Heidi Splete

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement issued by the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians prepare to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling.

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation).

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement. To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said.

The codes were created in a joint effort by the AMA CPT editorial panel and the U.S. Department of Health and Human Services.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement issued by the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians prepare to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling.

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation).

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement. To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said.

The codes were created in a joint effort by the AMA CPT editorial panel and the U.S. Department of Health and Human Services.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement issued by the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians prepare to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling.

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation).

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement. To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said.

The codes were created in a joint effort by the AMA CPT editorial panel and the U.S. Department of Health and Human Services.

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC said.

The CDC recommends influenza diagnostic testing for:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients. Those with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the 2009 H1N1 virus, according to the CDC statement.

If specific diagnosis of the 2009 H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for 2009 H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete recommendations online at the CDC Web site, www.cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC said.

The CDC recommends influenza diagnostic testing for:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients. Those with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the 2009 H1N1 virus, according to the CDC statement.

If specific diagnosis of the 2009 H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for 2009 H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete recommendations online at the CDC Web site, www.cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC said.

The CDC recommends influenza diagnostic testing for:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients. Those with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the 2009 H1N1 virus, according to the CDC statement.

If specific diagnosis of the 2009 H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for 2009 H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete recommendations online at the CDC Web site, www.cdc.gov

Current information about the ordering and distribution of the pandemic influenza A(H1N1) vaccine is available on the Centers for Disease Control and Prevention's Web site, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said in a teleconference.

Every Friday, data on how many doses of vaccine were available for ordering and how many were shipped to states or large cities will be made available on the CDC Web site, she noted.

Although the CDC recommends against the overuse of antivirals, individuals who have severe illness or who are at high risk for complications, such as pregnant women, “can greatly benefit from antiviral medications,” Dr. Schuchat said. As of Oct. 1, the CDC had confirmed reports of 28 pregnant women in the United States who have died as a result of H1N1 influenza, Dr. Schuchat said. She also noted that Health and Human Services Secretary Kathleen Sebelius had authorized distribution to the states of several thousand courses of liquid Tamiflu for children.

Dr. Schuchat added that the CDC was in the process of updating its guidance on the use of personal protective equipment for health care workers to protect against influenza.

Data from a study of 221 health care workers published recently online (JAMA 2009 Oct. 1; doi:10.1001/jama. 2009.1466]) showed that standard surgical masks appeared to be no worse than N95 respirators in preventing the spread of influenza in routine health care settings.

Current information about the ordering and distribution of the pandemic influenza A(H1N1) vaccine is available on the Centers for Disease Control and Prevention's Web site, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said in a teleconference.

Every Friday, data on how many doses of vaccine were available for ordering and how many were shipped to states or large cities will be made available on the CDC Web site, she noted.

Although the CDC recommends against the overuse of antivirals, individuals who have severe illness or who are at high risk for complications, such as pregnant women, “can greatly benefit from antiviral medications,” Dr. Schuchat said. As of Oct. 1, the CDC had confirmed reports of 28 pregnant women in the United States who have died as a result of H1N1 influenza, Dr. Schuchat said. She also noted that Health and Human Services Secretary Kathleen Sebelius had authorized distribution to the states of several thousand courses of liquid Tamiflu for children.

Dr. Schuchat added that the CDC was in the process of updating its guidance on the use of personal protective equipment for health care workers to protect against influenza.

Data from a study of 221 health care workers published recently online (JAMA 2009 Oct. 1; doi:10.1001/jama. 2009.1466]) showed that standard surgical masks appeared to be no worse than N95 respirators in preventing the spread of influenza in routine health care settings.

Current information about the ordering and distribution of the pandemic influenza A(H1N1) vaccine is available on the Centers for Disease Control and Prevention's Web site, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said in a teleconference.

Every Friday, data on how many doses of vaccine were available for ordering and how many were shipped to states or large cities will be made available on the CDC Web site, she noted.

Although the CDC recommends against the overuse of antivirals, individuals who have severe illness or who are at high risk for complications, such as pregnant women, “can greatly benefit from antiviral medications,” Dr. Schuchat said. As of Oct. 1, the CDC had confirmed reports of 28 pregnant women in the United States who have died as a result of H1N1 influenza, Dr. Schuchat said. She also noted that Health and Human Services Secretary Kathleen Sebelius had authorized distribution to the states of several thousand courses of liquid Tamiflu for children.

Dr. Schuchat added that the CDC was in the process of updating its guidance on the use of personal protective equipment for health care workers to protect against influenza.

Data from a study of 221 health care workers published recently online (JAMA 2009 Oct. 1; doi:10.1001/jama. 2009.1466]) showed that standard surgical masks appeared to be no worse than N95 respirators in preventing the spread of influenza in routine health care settings.

The Centers for Disease Control and Prevention is pilot-testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers to participate in the pilot testing, but standard text messaging rates may apply based on individuals' different wireless service contracts.

Upon initial registration, users will receive several introductory messages and questions, according to the Web site. The program then sends three health tips per week.

The Centers for Disease Control and Prevention is pilot-testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers to participate in the pilot testing, but standard text messaging rates may apply based on individuals' different wireless service contracts.

Upon initial registration, users will receive several introductory messages and questions, according to the Web site. The program then sends three health tips per week.

The Centers for Disease Control and Prevention is pilot-testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers to participate in the pilot testing, but standard text messaging rates may apply based on individuals' different wireless service contracts.

Upon initial registration, users will receive several introductory messages and questions, according to the Web site. The program then sends three health tips per week.

The United States is better prepared now to handle a pandemic than in recent years, but challenges remain in the areas of surge capacity, vaccine distribution, and general emergency preparedness, according to a report by the Trust for America's Health.

“This report focuses on the challenges a pandemic poses for our health care system,” Jeffrey Levi, Ph.D., executive director of the Trust for America's Health, said in a telebriefing.

The report's authors based their estimates on two predictions from the scientific community: The pandemic influenza A(H1N1) virus is relatively mild, and up to 35% of Americans could potentially become ill during flu season.

If that percentage were to become ill, hospitals in 15 states could potentially run out of beds, according to the report. States and localities also would have to manage a likely influx of people in doctors' offices and ambulatory care settings, Dr. Levi noted.

Challenges related to vaccination include issues of distribution, reimbursement, and getting the message out to populations that don't often get vaccinated, such as young adults and minority populations, Dr. Levi said.

“State and local governments are struggling to create distribution systems,” especially for priority groups for H1N1 vaccination. The administrative costs of the H1N1 vaccine also could become a burden for state and local health departments, he noted.

Inconsistent resources remain a problem, Dr. Levi added, because emergency departments and public health departments have lost personnel and funding in recent years.

Local health department staffing levels this fall are lower than they were in spring 2009, according to the National Association of County and City Health Officials (NACCHO). That reduction comes just as the demands on these systems are likely to increase with the spread of the pandemic virus. State and local health departments need “renewed and sustained and constant funding to give us the core capacity that people expect,” said NACCHO Executive Director Robert M. Pestronk, during the telebriefing.

The take-home message for clinicians is to stay on top of the H1N1 situation as it evolves, and communicate with their local health departments, Dr. Levi said. H1N1 “is going to pose a challenge for the entire health care system,” he said. “Clinicians are going to be on the front lines to educate patients” about the importance of vaccination and about protective measures such as hand hygiene and covering coughs. “Local physicians should be working closely with their local health departments,” added Mr. Pestronk. Clinicians might also consider stepping outside their practices to help administer vaccinations or volunteering staff members to assist with these efforts, he said.

To view the complete report, including state-specific data on hospital capacity, visit healthyamericans.org

The United States is better prepared now to handle a pandemic than in recent years, but challenges remain in the areas of surge capacity, vaccine distribution, and general emergency preparedness, according to a report by the Trust for America's Health.

“This report focuses on the challenges a pandemic poses for our health care system,” Jeffrey Levi, Ph.D., executive director of the Trust for America's Health, said in a telebriefing.

The report's authors based their estimates on two predictions from the scientific community: The pandemic influenza A(H1N1) virus is relatively mild, and up to 35% of Americans could potentially become ill during flu season.

If that percentage were to become ill, hospitals in 15 states could potentially run out of beds, according to the report. States and localities also would have to manage a likely influx of people in doctors' offices and ambulatory care settings, Dr. Levi noted.

Challenges related to vaccination include issues of distribution, reimbursement, and getting the message out to populations that don't often get vaccinated, such as young adults and minority populations, Dr. Levi said.

“State and local governments are struggling to create distribution systems,” especially for priority groups for H1N1 vaccination. The administrative costs of the H1N1 vaccine also could become a burden for state and local health departments, he noted.

Inconsistent resources remain a problem, Dr. Levi added, because emergency departments and public health departments have lost personnel and funding in recent years.

Local health department staffing levels this fall are lower than they were in spring 2009, according to the National Association of County and City Health Officials (NACCHO). That reduction comes just as the demands on these systems are likely to increase with the spread of the pandemic virus. State and local health departments need “renewed and sustained and constant funding to give us the core capacity that people expect,” said NACCHO Executive Director Robert M. Pestronk, during the telebriefing.

The take-home message for clinicians is to stay on top of the H1N1 situation as it evolves, and communicate with their local health departments, Dr. Levi said. H1N1 “is going to pose a challenge for the entire health care system,” he said. “Clinicians are going to be on the front lines to educate patients” about the importance of vaccination and about protective measures such as hand hygiene and covering coughs. “Local physicians should be working closely with their local health departments,” added Mr. Pestronk. Clinicians might also consider stepping outside their practices to help administer vaccinations or volunteering staff members to assist with these efforts, he said.

To view the complete report, including state-specific data on hospital capacity, visit healthyamericans.org

The United States is better prepared now to handle a pandemic than in recent years, but challenges remain in the areas of surge capacity, vaccine distribution, and general emergency preparedness, according to a report by the Trust for America's Health.

“This report focuses on the challenges a pandemic poses for our health care system,” Jeffrey Levi, Ph.D., executive director of the Trust for America's Health, said in a telebriefing.

The report's authors based their estimates on two predictions from the scientific community: The pandemic influenza A(H1N1) virus is relatively mild, and up to 35% of Americans could potentially become ill during flu season.

If that percentage were to become ill, hospitals in 15 states could potentially run out of beds, according to the report. States and localities also would have to manage a likely influx of people in doctors' offices and ambulatory care settings, Dr. Levi noted.

Challenges related to vaccination include issues of distribution, reimbursement, and getting the message out to populations that don't often get vaccinated, such as young adults and minority populations, Dr. Levi said.

“State and local governments are struggling to create distribution systems,” especially for priority groups for H1N1 vaccination. The administrative costs of the H1N1 vaccine also could become a burden for state and local health departments, he noted.

Inconsistent resources remain a problem, Dr. Levi added, because emergency departments and public health departments have lost personnel and funding in recent years.

Local health department staffing levels this fall are lower than they were in spring 2009, according to the National Association of County and City Health Officials (NACCHO). That reduction comes just as the demands on these systems are likely to increase with the spread of the pandemic virus. State and local health departments need “renewed and sustained and constant funding to give us the core capacity that people expect,” said NACCHO Executive Director Robert M. Pestronk, during the telebriefing.

The take-home message for clinicians is to stay on top of the H1N1 situation as it evolves, and communicate with their local health departments, Dr. Levi said. H1N1 “is going to pose a challenge for the entire health care system,” he said. “Clinicians are going to be on the front lines to educate patients” about the importance of vaccination and about protective measures such as hand hygiene and covering coughs. “Local physicians should be working closely with their local health departments,” added Mr. Pestronk. Clinicians might also consider stepping outside their practices to help administer vaccinations or volunteering staff members to assist with these efforts, he said.

To view the complete report, including state-specific data on hospital capacity, visit healthyamericans.org