Noisy Homes Can Slow a Toddler’s Vocabulary

THURSDAY, July 21, 2016 (HealthDay News) — Background noise can hamper a toddler’s ability to learn new words, a new study suggests.

“Modern homes are filled with noisy distractions such as TV, radio and people talking that could affect how children learn words at early ages,” said study leader Brianna McMillan.

“Our study suggests that adults should be aware of the amount of background speech in the environment when they’re interacting with young children,” said McMillan, a doctoral student in psychology at the University of Wisconsin at Madison.

Researchers from the university assessed the ability of 106 children, aged 22 to 30 months, to learn new words. They found they were more successful when their surroundings were quiet than when there was background noise.

But providing the children with additional language cues helped them overcome the detrimental effects of a noisy environment, according to the study. The findings appear July 21 in the journal Child Development.

“Learning words is an important skill that provides a foundation for children’s ability to achieve academically,” McMillan said in a journal news release.

Because of urban settings and crowding, homes in lower-income areas tend to have higher-than-normal noise levels, according to background notes with the study.

“Hearing new words in fluent speech without a lot of background noise before trying to learn what objects the new words corresponded to may help very young children master new vocabulary,” said study co-author Jenny Saffran, a professor of psychology.

“But when the environment is noisy, drawing young children’s attention to the sounds of the new word may help them compensate,” she added.

More information

The U.S. National Institute on Deafness and Other Communication Disorders has more about speech and language development.

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Scans Not Worthwhile for Most Thyroid Cancers: Study

THURSDAY, July 21, 2016 (HealthDay News) — Having scans after treatment does not improve thyroid cancer patients’ chances of survival, a new study shows.

Researchers from the University of Michigan looked at more than 28,000 patients in the United States who were diagnosed with thyroid cancer between 1998 and 2011. After treatment, 57 percent of the patients had at least one ultrasound, 24 percent had a radioiodine scan and 15 percent had a PET scan to monitor for signs of the return of their cancer.

Patients who had scans were more likely to undergo further treatment, such as surgery, radioactive iodine treatment or radiation therapy. However, patients who had scans were as likely to die as those who did not have scans, according to the study.

“Over time, we have seen this marked increase in the use of imaging after primary treatment of thyroid cancer, despite the fact that the majority of our patients have low-risk cancer. For the most part, this imaging isn’t affecting survival,” study researcher Dr. Megan Haymart, an assistant professor of medicine, said in a university news release.

Study author Mousumi Banerjee, a research professor of biostatistics, said, “With this post-treatment surveillance imaging, we’re picking up more recurrences. But is that clinically significant? We might be picking up really small lymph nodes that if left untreated wouldn’t have impacted survival.”

There has been a sharp increase in the use of scans among patients with low-risk thyroid cancer. Thyroid cancer has a high survival rate, with 96 percent of patients still alive after 10 years. However, a small number of thyroid cancers are aggressive and likely to return, the researchers said.

“There is a place for imaging in thyroid cancer survivors. But the specific type of imaging needs to be tailored to the patient,” Haymart said. “When we have a patient with a favorable prognosis, certain types of imaging may not be necessary. But there is a group for whom it might be appropriate.”

The study did find that radioiodine scans (where radioactive iodine is injected or swallowed and a camera is used to detect possible cancer spread) were associated with improved survival. These scans are best used when blood tests indicate increased levels of a certain tumor marker and the patient is known to be responsive to radioactive iodine treatment, the researchers explained.

The findings were published July 20 in the BMJ.

More information

The American Cancer Society has more on thyroid cancer.

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Living Past 90 Doesn’t Doom You to Disease, Disability

By Karen Pallarito
HealthDay Reporter

THURSDAY, July 20, 2016 (HealthDay News) — What if you could live well into your 90s and still be in good health?

A new study suggests that may be possible, particularly if you have good genes.

“Chronic disease is not an inevitable part of aging,” said Dr. Sofiya Milman, an assistant professor of medicine at the Albert Einstein College of Medicine in New York City. “An extended period of good health can accompany a long life span and is an achievable goal.”

Milman is one of the authors of a U.S. National Institutes of Health-funded study on aging.

Americans are living longer than ever. In 2014, the average life expectancy at birth had reached nearly 79 years, according to the U.S. National Center for Health Statistics. A century earlier, it was just slightly over 54 years.

But gains in “health span — the period of time that people live in good health — have not kept pace with longevity, the study authors noted. Rather, longer life expectancy has been associated with greater disability.

Of course, some people are beating the odds, outliving their average life expectancy, surviving near the limit of the human life span, and spending fewer years sick and disabled.

How do they do it?

Using data from two previous studies, researchers from Albert Einstein and Boston University examined whether people experienced similar delays in the onset of disease and disability before death.

One study, the Longevity Genes Project, included Ashkenazi Jewish people who at age 95 were living independently. For comparison, the study also included a group of somewhat younger Ashkenazi Jews with no parental history of longevity.

The research team also drew data from the New England Centenarian Study, which included 100 year olds living in eight towns in the Boston area, as well as in England, Ireland, Australia and New Zealand. It also included people without a family predisposition of exceptional longevity for comparison.

Researchers then compared the health of 439 long-lived people and their 696 somewhat younger counterparts, aged 53 to 93, from the Longevity Genes Program with the health of 1,498 long-lived participants and 302 comparison participants, aged 49 to 89, from the New England Centenarian Study.

For both sets of comparisons, researchers tracked people’s ages at the onset of cancer, cardiovascular disease, diabetes, high blood pressure, osteoporosis and stroke. Alzheimer’s disease, however, was not included because the Longevity Genes Project does not collect that data, Milman explained.

Remarkably, the long-lived participants in each study experienced disease and disability later in life, resulting in a shorter period of illness before death, compared with the younger adult groups.

The researchers assessed disease-free survival years by approximating the prevalence for each disease in older adults. Take cancer, as an example. Cancer prevalence is 20 percent for people aged 65 to 80, the study authors said.

For people in the Longevity Genes Project, the age at which 20 percent of the long-lived individuals had developed cancer was delayed to 96 for both men and women. Twenty percent of their younger counterparts, however, experienced cancer by age 78 for men and by age 74 for women, the findings showed.

Likewise, for people in the centenarian study, cancer did not strike 20 percent of men until age 97 and women until age 99. But 20 percent of their younger counterparts were afflicted by age 67 in men and by age 74 in women.

“A lot of concern is that, well, if you live a long time, you’re just going to be bedridden. And what they’re showing is that’s not true. The people who are living longer are living healthier,” said Dr. Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh.

“Their health span was longer, and that’s the important piece of it,” added Newman, a professor and chair of population health sciences and epidemiology.

So what’s their secret?

According to Milman, “Genetic factors are thought to be the main reason. We have identified several genetic factors that appear to slow aging and/or protect from diseases.”

Environment factors — at least among these long-lived people — seem to be less important, she noted.

“Our centenarians were not practicing particularly healthy behaviors: 60 percent of men and 30 percent of women were smokers, less than half exercised regularly, and approximately 50 percent were overweight or obese,” Milman noted.

The report was published online this month in the Journal of the American Geriatrics Society.

More information

Learn more about living long and living well from the U.S. National Institute on Aging.

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Much-Maligned Pigeon May Be a Lead Detective

WEDNESDAY, July 20, 2016 (HealthDay News) — Though pigeons are generally considered a city-dwelling nuisance, researchers have found that these “rats of the sky” can be used to monitor levels of lead and other toxic compounds in cities.

Blood samples taken from hundreds of sick or injured pigeons in New York City between 2010 and 2015 showed that their lead levels rose in the summer. Those findings correlated to what happened with lead levels in blood samples from children.

Zip codes in the city with high lead levels in pigeons also had some of the highest levels of lead in children, the study found.

“Pigeons breathe the same air, walk the same sidewalks, and often eat the same food as we do. What if we could use them to monitor possible dangers to our health in the environment, like lead pollution?” said study leader Rebecca Calisi.

Calisi, an assistant professor of neurobiology, physiology and behavior at the University of California, Davis, conducted the study with a colleague while at Columbia University in New York City.

Elevated lead levels are a concern because they can cause lower IQ levels in children, as well as an inability to pay attention, according to the U.S. Centers for Disease Control and Prevention.

The study researchers said the source of the urban lead isn’t clear. Lead in gasoline has been banned for decades. Some homes still have lead paint, but the researchers noted that pigeons wouldn’t be exposed to lead that way.

Roads and construction sites are places where airborne lead exposure may occur, the researchers said. Pigeons pick up roadside gravel to help their digestion. And, children may bring lead on their shoes into their homes.

Pigeons are used to monitor certain types of pollution in some European cities. But this is the first study to compare lead levels in pigeons and children, Calisi said.

“This is a powerful example of how we can use pigeons to monitor the location and prevalence of pollutants,” Calisi said in a UC Davis news release. The birds can be used to monitor dangers to human health, she added.

Pigeons are ideal for this type of monitoring because they typically spend their lives within an area of a few city blocks, she explained.

Calisi is expanding her research to include other pollutants, such as other heavy metals, pesticides and fire retardants.

The study was published July 18 in the journal Chemosphere.

More information

The U.S. Environmental Protection Agency has more on lead.

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Is Surgery Always Needed for Meniscal Tears of the Knee?

WEDNESDAY, July 20, 2016 (HealthDay News) — A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.

Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.

Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.

According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year — although there’s debate over how valuable these procedures are for meniscal tears.

To help settle the matter, a team led by Nina Jullum Kise, an orthopedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.

These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.

Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.

After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise’s team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.

Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.

According to Kise’s group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.

Two knee specialists in the United States had differing views on the findings.

Dr. Matthew Hepinstall is an orthopedic surgeon at Lenox Hill Hospital in New York City. He said the new study “complements prior research” finding much the same thing, and he believes that “the majority of patients can experience significant improvement over weeks to months without undergoing surgery.”

He did offer one caveat, however: the size and cause of the tear matters. “The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury,” Hepinstall explained.

Still, “the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention,” Hepinstall said.

But another orthopedic surgeon took issue with the study’s design.

“Many important factors were not taken into account,” said Dr. Victor Khabie, who co-directs the Orthopedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, N.Y.

“This study did not look at ‘injuries,’ it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopedics office; excluding these patients limits this study,” Khabie said.

“My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen,” Khabie said.

He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. “The study included ‘all’ meniscal tears,” Khabie noted. “Most orthopedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient’s symptoms.”

According to Khabie, “The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopedic surgeon with experience in knee surgery can determine the best treatment option for any given patient.”

The study was published July 20 in the BMJ.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about knee problems.

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Is Surgery Always Needed for Meniscal Tears of the Knee?

WEDNESDAY, July 20, 2016 (HealthDay News) — A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.

Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.

Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.

According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year — although there’s debate over how valuable these procedures are for meniscal tears.

To help settle the matter, a team led by Nina Jullum Kise, an orthopedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.

These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.

Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.

After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise’s team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.

Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.

According to Kise’s group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.

Two knee specialists in the United States had differing views on the findings.

Dr. Matthew Hepinstall is an orthopedic surgeon at Lenox Hill Hospital in New York City. He said the new study “complements prior research” finding much the same thing, and he believes that “the majority of patients can experience significant improvement over weeks to months without undergoing surgery.”

He did offer one caveat, however: the size and cause of the tear matters. “The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury,” Hepinstall explained.

Still, “the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention,” Hepinstall said.

But another orthopedic surgeon took issue with the study’s design.

“Many important factors were not taken into account,” said Dr. Victor Khabie, who co-directs the Orthopedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, N.Y.

“This study did not look at ‘injuries,’ it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopedics office; excluding these patients limits this study,” Khabie said.

“My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen,” Khabie said.

He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. “The study included ‘all’ meniscal tears,” Khabie noted. “Most orthopedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient’s symptoms.”

According to Khabie, “The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopedic surgeon with experience in knee surgery can determine the best treatment option for any given patient.”

The study was published July 20 in the BMJ.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about knee problems.

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New Treatments Helping Kids With Juvenile Arthritis

WEDNESDAY, July 20, 2016 (HealthDay News) — New treatments for juvenile arthritis offer hope to children with the chronic autoimmune condition, doctors say.

Scientists are still working to understand what causes juvenile arthritis and how to stop its progression. But, kids coping with its effects have reason to be optimistic, according to Dr. Nikolay Nikolov, a rheumatologist and clinical team leader at the U.S. Food and Drug Administration.

“We don’t have a cure for juvenile arthritis — we’re not there yet,” Nikolov said in an FDA news release. “But we’re making progress.”

But it’s important to note that the drugs aren’t risk-free.

Juvenile arthritis is one of the most common chronic childhood conditions, affecting nearly 300,000 children in the United States, according to the FDA.

The disease causes the immune system to attack its own tissues, resulting in pain, swelling, tenderness and stiffness in the joints. These symptoms usually begin before children are 16 years old.

There are several types of juvenile arthritis, known collectively as Juvenile Idiopathic Arthritis (JIA). JIA can involve the knees, wrists and ankles as well as smaller joints, according to the FDA.

The largest subtype of JIA is known as polyarticular JIA, which affects many joints. Systemic JIA is another subtype that affects the entire body, triggering fevers and rashes, the agency explained.

New treatments can help. In the past, children with the condition were given drugs to suppress their immune system or medications to ease inflammation, including aspirin and ibuprofen.

More recently, however, drugs extracted from biological sources — called biologics — have become available to treat polyarticular and systemic JIA. Different biologics tend to work better for different subtypes of the disease, Nikolov said.

Among the biologics approved by the FDA since 1999 for treatment of polyarticular JIA are Humira (adalimumab); Orencia (abatacept); Enbrel (etanercept); and Actemra (tocilizumab).

Biologics approved since 2011 for treatment of systemic JIA are Actemra and Ilaris (canakinumab).

These medications are typically injected under the skin or given intravenously. Children usually take them for years.

The treatments target specific molecules in the body that trigger inflammation called cytokines, and other naturally occurring proteins that stimulate the immune system, according to Nikolov.

But biologics are powerful drugs that suppress the immune system and can increase children’s risk of serious infections, including tuberculosis. The FDA weighs these risks and whether the potential benefits of the drugs for children with juvenile arthritis outweigh them, Nikolov said.

“It’s possible that safety issues might come up in kids that we have not found in adults,” he said. “For example, these drugs may affect the developing body and immune system in children, and that may warrant changes in the labels to let both health care providers and patients know what are the risks involved, and how to recognize and respond to potential problems.”

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on juvenile arthritis.

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New Drug May Treat Rare Obesity Disorder Causing Constant Hunger

By Amy Norton
HealthDay Reporter

WEDNESDAY, July 20, 2016 (HealthDay News) — An experimental drug spurred substantial weight loss in people with a rare genetic disorder that causes severe obesity because patients feel perpetually hungry.

The study included only two patients with the disorder, known as proopiomelanocortin deficiency.

But those two patients account for two-thirds of all known adult cases worldwide, said Dr. Marc Reitman, of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

The disorder is caused by mutations in the gene that makes the protein called proopiomelanocortin (POMC).

Normally, the POMC protein gets chopped into smaller proteins that affect different hormones in the body, explained Reitman, who wrote an editorial published with the study.

When the body lacks POMC, the adrenal glands (which churn out vital hormones) cannot work properly. If that adrenal insufficiency isn’t recognized and treated quickly, the disease kills in infancy.

Around 50 cases of POMC deficiency have been reported in the medical literature, according to the U.S. National Institutes of Health (NIH).

But only three people are known to have survived into adulthood, Reitman added.

Those survivors have revealed another consequence of POMC deficiency: extreme obesity. And that, research has shown, seems to stem from a lack of another hormone derived from POMC — called melanocyte-stimulating hormone (MSH).

Without MSH, people are constantly hungry. “It’s like your body doesn’t know you’ve been fed, no matter how much you eat,” Reitman said.

The standard way to treat any hormone deficiency is to replace the hormone. But until now, there has been no good replacement for MSH.

In the new study, researchers in France and Germany tested an experimental compound called setmelanotide in two adults with POMC deficiency.

The drug is being developed by a Boston biotech firm called Rhythm Pharmaceuticals, to treat rare genetic causes of obesity.

According to the company, setmelanotide activates a receptor on body cells that would normally be turned on by MSH. So it essentially acts as a replacement for MSH, Reitman explained.

The patients in this study — both women in their 20s — were severely obese, weighing close to 350 pounds.

After about 10 months of daily setmelanotide injections, one patient had lost 112 pounds. The other dropped 45 pounds over three months of treatment.

The first patient initially had her treatment stopped after three months. She immediately became excessively hungry and began to regain the weight, said lead researcher Dr. Peter Kuhnen.

Once the patient went back on the drug, her hunger eased and her weight loss continued, the researchers said.

“For this reason, we presume that the patients will need to take the drug indefinitely,” said Kuhnen, who is based at Charite-Medical University of Berlin, in Germany.

No one can predict how the patients will fare in the long term.

In theory, Kuhnen said, they could develop resistance to the drug, and at least need a dosage change.

Reitman said there’s also some concern that the drug could cause high blood pressure.

But that has not happened yet in these patients. And one woman saw her blood pressure go down — probably because of the large weight loss, according to Reitman.

One side effect was seen in both women: Their skin and hair darkened.

That’s not surprising, Reitman said, because MSH stimulates another cell receptor in the skin and hair. (Lacking MSH, people with POMC deficiency have pale skin and red hair.)

According to Rhythm Pharmaceuticals, which provided the drugs for the study, setmelanotide will be tested in other genetic forms of obesity.

An ongoing study is looking at patients with Prader Willi syndrome — which affects an estimated one in 10,000 to 30,000 people worldwide, according to the NIH.

The genetics of Prader Willi are complex. But patients’ obesity is thought to involve the same molecular “pathway” seen in POMC deficiency, Kuhnen said.

Reitman speculated that the drug might benefit people who are obese because they lack cell receptors for leptin — an appetite-curbing hormone.

“Relatively speaking, that’s a common monogenic [single-gene] cause of obesity,” he said.

By NIH estimates, leptin receptor deficiency may account for up to 3 percent of people who become severely obese early in childhood.

What’s not clear is whether the findings have any relevance for the millions of people with “garden-variety” obesity, Reitman said.

It’s possible there is an issue with “MSH signaling” in some cases of common obesity, he said.

But he also pointed to the complexity of common obesity: For one, even though there’s a genetic component, many different genes have been linked to obesity risk.

The study was published July 21 in the New England Journal of Medicine.

More information

The U.S. National Institutes of Health has more on proopiomelanocortin deficiency.

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Opioids by Injection May Drive HIV Outbreaks

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, July 20, 2016 (HealthDay News) — The U.S. prescription drug abuse epidemic has increased the risk of HIV outbreaks in rural and suburban communities, where up to now the virus has posed little threat, warns a new case study.

Needle-sharing among prescription drug addicts created an outbreak in rural Scott County, Ind. Public health officials report HIV infected 181 people there between November 2014 and November 2015.

“It was the largest outbreak that has occurred in the U.S. since the introduction of HIV treatment,” said lead author Dr. Philip Peters, a medical officer with the Division of HIV/AIDS Prevention at the U.S. Centers for Disease Control and Prevention. “And it occurred in a poor and rural community. We have not seen HIV outbreaks in these types of communities before.”

Many of the infected people had crushed and cooked down the extended-release form of the opioid pain pill oxymorphone (Opana ER). The result was an injectable slurry, which increased potency and dodged drug-making technologies intended to prevent abuse, Peters said.

But the dose created by this process proved too powerful.

“The amount of opiates in one crushed pill that has been cooked into a drug slurry is more than one person could shoot,” Peters said. “It naturally led to sharing the same drug slurry among multiple people.”

More frequent needle-sharing was related to a higher risk of infection with HIV, the AIDS-causing virus, the study authors said.

“This particular community is rural and also very poor, and there wasn’t really any access to clean syringes,” Peters continued. “If persons started to inject drugs, they didn’t have many options other than to share syringes. That is probably a factor that caused such rapid transmission of HIV.”

The case report appears in the July 21 issue of the New England Journal of Medicine.

Moving on to an injectable slurry is a “natural progression of use” for people who are hooked on opiates, said Emily Feinstein, director of health law and policy with the U.S. National Center on Addiction and Substance Abuse.

“Injection happens usually after a person has been using long enough and their tolerance goes up,” Feinstein said. “They need to switch their method of administering the drug in order to get a higher dose and get a bigger high.”

A 2015 CDC study on syringe service programs found that rural drug users are more likely to cook prescription opioids and inject them than city dwellers. About 25 percent of rural drug users injected prescription painkillers, as opposed to 13 percent of suburban users and 15 percent of urban users.

Areas like rural Scott County often have little in the way of public health services, including addiction treatment and HIV prevention programs, said Lindsey Vuolo, associate director of health law and policy for the U.S. National Center on Addiction and Substance Abuse.

This leaves rural communities particularly vulnerable to an HIV outbreak caused by prescription drug abuse, she said.

“There’s little there to treat the addiction, and then to prevent the other health care issues that can come along with addiction, HIV being one of them,” Vuolo said.

As a result of the HIV outbreak, Indiana Gov. Mike Pence — now the Republican vice presidential candidate — declared a public health emergency on March 26, 2015, the case study noted.

Indiana established its first syringe service program, providing clean needles, testing for diseases like HIV and hepatitis C, and rapidly expanded access to substance abuse treatment services, the study authors said.

It helped that in January 2015 — near the height of the outbreak — Indiana joined the growing ranks of states that chose to expand their Medicaid programs under the federal Affordable Care Act.

That move greatly increased addicts’ access to health insurance and played a critical role in curbing the HIV outbreak, Vuolo said.

“Such a quick response may not have been possible in states that have not expanded Medicaid,” she said.

Rural and suburban public health officials need to be prepared for future outbreaks, particularly those facing a wave of prescription drug abuse in their area, Peters said.

“This outbreak was large and it was unexpected and it happened in one particular rural community, but there are many communities at risk for a similar type problem,” he said. “We need to be proactive to make sure that doesn’t happen.”

More information

For more on prescription drug abuse, visit the U.S. National Institute on Drug Abuse.

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Meningitis B Vaccine Falls Short of Expectations

By Karen Pallarito
HealthDay Reporter

WEDNESDAY, July 20, 2016 (HealthDay News) — About one-third of Princeton University students given a vaccine to combat a meningitis B outbreak on campus in 2013 didn’t show signs of protection from the immunization, researchers reported.

However, none of the vaccinated students developed a meningitis infection, the study found.

It was the first-ever use of the meningococcal group B vaccine Bexsero (4CMenB) in the United States. Two-thirds of those who got the vaccine did develop evidence of an immune response against the specific strain that caused the outbreak, the study authors said.

But researchers had expected a better response since the outbreak strain was very similar to the strains used to produce the vaccine.

“No vaccine’s 100 percent,” said Dr. Dan Granoff, of UCSF Benioff Children’s Hospital Oakland, who wasn’t involved in the study.

But in this case, blood samples revealed that 34 percent of the students who received the two doses had no evidence of antibodies to the disease, he observed.

“You would expect something like 10 or 15 percent, so it was about double,” said Granoff. He’s the chair and director of the Center for Immunology and Vaccine Development at the hospital’s research institute.

According to the study’s lead author, Nicole Basta, the results indicate “that we need to go further to understand how broadly protective this vaccine might be against the diversity of strains that can cause meningococcal disease, and especially meningococcal outbreaks.” Basta is an assistant professor at the University of Minnesota School of Public Health in Minneapolis.

The meningitis B (MenB) outbreak at Princeton, in New Jersey, occurred between March 2013 and March 2014, the researchers said. There were nine cases of disease, including one death.

Bacterial meningitis is a rare but potentially deadly infection of the membranes surrounding the brain and spinal cord, according to the U.S. National Institutes of Health (NIH). Symptoms include sudden onset of fever, headache and neck stiffness. The disease is spread via respiratory and throat secretions.

College students are among those at greater risk of infection because they live in close contact in dorms and engage in potentially risky behaviors, such as sharing drinks and cigarettes. People diagnosed with bacterial meningitis require immediate treatment with antibiotics, the NIH advises.

Rates of meningococcal disease in the United States have been declining since the late 1990s, the U.S. Centers for Disease Control and Prevention says. An estimated 550 cases were reported in 2013.

Dr. Nancy Bennett is chair of the Advisory Committee on Immunization Practices, a group that makes recommendations on vaccine use in the United States. She said, “We’re at a historical low point in the incidence of meningococcal disease, so it’s very hard to do certain kinds of studies that we would otherwise do.” Bennett is also a professor of medicine at the University of Rochester in New York.

Until recently, the only licensed meningitis vaccines in the United States protected against four groups of meningococcal disease, known as A, C, W, and Y. These are much more common in the United States than group B disease, Bennett said.

However, from 2009 through 2015, seven outbreaks of group B disease occurred at U.S. universities, raising concern about the impact of this rare strain in the United States, the researchers said.

The first MenB vaccine was approved by the U.S. Food and Drug Administration (FDA) in late 2014. It’s a three-dose vaccine called Trumenba.

The FDA granted special approval for the use of another group B vaccine, Bexsero, during the 2013 to 2014 Princeton outbreak, the researchers said. That provided a unique opportunity to evaluate the effect of the MenB vaccine on individual immunity.

Researchers at Princeton University, the University of Minnesota and Public Health England tested blood samples collected from students eight weeks after the second dose of vaccine, Basta said.

Almost 500 students received the recommended two doses of vaccine. The first was given in December 2013 and the second in February 2014.

Researchers used certain cut-offs to determine which vaccinated students had immunity against MenB. The problem is that “we don’t know at what point it actually means someone would be protected,” Bennett said.

The Advisory Committee on Immunization Practices doesn’t recommend that all adolescents receive the MenB vaccine. This study probably won’t change that recommendation, she said.

More information is needed, including data on the strength and duration of protection that the vaccine provides, Bennett explained. For now, it’s up to young adults, parents and their doctors to decide whether to get that additional vaccine, she added.

Writing in an accompanying journal editorial, Dr. Jerome Kim, of the International Vaccine Institute in Seoul, South Korea, concluded that “vaccination of all adolescents would prevent 15 to 29 cases and five to nine deaths annually in the United States.”

The study is published in the July 21 issue of the New England Journal of Medicine. Funding came from Princeton University and the NIH.

More information

Learn more about meningitis by visiting the U.S. Centers for Disease Control and Prevention.

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