New coronavirus case confirmed in France

A 65-year-old Frenchman is hospitalized after contracting France's first case of a deadly new respiratory virus related to SARS, and French health authorities said Wednesday they are trying to find anyone who might have been in contact with him to prevent it from spreading.

It's unclear how or where the man was infected with the novel coronavirus, which has killed 18 people in four countries and raised new public health concerns since being identified last year in the Middle East. It can cause acute pneumonia and kidney failure.

A novel coronavirus has killed 18 people in four countries. (Beth Fischer/Canadian Press)

The Frenchman fell ill after returning from a trip to the United Arab Emirates, the Health Ministry said. He has been under isolation and medical surveillance at a hospital in Douai in northern France since April 23, and is receiving respiratory assistance and blood transfusions, said Jean-Yves Grall, the government health director.

Paris' Pasteur Institute analyzed the man's virus and confirmed that it is a novel coronavirus, the ministry announced Wednesday.

Since September 2012, the World Health Organization has been informed of 30 confirmed cases of the virus, and 18 of the patients have died. Cases have been emerged in Saudi Arabia, Jordan, the UAE, Qatar, Britain and Germany, and health officials have said the virus has likely already spread between people in some circumstances.

France's health minister, Marisol Touraine, said "this is an isolated case" in France but said authorities are "fully mobilized" to prevent it from spreading. Authorities are trying to reach anyone who was in contact with the patient before he was hospitalized, and a national hotline was established Wednesday for the public to call about the virus.

WHO has advised countries to test any people with unexplained pneumonia.

"Any virus that has the potential to develop into something that is highly transmissible between people, including the coronavirus, is a major concern," WHO spokesman Gregory Hartl said.

"We need to follow up on all possible routes of infection, i.e. animal to human, whether it's being spread in hospitals or from human-to-human," he said.

Health authorities are trying to determine how humans are contracting and spreading the virus and how best to treat it. It does not appear to be as contagious as SARS or the flu, but it has probably spread between people who had close contact. It seems to have spread among family members in Britain and in health workers in Jordan who were caring for patients, for example.

The new coronavirus is most closely related to a bat virus and scientists are considering whether bats or other animals like goats or camels are a possible source of infection.

"We still don't know the animal reservoir of this virus or the source of exposure," Hartl said. "We need a solid epidemiological investigation to nail down a common behavior between patients...All we can tell people at the moment is they should be very vigilant about their basic hygiene practices."

He said it's unclear whether there is something specific in the environment in the Middle Eastern countries where cases have been confirmed.

Several cases have been reported in Saudi Arabia. In the most recent Saudi outbreak, the Health Ministry has said five people have died and at least five others are hospitalized with confirmed cases of the virus.

SARS, or severe acute respiratory syndrome, killed some 800 people in a 2003 epidemic.

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Medical community rescues Halifax brain mapping lab

The Halifax lab maps the brain and is considered valuable for companies working on cancer treatmetns. (Brian Snyder/Reuters)

Nova Scotia is keeping a brain mapping laboratory the federal government had planned to close thanks to a group effort from the local life sciences community.

The National Research Council announced the closure last October, but the provincial government, medical researchers, Dalhousie University and a cluster of biotech companies rallied to raise close to $1 million to keep 13 jobs and specialized imaging equipment at the IWK Health Centre and the Queen Elizabeth II Health Sciences Centre for the next two years.

Dr. Patrick McGrath, research head for both the Capital District Health Authority and the children's hospital, said news of the closure was a bitter pill for researchers who relied on its expertise to map the brain and for homegrown companies such as Immunovaccine working on cancer treatments.

"We can get extraordinary precise size of tumours so we can then determine if their vaccine platform is being effective," he said.

"If we had lost this facility then we would have been unable to attract and retain the best and brightest clinicians, clinicians scientists and scientists. There would have been a huge brain drain from Nova Scotia, much larger than the number of people working together on this imaging."

In two years the lab will have to generate enough business to pay its own way.

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Curb junk food ads aimed at children, group says

Canadian children under 13 shouldn't be exposed to marketing of unhealthy foods and beverages, a coalition of medical groups says.

Thursday's policy statement from the Canadian Medical Association, Heart and Stroke Foundation, Hypertension Canada and others calls on food companies to immediately stop marketing foods high in fats, added sugars or sodium to children.

The proposed advertising restriction includes characters or mascots promoting sugary cereals. (Ryan Remiorz/Canadian Press)

"It is expected that the current generation of Canadian children may live shorter, less healthy lives as a result of unhealthy behaviours, including poor diets," said Bobbe Wood, president of the Heart and Stroke Foundation, said in a release.

Wood said implementing policies that restrict the marketing of unhealthy foods and beverages to children has been proven as a cost-effective way to reduce some chronic diseases.

The groups say that in 1989, the Supreme Court of Canada ruled that "advertisers should not be able to capitalize upon children's credulity" and "advertising directed at young children is per se manipulative."

Food companies in Canada, with the exception of Quebec, are not required by law to restrict unhealthy food and beverage marketing to children.

Canada hasn't acted

In May 2010, the World Health Organization released recommendations on the marketing of food and beverages to children and called on governments worldwide to reduce the exposure of children to advertising and to reduce the use of powerful marketing techniques employed by the manufacturers of foods and beverages high in saturated fats, trans-fatty acids, free added sugars or sodium.

Canada has not acted on the recommendations, the health groups said.

The group's statement describes the policy goal this way: "Federal government to immediately begin a legislative process to restrict all marketing targeted to children under the age of 13 of foods and beverages high in saturated fats, trans-fatty acids, free sugars or sodium and that in the interim the food industry immediately ceases marketing of such food to children."

They plan to use WHO's recommendations on high content of saturated fats, trans-fatty acids, free sugars or sodium.

If enacted, the restrictions would apply to TV, internet, radio, magazines, mobile phones, video and adver-games, brand mascots, product placement, cross-promotions, school or event sponsorships and viral marketing.

On Wednesday night, NDP member of Parliament Libby Davies's bill to phase in lower sodium levels in prepackaged foods and add simple, standardized labels, failed to pass with a vote of 147 to 122, the Centre for Science in the Public Interest said.

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7 ways to beat seasonal allergies

Dr. Lee gives Kirsten Cornelson her first allergy shot. (CBC)

Tree pollens could be making some people feel like their seasonal allergies are worse than usual, but there are ways to counter it, doctors say.

Spring breezes carry tree pollens first, said microbiologist Frances Coates of Ottawa, who identifies pollen and spores to assess allergen levels collected from 30 stations across Canada at Aerobiology Research Laboratories.

"If someone has allergies to more than one tree, say ash and birch, which is not that uncommon to have allergies to those two trees, they're showing up together," said Coates. "So people are getting a double-whammy from their allergies."

Hot weather generally creates a shorter tree pollen season with higher counts, meaning people with those allergies don't get sick for as long, she said.

"I hear that every year that everybody says it's the worst season," said Coates.

After 20 years of collecting data, Coates see no clear overall patterns, because every tree species reacts differently to weather conditions each year.

Allergist Dr. Jason Lee in Toronto also hears patients say it's getting worse.

"It's actually not necessarily the case," Lee said. "Most allergen pollen levels are determined by the number of trees and grasses out there and those levels don't fluctuate that much in total."

Avoidance, medication

Rather, when people develop symptoms and how severe they perceive them varies from year to year because of factors like sinus infections, Lee said.

Dr. Karen Binkley, an allergist and clinical immunologist at the University of Toronto wrote a guide for patients with allergies and asthma.

Lee and Binkley both recommend non-medical approaches first for everyone coping with allergies as well as treatments:

• Keep doors and windows closed to keep out pollen.
• Wear wraparound sunglasses when outside.
• Use a salt water rinse for excess mucous and pollen.
• Use nasal strips at night if congestion is a problem.
• Over-the-counter medications like antihistamines, nasal sprays or eye drops.
• Allergy injections.
• Under-the-tongue tablets for grass allergies.

"When everything else doesn't work, there are allergy injections," Binkley said in an interview on Wednesday.

"They don't work for everybody and they can take up a long time to work, so we usually sort of keep those in reserve for when other things fail."

Allergy patients have to go to a doctor for the weekly allergy shots, which carry a slight risk of anaphylaxis and a 1 in 2.5 million risk of death, Lee said.

Kirsten Cornelson just got her first allergy shot from Lee.

"Runny nose, itchy eyes, my breathing isn't as good because I have asthma," Cornelson said.

Newer option

Previously, she took over-the-counter medications but didn't like the sedating side-effect.

A newer option for grass allergies is a daily pill taken under the tongue to desensitize the immune system to grass pollen.

"Essentially you are slowly escalating the amount of grass pollen you can be exposed to and that seems to induce an immune response," Lee said.

So far, the tablets seem to help for at least one season but they aren't quite as effective as the shots, Binkley said.

A vaccine for grass allergies is also being tested in a clinical trial.

Prof. Mark Larché of McMaster University in Hamilton said those injections could offer the same benefits as allergy shots over a shorter course with fewer side-effects.

With files from CBC's Kim Brunhuber and Melanie Glanz

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Mental health groups say new crime bill fuels stigma

The government's proposed changes to laws dealing with those found not criminally responsible for alleged crimes will fuel a stigma and teach Canadians to be afraid of people living with mental illness, advocates said Tuesday.

Representatives from national mental health organizations were on Parliament Hill to voice their concerns with Bill C-54. The news conference tied in with Mental Health Week in Canada.

Chris Summerville, CEO of the Schizophrenia Society of Canada, said the coalition of groups supports the measures in the bill designed to support victims of crime, but the rest of it is flawed.

"We understand the need to protect Canadians from individuals who commit violent crimes however, this bill as it is currently written will not do this," he said. "What this bill has done is to tell Canadians that they should be afraid of people living with mental illness. Fearing people living with mental illness will only set us back."

The proposed not criminally responsible (NCR) reform act seeks to create a new "high-risk offender" designation for those who have been declared NCR because of mental illness. The high-risk designation would be given by the courts, not the existing review boards that currently determine the timing of an accused's release and his or her supervision afterwards.

High-risk offenders could not be discharged until a court agrees to lift the designation; they would not be eligible for unescorted passes into the community and could have their mandatory review period extended from one year up to three years.

Groups want to amend bill

The bill also aims to give victims of crimes a greater role by providing them with notification upon a person's release, if it is requested. Those found by a court to be NCR are neither convicted nor acquitted. They are kept at mental health facilities until the review board determines they can be released, sometimes with strict conditions.

The government argues the legislation will keep dangerous people in custody and address the concerns of victims.

But the mental health advocates say the legislation won't help reduce crime and that more support for victims shouldn't have to come at the expense of the rights of people with mental illness.

"This is not an issue of give or take but rather one of working together," said Dr. Paul Fedoroff, a member of the board of directors of the Canadian Psychiatric Association and president of the Canadian Academy of Psychiatry and the Law.

Fedoroff said mental health groups were not consulted during the drafting of this bill and they have not been able to get a meeting with Justice Minister Rob Nicholson directly, only his staff. He said they want to work with the government to try and amend the bill so it more fairly deals with people with mental illness.

'All the progress we've made is now being undermined.'—Peter Coleridge, CEO, Canadian Mental Health Association

A proposal to prevent people from leaving hospital grounds, for example, does not contribute to treatment and recovery or the preparation of people for reintegration once they are released, the advocates said.

They said the language in the bill demonstrates a complete lack of understanding about people living with mental illness. They are also concerned about the wider implications the measures could have.

"It's not just the group of people affected by the bill, it has broader ripple effects," said Peter Coleridge, national CEO of the Canadian Mental Health Association. "There is language in the bill that provide labels that fuel stigma."

"All the progress we've made is now being undermined," said Coleridge.

Summerville said language is important and that he doesn't consider people deemed NCR as "criminals."

"They did not do what they did with a criminal mind. It was mental illness," he said.

The review boards already take into consideration the need to protect the public when deciding if an accused found not criminally responsible is ready for release, and balances that with other factors including the mental condition of the accused, the reintegration of the accused into society and the other needs of the accused.

The government wants public safety to be the paramount concern, placing a priority on the severity of the crime, and for victims' needs to be considered and is changing the current legislation to reflect those priorities.

The groups at Tuesday's news conference are concerned the government is trying to correct a problem that doesn't exist and that the changes are not evidence-based.

Criminal justice groups consulted

Low recidivism rates among those deemed not criminally responsible who are later released show that the review board system is working properly, they said.

"Mental illnesses are treatable, we have the best science today to do that and furthermore recovery is possible," said Summerville.

The advocates are also worried that some lawyers may advise clients not to pursue an NCR defence because the penalties and conditions may be less strict in the regular justice system, which would result in people with mental illness being diverted to jails instead of hospitals.

A spokeswoman for Nicholson was asked to address the concern about stigma. Julie Di Mambro responded in an email by quoting Prime Minister Stephen Harper who said: "When atrocious events do occur and the state fails to act, fails to do all it can do to defend innocent citizens, it violates the inherent trust upon which its existence is justified."

Di Mambro also wrote that the bill's measures are responsible and carefully crafted and "are designed to apply to the most dangerous and egregious of cases."

She also said that the provinces and organizations specializing in the criminal justice system were consulted about the bill.

The government says these measures will only apply to a small number of people and only in cases of serious personal injury but that they are necessary to ensure public safety.

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I'm no hero, says pharmacy worker who found diluted chemo drugs

A pharmacy assistant from the Ontario hospital that first detected watered down chemotherapy drugs was praised for his "keen eye," but he doesn't accept the label of "hero."

"It's just part of the process, it's part of our job, and it just happens that this check that we made had a broader impact than we certainly would have anticipated," Craig Woudsma said Tuesday.

The total volume and final concentration were not included on Marchese's chemotherapy bag, Peterborough pharmacy assistant Craig Woudsma said. (CBC)

"But definitely not a hero, no," he said.

Speaking at a meeting of the Ontario legislature's standing committee on social policy, Woudsma, 28, of Peterborough Regional Hospital and senior pharmacy assistant Judy Turner described the chance discovery that revealed cancer drugs administered to 1,200 patients in Ontario and New Brunswick were diluted.

The committee is looking into the oversight, monitoring and regulation of non-accredited pharmaceutical companies in the province.

Last Tuesday, officials from the Peterborough hospital told committee members a red flag went up when an assistant checked the labels on IV bags provided by Marchese Hospital Solutions.

It was the first day that the hospital used the new supplier. A staffer noticed a difference between Marchese's label for the chemo drug gemcitabine and the one from the previous supplier, Baxter.

Woudsma said he began to question what the final concentration per millilitre was, which led to a series of phone calls and emails among hospital staff and the Durham Regional Cancer Centre and Marchese, the committee heard.

Woudsma told the committee he started to ask questions when hospital staff observed that the IV bags from Marchese Hospital Solutions required refrigeration while Baxter's didn't.

Progressive Conservative health critic Christine Elliott is concerned that experienced experts in the health-care system weren't able to catch the problem before so many patients were affected.

"We need to make sure that we have all the checks and balances necessary in the system to make sure that mistakes like this don't happen," Elliott said.

Patients at four hospitals in Ontario and one in Brunswick received IV bags of the chemotherapies cyclophosphamide and gemcitabine that were overdiluted between three and 20 per cent, according to Cancer Care Ontario.

Medbuy executives

On Monday, MPPs at the committee heard executives of Medbuy, the London,-based company that awarded the contract for intravenous chemotherapy drugs to Marchese Hospital Solutions in 2011.

Medbuy officials said Marchese pharmacists didn't account for the overfill of saline and assumed the entire bag would be given to a single patient.

Medbuy's "testimony was in stark contrast to that of Marchese, the supplier of diluted chemo drugs," France Gélinas, an NDP MPP for Nickel Belt, said during Question Period.

"But to Ontario's patients, all they see is a lot of finger pointing, but none of the accountability, none of the oversight that they know is needed. Will the minister admit that her office stood back and did nothing while oversight of our health-care system vanished?"

Ontario's Health Minister Deb Matthews replied: "I completely reject that notion.

"We have learned that there are steps that need to be taken and that are being taken to be able to give the assurance to patients that when their doctor orders a drug, they get exactly that drug in exactly the concentration that was ordered."

Last week, Marita Zaffiro, the president of Marchese Hospital Solutions, appeared before the same committee and said it prepared pre-mixed cancer medications under the supervision of qualified pharmacists and according to the contract it was awarded by Medbuy.

MPPs have been asking hospital staffers and officials from the health ministry and pharmacy college about the regulatory grey zone surrounding Marchese Hospital Solutions' mixing services, which was not accredited by the Ontario College of Pharmacists.

Health Canada and the provinces and territories say they are working to improve oversight, including inspections of companies like Marchese Hospital Solutions that aren't federally licensed as manufacturers or provincially accredited as pharmacies, while they look for a long-term solution.

With files from The Canadian Press and CBC's Kas Roussy

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New coronavirus case confirmed in France

A 65-year-old Frenchman is hospitalized after contracting France's first case of a deadly new respiratory virus related to SARS, and French health authorities said Wednesday they are trying to find anyone who might have been in contact with him to prevent it from spreading.

It's unclear how or where the man was infected with the novel coronavirus, which has killed 18 people in four countries and raised new public health concerns since being identified last year in the Middle East. It can cause acute pneumonia and kidney failure.

A novel coronavirus has killed 18 people in four countries. (Beth Fischer/Canadian Press)

The Frenchman fell ill after returning from a trip to the United Arab Emirates, the Health Ministry said. He has been under isolation and medical surveillance at a hospital in Douai in northern France since April 23, and is receiving respiratory assistance and blood transfusions, said Jean-Yves Grall, the government health director.

Paris' Pasteur Institute analyzed the man's virus and confirmed that it is a novel coronavirus, the ministry announced Wednesday.

Since September 2012, the World Health Organization has been informed of 30 confirmed cases of the virus, and 18 of the patients have died. Cases have been emerged in Saudi Arabia, Jordan, the UAE, Qatar, Britain and Germany, and health officials have said the virus has likely already spread between people in some circumstances.

France's health minister, Marisol Touraine, said "this is an isolated case" in France but said authorities are "fully mobilized" to prevent it from spreading. Authorities are trying to reach anyone who was in contact with the patient before he was hospitalized, and a national hotline was established Wednesday for the public to call about the virus.

WHO has advised countries to test any people with unexplained pneumonia.

"Any virus that has the potential to develop into something that is highly transmissible between people, including the coronavirus, is a major concern," WHO spokesman Gregory Hartl said.

"We need to follow up on all possible routes of infection, i.e. animal to human, whether it's being spread in hospitals or from human-to-human," he said.

Health authorities are trying to determine how humans are contracting and spreading the virus and how best to treat it. It does not appear to be as contagious as SARS or the flu, but it has probably spread between people who had close contact. It seems to have spread among family members in Britain and in health workers in Jordan who were caring for patients, for example.

The new coronavirus is most closely related to a bat virus and scientists are considering whether bats or other animals like goats or camels are a possible source of infection.

"We still don't know the animal reservoir of this virus or the source of exposure," Hartl said. "We need a solid epidemiological investigation to nail down a common behavior between patients...All we can tell people at the moment is they should be very vigilant about their basic hygiene practices."

He said it's unclear whether there is something specific in the environment in the Middle Eastern countries where cases have been confirmed.

Several cases have been reported in Saudi Arabia. In the most recent Saudi outbreak, the Health Ministry has said five people have died and at least five others are hospitalized with confirmed cases of the virus.

SARS, or severe acute respiratory syndrome, killed some 800 people in a 2003 epidemic.

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Early infant mortality in Canada called 2nd worst in developed world

Babies born in Canada have a surprisingly high likelihood of dying on the day of their birth, a new study suggests.

A report from international aid organization Save the Children assessed infant mortality data from 176 countries worldwide, focusing specifically on how many newborns are able to survive beyond their first day out of the womb.

Canada does not seem able to break below the rate of five deaths per 1,000 live births, experts say. (iStock)

The report said Canada had the second-highest rate of first-day infant mortality in the industrialized world, with roughly 900 babies — or 2.4 per 1,000 births — ending in early tragedy.

Only the United States posted a higher number of babies who die within their first 24 hours on earth, with 11,300 or 2.6 per 1,000 births.

Switzerland rounded out the top three with 2.2 first-day deaths per 1,000 births, Save the Children said, noting the three countries fell well short of the nations that boast a first-day mortality rate of just 0.5.

Cyprus, Estonia, Iceland, Luxembourg, Singapore and Sweden all boast that distinction, the report said.

Experts said Canada's poor results come as little surprise, noting infant mortality rate has been an issue of increasing concern for the past several years.

Dr. Janet Smylie, a physician in the department of family and community medicine at Toronto's St. Michael's Hospital, said Canada's infant mortality rate — or number of babies who die within their first year of life — has averaged around five per 1,000 births for the past decade.

Smylie said that number is driven higher by the mortality rate for aboriginal infants, adding some First Nations populations register mortality rates of up to four times the national average.

"At the root of it is a distribution problem," Smylie said in a telephone interview. "We're an affluent country, but at a systems level we're still not distributing all of our health and social resources equally to all groups."

Smylie said the social imbalance that sees aboriginals struggling with higher than average levels of poverty is compounded by the country's geography. Canada's vast size ensures that people living in remote northern communities often have to travel dozens, even hundreds, of kilometres to receive proper maternity care, Smylie said.

Such factors drive up infant mortality within the first year and by extension those infants who do not survive their first 24 hours on earth, she said.

Fertility treatment advances

But Smylie said some of Canada's results may also be attributable to its scientific advancements.

Physicians in the U.S. and Canada have a wide range of technology at their disposal to bring infants into the world before they've reached full term, she said. Since all live births are counted in most countries' mortality data, she said the number of premature births — induced or otherwise — may have an impact on the overall figures for developed nations.

"Some of the technologies in advanced maternity care, particularly when you're speaking of multiples [births], you might actually have 23 or 22 weekers born alive, but their mortality rate is very high," she said.

In a 2012 report on infant mortality, the Conference Board of Canada also suggested advancements in fertility treatments that result in more multiple, high-risk births may also be driving Canada's overall numbers higher.

Still, the board report concluded Canada falls well below other comparable countries, including fellow members of the Organization for Economic Co-operation and Development.

"The fact that Canada does not seem able to break below the rate of five deaths per 1,000 live births, while 14 peer countries already have, suggests that further attention must be paid to better understanding international differences in infant mortality rates — whether they are due to methodological or socio-economic factors, or both," the report said.

While Canada's numbers may seem elevated compared to their industrialized peers, Save the Children said Tuesday they account for just a fraction of all first-day infant deaths.

Developed nations account for less than two per cent of the global total, adding most of the countries with high numbers are located in subsaharan Africa.

Somalia had the highest first-day mortality rate with 18 of every 1,000 babies dying within their first 24 hours.

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Putting pacifier in your mouth may be good for baby

Parents who clean their baby's pacifier by sucking on it and giving it back to the child might be helping to protect the baby from developing allergies, a small study suggests.

"Ick" factor aside, the transferring bacteria from adults' mouths to infants may help to train their developing immune systems to better recognize true threats rather than overreacting to harmless proteins called allergens, researchers speculate.

Newborns are exposed to a complex mix of microbes from their mother during childbirth. (Claudia Daut/Reuters)

"Parental sucking of their infant's pacifier may reduce the risk of allergy development, possibly via immune stimulation by microbes transferred to the infant via the parent's saliva," Dr. Bill Hesselmar, an associate professor at Queen Silvia Children's Hospital, in Gothenberg, Sweden, and his co-authors concluded in Monday's issue of the journal Pediatrics.

For the study, researchers examined 184 infants for clinical allergy when any symptoms first occurred, and again at 18 months of age. A subgroup of 174 were followed until 36 months of age.

The researchers chose to include babies from families with at least one allergic parent to try to look for differences in immune responses.

The investigators used DNA fingerprinting of bacteria from parents and babies to obtain "suggestive evidence" of how pacifier cleaning may influence the makeup of bacteria in the infant's saliva.

Pacifier cleaning offered additional and independent protective effects against developing eczema separate from the benefits of a vaginal delivery, when newborns are exposed to a complex mix of microbes from the mother, the researchers said.

Dr. Tom Glass, a professor of forensic sciences, pathology and dental medicine at Oklahoma State University, presented research at the American Society for Clinical Pathology in Boston last November that found a wide range of disease-causing bacteria, fungus and mold on children's pacifiers.

Glass said he's long advocated that parents put a pacifier into their mouth to clean it because adult saliva helps fight bacteria.

The researchers weren't able to specifically identify which bacteria were transferred. They are planning a longer study to see if the pacifier methods could reduce allergy development.

The study was funded by the Swedish Research Council, the Vardal Foundation, the European Commission, the Swedish Asthma and Allergy Association Research Foundation, the Torsten and Ragnar Soderberg Foundation, Gotenburg Medical Society and the Cancer and Allergy Foundation.

With files from The Canadian Press

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Chemo IV drugs weren’t properly labelled, firm says

Executives from Medbuy, the company that arranged hospitals' contracts for intravenous chemotherapy drugs, told an Ontario legislature committee that the labels on the IV bags didn't accurately describe the contents.

The executives testified Monday at Ontario's standing committee on social policy, which is looking into diluted chemotherapy treatments given to about 1,200 cancer patients in Ontario and New Brunswick.

Medbuy, a London, Ont.-based group purchasing organization, works with hospitals to reduce the cost of their health-care supplies, such as medication and surgical masks.

Marchese Hospital Solutions and the hospitals differed in their interpretations of how the chemotherapy IV bags would be used. (CBC)

Until Monday, no one from the company had spoken publicly about its role as a broker between five hospitals — including four in Ontario and one in New Brunswick — and Marchese Hospital Solutions, which won a contract to produce intravenous chemotherapy mixtures.

Last week, Marita Zaffiro, the president of Marchese Hospital Solutions, which supplied the chemotherapy drugs cyclophosphamide and gemcitabine, testified that the chemo was made according to Medbuy's contract.

The four Ontario hospitals have told members of the standing committee on social policy at Queen's Park that they used the IV bags of chemotherapy for multiple patients.

Zaffiro said her company believed each bag was intended for a single patient, so any excess saline would not result in an overdilution.

Hospitals have said that Marchese's bags were labeled with the volume and amount of drug only.

Kent Nicholson, CEO of Medbuy, and Michael Blanchard, the company's vice-president of pharmacy, testified Monday, with Blanchard saying the problem is that the bags' labels from Marchese did not accurately describe the contents.

"This particular issue could have been avoided had the label correctly indicated what was the contents of the bags. Their ability to admix is not in question," Nicholson told reporters after the hearing.

"If the label had accurately described what was in the bag, we would not have had an issue here."

Nicholson said the bags contained more gemcitabine — four grams of it — than would be given to a single patient, adding that a qualified pharmacist would know that.

Admixing is the bulk mixing or compounding of drugs for multiple patients, who may be in different locations, without individual prescriptions.

Previously, the committee heard that Medbuy bought the chemotherapy treatments from Marchese Hospital Solutions of Mississauga, which won the contract from longtime supplier Baxter in late 2011 after a public bidding process.

MPPs have been asking hospital staffers and health ministry officials about the regulatory grey zone surrounding Marchese Hospital Solutions' mixing services, which was not accredited by the Ontario College of Pharmacists.

Health Canada and the provinces and territories are working to improve oversight, including inspections of companies like Marchese Hospital Solutions that aren't federally licensed as manufacturers or provincially accredited as pharmacies, while they look for a long-term solution.

A "communication issue" at the hospitals contributed to the overdilution issue, Zaffiro said.

The communication issue is separate from the questions about federal and provincial jurisdiction.

With files from CBC's Genevieve Tomney and Melanie Glanz

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Millions of baby deaths preventable, Save the Children says

Worldwide, the riskiest day of a child's life is the first day, says a report from Save the Children, which also suggests inexpensive strategies to reduce the annual toll of more than one million babies that die the day they are born.

The report released Tuesday compiles a list of birth-day death rates for 186 countries and provides an annual Mothers' Index, which examines the best and most difficult countries in the world to be a mother.

Finland tops the ranking of 176 countries based on the health of women and children, education, economic well-being and female participation in politics, while Congo ranks at the bottom. Canada sits in 22nd spot, ahead of the U.S. in 30th place.

Although only one per cent of newborn deaths occur in industrialized countries, the U.S. has the highest first-day death rate among developed countries, followed by Canada and Switzerland.

Globally, child mortality has declined by more than half since 1970, the report says, even as the world population has doubled, but a rising share — 43 per cent — is occurring in the first month of life, a toll of 19,000 babies each day. Each year, about one million babies will die the day they are born — three million within the first month — and about three-quarters of those deaths are preventable, Save the Children says.

The report identifies three major causes of newborn mortality — birth complications, premature birth and infections — and says that universal access to products that cost between 13 cents and $6 each could save more than one million babies a year. The recommended products are:

• Steroid injections for women in preterm labour (to reduce deaths due to premature babies' breathing problems).
• Resuscitation devices (to save babies who do not breathe at birth).
• Chlorhexidine umbilical cord cleansing to prevent infections.
• Injectable antibiotics to treat newborn sepsis and pneumonia.

U.S., Canada lag

By country, first-day deaths occur most in India (more than 300,000 each year), while the highest first-day death rate is in Somalia (18 per 1,000 live births). Luxembourg, Singapore and Sweden have the lowest death rate (less than 0.5 per 1,000 live births).

Although first-day mortality is most severe in the developing world, Save the Children notes that among industrialized countries the U.S. has by far the highest newborn mortality, with 60 per cent of first-day deaths but only 38 per cent of live births. Some U.S. counties have first-day death rates similar to those in developing countries, the report says.

The U.S. pre-term birth rate is the second-highest in the world, and complications from premature births are the cause of more than 35 per cent of newborn deaths in the U.S. The U.S. has the highest adolescent birth rate of any industrialized country, and teen mothers tend to be poorer, less educated and receive less pre-natal care.

Mothers' Index

European countries and Australia hold top position in Save the Children's Mothers' Index, while countries in sub-Saharan Africa rank at the bottom. The U.S. and Canada sit in 30th and 22nd spot respectively.

Finland ranks at the top of the Mothers' Index, based on strong showings in all five indicators of the index, which are:

• Lifetime risk of maternal death.
• Under-five mortality rate.
• Expected years of formal schooling.
• Gross national income per capita.
• Participation of women in national government.

Congo ranked in the bottom 12 per cent of countries in all five categories.

In a foreword to the report, Melinda Gates of the Bill & Melinda Gates Foundation writes that saving newborn lives "will prevent incalculable suffering. It is also a vital piece of the global development agenda. The long-term economic prospects of poor countries depend on investments in the health, nutrition and education of the people, particularly the women and young children living there."

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Hospital assistants who found diluted cancer drugs to testify

Two pharmacy assistants from the hospital that first detected overdiluted intravenous chemotherapy will testify at an Ontario legislature committee today.

It was a chance discovery by a pharmacy assistant at a Peterborough, Ont., hospital that revealed cancer drugs administered to 1,200 patients in Ontario and New Brunswick were diluted.

Technicians Craig Woudsma and Judy Turner of Peterborough Regional Hospital are scheduled to speak at Ontario's standing committee on social policy, which is looking into the oversight, monitoring and regulation of non-accredited pharmaceutical companies in the province.

Last Tuesday, officials from the Peterborough hospital told committee members a red flag went up when an assistant checked the labels on IV bags provided by Marchese Hospital Solutions.

It was the first day that the hospital used the new supplier. A pharmacy technician noticed a difference between Marchese's label for gemcitabine and the one from the previous supplier, Baxter.

The technician began to question what the final concentration per millilitre was, which led to a series of phone calls and emails among hospital staff and the Durham Regional Cancer Center and Marchese, the committee heard.

Patients at four hospitals in Ontario and one in Brunswick received IV bags of the chemotherapies cyclophosphamide and gemcitabine that were overdiluted between three and 20 per cent, according to Cancer Care Ontario.

Medbuy executives

Yesterday, MPPs at the committee heard executives of Medbuy, the London,-based company that awarded the contract for intravenous chemotherapy drugs to Marchese Hospital Solutions in 2011.

Medbuy officials said Marchese pharmacists didn't account for the overfill of saline and assumed the entire bag would be given to a single patient.

Last week, Marita Zaffiro, the president of Marchese Hospital Solutions, appeared before the same committee and said it prepared pre-mixed cancer medications under the supervision of qualified pharmacists and according to the contract it was awarded by Medbuy.

MPPs have been asking hospital staffers and officials from the health ministry and pharmacy college about the regulatory grey zone surrounding Marchese Hospital Solutions' mixing services, which was not accredited by the Ontario College of Pharmacists.

Health Canada and the provinces and territories say they are working to improve oversight, including inspections of companies like Marchese Hospital Solutions that aren't federally licensed as manufacturers or provincially accredited as pharmacies, while they look for a long-term solution.

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Doctors writing prescriptions to get patients active

Canadian doctors are increasingly turning to prescriptions of exercise as a means to prevent and treat a host of illnesses.

In Leduc, Alta., south of Edmonton, family doctors realized the authoritative impact of a physician's prescription.

For a year, they've handed out "Prescriptions to Get Active" — complete with check boxes for the intensity, duration and type of physical activity — to patients they consider healthy but at risk for obesity and chronic diseases.

Exercise is part of Kimberley Harris's recovery prescription. (CBC)

"There is a sense of tangibility and authoritativeness to a prescription," said Dr. Justin Balko, a family physician and president of the Leduc Beaumont Devon Primary Care Network. "People understand what a prescription is. They know it's not just a good idea. It's a health expert telling them that they want to do this for their own health."

Balko said more than 200 individuals have taken up the recommendations by signing up with a city's recreation centre, which offers a free month-long membership as part of the program. Of those who signed up for the month free, nearly 30 per cent continued with long-term memberships. Other patients may be getting fit on their own.

Balko was inspired by researchers in New Zealand. Since 2003, they've published studies in medical journals showing how doctors' prescriptions for exercise in that country can increase physical activity in adults by 10 per cent for at least a year.

Participants in Alberta are also provided time with an exercise specialist, who gets them accustomed to the facility and its equipment and who helps reduce barriers to getting active.

Family physician Dr. Justin Balko writes exercise prescriptions. (CBC)

For the family doctors, the printed prescription pads are quick and easy to fill out, similar to the scripts they commonly use for medications.

At Toronto Rehab hospital, doctors have found that people living with heart disease who exercise regularly have a 50 per cent lower chance of dying than cardiac patients who don't work out.

Making doctors champions of exercise

"We think that exercise is helpful in every condition that we could think of," said Dr. Paul Oh, medical director of the cardiovascular prevention and rehabilitation program. "For brain health, for heart health, for cancer, for arthritis, the benefits are so large."

For an exercise prescription to be a success, doctors need to spend a few minutes counselling patients, setting up goals and an action plan, something Oh acknowledged that doctors aren't well trained to do. He said there's a movement afoot to train physicians to be better prescribers and champions of exercise.

Kimberley Harris, 42, goes to Toronto Rehab to follow her prescription to walk an 18-minute mile twice a day and lift light weights two or three times a week, all in the hopes of delaying the heart transplant she needs.

Harris was born with a very rare heart condition. Following reconstructive heart surgery as a teen, she had a heart attack in her mid-30s and now has a mechanical valve and an implanted defibrillator.

"It is part of my recovery prescription," Harris said of the exercise routine. "It is just as good as the eight drugs that I take daily. It helps my head a lot more than the drugs do."

Harris said that without the support and accountability provided by her health-care team — which includes doctors, nurses or nurse practitioners, dietitians, exercise rehabilitation supervisors, lab technicians, a psychologist and a social worker — she wouldn't follow through.

"It keeps you on track," said Harris. "It is so easy to go home and sit in your house and say, 'Oh, I am feeling sick. I don't want to do anything.' You are not allowed to do that here. You have to keep on track, it's a much more structured program."

Harris said she wishes the health-care system that caters to people after they're sick would pay more attention to preventing illness, particularly in congenital patients like herself.

With files from CBC's Kelly Crowe and Terry Reith

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Narcotics safety act called short on consultation

An act before the P.E.I. legislature to give the government tighter control over the prescribing of narcotics should have been subject to more consultation, says the Opposition.

The proposed Narcotics Safety and Awareness Act requires medical professionals keep records of prescriptions for narcotics, and gives government the ability to monitor and notify the authorities if it suspects over-prescribing.

Steven Myers says it's not too late for government to consult doctors on the Narcotics Safety and Awareness Act. (CBC)

The legislation provides for fines of up to $20,000 and jail terms of up to a year for offenders.

Opposition leader Steven Myers says government should have consulted more widely with doctors in drafting the legislation. Myers noted prescription drug abuse is becoming a serious issue amongst youth on the Island.

"We need to do everything we can do to fix the problem," he said.

"It's important to consult to make sure that the steps that we're taking are clear and concise, and actually attack the problem."

Health Minister Doug Currie said there were minimal consultations with doctors, and he sees nothing wrong with that.

"We didn't roll out an extensive consultation with the physicians in the province. I don't feel that was necessary," said Currie.

"I recognize that drug therapy in a range of different settings is important for treatment. But I also recognize we're seeing intense growth in the level of opioids and painkillers in the province."

Myers said he'd like to see government spend the remaining time of the fall sitting of the legislature consulting with doctors, law enforcement and families on the problem of prescription drug abuse.

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Q & A with two of the most powerful people in Canadian health care

Two of Canada's most powerful medical organizations are led by Hamiltonians, putting two local doctors in the centre of the key debates affecting health care for Canadians.

Dr. Anna Reid is the President of the CMA and moved to from Kenya to Dundas when she was six. Dr. Reid has a degree in wildlife biology, and a medical degree. She has also completed critical care and trauma training. Dr. Reid has served as Chief of Staff of Kootenay Lake Hospital, and President and Chair of the Medical Advisory Committee. She currently practices in Yellowknife, and has been President of the CMA since 2011.

Dr. Scott Wooder is the president of the OMA, and was sworn in on May 4, 2013. Practicing as a family physician in Stoney Creek for 27 years, Dr. Wooder is 132nd President of the OMA.

Both doctors agree that a healthy population equals a healthy economy but there are some issues facing healthcare provincially and nationally.

What are some issues facing healthcare?

Dr. Wooder: "Getting good quality care to our patients, making sure that they have access to the care they need."

Dr. Reid: "Traditionally in medicine, in the medical care system, we are very poor at measuring anything. We're actually far behind other industries. We're way behind the aviation industry in things such as safety and measurements, and those sorts of things. It's an unbelievably complex system to measure as you can probably imagine, so it's very hard to assess what you do in the system unless you actually measure outcomes. A lot of our work is trying to look at ways to put into place accountability measures. I don't mean that in a negative sense, but how do we find a way to measure the outcomes of what we do, and if they're not working figure out how to improve on them."

Dr. Anna Reid has been President of the CMA since 2011.

"We need to make the system work around the needs of the patient, and not so much around the needs of the institutions that run the system."

How does Hamilton compare to the rest of Ontario?

Dr. Wooder: "I think Hamilton has some really big advantages. We have a very good hospital system, there's a lot of co-operation between the two hospitals. The university is a huge asset, so there's lots of learners, lots of very high quality teaching, some world-class research and I think it leads to excellence in clinical care, too. In the community there is a very progressive primary care system, family doctors working with other providers."

Dr. Reid: "I think Hamilton, in some ways, has been a bit of a leader with the town council trying to address some of these [healthcare] problems, that maybe don't happen as well in other cities."

Dr. Wooder: "We want to take a leadership role. We want to work with other providers, other stakeholders like hospitals, nurses, CCAC [Community Care Access Centre] patients... and we think we need a province wide plan on developing a comprehensive end of life plan."

150 physicians in Hamilton make the city the largest family health care team in Ontario.

Where can Hamilton improve?

Dr. Scott Wooder is the president of the OMA. He was sworn in on May 4, 2013. (Ontario Medical Association)

Dr. Wooder: "The whole social determents of health issue. Where people in the city core have worse health outcomes than people in the affluent suburbs. They have higher smoking rates, higher rates of obesity, less education, more illiteracy — it leads to worse health outcomes."

What is palliative care and why is it important?

Dr. Wooder: "It's part of end of life care, when the goal shifts from extending the person's life to relieving symptoms."

"Hamilton has some strong advantages; there's a regional palliative care team who will go out to people's houses to provide care, and also do consultations. I'm a family physician and I do palliative care in my patient's homes."

What about childhood obesity and early education?

Dr. Wooder: "It has such an effect on people's health throughout their lives, and there's some real positive things we can do to prevent illness. It's much better to prevent illness than to treat it. Things like exercise programs, physical education in schools, calorie labeling in chain restaurants, general education about proper eating and food guides"

Dr. Reid: "If you invest in early childhood development and education your return on your investment is anywhere from 1:6 to 1:8 times"

Dr. Reid: "Things such as understanding early stimulation of kids in a way that's interactive … getting them interested in books and in reading from an early age, and interested in learning. Exposing kids to various experiences where their imagination and interests are peaked."

What kind of social programs do we need to put into place to help create a healthier city?

Dr. Wooder: "Smoking is a huge thing."

"I think we especially need to focus on young women and children, and keep people from starting to smoke."

Dr. Reid: "We need to find venues and programs to actually get kids out, and get them socialized with other kids and other adults, and get them curious about the world and learning how to play."

What are some social determinants that affect health?

Dr. Reid: "The number one social determinant which affects your health and your longevity is your income level. The second most important social determinant that leads to your health is actually your early childhood development and education."

"We know it's key that we have to start getting governments at all levels, federal, provincial, and municipal, as well as community leaders, businesses, schools, police, everyone involved in addressing these issues of severe poverty, and these other socioeconomic determinates of health."

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Flu shots safe for children with inflammatory bowel disease

Getting a flu shot doesn't exacerbate inflammatory bowel disease in children and teens and may even protect them from flare-ups, a new study suggests.

Children who suffer from inflammatory bowel disease are encouraged to get flu shots every year, because the drugs they take weaken their ability to fend off infections.

A doctor hopes the findings will persuade parents of children with inflammatory bowel disease to ensure their kids get a flu shot every year. (Jeff McIntosh/Canadian Press)

But some of these patients are worried about getting the shots because there have been reports the flu vaccine can cause their disease to flare.

So several Ottawa researchers did a study to see if that was true; their work is in this week's issue of the journal Pediatrics.

Lead author Dr. Eric Benchimol says the findings show that getting a flu shot doesn't lead to flare-ups in these patients.

Children with inflammatory bowel disease cannot use the inhaled flu vaccine, which contains live but weakened viruses; they can only get the shot, which contains killed flu viruses.

Inflammatory bowel disease is an umbrella term for conditions of the small intestines and colon such as Crohn's disease and ulcerative colitis.

Benchimol, a pediatric gastroenterologist from the Children's Hospital of Eastern Ontario, says Canada has among the world's highest rates of inflammatory bowel disease in both children and adults, with about one in 200 Canadians affected. Rates appear to be climbing sharply among kids under the age of 15.

The reason for the high rates isn't known, though it is suspected some environmental factor may be at play.

Using administrative data for Ontario, Benchimol and his co-authors looked at records for all children under the age of 19 with inflammatory bowel disease between 1999 and 2009.

They did several analyses, comparing their rates of hospital or outpatient visits during flu seasons when they got a shot to those when they didn't. They also compared them to children who were like them in age, gender and other characteristics, but who didn't have inflammatory bowel disease.

Only about a third of the inflammatory bowel group got flu shots, though fewer of the other children did.

The researchers saw no real increase in health-care use after the inflammatory bowel patients got flu shots. And they appeared to use health care less in the years when they got a flu shot, suggesting the vaccine might have been protective, Benchimol says.

That would make sense, he explains. Often when these patients contract infections — stomach bugs or colds or flu — they will experience an episode of disease activity.

"Everybody in the house gets it and everyone else gets better but the IBD patient kind of flares up and starts having blood in their stool and other symptoms," he says.

He says the authors hope these results will persuade the parents of children with inflammatory bowel disease that these kids should get a flu shot every year.

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Cancer drug Avastin tied to 2 cases of flesh-eating disease in Canada

The cancer-treatment drug Avastin has been linked to 52 cases of flesh-eating disease worldwide, including one that resulted in death in Canada.

Health Canada issued a warning today in conjunction with the drug's manufacturer, Hoffmann-La Roche Ltd., echoing an earlier one from the U.S. Food and Drug Administration. It offered no specific details on two Canadian cases.

Severin Schwan is the CEO of the Roche group, the global pharmaceutical company that makes Avastin. (Christian Hartmann/Reuters)

Avastin is used either alone to treat a particular type of brain cancer (glioblastoma), or in combination with chemotherapy to treat cancers that have spread to other parts of the body such as colon, rectal and lung cancer.

"Roche has conducted a comprehensive safety review that has identified 52 serious case reports of necrotizing fasciitis that occurred between November 1997 and September 2012, worldwide," the company said in a letter to health-care professionals posted on Health Canada's website.

"Two of these reports occurred in Canada. A total of 17 of the global cases reported a fatal outcome, including one Canadian death."

The agency said that necrotizing fasciitis is a severe, fast-moving and life-threatening bacterial infection of the skin and soft tissue. It can be brought on by a number of conditions and is the disease that threatened former Quebec premier Lucien Bouchard in the early 1990s.

People who have diabetes or cancer have a greater risk of developing necrotizing fasciitis because their immune system responses are lowered.

Anyone taking Avastin who notices unusual signs or symptoms should contact their health-care professional immediately. (CBC)

The FDA issued a similar warning in mid-March, indicating that cases have mainly been seen in people who had wound-healing complications, gastrointestinal perforations or fistulas.

Health Canada and Roche said about two-thirds of the cases occurred in people treated for colorectal cancer. Of the worldwide cases, 21 had gastrointestinal perforation, fistula formation or wound healing complications before the necrotizing fasciitis developed.

All of the patients were receiving other chemotherapies besides Avastin, and some patients did not have any other risk factors.

Roche will be working with Health Canada to revise the drug's labelling information.

Symptoms can develop rapidly, sometimes within 24 hours of a minor skin injury or surgical wound, Health Canada said.

Symptoms include sudden, severe pain in the affected area, fever, redness, heat, swelling or fluid-filled blisters in the skin, scaling, peeling, or discoloured skin over the affected area.

"Health Canada recommends that patients who are taking Avastin continue using the drug and to visit their health-care provider if there are any concerns," a spokesperson for the department said.

"If necrotizing fasciitis occurs, Avastin administration should be discontinued. Your health-care professional will decide whether Avastin can be re-administered."

The warning says that anyone taking Avastin who develops these symptoms or notices other unusual signs or symptoms should contact their health-care professional immediately.

Accurate diagnosis and prompt treatment with antibiotics through a vein and surgery are important when treating cases of necrotizing fasciitis, the U.S. Centers for Disease Control and Prevention says.

With files from The Canadian Press

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More allergies in children reported in U.S. survey

Parents are reporting more skin and food allergies in their children, a big U.S. government survey found.

Experts aren't sure what's behind the increase. Could it be that children are growing up in households so clean that it leaves them more sensitive to things that can trigger allergies? Or are mom and dad paying closer attention to rashes and reactions, and more likely to call it an allergy?

Jeff Glazer guides his allergy-sniffing dog, Riley, through a dugout of a ball field to ensure there are no peanut products or residue that could trigger his life-threatening allergic reactions. (Jessica Hill/Associated Press)

"We don't really have the answer," said Dr. Lara Akinbami of the U.S. Centers for Disease Control and Prevention, the senior author of the new report released Thursday.

The CDC survey suggests that about 1 in 20 U.S. children have food allergies. That's a 50 per cent increase from the late 1990s. For eczema and other skin allergies, it's 1 in 8 children, an increase of 69 per cent. It found no increase, however, in hay fever or other respiratory allergies.

About seven per cent of Canadians self-report a food allergy, but the prevalence of physician-diagnosed food allergy is about five to six per cent for young children and three to four per cent for adults, according to Health Canada.

Already familiar with the trend in food allergies are school nurses, who have grown busier with allergy-related duties, like banishing peanuts at school parties or stocking emergency allergy medicine.

Sally Schoessler started as school nurse in 1992 in New York state, and didn't encounter a child with a food allergy for a few years. But by the time she left school nursing in 2005, "there were children in the majority of classrooms" with the disorder, said Schoessler, who now works at the National Association of School Nurses in Silver Spring, Md.

Food allergies tend to be most feared; severe cases may cause anaphylactic shock or even death from eating, say, a peanut. But many food allergies are milder and something children grow out of. Skin conditions like eczema, too, can be mild and temporary.

It's been difficult getting exact numbers for children's allergies, and the new report isn't precise. It uses annual surveys of thousands of adults interviewed in person. The report compares answers from 1997-1999 to those from 2009-2011.

Parents were asked if — in the previous year — their child had any kind of food or digestive allergy, any eczema or skin allergy, or any kind of respiratory allergy like hay fever.

The researchers did not ask if a doctor had made the diagnosis or check medical records. So some parents may have been stating a personal opinion, and not necessarily a correct one.

"We see a lot of kids in clinic that really aren't" allergic to the foods their parents worry about, said Dr. Morton Galina, a pediatric allergist at Atlanta's Emory School of Medicine.

Eczema explanations

For example, hives are sometimes blamed on a certain food when a virus was the actual cause, he added.

But experts also said they believe there is a real — and unexplained — increase going on, too.

One of the more popular theories is "the hygiene hypothesis," which says that exposure to germs and parasites in early childhood somehow prevents the body from developing certain allergies.

The hypothesis argues that there is a downside to America's culture of disinfection and overuse of antibiotics. The argument has been bolstered by a range of laboratory and observational studies, including some that have found lower rates of eczema and food allergies in foreign-born children in the U.S.

There could be other explanations, though. Big cities have higher childhood allergy rates, so maybe some air pollutant is the unrecognized trigger, said Dr. Peter Lio, a Northwestern University pediatric dermatologist who specializes in eczema.

Some suspect the change has something to do with the evolution in how foods are grown and produced, like the crossbreeding of wheat or the use of antibiotics in cattle. But Lio said tests haven't supported that.

Emory's Galina said the new CDC statistics may reflect a recent "sea change" in the recommendations for when young children should first eat certain foods.

In families with a history of eczema or food allergies, parents were advised to wait for years before introducing their young children to foods tied to severe allergies, like peanuts, milks and eggs. But professional associations changed that advice a few years ago after research suggested that allergies were more likely in those kids when the foods were delayed.

The old advice "was exactly the wrong thing to do," and could have contributed to some of the increased cases, Galina said.

The CDC report also found:

• Food and respiratory allergies are more common in higher-income families than the poor.
• Eczema and skin allergies are most common among the poor.
• More black children have the skin problems, 17 per cent, compared to 12 per cent of white children and about 10 per cent of Hispanic children.

The mother of a 13-year-old girl, who is black, runs an eczema support group in suburban Washington, D.C. Renee Dantzler says roughly half the families in her group are African-American. Eczema is an itchy skin condition, which often occurs on the arms or behind the knees. The cause isn't always clear.

Her daughter, Jasmine, started getting rashes at 6 months and got much worse when she was 4.

"Her whole body would flare. If she ate something, you would kind of hold your breath," Dantzler said. "And she's allergic to every grass and tree God made."

Her daughter took to wearing long sleeves and pants, even in hot weather, so people wouldn't see her skin scarred — and whitened in spots — from scratching. She began to improve about four years ago with steroid creams and other treatments and has gradually become less self-conscious about her skin, Dantzler said.

She's now on a school track team, which means wearing shorts.

"She's the only one on the team with long socks," her mom said.

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Ottawa teen with autism finds place to stay

A teenager with autism whose parents said they couldn't care for him anymore has found a semi-permanent place to stay.

Amanda Telford left her 19-year-old son Philipp at a provincial Developmental Services Ontario office on Tuesday, saying his family was exhausted and couldn't keep him safe.

Philipp has a severe form of autism that leaves him unable to speak. He functions at the level of a two-year-old and has Tourette's syndrome and insulin-dependent diabetes.

His mother said Thursday the agency has found temporary space for him at an Ottawa group home.

Space available for weeks or months

She said she was told that space would be available for weeks, maybe even months.

He'll also be getting medical care for his diabetes from a Community Care Access Centre

Philipp spent the first few nights after being given up at a south Ottawa hospice, one his mother said he'd been going to off and on since he was 16 years old.

Amanda Telford says three incidents over the weekend made her realize she can't keep her son Philip safe any longer. (CBC)

She told CBC News on Tuesday the breaking point for her family was last weekend, when Philipp wandered away twice and swallowed 14 blood pressure pills in one sitting.

She said she'd been in contact with all levels of government and had been told there was no room for her son in the crowded, under-funded social system.

Autism Ontario said Friday the lack of specific mention of autism in Thursday's provincial budget is concerning, especially the "unacceptable" general lack of commitment to addressing adults in crisis.

The group said in a news release it is encouraged by efforts to reduce wait times and help students transition at school.

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Saudi Arabia reports 3 new coronavirus cases

Saudi Arabian authorities are reporting three more infections with the new coronavirus, bringing to 10 the total cases they have reported in recent days.

The cases have all occurred in the same area of the country, a worrying sign.

A colourized transmission electron micrograph of a coronavirus. Some coronavirus infections can cause severe pneumonia. (Beth Fischer/Associated Press)

At least one of the new cases is a family member of an earlier case, which might suggest person-to-person spread of the virus.

The country's deputy minister of health is reporting details of the cases in ProMED-Mail, an internet-based disease alert system.

Dr. Ziad Memish says investigations into the cases are continuing.

The three new cases are all currently alive, but five of the seven cases reported earlier in the week have died.

To date there have been 27 confirmed cases of infection with the new virus, and 16 of those people have died.

Cases have been linked to Saudi Arabia, Jordan, Qatar and the United Arab Emirates.

There was a cluster of three cases in Britain, but the first case in the group is believed to have been infected while travelling in Saudi Arabia.

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Cancer drug Avastin tied to 2 cases of flesh-eating disease in Canada

The cancer-treatment drug Avastin has been linked to 52 cases of flesh-eating disease worldwide, including one that resulted in death in Canada.

Health Canada issued a warning today in conjunction with the drug's manufacturer, Hoffmann-La Roche Ltd., echoing an earlier one from the U.S. Food and Drug Administration. It offered no specific details on two Canadian cases.

Severin Schwan is the CEO of the Roche group, the global pharmaceutical company that makes Avastin. (Christian Hartmann/Reuters)

Avastin is used either alone to treat a particular type of brain cancer (glioblastoma), or in combination with chemotherapy to treat cancers that have spread to other parts of the body such as colon, rectal and lung cancer.

"Roche has conducted a comprehensive safety review that has identified 52 serious case reports of necrotizing fasciitis that occurred between November 1997 and September 2012, worldwide," the company said in a letter to health-care professionals posted on Health Canada's website.

"Two of these reports occurred in Canada. A total of 17 of the global cases reported a fatal outcome, including one Canadian death."

The agency said that necrotizing fasciitis is a severe, fast-moving and life-threatening bacterial infection of the skin and soft tissue. It can be brought on by a number of conditions and is the disease that threatened former Quebec premier Lucien Bouchard in the early 1990s.

People who have diabetes or cancer have a greater risk of developing necrotizing fasciitis because their immune system responses are lowered.

Anyone taking Avastin who notices unusual signs or symptoms should contact their health-care professional immediately. (CBC)

The FDA issued a similar warning in mid-March, indicating that cases have mainly been seen in people who had wound-healing complications, gastrointestinal perforations or fistulas.

Health Canada and Roche said about two-thirds of the cases occurred in people treated for colorectal cancer. Of the worldwide cases, 21 had gastrointestinal perforation, fistula formation or wound healing complications before the necrotizing fasciitis developed.

All of the patients were receiving other chemotherapies besides Avastin, and some patients did not have any other risk factors.

Roche will be working with Health Canada to revise the drug's labelling information.

Symptoms can develop rapidly, sometimes within 24 hours of a minor skin injury or surgical wound, Health Canada said.

Symptoms include sudden, severe pain in the affected area, fever, redness, heat, swelling or fluid-filled blisters in the skin, scaling, peeling, or discoloured skin over the affected area.

"Health Canada recommends that patients who are taking Avastin continue using the drug and to visit their health-care provider if there are any concerns," a spokesperson for the department said.

"If necrotizing fasciitis occurs, Avastin administration should be discontinued. Your health-care professional will decide whether Avastin can be re-administered."

The warning says that anyone taking Avastin who develops these symptoms or notices other unusual signs or symptoms should contact their health-care professional immediately.

Accurate diagnosis and prompt treatment with antibiotics through a vein and surgery are important when treating cases of necrotizing fasciitis, the U.S. Centers for Disease Control and Prevention says.

With files from The Canadian Press

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More allergies in children reported in U.S. survey

Parents are reporting more skin and food allergies in their children, a big U.S. government survey found.

Experts aren't sure what's behind the increase. Could it be that children are growing up in households so clean that it leaves them more sensitive to things that can trigger allergies? Or are mom and dad paying closer attention to rashes and reactions, and more likely to call it an allergy?

Jeff Glazer guides his allergy-sniffing dog, Riley, through a dugout of a ball field to ensure there are no peanut products or residue that could trigger his life-threatening allergic reactions. (Jessica Hill/Associated Press)

"We don't really have the answer," said Dr. Lara Akinbami of the U.S. Centers for Disease Control and Prevention, the senior author of the new report released Thursday.

The CDC survey suggests that about 1 in 20 U.S. children have food allergies. That's a 50 per cent increase from the late 1990s. For eczema and other skin allergies, it's 1 in 8 children, an increase of 69 per cent. It found no increase, however, in hay fever or other respiratory allergies.

About seven per cent of Canadians self-report a food allergy, but the prevalence of physician-diagnosed food allergy is about five to six per cent for young children and three to four per cent for adults, according to Health Canada.

Already familiar with the trend in food allergies are school nurses, who have grown busier with allergy-related duties, like banishing peanuts at school parties or stocking emergency allergy medicine.

Sally Schoessler started as school nurse in 1992 in New York state, and didn't encounter a child with a food allergy for a few years. But by the time she left school nursing in 2005, "there were children in the majority of classrooms" with the disorder, said Schoessler, who now works at the National Association of School Nurses in Silver Spring, Md.

Food allergies tend to be most feared; severe cases may cause anaphylactic shock or even death from eating, say, a peanut. But many food allergies are milder and something children grow out of. Skin conditions like eczema, too, can be mild and temporary.

It's been difficult getting exact numbers for children's allergies, and the new report isn't precise. It uses annual surveys of thousands of adults interviewed in person. The report compares answers from 1997-1999 to those from 2009-2011.

Parents were asked if — in the previous year — their child had any kind of food or digestive allergy, any eczema or skin allergy, or any kind of respiratory allergy like hay fever.

The researchers did not ask if a doctor had made the diagnosis or check medical records. So some parents may have been stating a personal opinion, and not necessarily a correct one.

"We see a lot of kids in clinic that really aren't" allergic to the foods their parents worry about, said Dr. Morton Galina, a pediatric allergist at Atlanta's Emory School of Medicine.

Eczema explanations

For example, hives are sometimes blamed on a certain food when a virus was the actual cause, he added.

But experts also said they believe there is a real — and unexplained — increase going on, too.

One of the more popular theories is "the hygiene hypothesis," which says that exposure to germs and parasites in early childhood somehow prevents the body from developing certain allergies.

The hypothesis argues that there is a downside to America's culture of disinfection and overuse of antibiotics. The argument has been bolstered by a range of laboratory and observational studies, including some that have found lower rates of eczema and food allergies in foreign-born children in the U.S.

There could be other explanations, though. Big cities have higher childhood allergy rates, so maybe some air pollutant is the unrecognized trigger, said Dr. Peter Lio, a Northwestern University pediatric dermatologist who specializes in eczema.

Some suspect the change has something to do with the evolution in how foods are grown and produced, like the crossbreeding of wheat or the use of antibiotics in cattle. But Lio said tests haven't supported that.

Emory's Galina said the new CDC statistics may reflect a recent "sea change" in the recommendations for when young children should first eat certain foods.

In families with a history of eczema or food allergies, parents were advised to wait for years before introducing their young children to foods tied to severe allergies, like peanuts, milks and eggs. But professional associations changed that advice a few years ago after research suggested that allergies were more likely in those kids when the foods were delayed.

The old advice "was exactly the wrong thing to do," and could have contributed to some of the increased cases, Galina said.

The CDC report also found:

• Food and respiratory allergies are more common in higher-income families than the poor.
• Eczema and skin allergies are most common among the poor.
• More black children have the skin problems, 17 per cent, compared to 12 per cent of white children and about 10 per cent of Hispanic children.

The mother of a 13-year-old girl, who is black, runs an eczema support group in suburban Washington, D.C. Renee Dantzler says roughly half the families in her group are African-American. Eczema is an itchy skin condition, which often occurs on the arms or behind the knees. The cause isn't always clear.

Her daughter, Jasmine, started getting rashes at 6 months and got much worse when she was 4.

"Her whole body would flare. If she ate something, you would kind of hold your breath," Dantzler said. "And she's allergic to every grass and tree God made."

Her daughter took to wearing long sleeves and pants, even in hot weather, so people wouldn't see her skin scarred — and whitened in spots — from scratching. She began to improve about four years ago with steroid creams and other treatments and has gradually become less self-conscious about her skin, Dantzler said.

She's now on a school track team, which means wearing shorts.

"She's the only one on the team with long socks," her mom said.

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Ottawa teen with autism finds place to stay

A teenager with autism whose parents said they couldn't care for him anymore has found a semi-permanent place to stay.

Amanda Telford left her 19-year-old son Philipp at a provincial Developmental Services Ontario office on Tuesday, saying his family was exhausted and couldn't keep him safe.

Philipp has a severe form of autism that leaves him unable to speak. He functions at the level of a two-year-old and has Tourette's syndrome and insulin-dependent diabetes.

His mother said Thursday the agency has found temporary space for him at an Ottawa group home.

Space available for weeks or months

She said she was told that space would be available for weeks, maybe even months.

He'll also be getting medical care for his diabetes from a Community Care Access Centre

Philipp spent the first few nights after being given up at a south Ottawa hospice, one his mother said he'd been going to off and on since he was 16 years old.

Amanda Telford says three incidents over the weekend made her realize she can't keep her son Philip safe any longer. (CBC)

She told CBC News on Tuesday the breaking point for her family was last weekend, when Philipp wandered away twice and swallowed 14 blood pressure pills in one sitting.

She said she'd been in contact with all levels of government and had been told there was no room for her son in the crowded, under-funded social system.

Autism Ontario said Friday the lack of specific mention of autism in Thursday's provincial budget is concerning, especially the "unacceptable" general lack of commitment to addressing adults in crisis.

The group said in a news release it is encouraged by efforts to reduce wait times and help students transition at school.

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Saudi Arabia reports 3 new coronavirus cases

Saudi Arabian authorities are reporting three more infections with the new coronavirus, bringing to 10 the total cases they have reported in recent days.

The cases have all occurred in the same area of the country, a worrying sign.

A colourized transmission electron micrograph of a coronavirus. Some coronavirus infections can cause severe pneumonia. (Beth Fischer/Associated Press)

At least one of the new cases is a family member of an earlier case, which might suggest person-to-person spread of the virus.

The country's deputy minister of health is reporting details of the cases in ProMED-Mail, an internet-based disease alert system.

Dr. Ziad Memish says investigations into the cases are continuing.

The three new cases are all currently alive, but five of the seven cases reported earlier in the week have died.

To date there have been 27 confirmed cases of infection with the new virus, and 16 of those people have died.

Cases have been linked to Saudi Arabia, Jordan, Qatar and the United Arab Emirates.

There was a cluster of three cases in Britain, but the first case in the group is believed to have been infected while travelling in Saudi Arabia.

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5 coronavirus deaths revealed in Saudi Arabia

The World Health Organization would like more and quicker information about new coronaviruses cases, the organization's head of infectious diseases said Thursday after Saudi Arabia surprised the world with the news it had found seven more coronavirus infections.

The Saudi ministry of health revealed late Wednesday that it had diagnosed the new cases, which bring the global case count to 24 infections. Five of the new seven cases had died by the time the Saudi government told the World Health Organization that additional cases had been found.

Electron micrograph image released by the British Health Protection Agency shows a coronavirus, which was first identified last year in the Middle East. (Health Protection Agency/Associated Press)

Infections with the new virus have popped up in several Middle Eastern countries and in Britain, though that cluster of three cases appears to have been set off when a man who lives in Britain became ill while travelling in Saudi Arabia. The man, who later died, infected his son and another member of his extended family.

Though the majority of the total cases — 16 of which have been fatal — have come from Saudi Arabia, the Saudi government has been very closed-mouthed about the outbreak.

Dr. Keiji Fukuda, the WHO's assistant director general for health security and the environment, said the WHO was informed of the cases late Wednesday, but has been given little information about them. It has asked for more, Fukuda said in an interview with The Canadian Press.

"As a matter of course we would prefer to hear and know about things as early as possible. The whole aim of detecting [diseases] is really to try to move and protect as quickly as possible," Fukuda said from Geneva.

"I won't speak for the government of Saudi Arabia, but I can speak for WHO in saying that it's a point that we have made and it's a position that we hold very clearly with everybody."

Case information sparse

Among the information the WHO would like to know is whether the new cases are linked in any way. That information that is needed to assess whether the infections were sporadic jumps of the virus from its reservoir in nature or whether the virus passed person to person in some or all of these cases.

"Actually we don't have much epidemiological information or supporting information about these cases right now. This is again some of the things that we would very much like to know," Fukuda said.

Disease experts have been anxiously watching this new coronavirus to see if it will acquire the ability to spread from human to human, so knowing if cases are sporadic or linked is critical.

A Saudi newspaper, The National, quoted the country's deputy minister of health saying the cases all occurred or were being treated in the same hospital, in the eastern region of Alhasaa.

"All the cases that have been reported were in the same hospital in Alhasaa. We have not found any cases anywhere else in the eastern region," Dr. Ziad Memish told the paper.

The new virus, which the WHO calls NCoV for short and which is identified as hCoV-EMC in the scientific literature, is a member of the same virus family as the pathogen that caused the 2003 SARS outbreak.

To date, most cases spotted have been severely ill, their lungs ravaged by the new virus. While the majority of infected people have died, a few have recovered and left hospital, and a few more remain in hospital on breathing machines months after they were infected.

The first known cases occurred in April 2012, in a cluster of 11 illnesses in a hospital in Jordan. Samples from two of those cases were tested after the fact and found to be positive for the new virus.

The coronavirus was first spotted when a Saudi man died of a mysterious and severe pneumonia last June. When the cause of his illness could not be detected, an infectious disease specialist sent a sample to Erasmus Medical Centre in Rotterdam, the Netherlands, where virologists determined a new coronavirus was behind the infection.

Since then 21 additional cases have been discovered in Saudi Arabia, Qatar, the United Arab Emirates and Britain, but the world appears to be no closer to knowing what the source of the infection is or how people are getting infected.

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Cancer drug Avastin tied to 2 cases of flesh-eating disease in Canada

The cancer-treatment drug Avastin has been linked to 52 cases of flesh-eating disease worldwide, including one that resulted in death in Canada.

Health Canada issued a warning today in conjunction with the drug's manufacturer, Hoffmann-La Roche Ltd., echoing an earlier one from the U.S. Food and Drug Administration. It offered no specific details on two Canadian cases.

Severin Schwan is the CEO of the Roche group, the global pharmaceutical company that makes Avastin. (Christian Hartmann/Reuters)

Avastin is used either alone to treat a particular type of brain cancer (glioblastoma), or in combination with chemotherapy to treat cancers that have spread to other parts of the body such as colon, rectal and lung cancer.

"Roche has conducted a comprehensive safety review that has identified 52 serious case reports of necrotizing fasciitis that occurred between November 1997 and September 2012, worldwide," the company said in a letter to health-care professionals posted on Health Canada's website.

"Two of these reports occurred in Canada. A total of 17 of the global cases reported a fatal outcome, including one Canadian death."

The agency said that necrotizing fasciitis is a severe, fast-moving and life-threatening bacterial infection of the skin and soft tissue. It can be brought on by a number of conditions and is the disease that threatened former Quebec premier Lucien Bouchard in the early 1990s.

People who have diabetes or cancer have a greater risk of developing necrotizing fasciitis because their immune system responses are lowered.

Anyone taking Avastin who notices unusual signs or symptoms should contact their health-care professional immediately. (CBC)

The FDA issued a similar warning in mid-March, indicating that cases have mainly been seen in people who had wound-healing complications, gastrointestinal perforations or fistulas.

Health Canada and Roche said about two-thirds of the cases occurred in people treated for colorectal cancer. Of the worldwide cases, 21 had gastrointestinal perforation, fistula formation or wound healing complications before the necrotizing fasciitis developed.

All of the patients were receiving other chemotherapies besides Avastin, and some patients did not have any other risk factors.

Roche will be working with Health Canada to revise the drug's labelling information.

Symptoms can develop rapidly, sometimes within 24 hours of a minor skin injury or surgical wound, Health Canada said.

Symptoms include sudden, severe pain in the affected area, fever, redness, heat, swelling or fluid-filled blisters in the skin, scaling, peeling, or discoloured skin over the affected area.

"Health Canada recommends that patients who are taking Avastin continue using the drug and to visit their health-care provider if there are any concerns," a spokesperson for the department said.

"If necrotizing fasciitis occurs, Avastin administration should be discontinued. Your health-care professional will decide whether Avastin can be re-administered."

The warning says that anyone taking Avastin who develops these symptoms or notices other unusual signs or symptoms should contact their health-care professional immediately.

Accurate diagnosis and prompt treatment with antibiotics through a vein and surgery are important when treating cases of necrotizing fasciitis, the U.S. Centers for Disease Control and Prevention says.

With files from The Canadian Press

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H7N9 bird flu virus genes show signs of chicken, duck origins

The H7N9 bird flu virus that has killed 27 people in China might have originated from chicken and duck influenza viruses, a study suggests.

Chinese researchers have published a detailed genetic analysis of the H7N9 virus, which was identified on March 30.

A breeder covers his face as he sits behind chickens, in Yuxin township, Zhejiang province, last month. Poultry-to-person virus transmission in China needs to be watched carefully, researchers say. (William Hong/Reuters)

Results of the study appear in this week's issue of the medical journal The Lancet.

Researchers examined genomic sequences of the virus and ecological information such as the birds' migratory paths to extrapolate its potential family tree and possible routes.

Scientists are watching the virus closely to see if it could spark a global pandemic.

The World Health Organization said Thursday there is no evidence of sustained human-to-human transmission, meaning it doesn't spread easily from human to human.

"Investigations into the possible sources of infection and reservoirs of the virus are ongoing," WHO said in a statement. "Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus."

The study is part of the investigation into the potential animal reservoirs of H7N9, such as the "intermediate hosts" like birds or mammals that pass it on to humans.

"The novel avian influenza A H7N9 virus might have evolved from at least four origins," Prof. George Gao of the Chinese Center for Disease Control and Prevention in Beijing and his co-authors concluded.

"Unknown intermediate hosts involved might be implicated, extensive global surveillance is needed, and domestic-poultry-to-person transmission should be closely watched in the future."

The researchers said the evidence points to H7N9 gaining genes for its surface proteins from duck bird flu viruses while the virus's internal genes seem to have come from chicken viruses.

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