WELCOME TO VITAL SIGHS!

This is the accompanying medical blog of Radioactive Adobo. All topics found here are either essays or comments on current medical issues, as well as photos of my so-so existence in the medical field.

At any rate, this blog is dedicated to Che Guevara. We all need a Che in these days and times.

Che, the revolutionary, trained as a physician at the University of Buenos Aires, Argentina.

(Artwork by Andy Warhol)

WHEW!

It's been a long time since I last visited this site. It needs updating. I have chosen this lovely template to dissipate any gore or anything likely to make you wish you were never born.

The reason why we choose blue or green fabric as scrub suits is because blood looks brown instead of scarlet when it spurts or splashes on it, hence this color for my template.

If i find a new one soon, we will see which one's more effective.

For now, have fun!

PINOY.MD

Do visit Pinoy.MD to discuss issues about the Philippine Medical Community.

Visit here.

IT MUST BE THE MILK!

INFANT DEATHS BLAMED ON USE OF MILK FORMULA

First posted 11:33pm (Mla time) Aug 08, 2005
Inquirer News Service

DAVAO CITY—More infants die every year because many mothers refuse to breastfeed their young for at least six months, Health Secretary Francisco Duque III said.

Duque said breastfeeding ensured the survival and health of babies. But because more mothers refuse or neglect breastfeeding, about 16,000 babies die every year.

Mother’s milk is the only complete food for the child, Duque said. It contains colostrum, an antibody that fights life-threatening childhood diseases, such as pneumonia, diarrhea and measles.


Breastfeeding has more benefits for BOTH mother and baby than previously believed

Mothers who breastfeed their young are known to reduce the risk of contracting ovarian and breast cancer and even osteoporosis.

But Duque said many mothers, especially those who work, resort to infant milk formula.

“It’s a waste of money,” he said of commercial infant milk.

On the average, mothers who use infant formula milk for their children spend P2,000 a month, he said.


"Cow's milk is best for cows. Now, repeat after me..."

The health department estimates that some P3 billion worth of infant milk are consumed each year.

“It’s a dilemma,” Duque described how lactating mothers failed to analyze the economic and health benefit of breastfeeding.

“More and more poor women buy infant formula milk,” he said.

Dr. Howard Sobel, a representative of the World Health Organization, said the 16,000 infant deaths that occur yearly in the country could be traced to formula feeding.

He cited a study of the United Nations Children’s Fund which showed that the risk of infant formula-fed babies who die from diarrhea was 25 times higher than that of breastfed babies.

Dennis Jay Santos, PDI Mindanao Bureau

DENGUE HERE TO STAY; 12,308 TAKEN ILL

First posted 02:24am (Mla time) Aug 10, 2005
By Christian V. Esguerra
Inquirer News Service

THE NUMBER of Filipinos running dengue fever continues to soar despite strict sanitation measures put in place by local government units and the Department of Health (DOH).

Exactly 12,308 cases nationwide, including 159 deaths, have been reported from Jan. 1 to Aug. 3, according to a DOH update yesterday.

The figures represented a 15-percent rise in the number of dengue cases registered in the same period last year. Back then, the DOH documented 10,690 cases.

Considering the current trend, government health experts are expecting around 20,000 cases by the end of the "dengue season" in October, said Dr. Enrique Tayag, chief of the DOH National Epidemiology Center.

Tayag said the estimate was still a far cry from the 40,000 cases reported during the dengue crisis in 1998. He said the fatality rate (the number of deaths compared with the total number of cases in an area) was nowhere near the 2-percent threshold.

"It is not actually high but we are all working to minimize the number of infections," he told the Inquirer on Monday.

Most of the fatalities died within 48 hours, suggesting that they had been afflicted with a "virulent" strain of dengue or were slow in seeking treatment, he said.

There was good news in Quezon City where Barangay Pag-asa recorded 42 cases from May 1 to July 31 this year alone. Dengue infection peaked at 10 cases from June 5 to June 11.

The village had only two cases from July 24 to 30, the DOH reported yesterday.

Another badly afflicted area, General Tinio in Nueva Ecija, had a total of 99 cases and two deaths from July 1 to Aug. 2. Cases there in fact decreased to only six in the first two days of the month.

As of Aug. 3, Region 10 registered the biggest number of infections at 2,221, of whom 49 people died, according to the DOH report. Metro Manila came in second with 25 deaths out of 1,853 cases.

Region 9 had only five deaths despite having the third highest number of cases at 1,327. Region 7 recorded 1,198 cases and 22 deaths.

Two types of fever

Areas with a high prevalence of infections, including fatalities, suggested that the victims came down with "dengue hemorrhagic fever," the more common and more fatal of the two types of dengue fever, said Tayag. The other is "classical dengue" or "break-bone fever."

Dengue is normally characterized by a drop in the platelet count below the normal 100,000. A worst-case scenario requires blood transfusion.

Of the country's 12,308 cases as of last week, Tayag said, 30-50 percent involved dengue hemorrhagic fever while the rest of the victims had "break-bone fever," which usually causes extreme muscle and joint pains.

The DOH reported a "clustering" of dengue cases in at least eight provinces and regions. An area is clustered if it registers three or more cases in four consecutive weeks.

Three of these areas were in Bukidnon province: Poblacion in Manolo Fortich town, Kalusungay in Malaybalay, and Poblacion in Lantapan. Three more were in the province of Misamis Oriental: Poblacion in Libertad town, Poblacion in El Salvador, and Poblacion in Claveria.

Bulacan province had two in Loma de Gato in Marilao town and Sapang Palay in San Jose del Monte. So did Camiguin province in Agoho in Mambajao town and Bonbon in Catarman.

Also affected were Poblacion in Infanta town in Quezon province, Mambongan in San Lorenzo town in Nueva Ecija, and 13 areas in Cagayan de Oro City.

In Metro Manila, clustering of cases was reported in Sunflower Street in the Urdaneta Village subdivision in Malabon town; F. Varona Street and Parola in Manila's Tondo district; and Anonas Street in Manila's Santa Mesa district.

As dengue cases continued to soar, Tayag urged the public to take pains in learning about the disease and to take measures to avoid getting infected.

Common symptoms

Common symptoms like a high fever that suddenly drops after a few days, listlessness and stomachache should prompt people to immediately seek treatment, Tayag said.

Eliminating breeding grounds for "Aedes aegypti" or dengue-carrying mosquitoes is also a must. These are usually containers holding stagnant water after a rain, allowing mosquitoes to breed.

A common misconception in dealing with dengue hemorrhagic fever involves the administering of aspirin, an anti-fever drug. Aspirin will just worsen a patient's condition because it prevents blood clotting, Tayag said.

"Dengue is here to stay," he said. "You can only reduce significantly the number of mosquito-breeding sites so you can limit the spread of dengue, but you cannot eliminate it totally."

On the average, most Filipinos get all four strains of dengue virus before reaching age 14, he said.

"No one can determine if it was your first or last," he said. "It affects all ages."

This dengue season, 43 percent of all the cases belong to the 1-9 age group, according to the epidemiologist.

MISCONCEPTIONS

The dengue scare is upon us again. From January to August of this year, over 12,000 cases have been logged with the Department of Health. Over a hundred deaths have already transpired as of this writing and many more are convalescing in hospitals all across the country. Already, Cebu and the Cordilleras have announced their own State of Emergencies because of the pronounced incidences of morbidity and morality in their areas.

This is the real enemy! Puksain ang lamok na nagdadala ng dengue!

The other day, while watching the local news, an officer of the DoH said "na dapat sugpuin na natin ang nakamamatay na dengue." I had to react immediately, of course. I mean, statements like this could be taken as facts by the clueless populace. While it is true that dengue cases have to be addressed immediately, it is not the disease process that needs to be "mapuksa." It should be the vector. And in this case, the usual suspect would be the mosquito Aedes aegypti.

I always frown upon knee-jerk responses like fogging. How long does the effect lasts anyway? The lay person's understanding of diseases that affect them is becoming vaguer by the day. To tweak Henry David Thoreau's maxim on simplifying matters to suit our purposes, Demystify, demystify! Education is still the key to preventing the deaths that have brought grief to many families across the islands.

It is a shock that despite the centuries-long existence of diseases like dengue or malaria, we haven't properly found a way to drill into the minds of the populace how to prevent these from happening. How many deaths should there be for us to make the 4 o'clock habit a real habit? If this is this a sign of how low the Filipino people regard health, I really am not surprised.

(Source: Center for Disease Control, GA)

A few months back, there were reported cases of cerebral malaria. The son of broadcaster Rey Langit, in fact, was a casualty although in reality - and I am sorry to say this - they may have virtually asked for their deaths by going to the areas where the disease was raging without undergoing the required immunzations. Any tourist in his right mind would always make sure he gets the required shots before traveling to Southeast Asia, how much more when we LIVE here?

And Mel Tiangco, broadcaster of GMA7, had the temerity to ask Mr Langit if Reyster was already administered antibiotics. Great.

Maybe I am getting technical, so sue me. I propose that we leave the discussion of vital health issues to the professionals, rather than to broadcast journalists who are more inclined to mere broadcasting than do real journalistic work. In fact, no physican or infectious disease specialist was asked to discuss the matter on television.

Reyster Langit did not die because he had to do a duty. He died out of ignorance. And with his death, the ignorance of many more was sorely amplified.

BE INFORMED. Read!

Cerebral Malaria

Dengue Hemorraghic Fever here and here

Do Free Drug Samples Influence Residents' Prescribing Decisions?

drugs
Originally uploaded by sensible28.

Here's an interesting article I came upon courtesy of Blogborygmi.

You need stories on how it happens in the Philippine setting, let me know.

Read the article here.

MARKED FOR LIFE

THE MARK FOR LIFE BREAST CANCER SELF-EXAMINATION KIT, originally uploaded by sensible28.

I saw this ad today and I feel that it must come out in this blog more than anywhere else.

The Mark for Life breast cancer self-examination kit includes this T-shirt with printed diagrams that guide the wearer’s hand motions, and allows them to mark the location of any lumps right on the shirt, enabling a comparison from month to month..

Please read more here.

SOMETHING TO THINK ABOUT

Source: Philippine Daily Inquirer (www.inq7.net )

WHO IS LISTENING?

UN: Asia in danger of AIDS explosion
By Elaine Lies, Manila Bulletin Saturday, 2 July 2005

Agency says region must attack it now or face epidemic in 5 years

Kobe, Japan (Reuters) – The risk of AIDS spreading in Asia in now higher than ever, with more than 12 million people in danger of getting the deadly disease by 2010 unless prevention efforts are made a global priority, the United Nations said on Friday.

One in four new infections occurs in Asia. The virus has spread to all provinces in China, while India has the world’s second-highest number of AIDS/HIV patients after South Africa.

The epidemic is still mainly concentrated among vulnerable groups such as homosexuals, injecting drug users and sex workers, but could spread into the general population unless determined efforts are made, says a report released in advance of an AIDS conference opening in the western Japanese city of Kobe later Friday.

“The risk of AIDS spreading further in Asia and the Pacific is now higher than ever,” said Peter Piot, Executive Director of UNAIDS, the UN agency devoted to fighting the epidemic.

Low condom use, limited access to HIV testing, gender inequality, widespread injecting drug use, and sex work are seen as a “dangerous cocktail” that could lead to a rapid expansion of the deadly disease.

“If HIV prevention programmes are urgently scaled up, six million HIV infections could be prevented in the next five years in the region,” he said in a statement.

“If Asian countries do not rise up to the challenge, then 12 million people will become newly infected.”

NEVER AGAIN

, which goes to prove that what you smell may kill you.

ARTICLE PENDING

TRAGEDY (PART TWO)

I received the following SMS from Dr. GP last June 18:

"My 2nd biopsy result s out, i have invasive ductal ca stage 2b. Wil be undergoing anothr surgery nxt mnth, plus chemotx or hormonal tx. M tired."

Only a few months ago, she also underwent MRM for another disease process which stumped her doctors, and now this.

Owing to the twin shock that I had last year during which I learned that my Mom and JGC's sister have breast cancers, I am almost always overwhelmed with grief when I am confronted with yet another case among people I know. I mentioned the SMS to my Mom in passing because we had guests that time, and proceeded to comfort Dr. GP in any way possible.

As usual, she's making a joke out of it again (the last time was about her brachial plexopathy, a side effect to her MRM when her brachial plexus was hit during the operation, giving her arm a mind of its own).

"OK lang. Its just dat i shud b bc at dis pt n my lyf learning 2 seduce men dan fytng against cancer. At least kylie minogue has a gorgeous bf 2 stay besyd her thru it ol".

Saying that that'd make her an instant slut, she replied:

"Eh ikaw kaya mamatay na virgin. How tragic. Kidng."

This morning, I was arguing with her that she should go on with her chemo, to which she replied that it may do more harm than good to her (during a quick visit to Cagayan de Oro last February, I was one among those who were literally forcing her to get her lump biopsied.)

Besides, Dr. GP is afraid she may lose her job (she's currently a First Year Resident in Radiology in a hospital in Cagayan de Oro).

I used my Mom as an example of someone who defied her oncologist and continued to travel and work despite the weakening effects of chemo.

Adriamycin (Doxorubicin) for example, one of the vital components of the existing therapy for Breast Ca called TAC (the T is for Taxotere and C is for Cyclophosphamide) is the one responsible for alopecia or hair loss, something that women don't take lightly.

Sigh. When will this scourge ever end?

BODY PARTS AND MEMORIES

I just received copies of my New York Life and Manulife manuals (at 29, I already have a pension AND a life plan?!), and I am shocked to realize how companies can actually append a monetary value to loss of life, a limb or two without thinking of the true cost of actually missing even a thumb or a pinkie or worse, eyesight or hearing!

Going through the compensation packages, it suddenly dawned on me that I just placed price tags on my body parts simply by subscribing to insurance policies. Not that that was my original intention, no. I got them to help people who needed to sell and reach their quotas for the fiscal year. Sigh.

The same thing was said of my application as an Organ Donor member of the National Kidney and Transplant Institute. Mom warned me about flaunting my organ donor card (it can easily be seen once you open my wallet) because I could be intentionally eliminated once certain people find out I am so willing to donate my organs (oh dear!). Not that I am afraid to be eliminated (at least it saves me from the trouble of having to hang myself in the bathroom) nor am I afraid to donate organs (if only to save a relative's life, of course). I guess being a donor requires great courage, really. For now, I have resorted to donating blood to the NKTI every 6 months as part of my Blood Insurance Program, whereby I am assured of blood products being made available to me anytime, anywhere and whenever I need it.

Now back to the insurance policies. How were these companies able to measure how much should be paid a patient if, say, she/he lost one ear? Or an eye, perhaps? Or the left thumb?

Let's say I get 50% for losing my left ear, does this mean I can already feel normal and live life like I still have two ears? Medically, each ear has a different role (one ear hears something else the other doesn't) so I don't think a 50% rebate is appropriate or enough. Some pundits would have it by saying that at least, I got something for it. What if i was a musician or a doctor? The ear means the world to me! I'd rather lose one leg! (I wasn't wishing I would, mind you.) The entire scheme appears to have been based on a person who doesn't do any thing at all so as to render his parts unimportant.

But losing a thumb, for example, would forever maim one person! The architecture of the hand requires a thumb to enable one to maneuver many things (aside from grasping). This is over and above the need to send SMS messages wherein the thumb plays the only role.

Really, sometimes things don't make sense.



N.B. Something tells me I just made a very unintelligent blog today. Either this is because I don't get enough sleep or I m______e too much, or both. Maybe I should start reading my medical books again if only to revive my atrophying brain.

Music playing in the background: HELP! by the the Beatles

GONG EXTREME

Not content with the usual precautions, the French anti-AIDS advocacy group AIDES has decided to go extreme just to prove a point that sex without protection is like cavorting with death (as portrayed here by a tarantula(?) and a scorpion).





Thanks to JUST JARED.

AND YET ANOTHER

Yeah, yet another disturbing ad from the French group AIDES. It's cool, nonetheless.


This "tool" can kill!

AT LAST

At last, someone is giving Folic Acid (Vitamin B9) the attention it so badly deserves.

ARTICLE PENDING

ALDOUS LEONARD HUXLEY, NOW AND FOREVER

English novelist and essayist Aldous Leonard Huxley, b. July 26, 1894, d. Nov. 22, 1963


Aldous Leonardo Huxley, pragmatic dreamer

Here's another favorite author I wish to introduce you to, dear reader. As is the case, I always get to discover certain writers by way of the same route - an accident. Not the violent type, no. Basta consider yourself lucky to have them come to you served on a silver platter - or via a blog.

Since I am perpetually on the lookout for the unusual, I chanced upon A BRAVE NEW WORLD in 1998 in Ayala Center Cebu's National Bookstore (where, incidentally, 85% of my current collection was bought).

It probably must be Huxley's visionary approach to the subject matter (perfect society concepts and cloning as topics in 1932? You must be kidding.) and his non-monotonous reasoning that attracted me to this book. Huxley wanted to become a physician, except that an eye ailment that almost blinded him when he was 16 prevented him from becoming one, and this book reflected much of his what-ifs scenarios although it's not something that one can call "smooth sailing". After all, it appeals to a specific kind of reader (traces of snobbery here, alert! alert!).

Snippets:

"But I like the inconveniences."

"We don't," said the Controller. "We prefer to do things comfortably."

"But I don't want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin."

"In fact," said Mustapha Mond, "you're claiming the right to be unhappy."

"All right then," said the Savage defiantly, "I'm claiming the right to be unhappy."

"Not to mention the right to grow old and ugly and impotent; the right to have syphillis and cancer; the right to have too little to eat; the right to be lousy; the right to live in constant apprehension of what may happen tomorrow; the right to catch typhoid; the right to be tortured by unspeakable pains of every kind." There was a long silence.

"I claim them all," said the Savage at last.

Mustapha Mond shrugged his shoulders. "You're welcome," he said.

from A Brave New World


Don't you just love the way the English write? Sigh.

_____________________________
Read more on the book: www.huxley.net

Medical Files : UPDATE ON THE COXIBS

By Rafael Castillo, MD

WE HAVE received inquiries from arthritis patients who are in a quandary whether to continue taking their antiarthritis pills, popularly known as coxibs or COX-2 blockers. This became a serious concern when rofecoxib (Vioxx) was voluntarily pulled out of the market by its manufacturer last September. Since then, drug regulatory authorities in the United States and Europe have conducted a thorough review on the long-term safety of the other coxibs in the market.


On the hot seat: Celebrex and Vioxx

Many anticipated the worst-case scenario of having the other coxibs also withdrawn. Many patients whose arthritic pains have been dramatically relieved by their coxib started becoming anxious over the prospect of going back to their previous medications which were not as effective as the coxibs and which had more side-effects, particularly stomach irritation.

It's amazing that some patients didn't seem to mind the potential risk of a stroke or a heart attack with prolonged continuous intake of a coxib. They would rather take the small risk rather than endure the intolerable pains of their arthritis.

Here to stay

We have a bit of good news for these patients. Coxibs are apparently here to stay. The European Medicines Evaluation Agency (EMEA) and the US Food and Drug Administration (FDA) Advisory Committee have issued separate recommendations last week, particularly on the label changes specifying the precautions that have to be taken by the physicians and patients taking the drug.

Those who don't have any heart or blood-vessel disease can safely take the coxib, but those with established cardiovascular disease should only take it with their doctor's supervision.

The EMEA issued the following statement:

"Patients treated with COX-2 inhibitors who have previously been diagnosed as having a stroke, mini stroke or heart disease, should make a nonurgent appointment to see their doctor who will review their medication and recommend alternative treatment.

"Patients are advised that stopping COX-2 treatment will not cause any harm, but they are likely to need alternative treatment to control symptoms.

"Patients who have risk factors for heart disease or stroke [high blood pressure, high cholesterol, diabetes or those who smoke] do not need to stop treatment, but should discuss their treatment with their doctor at their next routine appointment. He/she will consider whether it would be better to continue with their COX-2 inhibitor or change to another type of treatment, depending on their overall cardiovascular risks and risks of suffering gastrointestinal problems."


Bextra

New labels

The following caution and guideline will also be required to appear on the label:

"Cardiovascular risk of treatment may increase with dose and duration of exposure, therefore the lowest effective dose should be used for the shortest duration possible.

"In some patients, with insufficient relief from symptoms, an increased dose may increase efficacy. In the absence of increased therapeutic benefit after two weeks, other therapeutic options should be considered. In all cases, the patient's response to therapy should be re-evaluated periodically.

"The decision to prescribe a COX-2 specific inhibitor should be based on assessment of the individual patient's overall risk."

The new labels will also include precautions in combining COX-2 selective inhibitors with drugs for high blood pressure, i.e., ACE inhibitors or angiotensin II receptor antagonists, especially in the elderly or in dehydrated patients. Patients should be adequately hydrated and consideration should be given to periodic monitoring of kidney function to avoid the risk of kidney failure. This is standard precaution for all nonsteroidal anti-inflammatory drugs.

The US FDA Advisory Committee on COX-2 medicines reaffirmed that the coxibs were important treatment options for arthritis patients.

The committee has cited Pfizer's commitment to conduct long-term studies on the cardiovascular profiles of its coxibs Celebrex and Bextra. All manufacturers of coxibs should take the same initiative to dispel any doubt on the safety of their respective brands. The research designs should be approved by the FDA to prevent any bias.

NOT ANOTHER ONE!

What is in this biochemical formula that causes increased heart failure risk?

Not another one! Reports on BBC and CNN quoted the US FDA that it is pulling out Valdecoxib (Bextra) from the US and European market immediately because its adverse effects (Steve-Johnsons, among others) far outweigh its benefits. Last year, Vioxx of Merck was already pulled put, albeit upon the initiative of the company. The more popular Celebrex is also being questioned. Celebrex is by Pfizer, and so is Bextra (originally by another company which was bought by Pfizer 3 years ago. Just give me time to recall what it was).

I discovered the powers of Bextra three years ago when I was bed-ridden for days due to a hurting tophi on my left foot. I had to cling to the walls (wait, not in THAT manner) or use an umbrella as a cane to prop me up when I walk. 80 mgs of Bextra after, I was back to my usual self.



I have prescribed Bextra to my cousin who was here from Singapore, and to a Lola as well. My cousin's doctor in Singapore was about to prescribe her the same thing, only to find out she already was on it. Ditto for my other friends who also benefitted from this amazing Cox-2 inhibitor. I never fail to receive good feedback about it.

I have always been charmed by Pain Medicine, and I am torn between this specialty and Emergency Medicine, the latter being the current "baby" of the medical field. Any physician knows about the magic of taking away pain, and how this translates to more referrals by patients and other doctors alike (talk about patient 'impressions': "Magaling yan si Doc! Sa kanya ka na pumunta!"). This aspect of healthcare is the most fulfilling for doctors; to make patients "feel better".

I have always viewed Cox-2 medications as heaven-sent, considering their power to take away pain much, much faster than the usual NSAIDS. Although expensive, I have learned the economic aspects of healthcare when I was still connected with Abbott Laboratories. The longer the patient is in pain and not able to work, the more losses there will be: productivity and salary-wise. Physicians must be able to weigh things properly. A choice between cheaper medications versus expensive medications is never black and white. Expensive medications have a reason for being expensive.

For example, in my one year of work in the Pharma industry, I have learned that Paracetamols available in the market - currently the most accessible and MOST _(can't recall the word)_ of pain relievers - do not have the same effectivity in terms of speed or even dosaging. Biochemistry is the reason for this. Without advertising, I prefer Tylenol over the more-common Biogesic because the former is only taken b.i.d (twice a day) as opposed to the latter being taken at q.d. (four times a day). If a patient is taking a cocktail of drugs, it is easy to forget 4X as opposed to 2X a day.

Filipinos pa naman have this very, very bad habit of taking more than what is required "para gumaling agad". Kakainis!!! I have ranted about this several times to other MD friends, and berated many a patient for this maling akala (wrong notion). I suppose majority of patients haven't heard of paracetamol toxicity at all!

I hope Bextra and its other forms can be studied thoroughly once more. The patients will definitely benefit much from its re-release. I should know.

OOOOOOOOPS!

How terribly stupid.

Authorities are now doing everything possible to ensure samples of the killer influenza virus, tagged as Influenza A H2N2, sent to more than 4,000 laboratories in 18 countries are destroyed before anyone becomes infected, a top U.S. disease expert says.




"While the risk of the situation is very low, we're not taking any chances and we're doing everything we can to make sure that there is no threat to human health," Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention, told reporters at a news conference on Wednesday.

On September 10, the College of American Pathologists sent samples of the virus that caused the Asian flu pandemic of 1957 to laboratories in 18 countries, including the United States and Canada. The pandemic killed more than 1 million people, including about 70,000 in the United States.


These sick birds can kill...

The samples, part of a package of pathogens sent to laboratories to test their ability to identify them, were last seen in nature in the United States in 1968, Gerberding said. Anyone born since then would presumably have no immunity to the virus, she said. Authorities are still trying to determine how many laboratories got the samples of the virus.

The World Health Organization has contacted the ministries of health of the other 17 countries "to be sure that similar processes are in place" in all labs affected. How the virus wound up being included in a package of pathogens sent around the world was not clear, but Gerberding said health authorities would work to ensure such a lapse did not recur.

Organizations responsible for testing and accrediting laboratories' quality routinely send out panels of unknown organisms to determine if the laboratory can accurately identify them.

In this case, the College of American Pathologists contracted with Meridian Bioscience Inc., of Cincinnati, Ohio, to create the panel, Gerberding said.

"It is almost impossible to believe they didn't know they were dealing with an H2N2," she added. "It was probably a situation where the advantages of using a strain that grows well and can be readily manipulated in the lab were the driving force without even considering that ... it could potentially cause a hazard to not only the workers in the laboratory, but to the people in the community."

Gerberding said she did not know who made that decision. A company spokesman did not immediately return a call seeking comment. Most of the samples have been destroyed, she said.

It was not until March 26 that a laboratory in Canada discovered the presence of the virus and alerted Canadian health officials, who in turn notified the World Health Organization and CDC, Gerberding said.

Five days later, the lab was advised "to undertake a full stem-to-stern assessment" and, on April 8, the lab determined that the panels were the source, Gerberding said.

In addition to the United States and Canada, the other countries that got the panels are Bermuda, Belgium, Brazil, Chile, France, Germany, Israel, Italy, Japan, Lebanon, Mexico, South Korea, Saudi Arabia, Singapore and Taiwan. It also went to Hong Kong.

Tsk tsk tsk. What's next? The smallpox virus, perhaps? *sneers*