- Email: [email protected]
US maternal death rates are on the rise
THE LANCET
SCIENCE AND MEDICINE
US maternal death rates are on the rise
News in brief
A
FDA approve acellular pertussis vaccine The US Food and Drug Administration has approved Tripedia, which contains acellular pertussis vaccine, for use in infants at 2, 4, and 6 months, and for the first booster at 15–20 months. Tripedia is a combination tetanus, diphtheria, and pertussis vaccine. It has previously been approved in the USA for the fourth and fifth doses, and has milder side-effects than whole-cell pertussis formulations.
surveillance effort led by researchers at the US Centers for Disease Control and Prevention has found that pregnancy-related death rates in the USA seem to be rising. The CDC study (Obstet Gynecol 1996; 88: 161–67) found that the number of pregnancy-related deaths per 100 000 live births, a rate that has been declining for 50 years, rose from 7·2 in 1987 to 10·0 in 1990. The researchers identified 1453 pregnancy-related deaths in the period 1987–1990. Of these, 7·7% occurred while the woman was still pregnant, 54·9% occurred after a live birth, 7·1% after a stillbirth, 10·7% after an ectopic pregnancy, and 5·6% after an abortion. Gestational trophoblastic neoplasia accounted for 0·4% of the deaths. The outcome of the pregancy could not be determined in 13·6% of the deaths Haemorrhage, embolism, and pregnancy-induced hypertension were the leading causes of death (figure). Pregnancy-related death rates for
black women were 3·4 times higher than those of white women in 1987 and rose to 4·1 times higher by 1990. The researchers said that the observed rise in death rates may be due to better surveillance. But, they
noted that several studies indicate many pregnancy-related deaths are still going undetected—the actual pregnancy-related death rate could be more than twice as high as that reported for 1990. Michael McCarthy
Syrup contamination linked to Haitian child deaths
T
ainted acetaminophen syrups have been linked to an outbreak of renal failure that has killed more than 80 Haitian children over the past year. The syrups were sweetened with imported glycerine contaminated with diethylene glycol (DEG), a potent nephrotoxin and hepatotoxin. 86 children, ranging in age from 3 months to 13 years, were diagnosed with acute anuric renal failure between November, 1995, and June, 1996. Most cases began with a nonspecific febrile prodrome, followed within 2 weeks by the onset of anuric renal failure, pancreatitis, hepatitis, and neurological dysfunction progressing to coma. ten of the children were transported to the USA for care—nine of these are still living. Of the 76 children who remained in
Haiti only one is known to be alive. “The investigation indicated that at least 79% of patients had consumed one of two locally manufactured acetaminophen syrup preparations (Afebril and Valodon), which were subsequently found to contain DEG”, says the international investigative team (MMWR 1996; 45: 649–50). An accompanying editorial comments that the Haitian outbreak “emphasises the need for pharmaceutical producers worldwide to be aware of possible contamination of glycerin and other raw materials with DEG and to use appropriate quality-control measures to identify and prevent potential contamination”.
Good effects from salt? Favourable cardiovascular metabolic effects have been reported in 50 patients with essential hypertension. The patients were participating in a study examining fluid and hormonal consequences of high salt intake. When patients were switched from a low (20 mmol/day) to a high (260 mmol/day) salt diet, researchers from Barcelona found significant decreases in fasting glucose, total and LDL cholesterol, triglycerides, and uric acid (Clin Sci 1996; 91: 155–61). Yeasts inherit acquired characteristics Hereditability of a self-perpetuating, conformational alteration to a yeast protein, Sup35, has been proposed to explain unexpected genetic observations. Patino et al (Science 1996; 273: 622–26) provide experimental evidence for a “revolutionary model for the inheritance of a phenotypic trait” induced by environmental stress. Importantly, the experiments also provide evidence to support one of major tenets of the prion hypothesis (see Lancet, Aug 3, p326), by showing that [PSI+], a cytoplasmically inherited genetic element in yeast, is a prion-like aggregate of Sup35 which can induce conformational changes and aggregation of newly synthesised Sup35.
Michael McCarthy
Canadian programme reverses high anaemia incidence
T
he incidence of anaemia has been reduced from more than 50% to less than 5% of infants in a British Columbia Native reserve with an inexpensive programme initiated by general practitioners that provided iron-fortified formula to the infants. Paul Sawchuk and his colleague Margaret Rauliuk found that 52% of
394
infants surveyed on the Bella Bella reserve, a community of 2000 people, 500 km north of Vancouver, were anaemic—the Canadian average is 3·5%. Mother’s milk is widely recognised as a good source of iron for infants but the doctors knew from experience that about 75% of mothers in Bella Bella choose not
to breastfeed. To remedy the irondeficiency, a programme was established to provide iron-fortified formula to the infants—Can$3000 and less than a year later, a second survey found that the local rate of anaemia had dropped to 4%. Mark Quinn
Vol 348 • August 10, 1996
SCIENCE AND MEDICINE
US maternal death rates are on the rise
News in brief
A
FDA approve acellular pertussis vaccine The US Food and Drug Administration has approved Tripedia, which contains acellular pertussis vaccine, for use in infants at 2, 4, and 6 months, and for the first booster at 15–20 months. Tripedia is a combination tetanus, diphtheria, and pertussis vaccine. It has previously been approved in the USA for the fourth and fifth doses, and has milder side-effects than whole-cell pertussis formulations.
surveillance effort led by researchers at the US Centers for Disease Control and Prevention has found that pregnancy-related death rates in the USA seem to be rising. The CDC study (Obstet Gynecol 1996; 88: 161–67) found that the number of pregnancy-related deaths per 100 000 live births, a rate that has been declining for 50 years, rose from 7·2 in 1987 to 10·0 in 1990. The researchers identified 1453 pregnancy-related deaths in the period 1987–1990. Of these, 7·7% occurred while the woman was still pregnant, 54·9% occurred after a live birth, 7·1% after a stillbirth, 10·7% after an ectopic pregnancy, and 5·6% after an abortion. Gestational trophoblastic neoplasia accounted for 0·4% of the deaths. The outcome of the pregancy could not be determined in 13·6% of the deaths Haemorrhage, embolism, and pregnancy-induced hypertension were the leading causes of death (figure). Pregnancy-related death rates for
black women were 3·4 times higher than those of white women in 1987 and rose to 4·1 times higher by 1990. The researchers said that the observed rise in death rates may be due to better surveillance. But, they
noted that several studies indicate many pregnancy-related deaths are still going undetected—the actual pregnancy-related death rate could be more than twice as high as that reported for 1990. Michael McCarthy
Syrup contamination linked to Haitian child deaths
T
ainted acetaminophen syrups have been linked to an outbreak of renal failure that has killed more than 80 Haitian children over the past year. The syrups were sweetened with imported glycerine contaminated with diethylene glycol (DEG), a potent nephrotoxin and hepatotoxin. 86 children, ranging in age from 3 months to 13 years, were diagnosed with acute anuric renal failure between November, 1995, and June, 1996. Most cases began with a nonspecific febrile prodrome, followed within 2 weeks by the onset of anuric renal failure, pancreatitis, hepatitis, and neurological dysfunction progressing to coma. ten of the children were transported to the USA for care—nine of these are still living. Of the 76 children who remained in
Haiti only one is known to be alive. “The investigation indicated that at least 79% of patients had consumed one of two locally manufactured acetaminophen syrup preparations (Afebril and Valodon), which were subsequently found to contain DEG”, says the international investigative team (MMWR 1996; 45: 649–50). An accompanying editorial comments that the Haitian outbreak “emphasises the need for pharmaceutical producers worldwide to be aware of possible contamination of glycerin and other raw materials with DEG and to use appropriate quality-control measures to identify and prevent potential contamination”.
Good effects from salt? Favourable cardiovascular metabolic effects have been reported in 50 patients with essential hypertension. The patients were participating in a study examining fluid and hormonal consequences of high salt intake. When patients were switched from a low (20 mmol/day) to a high (260 mmol/day) salt diet, researchers from Barcelona found significant decreases in fasting glucose, total and LDL cholesterol, triglycerides, and uric acid (Clin Sci 1996; 91: 155–61). Yeasts inherit acquired characteristics Hereditability of a self-perpetuating, conformational alteration to a yeast protein, Sup35, has been proposed to explain unexpected genetic observations. Patino et al (Science 1996; 273: 622–26) provide experimental evidence for a “revolutionary model for the inheritance of a phenotypic trait” induced by environmental stress. Importantly, the experiments also provide evidence to support one of major tenets of the prion hypothesis (see Lancet, Aug 3, p326), by showing that [PSI+], a cytoplasmically inherited genetic element in yeast, is a prion-like aggregate of Sup35 which can induce conformational changes and aggregation of newly synthesised Sup35.
Michael McCarthy
Canadian programme reverses high anaemia incidence
T
he incidence of anaemia has been reduced from more than 50% to less than 5% of infants in a British Columbia Native reserve with an inexpensive programme initiated by general practitioners that provided iron-fortified formula to the infants. Paul Sawchuk and his colleague Margaret Rauliuk found that 52% of
394
infants surveyed on the Bella Bella reserve, a community of 2000 people, 500 km north of Vancouver, were anaemic—the Canadian average is 3·5%. Mother’s milk is widely recognised as a good source of iron for infants but the doctors knew from experience that about 75% of mothers in Bella Bella choose not
to breastfeed. To remedy the irondeficiency, a programme was established to provide iron-fortified formula to the infants—Can$3000 and less than a year later, a second survey found that the local rate of anaemia had dropped to 4%. Mark Quinn
Vol 348 • August 10, 1996