another study, a retrospective chart review of 18 patients published in 2009, had similar results, showing that in patients who undergo facial reconstructions, botulinum toxin can help with wound healing regardless of which type (A or B) is used. When administered intraoperatively during reconstruction post Mohs micrographic surgery, botulinum toxin types A and B were effective in helping wound healing, according to the researchers (Dermatol Surg. 2009 Feb;35[2]:182-8).

Botulinum toxin type A also has been scrutinized in preclinical studies, including one that looked at its effects on the synthesis of cytokines, “in a cell culture model of cutaneous scarring.” This study found no effect of botulinum type A on cell proliferation or on cytokines and growth factors. The researchers concluded that the results did not provide evidence “to suggest a significant therapeutic role of botulinum toxin A injections for cutaneous wound healing beyond chemoimmobilization” (Arch Facial Plast Surg. 2012 Mar-Apr;14[2]:122-6).

Results of another study that looked at the effect of botulinum type A on transforming growth factor beta-1 on fibroblasts that were isolated from a hypertrophic scar suggested that it may be worth studying further as a treatment for hypertrophic scars. (Aesthetic Plast Surg. 2010 Aug;34[4]:424-7).

Dr. Cohen did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com