News
Med tech accused of knowingly spreading hepatitis C is in custody. As this issue of Medical Laboratory Observer goes to press, David Kwiatkowski continues to be held on federal drug and other charges. Allegedly, Kwiatkowski intentionally caused a hepatitis C outbreak in New Hampshire by stealing anesthetics from the cardiac catheterization lab at Exeter Hospital and contaminating syringes that were used on patients with his own blood. The same strain of hep C with which Kwiatkowski is infected has been diagnosed in 30 Exeter patients. In the meantime, officials in 12 hospitals in seven other states where he has worked—Arizona, Georgia, Kansas, Maryland, Michigan, New York, and Pennsylvania—are investigating whether he committed similar alleged crimes there. New Hampshire U.S. Attorney John Kacavas zeroed in on the unique nature of this story: “Because of his employment as a traveler, working for agencies and being sent around the country to various states, it really has tentacles all over the country. Its scope is unprecedented and scary.”
In the meantime, reports have surfaced that Kwiatkowski was fired by hospitals in Pennsylvania and Arizona. He was relieved of his duties at UPMC Presbyterian in Pittsburgh in 2008 for being in an area that he was not authorized to enter. He was fired from Maryvale Hospital in Arizona in 2011 after testing positive for cocaine and marijuana. Kwiatkowski has denied using or stealing drugs. He acknowledges he has hepatitis C, but says he discovered his status only last May; authorities say they have evidence he was diagnosed nearly two years earlier.
Hospitals in all the states where Kwiatkowsi worked are contacting patients who may have been infected by him or evaluating whether a need to do so exists. Some 4,700 people in New Hampshire have been contacted. Former patients have been contacted by St. Francis Hospital in Poughkeepsie, New York; Hays Medical Center in Hays, Kansas; four hospitals in Maryland, including The John Hopkins Hospital and a VA hospital in Baltimore; and Maryvale Hospital and the Arizona Heart Hospital.
Kwiatkowski is entitled to the presumption of innocence, of course. He will have his day in court. He currently faces charges of tampering with a consumer product and fraudulently obtaining a controlled drug. If convicted of those charges alone, he could be sentenced to as many as 24 years in prison. You will read more about this dreadful story.
Influenza
Influenza A outbreak linked by CDC to county fairs. County fairs are a pleasant late-summer ritual for many people across the nation—but a pall has been cast on them this summer by reports of a new strain of influenza A that has been linked by the Centers for Disease Control and Prevention (CDC) to pigs in fairs in three states. Early last month, the agency reported that a dozen cases of the new strain, most of them among children, had been tied to fairs—ten to the Butler County Fair in southwestern Ohio, and one each in Hawaii and Indiana. The new strain, influenza variant type H3N2v, has been found in pigs in 11 states. The twelve cases are in addition to 17 others that have been reported over the last year. Flu symptoms have thus far been mild, but the CDC warned of the possible quick spread of infection. Attendees at fairs nationwide are being warned to avoid contact with animals that seem to be ill, to refrain from taking food or drink with them into livestock areas, and to wash their hands after contact with any farm animals. Says Joseph Bresee, MD, of the CDC’s Influenza Division, “Since the fall of 2011 there has been a big increase in these types of infections. All 29 cases have had H3N2v with the M gene of pandemic H1N1. This may confer increased transmissibility in and among humans.” Bresee continues: “We expect further cases of human infection, either from contact with swine or from limited human-to-human spread. We expect some of the cases will be severe.”
HIV/AIDS
CDC effort expands HIV testing into pharmacies. A pilot project to train pharmacists and retail clinic staff at 24 rural and urban sites to deliver confidential rapid HIV testing has been announced by the CDC. The goal of the initiative is to extend HIV testing and counseling into the standard everyday services offered by pharmacies and retail clinics. The CDC will use the results of the pilot effort to develop a model for implementation of HIV testing in these settings across the United States. The project is part of CDC’s efforts to support its 2006 testing recommendations, which call for all adults and adolescents to be tested for HIV at least once in their lives.
Throughout the two-year initiative, CDC will provide training for staff in community pharmacies and clinics in 12 urban areas and 12 rural areas with high HIV prevalence or significant unmet HIV testing needs. Training will focus on how to deliver rapid HIV testing and counseling and link those who are diagnosed with the virus with care and treatment. Based on lessons learned, CDC will develop a comprehensive toolkit that pharmacists and retail clinic staff from around the country can use for the implementation of testing.
CDC spokespersons suggest that community pharmacies and clinics, with their convenience and accessibility, could play a critical role to ensure that more Americans have access to an HIV test. Millions of Americans enter pharmacies every week, and an estimated 30% of the population lives within a 10-minute drive of a retail clinic. Compared to healthcare settings and conventional HIV testing sites, these locations may provide an environment that is more comfortable for persons who may be anxious about seeking an HIV test.
“We know that getting people tested, diagnosed, and linked to care are critical steps in reducing new HIV infections,” says Kevin Fenton, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “By bringing HIV testing into pharmacies, we believe we can reach more people by making testing more accessible and also reduce the stigma associated with HIV.”
Cancer
Researchers discover new mechanism behind resistance to cancer treatment. In research that could lead to the development of better cancer therapies, a team of scientists led by the Fred Hutchinson Cancer Research Center has discovered a key factor that drives the often lethal development of resistance to chemotherapy in patients with metastasized cancer. The key finding, in a study published in Nature Medicine, is that a type of normal, noncancerous cell, the fibroblast, sustains DNA damage that drives the production of a broad spectrum of growth factors that stimulate cancer growth. Under normal circumstances, fibroblasts help maintain the structural integrity of connective tissue, and they play a critical role in wound healing and collagen production.
Specifically, the researchers found that DNA-damaging cancer treatment coaxes fibroblasts to crank out a protein called WNT16B within the tumor neighborhood, or microenvironment, and that high levels of this protein enable cancer cells to grow, invade surrounding tissue, and resist chemotherapy. The researchers observed up to 30-fold increases in WNT production. The WNT family of genes and proteins plays an important role in normal development and also in the development of some cancers but, until now, was not known to play a significant role in treatment resistance. This discovery suggests that finding a way to block this treatment response in the tumor microenvironment may improve the effectiveness of therapy.
The team of researchers, which also included investigators at the University of Washington, Oregon Health and Science University, the Buck Institute for Research on Aging, the Lawrence Berkeley National Laboratory, examined cancer cells from prostate, breast, and ovarian cancer patients who had been treated with chemotherapy.
Vitamin D
Study questions the value of calcium and vitamin D supplements in prostate cancer treatment. New research from epidemiologists at Wake Forest Baptist Medical Center indicates that prescribing calcium and vitamin D supplements for men at risk of bone loss from hormonal treatment for prostate cancer does not prevent bone loss and, in fact, may increase the risk of cardiovascular disease and aggressive prostate cancer. The study was published online in the July issue of the journal The Oncologist.
Androgen deprivation therapy (ADT) is the mainstay treatment for men with advanced prostate cancer. It reduces serum levels of androgens on which most prostate cancers depend. Bone density loss is a side effect. Consequently, many clinicians recommend calcium and vitamin D supplements to help reduce fracture risk in these men. One in 10 men experiences a fracture within two years of therapy.
In the study, researchers reviewed guidelines for calcium and/or vitamin D supplementation, the results of 12 clinical trials of supplemental calcium and/or vitamin D in men with prostate cancer undergoing ADT, and the measurements of bone mineral density before and after ADT.
“We used these data to determine whether calcium and vitamin D supplements prevented bone loss in these men,” reports Mridul Datta, RD, PhD, co-author of the study. “The answer clearly is no.” The study showed that at commonly recommended doses, men undergoing ADT lost bone mineral density. The authors say further research is needed to verify these findings by comparing a calcium and vitamin D supplement-treated group vs. a non-supplemented group and looking both at potential benefits—in bone mineral density and in the risk of fracture—and at possible risks, including unwanted cardiovascular effects and the effects on the cancer itself.
Hematology
ASH launches multimillion-dollar grant program to support blood disease research. The American Society of Hematology (ASH), the world’s largest professional organization dedicated to the causes and treatment of blood disorders, has announced a commitment of $9 million over a three-year period to provide funding, in the form of bridge grants, for hematologists whose vital research would otherwise not be accomplished due to the severe funding reductions for biomedical research. ASH’s new grant program was designed to help bridge a gap created by nearly a decade of flat funding for the National Institutes of Health (NIH) followed by further projected cuts.
NIH’s inflation-adjusted funding is close to 20 percent lower today than in FY2003. Accordingly, NIH’s ability to sustain current research capacity and encourage promising new areas of science is and will be significantly limited. Under some funding scenarios, as many as 2,300 NIH grants could be eliminated beginning next year. This is having a devastating impact on scientists committed to careers in hematology research and may result in many investigators abandoning research careers. It may also slow momentum for finding new treatments or cures for some of the most deadly diseases.
The bridge grant program will provide 30 one-year awards annually, in the amount of $100,000 each, to support researchers in basic, clinical, or translational hematology who applied for an NIH R01 grant but were denied funding due to budget cutbacks. There will be two award cycles per year; the first application deadline will be January 4, 2013, and applicants will be notified of acceptance on or around March 31, 2013.
Learn more about ASH’s bridge grant program at www.hematology.org/bridgegrants.
Volunteerism
Health Volunteers Overseas calls for technicians to train counterparts in Cambodia. Health Volunteers Overseas (HVO), the private, nonprofit organization that works to improve global health through education of local healthcare providers in underserved and economically challenged nations, has had a request for volunteers to train laboratory technicians in Kampot, Cambodia. A few lab technicians are needed to volunteer in the near future to train young lab technicians in a recently built hospital in Kampot. Assignments are short term, averaging two to four weeks. HVO will likely need volunteers during the rest of this year and early in 2013. Anyone interested in learning more about these opportunities may contact HVO’s volunteer coordinator Danielle Stonehirsch at [email protected], or call 202-296-0928.
