National Institutes of Health scientists have identified how a kind of immature immune cell responds to a part of influenza virus and have traced the path those cells take to generate antibodies that can neutralize a wide range of influenza virus strains.

Study researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, were led by Gary Nabel, M.D., Ph.D., director of NIAID’s Vaccine Research Center. Their findings appear online in advance of print in Nature.

“This new understanding of how an immature immune cell transforms into a mature B cell capable of producing antibodies that neutralize a wide variety of influenza viruses could speed progress toward a universal flu vaccine – one that would provide protection against most or all influenza virus strains,” said NIAID Director Anthony S. Fauci, M.D.

Universal flu vaccines, which are in development at NIAID and elsewhere, differ significantly from standard influenza vaccines.

Unlike standard vaccines, which prompt the immune system to make antibodies aimed at the variable head of a lollipop-shaped influenza protein called hemagglutinin (HA), a universal flu vaccine would elicit antibodies that target HA’s stem.

Because the stem varies relatively little from strain to strain and does not change substantially from year to year, a vaccine that can elicit HA stem-targeted antibodies would, in theory, provide recipients with broad protection from the flu. The neutralizing antibodies generated would recognize any strain of flu virus.

Finding ways to elicit these broadly neutralizing antibodies (bnAbs) is thus a key challenge for universal flu vaccine developers.

However, there is a snag. Researchers knew what the end products (mature bnAbs) look like, but they did not have a clear picture of the initial steps that stimulate their development.

Specifically, they lacked an understanding of how the precursor immune cell – called a naïve B cell – first recognizes the HA stem and starts down a path that ends in mature bnAb-producing B cells.

In the new research, Dr. Nabel and his colleagues demonstrated that the immature antibodies can only recognize and bind to HA’s stem when the antibodies are attached to the membrane of a naïve B cell.

The investigators showed that this initial contact delivers a signal that triggers the maturation of these naïve B cell into countless daughter cells, some of which acquire the specific genetic changes that give rise to HA-stem-binding antibodies.

“We have repeated the first critical steps in the route leading to broadly neutralizing influenza antibodies,” said Dr. Nabel. “Understanding how such antibodies originate could allow for rational design of vaccine candidates that would prompt the correct naïve B cells to go on to mature into bnAb-producing cells.”

The findings could also be relevant to HIV vaccine design, noted Dr. Nabel. There, too, eliciting bnAbs to relatively constant portions of HIV is a key goal.

The insights into how naïve B cells recognize constant components of a virus and mature into bnAb-producing cells could guide efforts to design an HIV vaccine capable of reproducing this effect.

NIAID conducts and supports research – at NIH, throughout the United States, and worldwide – to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses.

The United States lags three other industrialized nations – France, Germany and the United Kingdom – in its potentially preventable death rate, and in the pace of improvement in preventing deaths that could have been avoided with timely and effective health care, according to a Commonwealth Fund–supported study published as a web first online on Aug. 29 in Health Affairs.

Between 1999 and 2006-07, the overall potentially preventable death rate among men ages 0 to 74 dropped by only 18.5 percent in the United States, while the rate declined by nearly 37 percent in the UK For women, the rate fell by 17.5 percent in the U.S. but by nearly 32 percent in the UK

In “In Amenable Mortality – Deaths Avoidable Through Health Care – Progress In the US Lags That of Three European Countries,” Ellen Nolte, director of Health and Healthcare at RAND Europe and Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine analyzed amenable mortality trends.

Amenable mortality is a measure of deaths before age 75 that could potentially have been prevented by timely access to appropriate health care.

The research also looked at death rates for those under 65, as well as deaths between ages 65 and 74 from conditions like treatable cancer, diabetes, infections, and heart disease.

While the pace of improvement was slower in the U.S. for both age groups, the lag was most pronounced among American men and women under age 65, who are more likely to be uninsured and have problems with access to care than those 65 and older, who are eligible for Medicare.

By comparison, France, Germany and the United Kingdom all provide affordable, universal coverage to their populations regardless of age.

“These findings strengthen the case for reforms that will enable all Americans to receive timely and effective health care” said Nolte, lead author of the study.

By 2007, the potentially preventable death rate among U.S. men under age 65 was 69 per 100,000, considerably higher than in the UK (53), Germany, (50) and France (37).

Death rates for men in this age group have declined more rapidly in all three countries since 1999 than in the United States.

Among women under age 65, the potentially preventable death rate dropped from 64 to 56 per 100,000 in the U.S., from 61 to 46 per 100,000 in the UK, from 49 to 40 per 100,000 in Germany, and from 42 to 34 per 100,000 in France.

For both women and men under age 65, U.S. potentially preventable death rates were higher than the other three countries.

In contrast to the under-65 population, U.S. potentially preventable death rates compared relatively well for men and women ages 65-74, the age when people in the U.S. become eligible for Medicare. However, the U.S. rate of decline in this age group was slower than that in the UK And Germany.

“Despite spending about twice as much per person each year on health care as France, Germany or the UK –  $8,400 in 2010 – the U.S. is increasingly falling behind these countries in terms of progress in lowering the potentially preventable death rate,” said Commonwealth Fund President Karen Davis. “The good news is that the Affordable Care Act is already beginning to close the gaps in access to care. When fully implemented, it will cover nearly all Americans, with the potential to put our country on track to improve to levels seen in the best-performing countries.”

NORTHERN CALIFORNIA – The Northern California Network of Adventist Health has established the Adventist Heart Institute, a network of physicians that incorporates specialists from the regions served by four Adventist Health hospitals – Frank R. Howard Memorial Hospital, St. Helena Hospital Napa Valley, St. Helena Hospital Clear Lake and Ukiah Valley Medical Center.

“We’re consistently working to improve outstanding care for the communities we serve,” said Northern California Network President Terry Newmyer.

“The Adventist Heart Institute provides access to a full spectrum of cardiac and vascular services to patients from Napa, Lake, Mendocino, Humboldt, Solano and Sonoma counties, and beyond,” he said.

Physicians of the Adventist Heart Institute have access to modern operating suites, the latest technology and one of the region’s most highly respected cath labs.

This will deliver to each patient comprehensive coordinated cardiac care, including diagnostics, intervention, surgery, rehabilitation and follow up in their own community.

To learn more about Adventist Heart Institute visit www.AdventistHeart.org .

For referrals please call 888-529-9018.

SACRAMENTO – Raw milk, raw skim milk (non-fat) and raw cream produced by Organic Pastures Dairy of Fresno County and with a code date of SEP 13 are the subjects of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Jones.

The quarantine order followed the confirmed detection of campylobacter bacteria in raw cream. No illnesses have been reported at this time.

Under the recall, Organic Pastures Dairy brand Grade A raw cream, Grade A raw milk and Grade A raw skim milk, all with a labeled code date of SEP 13, are to be pulled immediately from retail shelves, and consumers are strongly urged to dispose of any product remaining in their refrigerators.  

CDFA inspectors found the bacteria as a result of product testing conducted as part of routine inspection and sample collection at the facility.

According to California Department of Public Health, symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever.

Most people with campylobacteriosis recover completely. Illness usually occurs two to five days after exposure to campylobacter and lasts about a week.

The illness is usually mild and some people with campylobacteriosis have no symptoms at all. However, in some persons with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection.

In addition, a rare disease called Guillain-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

California will be the first state in the country to receive new Medicaid dollars under the Affordable Care Act to provide community-based personal attendant services and supports to beneficiaries as an alternative to nursing facility and other institutional services, according to an announcement made Tuesday by the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner.  

“Thanks to the Affordable Care Act, seniors and persons with disabilities in California will have better options that will help them get the care they need in their own homes and communities, rather than institutions like a nursing home,” said Acting Administrator Tavenner.

The “Community First Choice Option” was established under the Affordable Care Act and is a new State plan option under Medicaid.

It allows states to provide home and community-based attendant services to certain Medicaid enrollees who require an institutional level of care.  

States choosing to participate in this option receive a 6 percentage point increase in their federal medical assistance percentage for expenditures related to this option.  

California will receive an estimated $258 million for the first year of implementation, and $315 million for the second year.  

The increased funding is available as long as the option is included as a benefit in the State’s Medicaid program, known as Medi-Cal.

Community First Choice ensures that each beneficiary has a person-centered plan that reflects the individual’s choices and preferences about how services and supports are provided to achieve or maintain independence.

For more information on this Community First Choice option, visit www.hhs.gov/news/press/2012pres/04/20120426a.html .

Patients with psoriasis are at high risk of new-onset diabetes mellitus, according to research presented at ESC Congress 2012.

The findings were presented at the press conference by Dr Ole Ahlehoff from Copenhagen University Hospital, Gentofte, Denmark and at the scientific session by Usman KHALID.

Psoriasis is a common chronic inflammatory disease that affects approximately 125 million people worldwide.

A new study of the entire Danish population confirms previous reports of increased risk of diabetes mellitus in patients with psoriasis and shows that risk increases with severity of psoriasis.

Psoriasis, atherosclerosis and early steps in the development of diabetes mellitus are characterised by chronic inflammation, i.e. a chronic state of alert.

“This chronic state of alert may explain the increased risk of cardiovascular diseases and diabetes mellitus seen in these patients,” said Dr Ahlehoff.

The study comprised more than 4 million people, including approximately 50,000 patients with psoriasis, who were followed for 13 years.

The overall rates of new-onset diabetes mellitus per 1,000 observational years were 3.67 in the reference population who did not have psoriasis, 6.93for patients with mild psoriasis and 9.65 for patients with severe psoriasis.

The risk of new-onset diabetes mellitus was increased in all patients with psoriasis compared to people who did not have psoriasis.

Risk increased with the severity of psoriasis. Compared to people without psoriasis, patients with mild psoriasis were 1.5 times more likely to acquire new-onset diabetes mellitus and patients with severe psoriasis were more than twice as likely.

The results remained significant after adjustment for potential confounders, including age, sex, socioeconomic status, use of medication and comorbidity.

Dr Ahlehoff said: “The major conclusion of the study was that psoriasis was associated with increased risk of diabetes mellitus and the risk was highest in patients with severe psoriasis.”

“The results add to current evidence of increased risk of cardiovascular and metabolic disease in patients with psoriasis,” he added. “More needs to be done to increase awareness in this large group of patients on what steps they can take to decrease their risk factors for cardiovascular disease.”

Dr Ahlehoff continued: “Studies are urgently required to examine the impact of aggressive psoriasis treatment on cardiometabolic outcomes.”