Across the nation fewer and fewer teens are giving birth, especially Hispanic girls, according to a new government report.

Researchers from the Centers for Disease Control and Prevention found that from 2007 to 2011, the overall rate of teen births plummeted a full 30 percent. The biggest decline was among Hispanic teens, whose birth rate dropped 34 percent. Among non-Hispanic black teens there was a decline of 24 percent. Among white, non-Hispanic teens, the rate decreased by 20 percent.

“The thing that surprised me most was the big decline in rates for Hispanics: at least 40 percent in 22 states and the District of Columbia,” said Brady Hamilton, a report co-author and a statistician at the CDC’s National Center for Health Statistics. “That was pretty impressive. It really caught my eye.”

Hamilton suspects that public service messages are starting to resonate with teens. “Teen births are the focus of many public policies,” he said. “I think this shows the message is getting out.”

That makes sense to Dr. Carlos Lerner, medical director of the Children’s Health Center at the University of California, Los Angeles. “In settings like ours, we make sure we provide information in a culturally sensitive way in the patient’s own language,” he explained. “As we’ve learned to do that better, I think the message has been becoming more and more effective.”

The most important part of counseling teens may be finding a way to give the information in a non-judgmental way, Lerner said.

Higher rates of secondary and college education might also play a role in the declining birth rates in Hispanics, experts said.

Based on U.S. Census data, “it does look like both high school and college graduation rates are going up more quickly for Latina women in the 2007-2010 period than for the general population,” said Stefanie Mollborn, an associate professor of sociology at the University of Colorado Boulder. “That would be really interesting potential explanation, since education tends to be strongly related to postponing childbearing.”

The decline could also be related to the growing number of second generation Hispanics in the U.S., said Rogelio Sáenz, a sociologist and demographer and dean of the College of Public Policy at the University of Texas at San Antonio.

“From a separate analysis based on the American Community Survey (2007-2011), the drop in [births] among Latinos is slightly higher among native-born Latinas compared to foreign-born Latinas,” Sáenz said.

Another factor, Sáenz suggested, could be the increasing numbers of young Latino women who choose to remain single. That demographic change may also affect the long range birth rate among these women, he said.

As for the overall decline in the teen birth rate, that might be related to the economy, Mollborn said.

“The drop in the teen birth rate mirrors a fairly large drop in the overall U.S. birth rate - to women of all ages - during the same period,” she explained. “This coincides with the Great Recession. Many people are less likely to have children when they're experiencing economic troubles. Since most teen mothers are in or near poverty and come from disadvantaged backgrounds, it's not surprising that they would be especially likely to have fewer births during these difficult economic times.”

Related stories:

One in five teen births are repeats, CDC says

Teen birth rates plummet to record low

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

By Jason McLure
Reuters

Vermont on Monday became the fourth U.S. state to end legal penalties for doctors who prescribe medication to terminally ill patients seeking to end their own lives. 

The law, which includes a number of safeguards over the next three years as the state adapts, marked the first time a U.S. state has used the legislative process to make assisted suicide legal. Oregon and Washington have similar laws passed through ballot measures and a Montana court authorized the practice in 2009.

"Vermonters who face terminal illness and are in excruciating pain at the end of their lives now have control over their destinies. This is the right thing to do," said Governor Peter Shumlin, a Democrat, who signed the law on Monday.

Supporters of the practice are hoping Vermont's law will lend momentum in other states, such as Connecticut and New Jersey, that have considered similar legislation. A bill legalizing the practice failed in Massachusetts last year.

The law allows physicians to prescribe death-inducing medications, which terminally ill patients wishing to commit suicide could then administer to themselves. It limits the prescriptions to residents of the state.

"Vermont's law reflects another normalization of the practice of aid in dying in the practice of medicine," said Kathryn Tucker, director of legal affairs at Compassion and Choices, a group that backed the Vermont law. "Support for patients to be empowered and choose aid and dying is growing. So I think this is an important step in moving that forward."

The Vermont bill is more sweeping than the initiatives passed in Oregon or Washington. As in those two states, it provides a number of safeguards - though the Vermont bill calls for these to expire in 2016.

During the first three years, the law requires ailing patients to make three requests for death-inducing drugs. Both the patient's primary physician and a consulting doctor must agree the patient is suffering from a terminal illness and is capable of making an informed decision to request death-inducing drugs.

After July 1, 2016, the practice of prescribing life-ending medication will be overseen by professional practice standards that govern physician conduct in other aspects of medicine.

The two-tiered approach was instituted as a compromise between legislators who preferred Oregon's model of legal safeguards and others who objected to what they saw as government interference in end-of-life decisions.

Advocates of assisted suicide say the practice can save years of suffering for patients of painful terminal illnesses, such as bone cancer. Opponents warn that measures allowing it may encourage people to take their own lives at the behest of potential heirs or because they fear they are imposing a burden on family.

True Dignity Vermont, a group that opposed the Vermont law, said it would work with a network of health care providers to help support alternatives to the terminally ill.

"We now have state-sanctioned suicide in Vermont," said Edward Mahoney, president of the group, in a statement. "If the state won't protect Vermonters, we will try."

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

Centers for Disease Control and Prevention

A CDC scientist harvests H7N9 virus that has been grown for sharing with partner laboratories for research purposes.

More than 50 travelers just back in the United States from China who had flu-like symptoms have been tested for the H7N9 bird flu virus, federal health officials say. So far, none has tested positive.

But the fact that they’re being tested at all shows just how worried the U.S. government is about this new strain of bird flu, which threatens at the same time as a still-mysterious coronavirus from the Middle East. The test kits had to be specially made up and distributed under an emergency provision.

“While no cases of H7N9 have been detected at this time in the U.S., 54 people with flu-like symptoms after travel to China have been tested. All have 54 tested negative for H7N9; while six tested positive for seasonal influenza A, and three tested positive for seasonal influenza B,” the Centers for Disease Control and Prevention says in its latest update on the virus.

Emergency operations centers are running 24/7, keeping an eye on both situations. While it's not unusual for the centers to be operating around the clock, it is rare to have two pandemic threats at once to plan for, says Edward Gabriel, who heads preparedness and response issues at the health and Human Services Department. 

"We want the latest and best information that we can get," Gabriel told NBC News. "We also need to look and see where it is moving to. To try to isolate its motion is a pretty significant thing."

If either virus turns into a form that spreads easily from person to person, a pandemic could follow within weeks. Both seem especially deadly in their current form: H7N9 seems to have about a 20 percent fatality rate, while the new coronavirus appears to have killed more than half its victims.

“In the case of the two latest threats — the H7N9 influenza virus and the new coronavirus — the number of infected people is small, and the infections are occurring thousands of miles away from the United States. Yet we should be seriously concerned about both,” Mike Osterholm, an infectious disease expert at the University of Minnesota, wrote in the New York Times on Friday.

“Our public health tools to fight these viruses are limited. We have no vaccines or effective drugs readily available to stop or treat the new coronavirus in the Middle East,” Osterholm adds. 

CDC

Influenza A H7N9 as viewed through an electron microscope. Both filaments and spheres are observed in this photo.

The H7N9 flu can spread silently, as people transmit influenza before they’re sick themselves. If the flu did mutate into a pandemic form, it would probably take at least six months to make enough vaccines to protect large numbers of people.

“It may take longer than it takes the virus to spread,” says Dr. John Treanor, a flu vaccine expert at the University of Rochester Medical Center. “The technology that we have today is such that the bulk of the pandemic disease may have already taken place before a vaccine is in place and can be used,” he added.

“The virus can spread very, very quickly. You are in a race against time.”

That happened in 2009, when the new strain of H1N1 swine flu broke out to cause the first pandemic of a new flu in 40 years. Companies raced to make vaccine but it was months before it was ready.

There are drugs to fight flu – a pill called Tamiflu and an inhaled powder called Relenza. Neither is a cure, however, and both need to be given very quickly to do much good at all.

Right now, H7N9 seems mostly confined to China and the spread has slowed. The World Health Organization reports 32 people have died out of 131 lab-confirmed cases.

“The drop-off in newly reported H7N9 cases in China may be the result of containment measures reportedly taken by Chinese authorities, including closing live bird markets, a venue where the risk of exposure to bird flu viruses can be high," the CDC says. “However it may also be a result of changing seasons, or a combination of both.”

Researchers in Hong Kong did a computer analysis of the outbreak and estimate that at least 200-500 more people have likely been infected with H7N9. The virus seems to cause serious illness mostly in people over 65 – doctors are not sure why yet.

“We estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages,” Ben Cowling and colleagues at Hong Kong University wrote in the journal Eurosurveillance.

The evidence suggests that most of the patients got infected directly by birds, probably in poultry markets. So Cowling’s team took all the data and estimated how many younger people were likely to have been infected without knowing they had H7N9. "Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date," they wrote. This would mean the virus isn’t that widespread, but which also confirms its high fatality rate. 

The coronavirus, which some are dubbing Middle East Respiratory Syndrome Coronavirus, or MERS, is a little different story. WHO says 33 infections have been reported, with 18 deaths. Experts are watching cases in France, where one patient who traveled from Dubai was confirmed to have the virus. 

A man who shared a hospital room with the 65-year-old man also has the virus, French officials said Sunday -- something that shows the virus and and does spread in hospitals. 

Officials were relieved that three health care workers who cared for the 65-year-old patient and who got sick have tested negative for the virus.

Also Sunday, WHO Assistant Director-General Keiji Fukuda could probably be passed between people in close contact, but there was no evidence of sustained "generalized transmission in communities."

Some reports suggest an outbreak in Saudi Arabia also affected people in the same hospital.

This worries Dr. Eric Toner of the Center for Health Security at the University of Pittsburgh Medical Center. SARS – severe acute respiratory syndrome – also spread mostly in hospitals. SARS spread to 29 countries in 2003, killing 775 people and making 8,000 sick before it was stopped.

“These cases, whether confirmed or not, should be a wake-up call,” Toner writes in his blog.

The good news is that SARS was stopped using good hospital hygiene. Face masks, gloves and careful disinfection prevented its spread. And SARS only spread once people were noticeably ill, unlike flu, which people can spread before they feel sick and after they feel better.

The bad news is that hospitals may have forgotten this lesson. “SARS was stopped by healthcare workers being aware of the disease, having a high index of suspicion of anyone with fever and respiratory symptoms who had recently been in an affected region, and quickly implementing infection control measures with any suspect case,” Toner says.

“Until now, all cases of MERS originated in the Middle East, but as the confirmed French case demonstrates, the virus is only a plane ride away from other parts of the world. In the 10 years since the SARS outbreak, many hospitals have become lax in their attention to respiratory precautions.”

Gabriel says he’s working to make sure this isn’t the case with U.S. hospitals. “Hygiene practices are now better than they ever have been,” Gabriel said. “We send out reminders daily.”

Related:

• WHO: New SARS-like virus can probably spread person to person
• US races to make new vaccines against bird flu
• New virus has officials worried about skimpy resources

This story was originally published on Sun May 12, 2013 9:33 AM EDT

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

Wang Zhao / AFP - Getty Images

A new strain of bird flu identified in China "is one of the most lethal influenza viruses we have seen so far," Dr. Keiji Fukuda, the World Health Organization (WHO)'s Assistant Director-General for Health Security, tells journalists at a press conference in Beijing on Wednesday.

BEIJING – A new type of bird flu that has killed 22 people in China since March is one of the most deadly strains of influenza known, international health experts said on Wednesday. 

"This is one of the most lethal influenza viruses we have seen so far," said Dr. Keiji Fukuda, the World Health Organization (WHO)’s Assistant Director-General for Health Security. "We are at the beginning of our understanding of this virus."

The H7N9 strain appears to spread more easily to humans than SARS, a different virus that started killing people in Asia a decade ago, experts said. Severe acute respiratory syndrome killed around 800 people globally in 2003 before it was stopped.

"This is an unusually dangerous virus for humans," added Fukuda, who was speaking in Beijing alongside leading flu experts from around the world.  

The delegation from United States, Europe, Hong Kong and Australia, as well as China, have just concluded a week-long investigation that took them to affected areas in Shanghai and Beijing.

Little is known
The group of experts made an impressive display of international cooperation, but at the same time admitted just how little is known about the virus that has infected 108 people since March.

"We are at the very early stages of this investigation," said Dr. Nancy Cox, who heads Influenza Division at the Center for Disease Control and Prevention in Atlanta. "There's a lot to be learned.”

Most of the cases so far have been found in eastern China, around the Yangtze River delta, but in recent days there have been cases in central and northern China, including the capital. Most have been what Fukuda called "sporadic cases."  

He said a few family clusters have been found, which could be the result of exposure to the same source of virus, or limited person-to-person transmission.

But he said: "'Evidence so far is not sufficient to conclude there is person-to-person transmission. Moreover, no sustained person-to-person transmission has been found.”

The experts concluded that live poultry markets were the most likely source of infection.

The experts praised the swift action of Chinese authorities in closing live poultry markets, and said it was "encouraging" that there have been no new cases in Shanghai since its markets were shuttered.

And they called for continued international cooperation against a virus that doesn't recognize borders. 

"The risks of an outbreak situation are shared in a globalized world, where we are all interconnected," said Fukuda.

Legacy of distrust
All of those who spoke today went out of their way to praise the response and of the Chinese authorities and their openness and transparency. There is enormous sensitivity to any suggestion that their presence in China implies any criticism of local efforts.

China still lives in the shadow of the SARS pandemic, which began here a decade ago and killed hundreds worldwide, including in the U.S. It was made worse by an initial cover-up by the Chinese authorities.

"The response reflects earlier and strong investments in health and preparedness made by China," said Fukuda.

SARS also left a legacy of distrust, which was on display earlier in the week in Shanghai, when a press conference by the local government and WHO was gatecrashed by the daughter of a couple infected with H7N9. The 26-year-old demanded information about her quarantined father; her mother had died.

"The hospitals and medical staff appear friendly to members of the media like you but have responded in a lukewarm manner to inquiries from family members like me," she told the South China Morning Post. She was taken away by officials.

The experts said that in the absence of so much basic information about the extent of the public health risk it was critical to maintain a high level of awareness. They also noted that the weather is warming up in China, which might provide a bit of a respite and buy them some important time, since H7N9 -- in common with other influenza -- spreads less easily in the spring and summer.

Related:

• A new openness as new bird flu virus spreads in China
• Six more diagnosed with new bird flu in China
• Scientists ready to re-start bird flu experiments

This story was originally published on Wed Apr 24, 2013 6:19 AM EDT

A Los Angeles City councilman is asking the police department to crack down on kids buying energy drinks, saying the buzz-worthy beverages contain far more caffeine than recommended by the U.S. Food and Drug Administration.

Councilman Bernard Parks, a former LAPD chief, is pushing for warning labels and restricting the amounts of energy drinks a customer can buy. He is also pushing to change drink placement on shelves to prevent children from buying them [PDF link to city motion].

In "many instances they are drinking seven to 10 times more caffeine than if they were drinking a regular soda," Parks said.

The push comes after a Consumer Reports study found some energy drinks to contain more caffeine than printed on the label, and as the FDA investigates claims made in 2012 that five deaths are possibly linked to the popular energy drink Monster.

"I think it is the FDA's job primarily to set standards but we as a city can do something as far as purchase location, labeling, and who gets access," Parks said.

Parks also recommended that LA County research the effects of energy drinks similar to studies conducted by the Centers for Disease Control and Prevention.

Monster energy drinks contain 240 milligrams per 24-ounce can, about two and a half times the amount in an average cup of coffee, according to Consumer Reports.

More news from NBCLosAngeles.com

The South Los Angeles community in Parks’ district has been called a "food desert" due to lack of healthy options, and tops the charts in obesity rates at 30 percent of kids, according to the LA County Department of Health.

"What a waste of time," said South Los Angeles resident Wayne Clinton. "There's so many other things that need to be done."

With parts of South LA neglected, Clinton suggested the streets of South LA be "swept up" before the council focuses on banning caffeinated drinks.

"Look across the way -- you got alleys that need cleaned up," Clinton said.

The motion was submitted on March 6. Parks said he hopes it will move forward in committee this week.

NBC4's Michelle Valles contributed to this report.

A new report on three of the first patients in China to contract a novel strain of bird flu has U.S. officials worried about a grim scenario that includes severe illness with pneumonia, septic shock, brain damage and multi-organ failure.

All three of the patients died, according to a Thursday report by a group of Chinese scientists in the New England Journal of Medicine.

“It is possible that these severely ill patients represent the tip of the iceberg,” wrote Dr. Timothy Uyeki and Dr. Nancy Cox, both of the influenza division at the Centers for Disease Control and Prevention, in a perspective piece accompanying the article.

The reports chronicle the early days of an outbreak of a new influenza A virus, H7N9, which has never before been seen in humans. As of Friday, Chinese officials said it had infected at least 43 people in four Chinese provinces and killed 11 in the past two months.

On Saturday, China's center for disease control confirmed the first case of the new bird flu strain in Beijing: A seven-year-old girl whose parents work in the live poultry trade has been infected.

The patients described in the report included two men, ages 87 and 27, both from Shanghai, and a 35-year-old woman from Anhui. All had preexisting health conditions and two had been exposed to chickens at live poultry markets in the previous week. They became ill between Feb. 18 and March 13 and died between March 4 and April 9 of severe complications, the report said. 

The virus, which has been traced to a reassortment of genes from wild birds in east Asia and chickens in east China, “raises many urgent questions and global public health concerns,” the U.S. researchers wrote.

It’s particularly concerning because the virus clearly has the potential to cause severe disease, it has genetic characteristics that suggest that it might be better adapted than other bird flu strains to infect mammals -- including humans -- and people have no resistance to it, the U.S. scientists reported.

The virus doesn’t make birds sick, so it may spread widely and remain undetected until people become ill.

In addition, previous vaccines developed to fight other H7 strains did not invoke strong immune responses in humans, the U.S. scientists wrote. Even so, researchers at the Centers for Disease Control and Prevention said they received an isolate of the virus from China on Thursday and were continuing to rush efforts to create a vaccine, a process that could take several months.

Scientists are expected to start growing more of the virus to share for use in several ways, including not only developing a vaccine, but also creating a blood test that can detect previous human immune system protection against the virus, and testing to see whether the virus remains susceptible to antiviral drugs.

CDC officials also will use it to create a diagnostic test that could be used to detect infection in travelers who return to the U.S. from China with symptoms of flu, or those who’ve been in contact with someone who’s been sick.

Officials with CDC and the Food and Drug Administration are working to quickly expedite approval and manufacture of the kits, said Mike Shaw, associate director of laboratory science for the CDC's flu division. About 400 diagnostic kits, which each can perform 1,000 tests, may be complete by Monday, he said. They could be shipped as early as next week to public health labs across the country. 

The CDC has urged local public health officials to watch for signs of sick travelers from China. So far, about 10 people who recently traveled from China to the U.S. have been tested for the H7N9 virus because of suspicious symptoms, officials said.

"So far, everyone that has been tested in the U.S. has been negative," Shaw said. 

The virus remains contained to China and there is no evidence of sustained person-to-person transmission, both good signs, scientists said.

But as the U.S. researchers concluded, vigilance remains high.

“We cannot rest our guard,” they wrote.

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This story was originally published on Fri Apr 12, 2013 7:40 AM EDT

A vital drug used to help feed the tiniest babies is in such short supply that at least seven extremely premature infants in the U.S. developed horrifying skin lesions and life-threatening reactions after their hospitals ran out.

At least 120,000 more fragile babies may be at risk each year from an ongoing shortage of injectable zinc, a trace element added to intravenous nutrition solutions, government and medical officials say.

“It’s very frustrating,” said Dr. Lamia Soghier, medical director of the neonatology unit at Children’s National Medical Center in Washington, D.C. “What can we do? We’re just short. We don’t have it. We can’t borrow it."

The crisis is the latest in the nation’s ongoing struggle with drug shortages. After federal intervention in 2012, the number of new shortages has fallen markedly, down to just 26 this year from a record high of 267 in 2011. But the number of active shortages of essential medications -- including injectable trace elements, vitamins and electrolytes -- is now 323, higher than it’s ever been, according to the University of Utah Drug Information Service, which tracks the problem.

Last December, three very premature infants at Soghier’s hospital, all born at 23 or 24 weeks of pregnancy -- suddenly developed severe diaper rash, skin erosions around their mouths and blistering lesions on their hands and feet, according to a recent CDC report.

At first, doctors were stumped. The babies were all in different rooms, cared for by different nurses. They were tested for infections, drug reactions, even problems caused by medical tape. Then specialists hit on the real source: severe zinc deficiency linked to an IV food solution called total parenteral nutrition, or TPN.

“These kids were not receiving food through any other method. They were exclusively on the TPN,” said Dr. Scott Norton, a dermatologist at Children's National who investigated the cases. 

Injectable zinc is typically added to the TPN mixture in prescribed doses for preemies. The hospital had run out of the drug on Nov. 21 following off-and-on shortages since 2010. Within weeks, the infants -- born without the boost of zinc that typically comes from the mother in the last weeks of pregnancy -- started to fail. Because they also had liver problems caused by receiving only TPN, they became even sicker, with levels of zinc 20 percent to less than 50 percent of the normal range.

That’s a problem because zinc is essential for about 300 enzyme-dependent processes, Soghier said. Premature babies require large doses of zinc for cell metabolism and growth. Without it, they can face issues ranging from severe skin erosion and growth restriction to immune system problems. 

CDC

This premature baby girl was one of three infants who developed severe skin lesions and other problems at a Washington, D.C., hospital as a result of severe zinc deficiency stemming from a nationwide shortage of injectable zinc.
Emergency supplies were rushed to those babies, who are now doing well, but the shortage continues, doctors say.

“Everything in your body probably requires zinc,” she said. “All your cells.”

The zinc crisis dates to 2011, when one U.S. maker of the drug -- American Regent -- suspended manufacture of most injectable products after problems with particulate matter in some drugs. The other maker of injectable zinc, Hospira, couldn’t keep up with the new demand.

Hospitals across the country juggled supplies for months, but, eventually, some ran out, including Children’s National Medical Center.

Doctors knew that the lack of zinc could cause problems in preemies, but they didn’t realize it would escalate so quickly, Soghier said. Such severe symptoms of zinc deficiency hadn't been seen in the U.S. for decades, Norton added. When the effect on the Children’s National patients became apparent, Hospira rushed supplies to the hospital quickly.

“We managed to get an emergency shipment,” Soghier said. Slowly, the children recovered.

But a query of the nation’s neonatologists by officials with the Centers for Disease Control and Prevention found more cases. In Texas, four other tiny preemies had developed the severe symptoms of zinc deficiency, said Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health. An adult dependent on TPN also showed signs of the problem, she added. 

“It could potentially be a life-threatening condition,” Barfield said. “Physicians should recognize that it can occur.”

Three months later, Soghier’s hospital has adequate supplies of injectable zinc, but the risk elsewhere remains high. Supplies of that drug -- and other components of TPN -- remain extremely scarce or unavailable, said Jay Mirtallo, immediate past president of the American Society for Parenteral and Enteral Nutrition, or ASPEN.

“One of the biggest concerns we have is that there has been nothing that has helped and it doesn’t seem like there’s any relief in sight,” said Mirtallo.

The TPN shortage affects not only premature babies, but also some 370,000 patients who receive TPN in the hospital each year, and tens of thousands more who use it at home, he said.

Food and Drug Administration officials, who have struggled to address drug shortages, are aware of the problem, said Sarah Clark-Lynn, an agency spokeswoman. The agency got a boost in 2012 from a new law that requires drugmakers to report imminent shortages in advance and gives the FDA authority to speed applications from firms to make drugs in short supply.

The agency has asked American Regent and Hospira to prioritize production of the injectable zinc, and they’re seeking foreign manufacturers who might be willing and able to ramp up supply, Clark-Lynn said.

American Regent has resumed operations, but no injectable zinc is available yet. Hospira officials hoped to have more drug on the market by now, but the plan has been delayed.

“Hospira is aware of the urgency of this product for patients, and we have prioritized its return to market,” said Dan Rosenberg, a company spokesman. “We have resumed manufacturing and are currently targeting second quarter for return to market.”

FDA officials, however, said there’s no firm timeline for either company to get injectable zinc back on hospital pharmacy shelves.

In the meantime, hospitals are monitoring their tiniest patients closely and working to meet demand under difficult circumstances, said Mark Wietecha, president and chief executive of the Children’s Hospital Association, which includes 220 hospitals in the U.S. and Canada.

There’s more emphasis than ever on conserving scarce drugs and prioritizing need, he said. Hospitals have been willing to share drugs in short supply because they know the next babies in need could be their own.

“Everybody’s kind of soldiering on,” he said. “The alarming thing is if the trend continues over the next five to seven years, we’re going to have more problems than we do now.”

Related:

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Most mothers may be starting their infants on solid foods months sooner than specialists recommend, mistakenly believing their children are old enough to graduate from breast milk or formula – but many say they’re simply following doctors’ orders, according to a study published today.

Parents should wait until their little ones are at least 6 months old before offering them solid foods, say many child-nutrition experts, including the American Academy of Pediatrics.

But researchers at the Centers for Disease Control and Prevention – who surveyed 1,334 new moms – discovered that almost 93 percent of those women had introduced solid foods to their infants before 6 months, that 40 percent did it before the 4-month mark, and that 9 percent had offered solids to their babies before they were even four weeks old, according to the study, published today in Pediatrics.

“Fifty percent said that their health care provider told them it was time to introduce solid food,” said Kelley Scanlon, a co-author of the study and lead epidemiologist in the nutrition branch in the division of nutrition, physical activity and obesity at the CDC.

“That, for us, indicates that health care providers need to provide clearer guidance and really support women in carrying out the recommendation,” Scanlon said.

Physicians' groups settled on the 6-month cut-off after earlier research determined that children who get solid food at too early might be at a greater risk for developing chronic diseases, such as diabetes, obesity, eczema and celiac disease, Scanlon said.

The mothers who volunteered for the CDC study filled out food diaries and questionnaires designed to ferret out their opinions on why and when solid foods should be offered.

Among the moms offering solid foods to infants younger than 4 months, the most commonly cited reasons for doing so included: “My baby was old enough;” “My baby seemed hungry;” “I wanted to feed my baby something in addition to breast milk or formula,” “My baby wanted the food I ate;” “A doctor or other health care professional said my baby should begin eating solid food;” and “It would help my baby sleep longer at night,” researchers reported.

What’s more, moms who fed their babies formula were far more likely to start solids too early versus those who exclusively breast-fed (53 percent versus 24 percent), the study showed.

One food expert unaffiliated with the CDC study suggested that some health-care providers may simply be unfamiliar with current baby-feeding recommendations.

“I think this is worrisome,” said Ann Condon-Meyers, a pediatric dietician at the University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh. “I think it may show that word isn’t getting out that … it is 6 months before solid foods should be offered.”

Still, the study’s findings didn’t surprise Condon-Meyers, who added: “I work in pediatrics and we see a lot of early introduction of solid foods when we do patient histories.”

In addition to possibly boosting, a child’s risk for contracting certain chronic diseases, introducing solid foods too early often means babies don’t drink an adequate amount of breast milk or formula, and that can translate into poorer nutrition, Condon-Meyers said.

Breast milk and formula have all the nutrients and vitamins a baby needs and in the right proportions, Condon-Meyers said.

“If you start giving solid food too early then you are diluting the nutritional intake,” she said. “You’re getting more calories, but less of the nutrients a baby needs to grow.”

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