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The Independent

5.2.2007

Minister defends action on bird flu outbreak

PA        The Independent

Published: 05 February 2007

http://news.independent.co.uk/uk/health_medical/article2239454.ece

 

Alzheimer's sufferers dying

in drug 'scandal'

· Sedatives blamed for thousands of deaths
· Campaigners point to lack of cash for trained staff

Friday March 30, 2007
Guardian
Polly Curtis,
health correspondent

A class of drugs widely prescribed for people suffering from dementia is leading to the premature deaths of thousands of patients every year, according to research published today. Campaigners branded the continued use of the sedatives, called neuroleptics, a national scandal after a five-year study revealed that people with Alzheimer's disease and other forms of dementia are twice as likely to die if they are prescribed them.

Neuroleptics are widely prescribed to help control symptoms of Alzheimer's and dementia including agitation, hallucinations and erratic behaviour, despite only being licensed for use in people suffering from schizophrenia. The research suggests they are of little benefit to patients with milder symptoms, greatly increase their risk of dying prematurely, and that 45% of Alzheimer's patients in care homes are prescribed a neuroleptic drug.

A group of 165 Alzheimer's patients were randomly assigned to take one of three types of neuroleptic drugs, or a placebo. After two years 45% of those who took the real drugs had died compared with 22% who were given the placebo.

The King's College London researchers who undertook the project, funded by the Alzheimer's Research Trust, found that after three years 65% of those on the drugs had died compared with 38% of those on placebos. After 42 months 75% of those on the drugs had died compared with 60% on the placebo. On average patients who were on the drugs died six months earlier.

Clive Ballard, professor of age-related disorders at King's and the lead researcher, said that not only were people more likely to die but they also suffered severe side-effects including stroke, chest infections and falls.

"If this was a massive increase in mortality in children there would be an outcry. Older people aren't seen as a priority. These sedatives are being used because the services can't cope with people who are in a distressed state. There are ways to avoid them but it would involve training of staff, which is costly."

In 2004 the medicines watchdog issued a warning that two types of neuroleptics, olanzapine and risperidone, should not be given to Alzheimer's patients because of an increased risk of stroke and death.

Despite this, in 2005 the Alzheimer's Society presented evidence that 100,000 people suffering from dementia were being prescribed a neuroleptic drug.

Neil Hunt, chief executive of the society, said: "Neuroleptics have been used as a dangerous fix for 'challenging behaviour' in people with dementia for too long. They are not licensed for use among people with dementia, but continue to be hugely over-prescribed. It is a national scandal that people are being sedated in this way ... These drugs must be a last resort, only used when all other methods have failed to alleviate the most distressing symptoms of dementia."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "These results are deeply troubling and highlight the urgent need to develop better treatments."

The Medicines and Healthcare products Regulatory Agency (MHRA), which is responsible for the safety of medications, said neuroleptics were not licensed for use to treat dementia. "The MHRA continues to monitor the unlicensed use of neuroleptics in the treatment of patients with Alzheimer's disease and will carefully review this new study to see what further action may be necessary."

Professor Mayur Lakhani, chairman of the Royal College of General Practitioners, said: "We would like to reassure patients, relatives and carers that neuroleptic drugs are not routinely prescribed to patients with dementia, and are used only as a last resort when patients suffer from severe episodes."

Alzheimer's sufferers dying in drug 'scandal', G, 30.3.2007, https://www.theguardian.com/society/2007/mar/30/health.medicineandhealth

4.45pm update

Government defends bird flu response

Monday February 5, 2007
Guardian Unlimited
James Sturcke and agencies

The environment secretary, David Miliband, today said he was satisfied that the response to the Suffolk bird flu outbreak had been "rapid, well co-ordinated and appropriate".

Mr Miliband told the House of Commons that there were "negligible" health risks to the general public after the highly-virulent form of the disease, which has killed more than 160 people worldwide, was discovered at a Bernard Matthews turkey farm in Holton.

He said the slaughter of the 159,000 birds at the farm was expected to be completed today, and that it remained unclear how the disease had reached the UK.

Mr Miliband urged all keepers of birds to exercise good biosecurity measures, and said he was hopeful the disease could be contained.

"Experience from previous outbreaks in Europe, and in the past in this country, has shown that, in all cases where disease was found in domestic poultry, the rapid action taken to restrict movements, to house birds and, above all, to cull all the birds on the infected premises, has eradicated the disease without further spread," he said.

"I am satisfied that the response has been rapid, well co-ordinated and appropriate."

In his ministerial statement, Mr Miliband said that, on Thursday evening, a private vet had informed of unexplained deaths among the birds.

By Saturday morning, the illness was confirmed as H5N1 bird flu and, in addition to the statutory controls, Defra also imposed a 2090 sq km wider restrictive zone as part of a "proportionate and risk based response" to the crisis.

Earlier, the animal welfare minister, Ben Bradshaw, admitted officials had been surprised by the discovery.

The minister said the first turkeys on the Holton farm began dying on Tuesday and Wednesday, but at rates that were "nothing out of the ordinary".

State Veterinary Service officials were only informed after 800 of the eight-week-old birds died on Thursday, and H5N1 was confirmed within 48 hours.

"I am satisfied that everybody has moved as quickly as they possibly could have," Mr Bradshaw told the BBC's Today programme.

He said Cobra, the government's emergency response team involving relevant ministers, police and scientists, would meet today as the culling of the 159,000 birds at the farm was being completed.

Efforts to identify the cause of the outbreak were also a key priority, Mr Bradshaw said, adding that most H5N1 cases had occurred among free range birds that mix with wild birds rather than among those reared indoors.

"Factory farms tend to have very good biosecurity ... it is somewhat surprising that the disease has started in this particular flock of Bernard Matthews birds, and of course we are exploring very carefully what the possible avenues for infection might have been," he said.

Defra officials and wardens from the Royal Society for the Protection of Birds were today monitoring wild birds on reserves around Britain.

RSPB officials said staff were maintaining regular patrols at the Minsmere reserve near Saxmundham, Suffolk, the reserve closest to the outbreak of bird flu.

Authorities in Holland, where a bird flu outbreak in 2003 resulted in the deaths of 31m birds, have ordered commercial flocks to be brought indoors. The French agricultural minister, Dominique Bussereau, urged "very strong vigilance", while Japan has banned British poultry imports.

The EU's most senior health official, the health and food safety commissioner, Markos Kyprianou, said he was optimistic that bird flu could be contained.

"The virus is still around. We should never feel that we are safe," he said. "Hungary is dealing with it in a very efficient way. The UK is doing the same, but we will probably have more outbreaks.

"Last year, we managed to control the disease. I'm optimistic we will be able to do the same again this year."

H5N1 bird flu has killed 164 people around the world since January 2003, mostly in communities where people live close to chickens, and led to the destruction of billions of birds.

Despite the virulence of the disease among poultry, it does not easily infect humans. The Food Standards Agency has reassured the public that the virus is not transmitted through food, and is killed by temperatures of more than 70C.

After the first birds at the Suffolk farm died, a Bernard Matthews vet concluded that the disease was "unidentifiable", a spokesman for the company said.

A State Veterinary Service spokeswoman said the organisation had been told the birds were initially diagnosed as suffering from E coli.

In a statement, today, Bernard Matthews said none of the affected birds had entered the food chain, and stressed that consumers were not at risk.

"Bernard Matthews continues to work very closely with Defra and other industry bodies," the firm said. "All proper procedures were followed, and we responded accordingly in good time.

"The company meets, and in many cases far exceeds, Defra's biosecurity standards for combating avian flu.

"Furthermore, we have been in constant contact with all of our staff, reassuring them that we have all the required measures in place for those who handle poultry. We also can confirm there are no jobs at risk."

The environment secretary, David Miliband, cancelled a planned trip to Cumbria and is expected to make a Commons statement on the outbreak at 3.30pm today.

Defra has set up a restricted area of more than 800 square miles surrounding the farm in a bid to contain the virus. The zone, in which poultry must be kept isolated from wild birds and movements must be licensed, covers 806 square miles of east Suffolk and south-east Norfolk.

Introduced after consultation with ornithologists, it is an addition to the 3km protection zone and 10km surveillance zones already in place.

The outbreak is the first of the highly-pathegenic aviation flu in Britain since 1991, when 8,000 turkeys at a Norfolk farm were affected by the disease. Last year, there were outbreaks of a less deadly form of bird flu, H7N3, at three Norfolk farms.

Government defends bird flu response, G, 5.2.2007,
https://www.theguardian.com/world/2007/feb/05/
birdflu.immigrationpolicy

Bird flu alert

as 1,000 turkeys found dead in Suffolk

· Bernard Matthews farm calls in vets after outbreak
· Preliminary tests confirm traces of H5 virus

Saturday February 3, 2007
Guardian
Thair Shaikh

An outbreak of bird flu at a turkey farm in Suffolk has killed more than 1,000 birds, the Department for Environment, Food and Rural Affairs said last night.

Preliminary tests at a Bernard Matthews farm in Holton, near Lowestoft, where there are three factories, found traces of the H5 virus in the poultry. Further tests are necessary to determine whether it is the H5N1 strain, which can be deadly to humans, a spokesman said.

Government vets were called to the site late on Thursday after hundreds of birds showed signs of illness that included going off their food and general malaise, symptoms associated with bird flu.

A Defra spokesman that the farmer had noticed "significant mortality" among his flock and that the site had been placed under restrictions.

"Preliminary tests have indicated that the avian influenza virus is present in samples from poultry found dead on the premises," a statement said. "Results show that it is the H5 strain of the virus but further confirmatory tests are in progress to identify the strain more fully and more will be known today.

"The affected premises were put under restriction and the appropriate contingency plan has been put into effect."

Officials stressed that the high mortality rate did not necessarily mean that it was H5N1 avian flu.

Dr Robert McCracken, former president of the British Veterinary Association and a specialist in bird diseases, said that mortality rates among turkeys with viruses were usually very high. "They are highly susceptible to infection, there could be an avian flu infection in ducks and we would not always notice it because the mortality rate is so low. In some infections in which 50% of chickens might die, we could still expect 100% mortality among turkeys."

He said that if the birds had been allowed outside, wild migratory birds could have been the source. "If these birds were kept indoors it would be very disappointing."

Daniel Parkes, of the British Poultry Veterinary Association, said: "The fact that it is H5 means that it is the highly pathogenic avian influenza, but it does not necessarily mean that it is H5N1. First and foremost we need to stress that it has been identified on a farm and they will try and contain it on that farm."

A spokesman for Bernard Matthews said that experts from Defra were investigating the outbreak.

In May, 50,000 chickens were culled after an outbreak of the H7 bird flu in Norfolk. In April, a poultry worker contracted H7 in the form of conjunctivitis - he is thought to have caught it on the Norfolk farm where the disease was discovered.

Only one other person is known to have contracted an H7 infection in Britain. In 1996 an Oxfordshire woman cleaned out her duck house before she was infected but a bird source was never confirmed.

A swan found washed up in a Scottish bay in March tested positive for H5N1.

Last month the Department of Health announced that thousands of poultry workers are to be offered free influenza jabs in an attempt to stop new forms of bird flu emerging. More than 60,000 farmers, vets and others who have close contact with poultry will be eligible. The government hopes that the vaccine will cut the risk that workers may catch human and bird flu at the same time, allowing the viruses to mutate and create new, contagious strains.

FAQ: Avian flu

What symptoms do birds show?

They may die suddenly or suffer respiratory problems, swollen heads, loss of appetite and reduced egg production. The pathogenic H5N1 strain can spread dramatically through poultry, causing 100% fatality in flocks within two days.

Is it safe to eat turkey?

The virus is easily destroyed by cooking. It spreads between infected birds, however, so plucking, handling or butchering risks exposure.

Is the virus dangerous to humans?

The H5N1 strain has killed more than 100 people since emerging in south-east Asia in 2003, but most have fallen ill after long, close contact with infected birds, either through keeping poultry or butchering.

Could the virus trigger a pandemic?

If it evolves to be easily transmissible between humans. An outbreak could claim 320,000 lives in Britain, according to a Home Office report. H5N1 evolves rapidly. If the virus infects someone carrying human influenza, the two viruses could produce a lethal strain infectious to humans.

Bird flu alert as 1,000 turkeys found dead in Suffolk, G, 3.2.2007, http://www.guardian.co.uk/birdflu/story/0,,2005157,00.html

NHS cash crisis

deprives thousands

of treatment for blindness

Published: 30 January 2007
The Independent
By Jeremy Laurance,
Health Editor

A legal campaign has been launched to eradicate regional inequalities in the NHS that deny treatment to thousands who are facing blindness.

The challenge is being spearheaded by a former Labour MP, Alice Mahon, who has pledged to force health bosses to provide the drugs to save her own sight - and that of other sufferers.

The condition at the centre of the battle is age-related macular degeneration (AMD) which affects 500,000 people in the UK. Mrs Mahon suffers from the "wet" form, of which there are 27,000 new cases a year in the UK.

Mrs Mahon said she would go to the High Court to compel her local primary care trust (PCT) to pay for a new drug that could prevent her going blind after the trust refused her request to fund it.

Campaigners claim 50 people a day go blind because they are refused access to drugs that could save their sight. MPs rallied to Mrs Mahon's cause yesterday tabling an early day motion calling for the treatment to be funded.

She will be joined by other MPs in Parliament today to speak out against the refusal to fund treatment for patients suffering from wet AMD. A private member's Bill tabled by Linda Riordan, the Labour MP for Halifax, is to have its second reading next month.

Ms Mahon, aged 69, has lost most of the sight in one eye and is likely to lose it in the other if nothing is done. The condition is caused by overgrowth of the capillaries behind the retina leading to bleeding and scarring of the macula, the centre of the retina.

Her best hope is a new drug, Lucentis, which has been shown in trials to improve vision in a third of patients and to halt the deterioration in most of the rest. But a request by her consultant at Calderdale Royal Hospital, where she was diagnosed in November, to Kirklees and Calderdale PCT to fund the drug was turned down.

Mrs Mahon said: "I have been an ardent supporter of the NHS all my life and now feel totally let down. The excuses that PCTs are giving for not funding treatment are scandalously lame.

"Everyone has a right to free treatment on the NHS for a condition that results in blindness and devastates lives. Supporting people who are blind or partially sighted, who may need home help and suffer injuries from falls, is far more expensive than the treatment. The Chancellor must ensure the NHS budget is large enough to fund such a basic health care need."

Mrs Mahon said she had written personally to Gordon Brown but had, so far, received no reply.

Lucentis was hailed as a "miraculous" advance against a modern epidemic in the New England Journal of Medicine last year. It is given by injection directly into the eye and, in patients treated, it not only halted the gradual deterioration in sight but even regained some of that lost.

Lucentis is due to receive its European licence shortly. But many PCTs refuse to fund Lucentis and a rival, Macugen, licensed last year, in advance of an assessment by the National Institute for Clinical Excellence (Nice). Macugen costs about £500 a dose and Lucentis about £1,000. Nice is to consider both drugs together and expects to publish its report in October.

Even if both drugs are approved by Nice, and recommended for use on the NHS, there is no guarantee they will be available to all patients. There is wide variation across the NHS in the provision of Nice-recommended drugs to patients and those are set to grow as PCTs struggle to clear deficits.

The Royal National Institute for the Blind said almost 20,000 people in England and Wales could go blind during the next year without either drug. In Scotland, Macugen was approved for use by the Scottish Medicines Consortium last August.

Steve Winyard, head of campaigns at the RNIB, said: "Fifty people a day are being condemned to blindness because PCTs are refusing to fund a licensed treatment, even though it could save patients' sight. The actions of these PCTs are simply unacceptable."

Mr Winyard said consultants were experimenting with the number of doses needed. In some cases, as few as three are required for successful treatment.

Mr Winyard said: "It would save the NHS money, because the cost of supporting someone who is blind is greater than the cost of treatment. We are hearing of blanket bans on Macugen by PCTs, even though Andy Burnham, the Health minister, told the Commons that each case should be treated on its merits."

In its response to the request from Mrs Mahon's consultant for funding for Lucentis, Kirklees and Calderdale PCTs, said - in a letter dated 16 December - that Lucentis was not currently licensed and had not been approved by Nice.

"This means there is insufficient clinical evidence of the effectiveness of this treatment to enable approval for funding to be given," the letter said.

Novartis, which markets Lucentis, announced last week that it had received its licence for the drug to be used across Europe. A spokesman for Nice said yesterday that it had contacted the European Medicines Agency, but had not yet received notification of licensing approval.

Nice has a "fast-track" assessment process, introduced last year, which was used for the first time for the breast cancer drug Herceptin, which was approved in record time. A spokesman said the fast-track process would not be used for Lucentis because the Department of Health had requested it be assessed alongside Macugen.

However, the Nice spokesman added: "There is no restriction on the prescribing of any drug, within its licensed indications, whilst Nice is developing guidance. In the absence of Nice guidance, local NHS organisations should develop their own prescribing policies."

The Department of Health said last night that patients should not be refused a treatment simply because Nice guidance does not exist yet. A spokesman said: "Macugen and Lucentis are being assessed by Nice against each other to ensure NHS patients receive clinically and cost-effective treatments. But, even while that process is taking place, doctors can prescribe Macugen within its licensed indications without Nice guidance if they believe it is the right treatment for their patient.

"We have made it clear it is not acceptable to refuse a treatment simply because Nice guidance does not yet exist."

Macular degeneration

* Macular degeneration affects 500,000 people in the UK.

* The macula is at the centre of the retina and is essential for seeing colour. In affected individuals, the cells at the centre of the macula stop working. Most cases are of the slow progressing, dry kind for which there is no treatment.

* Wet macular degeneration, which progresses faster, affects 27,000 new patients each year. About 7,000 of these can be helped by laser treatment. Most others can be helped by drugs.

* Most patients have to pay privately for drug treatment because the National Institute for Clinical Excellence is not due to issue guidance on NHS use until October 2007.

NHS cash crisis deprives thousands of treatment for blindness, I, 30.1.2007, http://news.independent.co.uk/uk/health_medical/article2198408.ece

2.45pm

Rise in rat numbers

spawns health fears

Thursday January 4, 2007
Guardian Unlimited
Sarah Bridge

It is said that you are never more than six feet from a rat but that distance could shrink further as a new report reveals that Britain's rat population is rising at an alarming rate.

The 2006 national rodent survey, published by the National Pest Technician Association (NPTA), says that there has been a "serious increase" in the number of rats in the UK.

The number of brown rat (rattus norvegicus) infestations jumped by 13% last year, showing an overall increase of 39% in rat numbers since 1998.

Even more worryingly, there was a 22% rise in the number of rat findings over the summer, a time when they are supposed to be less active than usual. In total there has been a 69% increase in rats during the summer months since records began eight years ago.

The survey of 70% of Britain's local authorities also shows that call-outs for house mice (mus domesticus) are also on the increase.

"Since doing our annual survey we have seen the number of rats getting more and more," says NPTA chairman Barrie Sheard, who compiled the report. "But what really alarmed us was that all regions across the country bar one - the Isle of Man - showed a rat increase. We don't want to be alarmist about it but there are simply more of them about."

The report highlights what it believes to be the main reasons for the increase: more councils charging for domestic rodent work; private water companies not clearing rats from drains; people putting out too much food for wild birds; increases in littering and fly-tipping; compost bins not being used correctly and urban properties standing derelict.

Over 60% of councils now charge for dealing with rats, so according to Mr Sheard, "if you see one in your back garden then you are going to be less likely to phone the council up as you might get charged".

While there are no precise figures regarding the number of rats in Britain, the report estimates that there are now 1.69 million rat infestations in the UK, adding that this is "far, far too many to ignore".

"Every area in the UK is affected by this," said Mr Sheard. "Wherever man has existed there have been rats but it is a huge problem. We are getting reports that rats are more often being seen in parks where children play."

He added: "Rats can live in drains, in roof spaces, even between walls if the brickwork is loose, and there is a possible problem of diseases such as salmonella and Weil's disease which is spread by infected rat urine."

Rise in rat numbers spawns health fears, G, 4.1.2007,
https://www.theguardian.com/environment/2007/jan/04/
waste.uknews