World Medical Health Updates: September 2009

Paralyzed Rats Walk Again

SUNDAY, Sept. 20 (HealthDay News) -- A three-pronged approach to treating spinal cord injuries allowed paralyzed rats to walk without receiving signals from the brain, scientists report.
Spinal cord injuries result in paralysis when the nerve fibers that carry information to and from the brain are damaged or severed. Much of the focus of research into spinal cord injuries has been exploring ways of regenerating those nerve fibers and connections, which has so far met with limited success in people.
In the new study, rats were treated with a combination of drugs, electrical stimulation of the spinal cord and locomotor training, a rehabilitation technique. The combined treatment enabled the rats to walk with a near-normal gait on a treadmill, without the muscles receiving signals from the brain.
"The study demonstrates that the lower spinal cord has circuitry that is sufficient to support virtually normal, weight-bearing locomotion," said senior study author V. Reggie Edgerton, a professor of physiological sciences and neurobiology at the University of California, Los Angeles.
The study appears in the Sept. 20 online edition of Nature Neuroscience.

Health Tip: When Bedwetting Signals Another Problem

(HealthDay News) -- Bedwetting affects many young children and often doesn't indicate a serious medical issue.
However, the Nemours Foundation says, if bedwetting starts all of a sudden or is accompanied by these other factors, it's time to call a pediatrician.

CDC: First swine flu vaccines may be nasal spray

ATLANTA – The first doses of swine flu vaccine may all be the nasal spray version, government health officials said Friday.
The government has said a trickle of vaccine will be available in early October, but on Friday they defined the size of that trickle — an estimated 3.4 million doses.
Currently it looks like all of them will be a nasal spray vaccine that is approved only for healthy people ages 2 to 49, said Dr. Jay Butler, an official with the Centers for Disease Control and Prevention.
The nasal spray, called FluMist, is not recommended for some of the people most in danger of severe swine flu complications. That includes pregnant women, children younger than 2, and people with asthma and other chronic respiratory diseases.
However, it's possible that some vaccine shots will become available by the first week of October as well, said Butler, chief of the CDC's swine flu vaccine task force.

Topical Cream for Erectile Dysfunction Shows Promise

A topical cream for erectile dysfunction shows promise in animal testing and could become an alternative for men who can't tolerate the pill form of the drugs, U.S. researchers report.
Oral erectile dysfunction (ED) drugs, which belong to a class of medications called phosphodiesterase 5 (PDE5) inhibitors, are widely used and highly effective but can cause such side effects as headache, upset stomach, nasal congestion, facial flushing and hearing and vision problems. Men who've recently had a heart attack or have severe heart disease have to use oral ED drugs with caution, if at all.
The new cream consists of nanoparticles that can carry drugs or other substances, such as nitric oxide, and deliver them in a controlled and sustained manner, according to the researchers, who are from Albert Einstein College of Medicine at Yeshiva University in New York City. Nitric oxide is the signaling molecule that dilates blood vessels responsible for creating an erection.

Scientists May Know How Lung Cancer Spreads

New insight into how primary lung cancer turns into invasive, or metastatic, cancer could lead to treatments that improve patient survival, U.S. scientists say.

The research team at the University of Texas M.D. Anderson Cancer Center found that lung cancer becomes invasive by suppressing a type of microRNA that normally keeps tumors in a non-metastatic state. Specifically, when microRNA-200 was suppressed in mice prone to metastatic lung cancer, all their primary lung tumors became invasive, the study found.

The study appears in the Sept. 15 issue of the journal Genes & Development.

"Existing treatments have little success against cancer that has spread to other organs, so finding a way to prevent metastasis could have a huge impact on survival," senior author Dr. Jonathan Kurie, a professor in M.D. Anderson's Department of Thoracic/Head and Neck Medical Oncology, said in a university news release.

"To do that, we need to understand the cues that initiate metastasis. In this paper, we show that microRNA-200 is one of those central cues," he explained.

The researchers are now trying to identify regulators of microRNA-200 that might offer targets for treatment.

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Genetics Linked to Early Sexual Activity in Kids

Children who grow up in a home without a biological father have sex at a younger age than children raised with their Dad in the picture, and a study now offers a new explanation for why this is true.

While previous research focused on environmental factors, researchers in this study, published in the September/October issue of Child Development, focused on genetic influences instead.

"Our study found that the association between fathers' absence and children's sexuality is best explained by genetic influences, rather than by environmental theories alone," study author Jane Mendle, an assistant professor of psychology at the University of Oregon, said in a news release from the Society for Research in Child Development.

Mendle and her colleagues looked at more than 1,000 cousins aged 14 and older who took part in the National Longitudinal Survey of Youth.

The more genes the children shared, the more similar their ages at first intercourse -- regardless of whether or not the children had an absent father, the study authors found.

This finding, the researchers explained, suggests that environmental factors, such as childhood stress caused by having a single parent or watching their mom date, are not the only ones that carry an influence. Instead, genetic influence also can help explain the tie between absent fathers and early sex.

"While there's clearly no such thing as a 'father absence gene,' there are genetic contributions to traits in both moms and dads that increase the likelihood of earlier sexual behavior in their children. These include impulsivity, substance use and abuse, argumentativeness and sensation-seeking," Mendle said in the news release.

"The same genetic factors that influence when children first have intercourse also affect the likelihood of their growing up in a home without a dad," Mendle added.

Diabetes Medications Don't Lower Inflammation

In people with newly diagnosed type 2 diabetes, the glucose-lowering medications metformin and insulin don't appear to reduce the inflammation associated with heart disease, new research suggests.

Even though these medications helped reduce glucose levels, the researchers found they didn't affect inflammatory markers any more than a placebo drug did, according to a study published in the Sept. 16 issue of the Journal of the American Medical Association.

"Heart disease is one of the many co-morbidities associated with diabetes," explained study author Dr. Aruna Pradhan, an assistant professor at the Harvard Medical School and Brigham and Women's Hospital in Boston, and a cardiologist at the VA Boston Medical Center. "We thought by lowering glucose levels that we would also address inflammation. But, we found that going lower in glucose levels doesn't impact inflammation, which is a risk factor for heart disease."

This study comes on the heels of other recent studies on diabetes and cardiovascular disease. Some suggested that intensive glucose control couldn't affect heart disease risk, while a recent meta-analysis suggests that good blood sugar levels could reduce death from heart attack, according to background information in Pradhan's study.

Almost 24 million Americans have diabetes, mostly type 2 diabetes, according to the American Diabetes Association. Risk factors for developing the disease include being overweight and being over 40, though younger and thinner people can also develop the disease. In type 2 diabetes, the body either doesn't produce enough insulin or can't use insulin effectively.

The current study included 500 men and women with type 2 diabetes diagnosed two years earlier on average. Slightly more women than men were included, and most of the study volunteers had a body-mass index above 30, which is considered obese. The majority of the study participants were white, and about one-quarter of the group were smokers.

The volunteers were randomized into one of four groups: placebo alone, placebo plus insulin glargine (Lantus), metformin (an oral anti-diabetes medication) alone or metformin plus insulin glargine. Study volunteers also received advice on diet and weight.

Overall, the volunteers lost an average of 3.2 pounds during the 14-week study, except for the insulin and placebo group.

As for markers of inflammation, the researchers found reductions in inflammation (as measured through levels of C-reactive protein, IL-6 and tumor necrosis factor receptor 2) for all of the groups. The insulin-plus-placebo group, however, had the smallest reduction in inflammatory markers. For example, C-reactive protein levels went down in the placebo group by 19 percent, in the metformin group by 16 percent and the metformin and insulin group by 20 percent. However, the insulin plus placebo group went down just 3 percent.

Pradhan said the researchers adjusted the data to account for the weight loss, and still found a similar effect. She said it may be that the weight changes affected the distribution of fat, and that abdominal fat tends to have more of an effect on inflammation.

"While these two agents didn't lower inflammation [any more than the placebo], they did lower glucose levels and are excellent drugs for preventing microvascular outcomes, like eye and kidney diseases," said Pradhan. The findings also confirm that diet and exercise can affect inflammation levels, she added.

"While this is a well-conducted study, there are no big surprises here," said Dr. Vivian Fonseca, chief of endocrinology at Scott & White Clinic in Temple, Tex., and Texas A&M Health Sciences Center, College Station. "There are many drugs that benefit people and reduce cardiovascular risk without decreasing inflammation, and there are drugs that reduce inflammation that have sometimes killed people from cardiovascular disease."

Men's sex lives may suffer on hepatitis C therapy

NEW YORK (Reuters Health) – Men taking the antiviral drugs peginterferon and ribavirin for chronic hepatitis C virus infection often experience sexual dysfunction, results of a study indicate.

This drug combination, which is standard therapy for chronic hepatitis C, has the potential to impact all three components of sexual health: desire, function and satisfaction, the researchers found.

"Men planning to receive peginterferon and ribavirin should be counseled about the possibility of a decline in sexual health during treatment and receive adequate support if these side effects occur," Dr. Lorna M. Dove of New York Presbyterian Medical Center and colleagues suggest in the journal Gastroenterology.

Hepatitis C is a blood-borne infectious disease that is often without symptoms and can cause inflammation of the liver, cirrhosis, and in extreme cases, liver cancer. It is usually contracted through transfusions of unscreened blood, or by injecting or inhaling drugs.

Chronic hepatitis C affects 1 percent to 2 percent of the American population and is more common among African Americans than Caucasian Americans and other racial and ethnic groups in the U.S.

The sexual health of men with chronic hepatitis C before, during, and after combination therapy has not been well studied, Dove and colleagues note.

The current study shows that impairments in sexual function and desire are common side effects of this therapy in men, and these effects are not always completely reversed after therapy is stopped.

As part of a large study, 260 men treated with peginterferon and ribavirin completed questionnaires about sexual health before, during and after therapy.

Prior to treatment, 37 percent reported mild impairment in their sex drive, 26 percent reported erectile dysfunction, 22 percent reported ejaculation trouble, and 44 percent reported dissatisfaction with their sex life.

By the end of therapy at either 24 or 48 weeks, 38 percent to 48 percent of men reported that their lower sexual function was worse than before treatment. African American men reported less impairment overall than Caucasian American men during treatment.

For patients who stopped therapy at 24 weeks, sexual health returned to near normal within 6 months of the end of treatment, the researchers found.

Relative to before treatment, men receiving treatment for 48 weeks reported higher erectile and ejaculation problems, although persistent erectile impairment was limited to Caucasian American men.

SOURCE: Gastroenterology, September 2009.

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Watch and wait good option in prostate cancer: study

LONDON (Reuters) – Doctors caring for patients with early stage prostate cancer may do better to watch and wait to see if tumors develop rather than engage in aggressive treatment that may do no good, scientists said on Tuesday.

A study in the Journal of the American Medical Association found the risk of dying from prostate cancer in the 10 years after diagnosis fell by more than 60 percent in patients diagnosed between 1992 and 2002 compared with patients diagnosed in the 1970s and 1980s.

But doctors only manage 10 percent of cases conservatively by watching closely and delaying treatment until symptoms demand it.

"When diagnosed, prostate cancer is contained within the prostate in approximately 85 percent of cases, and standard treatment options usually include surgery, radiation or conservative management," the researchers wrote.

Prostate cancer is the second most common cancer in men worldwide after lung cancer, killing 254,000 men each year.

But there are fears that in some countries such as the United States, it may now be being overdiagnosed and treated more aggressively than necessary.

All current treatments -- surgery, radiation or hormone therapy -- can cause harm and lead to impotence and incontinence in about a third of patients. The authors of Tuesday's report said with that in mind, doctors and patients should reconsider the watch and wait option.

A study published in August showed routine screening for prostate cancer has led to more than 1 million men in the United States being diagnosed with tumors who might otherwise have suffered no ill effects from them.

For Tuesday's study, Grace Lu-Yao and colleagues at the Cancer Institute of New Jersey studied 14,500 men 65 or older when they were diagnosed -- between 1992 and 2002 -- with early stage prostate cancer and who were cared for without surgery or radiation for 6 months after diagnosis.

They found that after 10 years, 6 percent had died from prostate cancer, far fewer than in results of previous studies dating from 1949 to 1992, when between 15 and 23 percent died within 10 years of being diagnosed.

"Patients tend to over-estimate the effects of treatment. They tend to see cancer as a life-threatening disease and think treatment will save their lives," Lu-Yao, a cancer epidemiologist, said in a telephone interview.

"But prostate cancer is sometimes different from other cancers, and with these early screenings, for a lot of people it really won't cause a problem during their lifetime."

Lu-Yao said the improvement in diagnosis and survival rates could relate to the introduction in 1986 of a widely used blood test that looks for a prostate specific antigen, or PSA.

PSA testing can pick up disease 6 to 13 years before it may otherwise be found, and patients identified in such tests would be expected to live between 6 and 13 years longer because of this lead time, the authors said.

Doctors in the U.S. have routinely recommended PSA screening in men over 50 based on the assumption that early diagnosis and treatment is better than standing by and doing nothing.

(Editing by Maggie Fox)

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Better Day Care, Smarter Kids?

WEDNESDAY, Sept. 16 (HealthDay News) -- Scientists have long known that poverty can inhibit a child's intellectual development. But now researchers have found a possible equalizer -- a good day care environment.

High-quality day care for the youngest poor kids may be enough to offset negative home environments and provide them the foundation for good school skills, at least up to the fifth grade, according to a new study.

Led by Eric Dearing, an associate professor at Boston College's Lynch School of Education, the research team found significant benefits from higher quality day care in the first five years of life.

Impoverished families may be too overwhelmed by the stresses of survival to devote time or resources to help their children achieve later academic success, but Dearing believes quality child care can fill the gap.

"Even minimal exposure to higher-quality child care at times was enough to offset the deprivation often encountered when growing up poor," said Dearing, whose team analyzed data on more than 1,300 children, many of them living at or below the federal poverty line, in 10 regions around the United States. The data, part of a long-term federal study that began in 1991, included half-day observations of children in child care.

Dearing defined "higher quality" day care as settings that offer above-average personal attention, intellectual stimulation and emotional comfort to babies and toddlers. Higher quality day care, he said, should not be confused with the elite services found in affluent communities. Rather, it can be as informal as a grandmother's house or as organized as an established neighborhood day care center.

The findings appear in the September/October issue of Child Development.

The study team, including researchers from Samford University in Alabama and the Harvard Graduate School of Education, found that the benefits of higher quality day care applied to most children, from poor to middle-class. And the more exposure to good day care, the bigger the impact, Dearing added. Most of the day care facilities in the study had no admissions standards, and there was no bias toward children with higher IQs, he noted.

The effect was seen in children from families with close to middle-class incomes, and got more significant as family income levels dropped, the researchers said. This meant that even a brief experience with higher-quality early child care was associated with significantly better math achievement by the time the child reached middle school.

As little as one or two years of day care corresponded to a 5 percent increase in math scores for children from lower-class families (200 percent of the poverty line), and this increment grew as the family income level went down.

"The greatest estimated benefits of higher-quality care were evident for the poorest children, but even for children close to 200 percent of the poverty line the effects of higher-quality child care compared favorably with those for (a rise in) family income," according to the study. "For these children, in fact, just one or two episodes in higher-quality child care produced estimated impacts on achievement similar in size to achievement gains that would be expected if a family's income increased enough to move them from low-income to approximately middle class."

Impoverished mothers and fathers, as much as more affluent parents, need places to care for their kids while they work or go to school. These families are often forced to rely on substandard day care because they have few choices, Dearing said.

The study did not make specific recommendations to improve day care in poor communities, but Dearing suggested the need to better educate parents on how to obtain quality day care and provide more public funding of day care. For those kids without access to higher quality care, later intervention in public schools may be effective, too.

Marta Flaum, a psychologist from Chappaqua, N.Y., agreed with Dearing's conclusions.

"It certainly makes sense, given what we know about the critical role that early experiences play in child development," said Flaum. "The first few years of life are absolutely critical for stimulating language, reasoning and problem solving, and encouraging a curiosity and love of learning. There are windows of opportunity for mastering such important benchmarks, and if skills are not acquired during these periods, learning is much slower and there is a risk of permanent developmental lag."

In related news, another study has found that children who were breast-fed as infants have superior cognitive skills compared with kids who were fed formula. Scientists believe that docosahexaenoic acid (DHA), an essential fatty acid found in mother's milk, is responsible for the improved cognitive skills.

When DHA was added to infant formula, babies showed greater cognitive improvement than the babies fed on regular formula.

"Currently, there is no clear consensus on whether infant formula should be supplemented with DHA," lead author James R. Drover, assistant professor of psychology at Memorial University in Canada, said in a news release. "However, our results clearly suggest that feeding infants formula supplemented with high concentrations of DHA provides beneficial effects on cognitive development."

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Is there really a skin cancer epidemic?

NEW YORK (Reuters Health) – Is melanoma, a potentially deadly form of skin cancer, on the rise, as is often reported? Maybe not, says a new study: The "melanoma epidemic" may simply represent a change in how doctors are diagnosing the disease.

Anti-skin cancer campaigns have highlighted the fact that the number of melanomas has doubled in the past two decades, and continue to rise. However, some have doubted whether there are actually more cases of the cancer.

"The main message is to be cautious about overstating messages about a melanoma epidemic to the public and media," study co-author Dr. Nick J. Levell from Norfolk and Norwich University Hospital, Norwich, UK, told Reuters Health in an email. "Such behavior will tend to induce unnecessary anxiety and behavior that may cause distress and harm."

Dr. Levell and colleagues had a hunch that some of the "epidemic" was due to the fact that many cases of a skin condition known as benign melanocytic nevi - a type of mole - were now being diagnosed as malignant melanoma. So they looked at diagnoses of melanomas from 1991 and 2004 in the East Anglia region of the UK.

The rate did in fact grow, from 9.39 cases per year per 100,000 people, to 13.91, the authors report in the British Journal of Dermatology.

But it was the early-stage melanomas that accounted for much of that difference, while the rate of diagnoses of later-stage melanomas did not change.

At the same time, the researchers note, the rate of death from melanoma rose from 2.16 to 2.54 deaths per 100,000 population per year, but essentially everyone with early stage melanomas survived.

Finally, most early cases were found in parts of the body not exposed to very much sun. Such exposure, which includes ultraviolet radiation, has been tied to melanoma.

All of that suggests, the authors write, that many of the cases of melanoma now being diagnosed would have been called benign melanocytic nevi in the past.

"The trend is to some degree a product of society's trend toward increasing litigation and physicians' increasing fear of making a mistake," Dr. Levell added. "Neither of these is likely to be reversed. Recognition of the phenomenon does however enable the public and physicians to compensate for it to some extent."

SOURCE: British Journal of Dermatology, September 2009.

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Studies: Swine flu spreads long after fever stops

SAN FRANCISCO – When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.

The federal Centers for Disease Control and Prevention has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer — especially at home where the risk of spreading the germ is highest.

Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said.

"This study shows you're not contagious for a day or two. You're probably contagious for about a week," said Gaston De Serres, a scientist at the Institute of Public Health in Quebec.

He presented one of the studies Monday at an American Society for Microbiology conference. It is the first big meeting of infectious disease experts since last spring's emergence of swine flu, which now accounts for nearly all of the flu cases in the United States. More than 1 million Americans have been infected and nearly 600 have died from it, the CDC estimates.

It is unclear whether the new research will lead the CDC to rethink its advice on how long people with swine flu should hole up. Long breaks from school and work do not seem worth it for a virus that now seems to cause mostly mild illness, said the CDC's flu chief, Nancy Cox. Swine flu is spreading so widely now that confining the sick does less good, she said.

"We tried to have our guidance balance out all of these factors," she said. "It's just virtually impossible not to have virus introduced into settings such as schools and universities."

Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug.

"It's probably realistic that this virus sheds much longer than seasonal flu," said Dr. Jonathan McCullers, an infectious diseases specialist at St. Jude Children's Research Hospital in Memphis, Tenn.

Three reports suggest this is so. De Serres and other researchers in Canada took nose and throat swabs from 43 patients with lab-confirmed flu and dozens of other sick family members.

On the eighth day after symptoms first appeared, 19 to 75 percent showed signs of virus remaining in their noses, depending on the type of test used.

"This proportion appears to be very big, and it is," but it's not clear how much virus is needed to actually spread flu, so the lower number is more reliable, he said.

Dr. David C. Lye reported on 70 patients treated at Tan Tock Seng Hospital in Singapore. Using a very sensitive test to detect virus in the nose or throat, he found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all.

A third report came from Dr. Guillermo Ruiz-Palacios of the National Institutes of Medical Science and Nutrition in Mexico, where the first cases of swine flu were detected.

Infected people "shed the virus for a very, very long time," often for more than a week after the start of symptoms, he told the conference. This was especially true of obese people, and patients who started on medicines longer than two days after symptoms first appeared.

The new reports suggest a longer contagious period for swine flu, but how long is not clear, Cox said. Even with it in your nose, "you might not be shedding enough virus to infect other people," she said.

That is why signs like coughing may matter more, De Serres said.

"Contagiousness varies, not only with the presence of the virus, but the other symptoms that would make you transmit," he said.

Swine flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, and sometimes diarrhea and vomiting. Young children may be cranky, less playful or not eat as much as normal, the CDC advises.

The agency's advice to stay home for a day after fever breaks does not apply to health care settings. There, confinement for seven days from the start of symptoms — or until they go away, whichever is longer — is still advised.

People who have had swine flu should cover their mouths when they cough or sneeze and wash their hands a lot once they do return to work and school, the CDC says.

Exercise can extend survival even in 'oldest old'

CHICAGO – Even in the "oldest old," a little physical activity goes a long way, extending life by at least a few years for people in their mid- to late 80s, Israeli researchers found.

The three-year survival rate was about three times higher for active 85-year-olds compared with those who were inactive. Getting less than four hours of exercise weekly was considered inactive; more than that was active.

The results "clearly support the continued encouragement of physical activity, even among the oldest old. Indeed, it seems that it is never too late to start," the researchers wrote in Monday's Archives of Internal Medicine, which published the study.

They noted that exercise reaped benefits even for previously sedentary 85-year-olds; their three-year survival rate was double that of inactive 85-year-olds.

Oldsters didn't have to be super-athletes to live longer; walking at least four hours weekly counted, even if it was just in 15-minute strolls a few times daily.

"As little as four hours a week was as beneficial as more vigorous or prolonged activity," said study author Dr. Jeremy Jacobs, a geriatric specialist at Hadassah Hebrew University Medical Center in Jerusalem.

Active octogenarians also reported less depression and loneliness and a greater ability to perform daily tasks.

Similar benefits have been shown in people in their 60s and 70s, but there has been little research about exercise benefits in people in their 80s.

The study involved 1,861 Jerusalem residents who were 70 years old in 1990. Participants filled out questionnaires about their health and activity levels through 2008.

At age 85, 64 percent were physically active, a relatively high percentage that reflects the Israeli lifestyle, Jacobs said. But he said similar benefits from exercise likely would be seen among the very old in other countries.

There were 512 deaths. Slightly fewer than 7 percent of the active 85-year-olds died by age 88, versus about 24 percent of those who were inactive.

Jacobs said the researchers took into account factors that also affect survival, including participants' overall health and whether they smoked, and still found that activity levels were strongly related to longevity.

Dr. James Webster, a professor of geriatric medicine at Northwestern University's Feinberg School of Medicine in Chicago, said the study can't completely rule out that participants who were able to exercise were already healthier than the others, and thus likely to live longer.

Still, Webster said the link between octogenarian exercise and longevity appears valid. He was not involved in the study.

Laura Thorp, a researcher at Chicago's Rush University Medical Center, said very old patients who want to increase their activity should do so under a doctor's supervision. Still, Thorp said, "Even those who are not exercisers or athletes can start and still see substantial benefits."

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Early flu season — what you need to know

WASHINGTON – Flu season's in full swing two months early this year — and nearly all the cases are the new swine flu strain that so far is targeting mostly children and younger adults.

That doesn't mean older people are off the hook. They sometimes catch swine flu. Also, we could see a one-two punch when regular flu strains start circulating as the weather gets colder. You probably won't know which kind you have. Very few people will get the specialized testing to tell. That doesn't matter — treatment's the same for both.

Here are answers to some questions about what the Centers for Disease Control and Prevention predicts will be a busy and long flu season.

Q: Where's the vaccine, and how many shots will I need?

A: Many people will need to line up twice. One vaccine protects against regular winter flu, and that vaccine's available now. A separate vaccine to protect against swine flu — the 2009 H1N1 strain — will arrive in October. It appears that adults will need one dose of that vaccine; dose studies are under way in children to see if they'll need a booster.

Q: Why couldn't both kinds be put into one shot?

A: Bad timing. Swine flu didn't burst onto the scene until April, after manufacturers had already begun brewing this fall's regular flu vaccine and too late to add into that mix.

Q: How does swine flu compare to regular flu strains?

A: So far it doesn't seem any more deadly than regular flu, which kills 36,000 Americans a year and hospitalizes 200,000. But swine flu does sicken the young much more frequently than the old, and it spreads very easily, especially in crowded schools. A University of Washington study found the typical sick school student infects two to three classmates — so keep sick kids at home.

The sad reality: You can be contagious up to 24 hours before you show symptoms, one reason flu spreads so easily.

Q: Who's at highest risk of severe illness or even death?

A: Children under 5. Pregnant women. People 65 or older. And people of any age with asthma or other lung disorders; diabetes; heart, kidney, liver or blood disorders; neurodevelopmental disorders such as cerebral palsy; or a weakened immune system.

Q: I think I had swine flu over the summer. Do I still need the vaccine?

A: Yes, says CDC flu specialist Dr. Anne Schuchat. Other viruses mimic flu so it's hard to be sure what you had.

Q: How does swine flu affect children, and what symptoms should prompt a race to the pediatrician?

A: Symptoms are the same regardless of age: Fever, aches, cough, sore throat, sneezing or runny nose, sometimes diarrhea and vomiting.

The CDC says to seek immediate care if a child has difficulty breathing or is breathing fast, turns bluish, isn't drinking enough fluids, has severe vomiting, is hard to wake up or lethargic, or is so irritable the child doesn't want to be held.

Also seek care if the fever breaks and then later returns, sign of a possible bacterial infection.

Asian Countries Race to Produce Vaccine for H1N1 Virus

The race to mass-produce vaccines for the lethal H1N1 virus has attracted contenders from Asia’s developing countries, confirming a noticeable expansion of a field that has been dominated by flu vaccine production centres in Europe and North America.

India and Thailand are among the countries working on such vaccine doses. The demand for immunisation measures comes at a time when public health authorities are warning that Asia, like other developing regions, is in dire need of vaccines to respond to the rapid spread of the Type A (H1N1) influenza pandemic.

'This is something new for these countries producing flu vaccines. But they have produced other vaccines,' says Dr Arun Thapa, coordinator for immunisation and vaccine development for the New Delhi-based South and East Asia office of the World Health Organisation (WHO). 'India, Indonesia and Thailand responded to WHO’s request to help boost the vaccine supply.'

'All three countries have received the seed virus for vaccine production,' Dr Thapa said during a telephone interview from Kathmandu, Nepal’s capital, where the region’s public health experts are meeting this week to chart a response ahead of a possible winter surge in (H1N1) flu cases. 'We expect this new vaccine to be ready in the first quarter of 2010. That is an optimistic scenario.'

The WHO, which has transferred technology and development funds to vaccine manufacturers in the three Asian countries, expects to have a 'collective capacity of about 220 million doses annually, with a surge capacity that could reach 420 million vaccine doses annually,' states a press release by the Geneva-based health body.

Those numbers for Asia will also be boosted by another vaccine production centre — China. The region’s giant is reported to have moved ahead of India, Indonesia and Thailand, following an announcement early this month that experts from the country’s State Food and Drug Administration (SFDA) approved a vaccine candidate. It is expected to have vaccines for 65 million people by the end of the year.

'China is set to be the first country to mass-produce a vaccine against the A(H1N1) flu pandemic,' reported the state-owned ‘China Daily’ on its website at the beginning of September. 'Only one shot is needed for inoculation.'

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