A cluster of mysterious respiratory illnesses that alarmed southeast Alabama turned out to be nothing more sinister than ordinary cold and seasonal flu, health officials said Thursday.

Lab tests by state and federal officials ruled out avian influenza and a novel coronavirus, now known as MERS, that has killed 22 people in the Middle East.

“There is no evidence of any new or unexpected virus circulating,” said Dr. Don Williamson, the Alabama state health officer, who said he wanted to put "closure to this cluster."

Seven people fell ill and two died earier this month in southeast Alabama after coming down with symptoms that included shortness of fever, shortness of breath and cough. All of the patients were adults ages 32 to 87. The people who died were 34 and 55, Williamson said.

Of the seven patients whose specimens were tested, six were found positive for influenza A or rhinovirus or a combination of the two and three patients were found to have bacterial pneumonia. 

“There wasn’t anything unusual or strange,” Williamson noted. He added that flu often continues to circulate in the spring and summer in his state.

Increased worries over the spread of two bird deadly flu viruses -- H5N3 and H7N9 -- and the identification of the new coronavirus likely contributed to the concerns about this cluster, he added.

“Because everybody is really worried about the possibility of either this novel coronavirus or the H7N9 flu from China, there was heightened awareness,” he said.”

He praised doctors and clinicians who raised questions about unusual respiratory illnesses because next time, it might be a new and deadly germ.

“If people aren’t attentive, we’re going to miss it,” Williamson said.

Related: 

• Mysterious respiratory illness strikes 7 in Ala.; 2 dead

When a devastating tornado touched down in Moore, Okla., on Monday afternoon, Shayla Taylor was on the upper floor of the local hospital, in active labor with her second child.

As the floor shook “like an earthquake” beneath her and ceiling tiles and insulation fell overhead, the 25-year-old huddled with four nurses, braving both the peak contractions of childbirth and the wrath of the worst twister the veteran Oklahoman had ever endured.

“We were all just sitting there holding each other’s hands and praying,” Taylor told NBC News.

Norman Regional Health System

Jerome Taylor, left, Shayla Taylor, center, and Shaiden Taylor, right, welcomed baby Braeden Immanuel at the height of Monday's killer tornado in Moore, Okla.

Moore Medical Center, a 46-bed acute care hospital at 700 S. Telephone Road, took a direct hit from the F-5 tornado, with wind speeds that topped 200 miles per hour.

The blow devastated the hospital, as news photos plainly show, ripping away the roof and walls.

After the chaos, Taylor said she heard not the freight train sound described by so many witnesses, but the absolute silence of the storm’s center. Then she opened her eyes.

“All of a sudden I could see daylight and the wall was gone,” she said. “I look out and I see I-35 and part of the Warren theater,” which later became the triage center for victims of the tornado that killed 24 and injured more than 230 people.

Rick Wilking / Reuters

An aerial view of damage at the Moore Medical Center is shown in Moore, Okla., on May 21, after a tornado ravaged the suburb of Oklahoma City.

She had been dilated to 9 centimeters, nearly ready to deliver the baby, when nurses gave her a quick shot to slow labor during the height of the storm. 

Taylor was quickly reunited with her husband, Jerome Taylor, 29, who had taken their 4-year-old son, Shaiden, to wait out the tornado with others in the hospital cafeteria. With the help of hospital workers, she was carefully carried through the destroyed building and out to a waiting ambulance, which whisked her 5 miles to another hospital in the Norman Regional Health System.

Three hours later, after doctors determined that the petite Taylor would need a cesarean section due to the baby's size, she delivered Braeden Immanuel, a healthy 8-pound, 3-ounce boy.

“His middle name means ‘God is with us,’” said Taylor. “The name had been picked out for months. Now I know why.”

Taylor is among 30 patients and staffers at Moore Medical Center who survived the tornado, which destroyed the hospital, said Kelly Wells, a health system spokeswoman. No decision has been made yet about whether to rebuild or simply raze the site.

Two days after the storm, Taylor and her family are recovering from the trauma of the chaotic birth. The family can’t locate their car, a Toyota Camry, which had been parked in the hospital lot and is now nowhere to be found.

Sossy Dombourian / NBC News

Newborn Braeden Immanuel Taylor is fine after his harrowing birth, his mother says.

“I don’t know if it ended up inside the hospital or down the street,” she said.

Their home is safe, however, and Jerome Taylor, who works for The Hartford insurance company, has been overwhelmed trying to help his neighbors cope.

Oklahomans are used to tornado warnings and Taylor said she wasn’t particularly alarmed before Monday’s storm.

“I’m used to sirens,” she said. “If you panicked, you’d be in a constant panic.”

Now, however, she’s thinking twice about living in Tornado Alley.

“The tornadoes always track through here,” she said. “It’s not to say everybody’s going to pack and leave tomorrow, but they start to reconsider things.”

Related: 

• Post-tornado peril: Victims could face deadly fungal infections
• Tornado victims identified

CDC

The Mucor fungus was responsible for infections that sickened 13 patients, including five who died, after a 2011 tornado in Joplin, Mo. Health officials are urging Oklahoma doctors to be on the alert for similar infections after Monday's twister.

Doctors treating victims hurt badly in Monday’s devastating Moore, Okla., tornado should be alert for a rare but deadly complication of wind-whipped debris: fungal infections like those that killed five people after the Joplin, Mo., twister in 2011.

That’s the word from government experts in fungal infections, who documented 13 serious cases of necrotizing cutaneous mucormycosis -- terrible soft tissue infections -- after the Joplin tornado, including instances when visible mold started growing from the patients’ wounds.

“We want to encourage clinicians to be aware that these infections can happen,” said Dr. Benjamin Park, chief epidemiologist with the mycotic diseases branch at the Centers for Disease Control and Prevention.

It's not yet clear whether any fungal infections are suspected in the victims of this week's disaster. In Joplin, it took five days for the first infections to show up; within 10 days, 10 patients had been identified. 

"In the chaos of everything, it's very hard," said Dr. Gary Wells, medical director for the Norman Regional Health System emergency department, who was at the initial triage site during Monday's storm. "It is something you keep in the back of your mind."

Early detection and diagnosis are key to treating the infections, which occur when molds usually found in dirt, decaying wood and other matter become airborne during a heavy storm.  

“When they are picked up out of their natural environment and injected into the skin, we’re always concerned about infection,” Park said.

The molds can contaminate the wounds that occur after the blunt trauma, fractures and penetrating injuries common in tornadoes. The resulting infections can lead to serious illness and death. “The case fatality rate can be very high -- 50 percent,” Park noted.

The Joplin tornado struck at 5:34 p.m. on May 22, 2011, a monster of a storm rated EF-5, with winds exceeding 200 miles per hour on the Enhanced Fujita Scale used to measure tornadoes. More than 1,000 people were hurt and 162 died.

The Moore tornado was upgraded to an EF-5 late Tuesday. At least 24 deaths and 237 injuries have been reported. The injuries are typical of tornadoes: crush injuries, impalements and major cuts, according to NBC’s Dr. Nancy Snyderman, who spoke to trauma officials in Oklahoma.

Doctors and other health workers have been swamped caring for the victims, so it’s not clear what steps they’re taking to detect or treat potential fungal infections.

“I’m not sure that they’ve gotten that far yet,” said Pamela Williams, spokeswoman for the Oklahoma Department of Health.

The need for vigilance is clear, according to a 2012 review of the Joplin infections published in the New England Journal of Medicine. Skin-related Mucormycosis infections have been reported after other natural disasters, including a 1985 volcanic eruption in Colombia and after the 2004 Indian Ocean tsunami.

“The risk of complex wounds with foreign-body contamination during natural disasters is high, and wound management can pose considerable clinical challenge in post-disaster settings, especially when the local health care infrastructure has been damaged,” wrote authors from the CDC.

Related: 

• Joplin victims had rare fungus from dirt
• Okla. tornado injuries: Even the doctors are 'crying'
• Latest NBC coverage of the Oklahoma tornado

Two people have died and five others have been hospitalized in a mysterious cluster of respiratory illnesses in southeast Alabama, state health officials said. 

The victims, all adults, had symptoms including fever, cough and shortness of breath, but the cause of the illnesses is unknown, said Dr. Mary McIntyre, the acting state epidemiologist for the Alabama Department of Public Health. The hospital is using respiratory precautions, which include requiring staff to wear special N95 masks that reduce the chance of infection.

State health officials have collected and analyzed samples of specimens from all patients. So far, one sample has tested positive for H1N1 influenza A, but it's not clear that that is behind the unusual illnesses. There's no evidence of other kinds of flu, including the H7N9 strain that has caused illness and death in China, McIntyre said. 

Laboratory samples have been sent to the Centers for Disease Control and Prevention, but testing results are not yet available, officials said. 

There's no evidence that any of the victims had a connection or traveled outside the country, which would have put them at risk for unusual pathogens, including a deadly new coronavirus recently christened MERS or Middle East Respiratory Syndrome.

"At this point it's too early to tell," McIntyre told NBC News. "That's why we called it a respiratory illness of unknown origin."

State and federal health officials will continue to investigate the illnesses. 

Related: 

• New SARS cousin finally has a name: MERS

Fuse / Getty Images

The decision to withdraw life-sustaining care varies widely in intensive care units, ICUs, across the U.S., a new study finds.

If you land in an intensive care unit sick enough for doctors to consider withdrawing life support, be warned. Whether and when to pull the plug may depend in large part on the practices and culture of the ICU itself -- perhaps more than your needs or wishes, a new study finds.

That may be especially true if you’re so ill or incapacitated that you can’t make decisions about your own care, according to research being presented Tuesday at the American Thoracic Society International Conference.

After accounting for patient factors such as age, function, gender and race, the probability of having life support withdrawn ranged from 3.5 percent in some ICUs across the nation to 20.6 percent in others -- a six-fold variance.

“The really important message for patients and their families is, before you end up in an ICU, talk to your loved ones about what you would want,” said Dr. Caroline M. Quill, lead author of the study by researchers at the Perelman School of Medicine at the University of Pennsylvania.

Quill and her team analyzed records of more than 269,000 patients treated in 153 ICUs in the United States between 2001 and 2009. Overall, nearly 12 percent of patients had a decision made to go from a “full code” -- an all-out effort to save lives -- to some kind of limit on care.

That could have included: a DNR or do-not-resuscitate order; an order to withhold CPR or cardio-pulmonary resuscitation plus removing mechanical ventilation; dialysis or other life-saving treatments; or simply an order to provide only comfort measures or hospice care. About 59 percent of the patients died in the ICU and another 41 percent survived to discharge, the study found.

Particular patient characteristics accounted for most of the variability in decisions to withdraw life support, Quill acknowledged. But even after age, illness, functional status and other factors were analyzed, the variation among ICUs to authorize a DFLST -- decision to forgo life-sustaining therapy -- was striking.

“The finding of a six-fold variability among ICUs strongly suggests that the ICU to which a given patient is admitted strongly influences his or her odds of having a DFLST, regardless of personal or clinical characteristics,” the authors write.

The study didn't find particular variance by geography and the decision to withdraw care wasn't related to regional differences in cutting costs, Quill said.

End-of-life experts have known for years that individual doctor and ICU practices can affect the decision to withhold care, said Dr. J. Randall Curtis, director of the Palliative Care Center of Excellence at the University of Washington in Seattle.

In some ICUs, there’s a kind of heroic standard, an atmosphere in which doctors don’t talk about dying and every effort is made to sustain life, he said. In others, there’s an early effort to acknowledge the likelihood of death and to talk about the risks and benefits of care and how it fits into what a patient would want.

“I think there are still parts of our medical culture that say it’s our job to keep people alive no matter what,” he said. “As opposed to talking with patients and families about their values.

In the absence of instructions from the patient or their family members, the ICU’s culture is more likely to sway the decision about whether to prolong care -- or not.

Quill emphasizes that the study didn’t draw any conclusions about the rates of ICU decisions to withdraw support. “We don’t necessarily think that the 3.5 percent rate is too low or the 20.6 percent rate is too high,” she said.

Surprisingly, perhaps, there actually are no hard-and-fast guidelines in the critical care field about when to withdraw life support. That’s mostly because it would be too hard to envision every potential scenario, said Dr. Douglas White, an associate professor of critical care medicine and director of the program on ethics and decision making in critical illness at the University of Pittsburgh.

“These decisions about whether and when to withdraw life support are not scientific decisions,” he said.

In an ideal scenario, a patient would have made his or her wishes about end-of-life care known well in advance. In practice, however, although the number of people who spell out their wishes is growing, only about 10 percent of the general public has completed an advance directive or obtained a durable power of attorney for health care, Curtis noted.

That means that the final decision often is left to family members or other “surrogate” decision makers, and to doctors and clinicians.

“If the patient hasn’t articulated a clear preference, it’s very, very hard for doctors and families to work together to make the decision, “ White said. “(They’re) left to do the best that they can that generally reflects who the patient is as a person.”

It would be far better, experts agree, if more people anticipated the possibility of end-of-life decisions and left clear instructions. Ten years ago, that might have been preferences for -- or rejection of -- specific treatments such as CPR or mechanical ventilation, experts say.

Today, the discussion centers much more on the overall goals of care and the values of the patient. Take the end-of-life instructions drafted by Dr. John Luce, an emeritus professor of anesthesiology and medicine at the University of California, San Francisco.

Luce, who has researched and written about end-of-life care, said he values a “sentient existence” in which he retains the ability to  “think, read, speak, write and communicate with people.”

“Anything that could not restore me to this, I would not want it,” he said.

So that’s how Luce’s advance directive reads, if, heaven forbid, he should need it. The new research that underscores the variability of ICU practices should also emphasize the need for ordinary people to make their wishes known, Luce said.

“The really important thing is to get people talking with those who could become their surrogates,” he said. “The written document is less important than the conversation that leads up to the directive.”

Related: 

• Good news about aging: Get older, feel better, study finds
• Doctor-assisted death: A dad's choice sheds light on a national issue
• Americans in denial about long-term care

John Makely / NBC News

Sisters Cathy Balsamo, left, Patti Broccoli, center, and Cindy Lepore, right, have all tested positive for the BRCA1 genetic mutation that raises the risk of breast and ovarian cancer. All three sisters have had preventive surgery to have their breasts and ovaries removed. Two weeks after her surgery, Broccoli was diagnosed with breast cancer.

Actress Angelina Jolie’s revelation this week that she’d had both breasts removed to lower her elevated risk of cancer came as a bombshell to many -- but not to three sisters from Berkeley Heights, N.J.

The women -- Cathy Balsamo, Cindy Lepore and Patti Broccoli -- have spent most of the past year grappling with the very dilemma that Jolie faced: What to do when a genetic mutation means you’ve got a sky-high chance of breast or ovarian cancer?

“Rich, poor, famous, not famous -- it’s the same decision,” said Balsamo, 46, who was the first to learn last spring that she had a mutation of the BRCA1 gene, which boosts the risk of both kinds of cancer.

“It doesn’t make it easier or harder.”

The family -- which includes the three sisters and a brother, Joseph Zichichi, 48 -- offers an extreme example of the issues now illuminated by Jolie’s spotlight. 

Like Jolie, all three women opted for preventive double mastectomies. Unlike Jolie, who’s 37, the 40-something sisters also all had concurrent operations to remove their ovaries. Jolie wrote in the New York Times that she plans to have that surgery later.

“The option of waiting and watching was never an option,” said Broccoli, a 49-year-old nurse. “Why would we wait for cancer?”

Though their mother, Patricia Zichichi, had always warned of a family history rife with cancer -- a grandmother and two great-aunts died young of what was then called “women’s cancer” -- the sisters didn’t know about their actual genetic risk until Balsamo asked her doctor to perform the BRCA test in April 2012.

“He was just so upset and said ‘I hate to have to tell you this,’” recalled Balsamo, who is an activity director at a nursing home. “Immediately, when he said BRCA1, breast and ovarian, I said, ‘I’m getting a double mastectomy and a hysterectomy.”

Within weeks, her sisters had the same test -- with the same results. It’s not surprising that all three women would turn up positive for BRCA mutations, said Dr. Larissa Korde, a breast cancer specialist at the Seattle Cancer Care Alliance in Washington. If one parent carries the defective gene, there’s 50 percent chance any child will get it.

“Sometimes you see it in families where everybody’s got it,” Korde said. “It’s just chance.”

A woman with a harmful BRCA1 or BRCA2 mutation has a 60 percent chance of developing breast cancer during her lifetime, about five times higher than the overall rate of 12 percent, cancer experts say. She has a 15 percent to 40 percent lifetime chance of getting ovarian cancer, compared with about 1.4 percent in the general population.

With those odds, the sisters opted for surgery within months of each other. Lepore, 42, a respiratory therapist who has type 1 diabetes, had her initial and reconstruction surgeries last October. Broccoli had her surgery in January and Balsamo followed in February.

Ironically, Broccoli’s preventive surgery actually may have saved her life. Two weeks after her double mastectomy in January, she was diagnosed with breast cancer -- but at such an early stage her chance of cure is very good. A mammogram and two MRIs before surgery had suggested strongly she was cancer-free, but doctors detected ductal disease after Broccoli's operation. 

“I consider it a blessing,” said Broccoli, who lost her hair to three rounds of chemotherapy. “I know what could have happened if it hadn’t been caught early.”

Rates of women opting for preventive mastectomies have risen by as much as 50 percent in recent years, cancer experts estimate. That's despite the small chance of getting cancer anyway, the risk of major surgery and the fact that there are alternatives, including drugs and careful monitoring. 

Still, some women who learn of BRCA mutations are devastated by the information -- and by the dilemma of whether to have surgery, Korde said. “I’ve definitely had women who were through childbearing and who feel emotionally conflicted about losing their breasts.”

But the New Jersey sisters aren’t among them. “For me, it was a no-brainer,” Balsamo said. “The good of it outweighed the bad. So I don’t have terrific boobs. I’ll never have nipples. I didn’t have that emotional thing.”

John Makely / NBC News

The sisters all live within a mile of each other in Berkeley Heights, N.J. They say they've supported each other through the ordeal.

What does make them emotional, the sisters said, is what the genetic legacy might mean for the rest of the family. Joe Zichichi is scheduled to be tested for BRCA mutations soon, too, the women said.

The results could have implications for him in the form of an increased risk of pancreatic, prostate or other cancers, doctors say.

“There’s more to BRCA genes than breast and ovary cancer,” said Dr. Eileen O’Reilly, a gastrointestinal cancer specialist at Memorial Sloan Kettering Cancer Center in New York. “As much as 5 percent of pancreatic cancer risk might be related to BRCA mutations.”

But the family is especially concerned about possible future effects on their children. They all live within a mile of each other; there are 13 grandchildren in the family, including Joe Zichichi’s four daughters.

Two of the granddaughters are in their early 20s. The U.S. Preventive Services Task Force recommends BRCA testing only for women with a strong family history of cancer, about 2 percent of all women in the U.S. But for those with that high risk, testing can be done at age 25.

Whether such young women choose to be tested -- and what action they’ll take afterward -- is something serious to ponder, the sisters said. 

“We have a good four years to figure this out,” said Balsamo. “God willing there will be something in that period of time that helps our daughters deal with it.”

It’s not clear when Jolie learned of her genetic risk or how long it took to decide that surgery was the best option. Her decision has prompted a flood of calls and inquiries to cancer centers nationwide, including Korde’s, and to geneticists, said Dr. Michael Watson, executive director of the American College of Medical Genetics and Genomics.

The New Jersey sisters said they’re grateful for the awareness that Jolie’s decision brings to an issue that has become central to their daily lives.

“I was actually very happy,” said Lepore. “In this world, it takes someone like Angelina Jolie to get recognition of important things.”

What choice would you make if you had a BRCA mutation, dramatically raising your cancer risk? Talk about it on Facebook.

Related stories: 

• More women opting for preventive mastectomy -- but should they be?
• Angelina Jolie: I had a double mastectomy because of high breast cancer risk
• Doctors detail Angelina Jolie's breast cancer surgery

Erik S. Lesser / EPA for NBC News

Dr. Hunter Johnson, a pathology resident at the Emory University School of Medicine, has helped at least four patients with C. difficile infections by giving them a dose of his stool. Fecal transplants have been shown to have a 90 percent success rate of curing the potentially deadly infection.

An Emory University medical resident has taken the notion of donation to a whole new level, agreeing to provide stool samples for multiple patients who need life-saving procedures called fecal transplants.

Dr. Hunter Johnson has aided at least four people in the past year by providing doses of his healthy feces -- yes, poop -- to help cure devastating bowel infections caused by a nasty germ known as C. difficile.

“As you can imagine, it’s not the most glamorous thing,” says Johnson, 30, of Atlanta, who was recruited by his boss, Dr. Colleen Kraft. “It’s hard enough to get people to donate blood, but it’s much harder to get people to donate feces.”

Kraft, an infectious disease specialist and clinical microbiologist at Emory, turned to Johnson and other medical residents last summer, when a gravely ill lung transplant patient came down with a C. diff infection as well.

“Basically, we had been doing it using a family member or friend to donate and this patient didn’t have anyone who could help,” she said. That's where Johnson came in. 

The process worked, allowing the woman to recover from the bowel infection with the help of a stranger’s stool.

Fecal transplants are rapidly becoming a treatment of choice for recurrent C. diff infections, which strike more than 336,000 people each year and are linked to 14,000 deaths, according to the Centers for Disease Control and Treatment. 

In the procedures, stool from a healthy patient is transplanted into the colon of a C. diff sufferer to restore the balance of bacteria. C. diff infections typically occur following heavy antibiotic use, when the drugs kill healthy bacteria in the gut, allowing toxic germs to flourish.

Though they sound distasteful, fecal transplants have been racking up success rates as high as 90 percent or more. Sufferers say they recover swiftly after the transplants, returning to full health within a few days.

“I’m telling you, I can’t say enough good things about this thing,” said Tom Wilson, 76, who received one of Johnson’s stool donations in March.

Wilson, who was treated for a serious bowel condition called diverticulitis in 2006, developed a life-threatening case of C. diff last December and was severely ill for months. He tried a fecal transplant using a sample from a family member, but it wasn’t completely successful.

When he fell ill again, doctors sent the real estate developer from Alpharetta, Ga., to Emory for help. He said the notion of accepting stool from a stranger didn’t faze him at all.

“When you’re as sick as I have been, you’ll do anything to feel better,” said Wilson, who figures he’s nearly fully recovered.

Johnson said he gets a sense of satisfaction from helping -- and from knowing he’s advancing knowledge about a new kind of therapy.

He figures he’s a good donor because he’s young, fairly healthy, and is at low risk for infections. People with kids, for instance, wouldn’t be good choices because children bring home so many germs.

“They don’t want you to be eating anything too crazy, not a lot of travel, no history of gastrointestinal illness,” he said. “We can’t have taken any drugs in the recent past.

“Essentially, the best donor is someone who leads a pretty boring life," he added.

In addition, a good donor has to have predictable bowel habits and be able to perform, as it were, on demand. Johnson typically donates on the morning of a patient’s transplant. “They want it to be relatively fresh,” he said.

He provides the sample and then takes it to the lab, where it’s processed to be given to the patient. At Emory, they use a colonoscope to deliver the donation, though others use enemas or tubes that run through the nose and to the stomach.

Kraft has conducted the transplants on a case-by-case basis with hospital approval. She plans to apply for a investigational new drug application that would essentially define Johnson's stool as a useful medication. Meanwhile, she and others who perform fecal transplants are waiting for the federal Food and Drug Administration to weigh in on regulation of the promising new therapy.

Both Kraft and Johnson say they’re excited by the promise of fecal transplants to cure the misery of C. diff infections. “I became a physician to help people,” Johnson said. “To these patients, it’s a big deal.”

Still, he acknowledges that not everyone finds his altruism so intriguing.

“My wife is kind of tentatively grossed out by it,” he said. “It’s a little weird for her. But she realizes it’s a good thing.”

Related stories: 

• Fecal transplant from mom cures ailing toddler
• Sounds gross, works great: Fecal transplants cure nasty C. diff infections

Wrigley is pulling its new caffeinated energy gum from the market temporarily after Food and Drug Administration officials said they’re investigating the impact of a proliferation of caffeine in food and drink.

Company officials announced they would suspend production, sales and marketing of Alert Energy Caffeine Gum, which contains 40 milligrams of caffeine per piece -- about the same as half a cup of coffee. The move comes a little more than a week after the product’s April 29 launch.

FDA officials said the company agreed to halt production after discussions about the need for a regulatory framework governing the appropriate uses of caffeine in food and beverages.

“The company’s action demonstrates real leadership and commitment to the public health,” Michael Taylor, the FDA’s deputy commissioner for foods and veterinary medicine, said in a statement.

Wrigley officials had marketed the gum to adults and said it shouldn’t be used by children or those sensitive to caffeine.

FDA’s probe follows growing concern over caffeine-containing energy drinks, which have been mentioned in connection with at least 25 deaths and 150 illnesses over several years, according to FDA reports. (The filing of a report doesn’t mean that a death or illness was attributed to the product, however.)

At the same time, other foods ranging from caffeinated water to jelly beans and popcorn have been introduced to a market aimed largely at children and teens.

Health officials, including the American Academy of Pediatrics, recommend that children limit consumption of caffeine, including caffeinated energy drinks.

Related stories: 

• Caffeinated gum raises buzz about health effects
• When caffeine kills: Energy drinks under the spotlight

David Maxwell / EPA

The house where Amanda Berry, Gina DeJesus and Michelle Knight, as well as Berry's 6-year-old daughter, were held.

Of the four captives rescued in this week’s hostage drama in Cleveland, the 6-year-old daughter of Amanda Berry may raise the most perplexing questions of all.

The young girl who followed as Berry, 27, kicked her way out of a house where she’d been held in alleged bondage for a decade will face complicated challenges as the youngster learns to navigate an entirely new universe, say child therapists and specialists in long-term trauma.

“For a child born into this situation, this is the only world that child has known,” said Rona Fields, a Washington, D.C., clinical psychologist and author who works with women who seek asylum from trauma.

Even an abusive world can seem normal, especially to a child who police reports indicate was denied typical experiences such as school, health care and play time with other kids.

“When they’re exposed to fear and threats and exploitation of a parent, that has a significant psychological impact on the child’s development and the child’s sense of safety,” said Terri Weaver, a professor of psychology at St. Louis University who specializes in post-traumatic stress disorder and the mental health effects of family violence and sexual assault.

The three women -- Berry, Gina DeJesus, 23, and Michelle Knight, 32 -- reported being bound in ropes and chains, isolated in locked rooms and forced to endure rapes, pregnancies and miscarriages, police said.  It’s not clear whether Berry’s daughter, born in captivity, was also abused. Berry's sister spoke briefly to a throng of reporters on Wednesday, pleading for time for her family to absorb the week's events.

"I just want to say we are so happy to have Amanda and her daughter home," said Beth Serrano. "At this time our family would request privacy so my sister and niece and I can have time to recover."

But experts say a child as young as 6 has a good chance of overcoming such a traumatic early life, especially with the help of a supportive family and community -- and specific, targeted, intensive therapy.

“These aren’t insurmountable obstacles by any means, but they are things that need to be dealt with and addressed, not in a single point of time, but as the child grows up and kind of encounters the world,” Weaver said.

Slideshow: Missing women found alive in Cleveland

Emmanuel Dunand / AFP - Getty Images

A daring escape and a dramatic 911 call led to the rescue of three women who allegedly had been held captive for years inside a home in Cleveland, Ohio.

Launch slideshow

Cases in which children are born to long-term hostages are very rare, of course, Weaver noted. Jaycee Dugard, the California woman who was kidnapped at age 11 in 1991, was held captive for 18 years, during which she gave birth to two daughters. In her book, "A Stolen Life," Dugard recounted that she insisted on educating her children in captivity. Since her rescue in 2009, Dugard, now 33, has shielded her daughters, now 18 and 15, from public view. 

The key to recovery could be the relationship between the little girl and her mom. Even in the worst situations, “there can be a great deal of love and a strong bond,” Weaver said.

The girl likely will have to grapple with conflicting feelings, especially if she regarded the alleged captor, Ariel Castro, 52,  as her father. Castro was charged Wednesday with kidnapping and rape. A DNA test was pending to determine paternity. His two brothers, who also were held, were not charged with crimes in connection with the captives.

Hostages and victims of long-term kidnappings often form bonds with their abusers over time, experts say. A report from the Cleveland Police Department indicates that Castro would sometimes take the child out with him. She was kept from knowing Knight or DeJesus' real names for fear she would say them in public, the report said. 

Such trauma in  early childhood will raise basic questions of identity: What does a "traumatic conception" mean for the child born from that union, Weaver said.

And there also will be the question of interacting with the wider world. Experience with children rescued from polygamist colonies showed that it can be difficult to counter messages ingrained since birth, said Douglas Goldsmith, executive director of the Children’s Center in Salt Lake City, Utah, which specializes in mental health care for families with young children.

“Suddenly a 6-year-old is exploring what is freedom,” said Goldsmith, who is a specialist in attachment theory, which focuses on the bond between children and caregivers. “They’ve been told to never, ever trust people in the outside world. They are absolutely terrified.”

The good news is, once they’ve been rescued, such children can almost certainly be helped, Weaver said. The first step is to make the little girl -- and her mom and the other women -- feel safe and protected. The next step will be to help the child understand what has happened and to answer any questions she may have.

After some time, the child may be treated with a cutting-edge therapy known as trauma-focused cognitive behavioral therapy, or TF-CBT. Developed during the past decade, it is now widely used to help children, families, caretakers and others process emotions and thoughts related to significant trauma, Weaver said.

One component of the therapy is creating a “trauma narrative,” where the child tells the story of the abuse, including all the scary or disturbing things that he or she saw, experienced or felt. That can help desensitize kids to the experience and allow them to work through inaccurate thoughts they may have had about what happened, experts say.

No one’s saying it will be an easy road for any of the women captives -- or for the 6-year-old born into such a world. But Weaver said she wants to offer a message of hope:

“We have effective treatments now for kids,” she said. “There is a great deal of reason to believe they can life happy, productive and successful lives.”

Related stories: 

• 'Never get over': Captives face psychic toll
• Cleveland story sparks hope for parents of missing kids
• Ohio victims describe rape and pregnancies while held captive

Mark Duncan / AP

Members of the FBI evidence team remove items from a house on Seymour Avenue in Cleveland, Ohio, on Monday after the rescue of three women who went missing separately about a decade ago.

For the three Ohio women held captive for nine years or more, the world had shrunk to a small white house on Cleveland’s Seymour Avenue.

Early reports indicated that locked doors and covered windows kept the women trapped inside the working-class dwelling. Police said they were hostages to the whims of three 50-something brothers -- until 27-year-old Amanda Berry kicked her way to freedom on Monday.

That act alone signals that Berry and the others -- Gina DeJesus, Michelle Knight, and Berry’s 6-year-old child -- might have the gumption and the resilience to recover from the ordeal, say therapists and experts in child trauma.

“It’s a really good sign. It shows a level of maturity and the ability to take positive initiative to escape a captor,” said John Fairbank, co-director of the UCLA-Duke University National Center for Child Traumatic Stress.

But, like other longtime captives – think Jaycee Dugard and Elizabeth Smart – the women will need time, support and individual attention to tackle the complex psychological demands of healing, experts said.

As many as half of kidnapping victims experience PTSD, or post-traumatic stress disorder, and about 30 percent suffered from major depression after their ordeals, according to one recent study.

It’s far too early to say how the Cleveland women will respond to the aftermath of the captivity, or to predict individual responses, therapists emphasized. Berry, DeJesus, 23 and Knight, 32, were allegedly held by Ariel Castro and brothers, Onil Castro and Pedro Castro since as early as 2002. Due to the sensitive nature of the situation, police say they haven't fully questioned the women yet. 

If they were psychologically healthy at the time they were abducted, they’ll likely come through OK, but with some common issues, said Herbert Nieburg, an assistant professor of law and justice at Mitchell College in New London, Conn. He specializes in trauma and PTSD and has been an FBI hostage negotiator.

“What we could expect logically is that they’ll have issues of trust, issues of being exploited, issues of being mind-controlled,” Nieburg said.

The women may grapple with questions about whether they tried hard enough to escape, or even whether they bonded in some ways with their captors, a common reaction.

“That’s secondary to the mind control,” Nieburg said. “I would suspect that they were told along the way that if they tried to get away that they would be hurt, or their families would be hurt.”

At the same time, the women will have to make up for missing out on crucial years of development – their teens and young adulthood, said Douglas Goldsmith, executive director of the Children’s Center in Salt Lake City.

“Now they’ve skipped their adolescence. They’re going to be struggling as adults,” he said. “If you listen to the 911 call, Amanda Berry sounded very young. She didn’t sound like a young adult.”

The 6-year-old child will need focused help, too. Though the environment may have been abusive, it is the only world the child has known, experts said. Adjusting to outside society could be a challenge. 

"The key thing is the bond with the mom," said Fairbank.

Dugard, a California woman who was 11 when she was abducted in 1991, spent 18 years living with her captor and had two children conceived by rape. Now 33, she wrote a best-selling memoir in 2011, “A Stolen Life.” On Tuesday, she said that the women’s escape demonstrates their resilience.

“This isn’t who they are,” she said in a statement. “It is only what happened to them.”

Elizabeth Smart was 14 when she was abducted at knifepoint from her Utah bedroom in 2003 and then held for nine months. Now 25, she has since written a book, married, and started a foundation to promote awareness about abduction.

She told ABC News on Tuesday that she was “overjoyed” to hear that the Ohio women were free.

“It’s just proof that there are more happy endings out there,” she said.

But Smart also said that the women will need privacy to heal, “to give them every chance they can to find their own way, to find their pathway back to some sense of healing.”

Therapists and fellow victims alike agreed that the Cleveland woman have taken the first step of what will be a long journey.

“They’ll never get over what happened,” Goldsmith said. “What they have to do is figure out, ‘How do I incorporate this trauma into my life?’” 

Related stories: 

• Nine years before rescue, cops visited Cleveland home where women were held
• 'Can I help?' Neighbor tells of role in discovery
• 5 missing child cases with happy endings

Reports of a new “sex superbug” threatening the U.S. aren’t true, public health officials say, even as they reiterate worries about the rise of drug-resistant gonorrhea.

“The sky is not falling -- yet,” said Dr. Kimberly Workowski, a professor of infectious disease at Emory University in Atlanta.

Several media outlets, including The Associated Press, last week reported that a rare strain of gonorrhea known as HO41 had been detected in Hawaii. That would have raised alarms nationwide, signaling the first domestic sign of a strain that's been found to be resistant to ceftriaxone, an injectable antibiotic that is the last-resort treatment for the sexually transmitted infection.

But the Hawaii cases, first discovered in May 2011, were actually a different strain, H11S8, resistant to a different drug, the antibiotic azithromycin, state health officials confirmed. That’s been a known problem for a while, Workowski added. The AP later withdrew the inaccurate report.

In fact, the HO41 strain hasn’t been detected anywhere in the world since 2009, when it was found in a Japanese sex worker, said Dr. Robert Kirkcaldy, a medical epidemiologist with the Centers for Disease Control and Prevention.  A handful of other cases that are resistant to ceftriaxone have been detected in other countries, but they’re different isolates, he added.

The false reports have put public health experts in the unusual position of refuting an error while also emphasizing that the threat of untreatable gonorrhea in the U.S. is very real.

“We think that that could be just a matter of a year or two,” said William Smith, executive director of the National Coalition of STD Directors.

Nearly 322,000 cases of gonorrhea were reported in the U.S. in 2011, making it again the second most commonly reported notifiable infection in the nation. Sufferers often show no signs, so the actual number of infections is likely closer to 700,000, according to the CDC.

For decades, gonorrhea was easy to treat with a single dose of antibiotics. But the germ is wily and easily mutable. It developed resistance to successive classes of drugs over the years until the cephalosporins, the current treatment, were all that’s left.

In recent years, though, there have been worrisome signs that the bug is starting to outsmart those drugs, too. Last year, the CDC stopped recommending the oral antibiotic cefixime to treat gonorrhea after surveillance showed it was on the verge of resistance. Now, the recommended treatment is the injectable ceftriaxone along with two other antibiotics, azithromycin or doxycycline.

“The point was to actually preserve the last remaining drug we know is effective,” said Workowski.

The NCSD, led by Smith, has asked Congress for $54 million in emergency appropriations to help bolster the US public health infrastructure that monitors, diagnoses and treats gonorrhea.

“Untreated gonorrhea is a disaster for public health and HIV prevention,” Smith said.

The best prevention against gonorrhea is monogamous sex between uninfected partners, Kirkcaldy said. Diligent use of condoms can also prevent infection, he added.

Related stories: 

• 'Ongoing, severe epidemic' of STDs in the US
• Untreatable gonorrhea threat rises in the U.S., Canada
• Bad bug: Gonorrhea strain resists all drugs

U.S. Department of Justice officials have filed notice that they will appeal a federal judge's order requiring the Food and Drug Administration to make the so-called "morning after" pill available without a prescription to all women without age or certain sales restrictions. 

The department also has asked the federal district court to stay its order, which was set to take effect on May 6, according to Allison Price, a spokeswoman. 

The move comes a day after the FDA agreed to lower the age limit to 15 for sales of non-prescription Plan B One-Step emergency contraception and to make the drug available in the general aisles of stores with pharmacies, instead of behind the counter. 

 Justice officials appeared to be concerned by the precedent the order would send in overturning a top administrative decision. Officials said that the court exceeded its authority by specifying action regarding the one-pill Plan B One Step product and by ordering the FDA to make emergency contraception available instead of sending the issue back to the agency for reconsideration, documents showed.

"Although FDA did not take that action for purposes of complying with the April 5 order, the approval has the effect of ensuring that all of the plaintiffs in this case (including the youngest of them) now have access without a prescription and without significant point-of-sale restrictions to at least one form of emergency contraception ..." reads a letter sent late Wednesday by justice officials to U.S. District Judge Edward Korman. "As a result, no plaintiff will be harmed by a stay."

Early last month, the New York judge ordered the FDA to reverse a 2011 agency decision and make emergency contraception containing levonorgestrel available to all women without a prescription and over the counter within 30 days. In the acidly worded ruling, the judge criticized the FDA and Health and Human Services Secretary Kathleen Sebelius for politicizing the availability of a drug that medical experts had concluded was safe and effective for women of all ages. In the 59-page ruling, he said that Sebelius' actions were "politically motivated, scientifically unjustified and contrary to agency precedent." 

But on Tuesday, the FDA granted an amended application from Teva Women's Health Inc., to make just Plan B One-Step available to girls as young as 15 without a prescription starting immediately. Under the previous ruling, the drugs were available without a prescription to girls and women older than 17. Consumers will find the product in the family planning and women's health aisles of stores with in-store pharmacies and they'll be available outside pharmacy hours. But shoppers will have to show identification to buy the products and they won't be sold if ID can't be verified, the FDA said. 

Reproductive-rights advocates who brought the lawsuit that led to Korman's order were frustrated at the decision. 

"Women who urgently need emergency contraception have been delayed in getting it or denied access entirely for more than a decade because of the political maneuverings of the last two presidential administrations," said Nancy Northup, president and chief executive of the Center for Reproductive Rights. "The federal court has made clear that these stalling tactics were based purely on politics, not science."

Terry O'Neill, president of that National Organization for Women, called the move "a step backwards for women's health."

"Millions of women need access to this safe and effective product, and the prevention of unwanted pregnancy, particularly in adolescents, should not be obstructed by politics," she said. 

Officials with Planned Parenthood said that lowering the age at which the drug is available without a prescription was a good move that should go further. 

"The Obama Administration took an important step forward earlier this week by moving emergency contraception out from behind the pharmacy counter and making it available to people ages 15 and older and we continue to believe that access should be expanded further," Cecile Richards, the agency's president, said in a statement.

A doctor who backed wider access said that advocates will still work toward the goal of reducing unwanted pregnancies.

"If someone had said to me years ago that we were allowing a 15-year-old girl to get this, it would be such progress," said Dr. Cora Breuner, a Seattle pediatrician and professor of adolescent medicine who authored the American Academy of Pediatrics guidelines on emergency contraception.

"We're getting there," she said. "It's a step in the right direction." 

Related: 

• Plan B available for 15-year-olds: Bring a passport
• FDA approves Plan B One-Step for girls 15 and older without prescription