Amy Pfeiffer

WASHINGTON — Influenza A virus shedding has been found to last for longer than 5 days, Dr. Surbhi Leekha reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

“In general, adults are considered to be infectious from a day or two before to approximately 5 days after the onset of symptoms,” said Dr. Leekha, an internal medicine resident at the Mayo Clinic.

The Centers for Disease Control and Prevention recommends providing standard precaution and droplet isolation for 5 days after symptom onset in hospitalized patients who are suspected or confirmed to have influenza. It is also recommended that infected health care workers not provide patient care for 5 days after the onset of flu symptoms, and that sick people should not visit hospitalized patients for 5 days after their symptom onset, she said.

But based on the new findings, she said, prolonged infection control should be considered for patients with influenza A, as well as vaccination for all health care workers who care for patients.

Of 50 patients hospitalized at the Mayo Clinic, Rochester, Minn., from December 2004 to March 2005, 22 (44%) were found to have influenza virus shedding on day 7 after symptom onset, Dr. Leekha said.

Patients were considered for study inclusion if they were older than 18 years and were hospitalized with lab-confirmed influenza A. The 50 patients enrolled in the study ranged in age from 21 to 91 years (mean age 76), and 62% were male, Dr. Leekha said. She and her associates excluded patients for whom they could not obtain written consent.

Almost all study participants had one or more underlying chronic medical conditions. Of the 50 patients, 81% had received an influenza vaccination; 54% were undergoing antiviral therapy.

Throat swabs were taken at symptom initiation, and then again at days 2, 3, 5, and 7 and then tested by culture and polymerase chain reaction (PCR) if the patient was still hospitalized, Dr. Leekha said.

“Positivity falls with increasing duration from symptom onset. But even beyond day 5, several samples continue to be positive,” she said.

At day 7, 22 patients were still shedding the influenza virus as detected by PCR, and 12 patients were shedding as detected by cultures. Of the 22 positive patients, the median age was 76 years, 64% were male, 71% had received a flu vaccination, 50% were receiving antiviral therapy, 4 had an identifiable cause of immunosuppression, and their median hospital stay was 6 days, Dr. Leekha said.

The longest shedding duration lasted for 14 days as detected by all three methods.

A greater than expected proportion of hospitalized patients with influenza A continued to shed detectable virus beyond 7 days from symptom onset in the study, Dr. Leekha said.

“Such prolonged shedding of influenza A virus has previously been shown in immunocompromised adults, also in children, and has been associated with drug-resistant strains in both these populations in previous studies. However, there are no studies of viral shedding in adults with other chronic illnesses,” she said.

Influenza immunity declines with age and is multifactorial, so “it is possible that adult patients who are hospitalized with influenza represent an older and sicker cohort of patients who may possibly be infected for longer than the traditional period of infectivity,” Dr. Leekha said.

Other study limitations as noted by Dr. Leekha include: The period of detection by PCR was greater than by culture detection methods; it is unclear if detection of the flu virus equals infectivity; and not all patients who tested negative were retested because patients were not followed after hospital release, so shedding duration is unknown.

Larger samples should be studied, outpatients should be tested for virus shedding, and patients should be followed until viral completion. The correlation between viral shedding and infectivity should also be explored, she said.

WASHINGTON — Influenza A virus shedding has been found to last for longer than 5 days, Dr. Surbhi Leekha reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

“In general, adults are considered to be infectious from a day or two before to approximately 5 days after the onset of symptoms,” said Dr. Leekha, an internal medicine resident at the Mayo Clinic.

The Centers for Disease Control and Prevention recommends providing standard precaution and droplet isolation for 5 days after symptom onset in hospitalized patients who are suspected or confirmed to have influenza. It is also recommended that infected health care workers not provide patient care for 5 days after the onset of flu symptoms, and that sick people should not visit hospitalized patients for 5 days after their symptom onset, she said.

But based on the new findings, she said, prolonged infection control should be considered for patients with influenza A, as well as vaccination for all health care workers who care for patients.

Of 50 patients hospitalized at the Mayo Clinic, Rochester, Minn., from December 2004 to March 2005, 22 (44%) were found to have influenza virus shedding on day 7 after symptom onset, Dr. Leekha said.

Patients were considered for study inclusion if they were older than 18 years and were hospitalized with lab-confirmed influenza A. The 50 patients enrolled in the study ranged in age from 21 to 91 years (mean age 76), and 62% were male, Dr. Leekha said. She and her associates excluded patients for whom they could not obtain written consent.

Almost all study participants had one or more underlying chronic medical conditions. Of the 50 patients, 81% had received an influenza vaccination; 54% were undergoing antiviral therapy.

Throat swabs were taken at symptom initiation, and then again at days 2, 3, 5, and 7 and then tested by culture and polymerase chain reaction (PCR) if the patient was still hospitalized, Dr. Leekha said.

“Positivity falls with increasing duration from symptom onset. But even beyond day 5, several samples continue to be positive,” she said.

At day 7, 22 patients were still shedding the influenza virus as detected by PCR, and 12 patients were shedding as detected by cultures. Of the 22 positive patients, the median age was 76 years, 64% were male, 71% had received a flu vaccination, 50% were receiving antiviral therapy, 4 had an identifiable cause of immunosuppression, and their median hospital stay was 6 days, Dr. Leekha said.

The longest shedding duration lasted for 14 days as detected by all three methods.

A greater than expected proportion of hospitalized patients with influenza A continued to shed detectable virus beyond 7 days from symptom onset in the study, Dr. Leekha said.

“Such prolonged shedding of influenza A virus has previously been shown in immunocompromised adults, also in children, and has been associated with drug-resistant strains in both these populations in previous studies. However, there are no studies of viral shedding in adults with other chronic illnesses,” she said.

Influenza immunity declines with age and is multifactorial, so “it is possible that adult patients who are hospitalized with influenza represent an older and sicker cohort of patients who may possibly be infected for longer than the traditional period of infectivity,” Dr. Leekha said.

Other study limitations as noted by Dr. Leekha include: The period of detection by PCR was greater than by culture detection methods; it is unclear if detection of the flu virus equals infectivity; and not all patients who tested negative were retested because patients were not followed after hospital release, so shedding duration is unknown.

Larger samples should be studied, outpatients should be tested for virus shedding, and patients should be followed until viral completion. The correlation between viral shedding and infectivity should also be explored, she said.

WASHINGTON — Influenza A virus shedding has been found to last for longer than 5 days, Dr. Surbhi Leekha reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

“In general, adults are considered to be infectious from a day or two before to approximately 5 days after the onset of symptoms,” said Dr. Leekha, an internal medicine resident at the Mayo Clinic.

The Centers for Disease Control and Prevention recommends providing standard precaution and droplet isolation for 5 days after symptom onset in hospitalized patients who are suspected or confirmed to have influenza. It is also recommended that infected health care workers not provide patient care for 5 days after the onset of flu symptoms, and that sick people should not visit hospitalized patients for 5 days after their symptom onset, she said.

But based on the new findings, she said, prolonged infection control should be considered for patients with influenza A, as well as vaccination for all health care workers who care for patients.

Of 50 patients hospitalized at the Mayo Clinic, Rochester, Minn., from December 2004 to March 2005, 22 (44%) were found to have influenza virus shedding on day 7 after symptom onset, Dr. Leekha said.

Patients were considered for study inclusion if they were older than 18 years and were hospitalized with lab-confirmed influenza A. The 50 patients enrolled in the study ranged in age from 21 to 91 years (mean age 76), and 62% were male, Dr. Leekha said. She and her associates excluded patients for whom they could not obtain written consent.

Almost all study participants had one or more underlying chronic medical conditions. Of the 50 patients, 81% had received an influenza vaccination; 54% were undergoing antiviral therapy.

Throat swabs were taken at symptom initiation, and then again at days 2, 3, 5, and 7 and then tested by culture and polymerase chain reaction (PCR) if the patient was still hospitalized, Dr. Leekha said.

“Positivity falls with increasing duration from symptom onset. But even beyond day 5, several samples continue to be positive,” she said.

At day 7, 22 patients were still shedding the influenza virus as detected by PCR, and 12 patients were shedding as detected by cultures. Of the 22 positive patients, the median age was 76 years, 64% were male, 71% had received a flu vaccination, 50% were receiving antiviral therapy, 4 had an identifiable cause of immunosuppression, and their median hospital stay was 6 days, Dr. Leekha said.

The longest shedding duration lasted for 14 days as detected by all three methods.

A greater than expected proportion of hospitalized patients with influenza A continued to shed detectable virus beyond 7 days from symptom onset in the study, Dr. Leekha said.

“Such prolonged shedding of influenza A virus has previously been shown in immunocompromised adults, also in children, and has been associated with drug-resistant strains in both these populations in previous studies. However, there are no studies of viral shedding in adults with other chronic illnesses,” she said.

Influenza immunity declines with age and is multifactorial, so “it is possible that adult patients who are hospitalized with influenza represent an older and sicker cohort of patients who may possibly be infected for longer than the traditional period of infectivity,” Dr. Leekha said.

Other study limitations as noted by Dr. Leekha include: The period of detection by PCR was greater than by culture detection methods; it is unclear if detection of the flu virus equals infectivity; and not all patients who tested negative were retested because patients were not followed after hospital release, so shedding duration is unknown.

Larger samples should be studied, outpatients should be tested for virus shedding, and patients should be followed until viral completion. The correlation between viral shedding and infectivity should also be explored, she said.

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast or ovarian cancer undergo genetic screening for gene mutations if they are at increased risk.

Women who are at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history.

The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years and younger with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women who have been found to have a BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options to reduce breast and ovarian cancer risk in women who are found to have BRCA gene mutations include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, adding that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians and patients work together to decide what if any preventive measures to pursue in patients with the gene mutations.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said Ned Calonge, M.D., the chair of the task force.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force wrote in its recommendation.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI. In addition, BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, according to the task force.

In 2000, the American College of Obstetricians and Gynecologists recommended offering BRCA testing to people who have multiple family members with breast or ovarian cancer and have been found to have the gene mutation.

The task force recommendations are available online at http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast or ovarian cancer undergo genetic screening for gene mutations if they are at increased risk.

Women who are at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history.

The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years and younger with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women who have been found to have a BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options to reduce breast and ovarian cancer risk in women who are found to have BRCA gene mutations include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, adding that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians and patients work together to decide what if any preventive measures to pursue in patients with the gene mutations.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said Ned Calonge, M.D., the chair of the task force.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force wrote in its recommendation.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI. In addition, BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, according to the task force.

In 2000, the American College of Obstetricians and Gynecologists recommended offering BRCA testing to people who have multiple family members with breast or ovarian cancer and have been found to have the gene mutation.

The task force recommendations are available online at http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast or ovarian cancer undergo genetic screening for gene mutations if they are at increased risk.

Women who are at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history.

The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years and younger with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women who have been found to have a BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options to reduce breast and ovarian cancer risk in women who are found to have BRCA gene mutations include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, adding that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians and patients work together to decide what if any preventive measures to pursue in patients with the gene mutations.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said Ned Calonge, M.D., the chair of the task force.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force wrote in its recommendation.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI. In addition, BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, according to the task force.

In 2000, the American College of Obstetricians and Gynecologists recommended offering BRCA testing to people who have multiple family members with breast or ovarian cancer and have been found to have the gene mutation.

The task force recommendations are available online at http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast and ovarian cancer undergo screening for gene mutations if they are at increased risk.

Women at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history. The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years or less with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women found to have BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options for women found to have BRCA gene mutations to reduce breast and ovarian cancer risk include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, which added that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians work together with patients who have the gene mutations to decide on a course of action.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said USPSTF Chair, Ned Calonge, M.D.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force recommended.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI, and BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, the task force added.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast and ovarian cancer undergo screening for gene mutations if they are at increased risk.

Women at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history. The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years or less with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women found to have BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options for women found to have BRCA gene mutations to reduce breast and ovarian cancer risk include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, which added that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians work together with patients who have the gene mutations to decide on a course of action.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said USPSTF Chair, Ned Calonge, M.D.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force recommended.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI, and BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, the task force added.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspsbrca.htm

Women should not routinely undergo genetic screening or counseling for breast and ovarian cancer risk based on gene mutations unless they are at high risk, according to a first-time recommendation on this topic by the U.S. Preventive Services Task Force.

The task force, an independent panel of experts in prevention and primary care, recommended that primary care physicians not routinely refer women for genetic counseling or DNA testing for BRCA1 or BRCA2 gene mutations because harms and costs outweigh the benefits (Ann. Intern. Med. 2005;143:355–61).

However, the task force did recommend that women with a family history of breast and ovarian cancer undergo screening for gene mutations if they are at increased risk.

Women at increased risk include those of Ashkenazi Jewish descent with a first- or second-degree relative with breast or ovarian cancer. Women not of this descent are at risk if they have family history patterns of breast and ovarian cancer (multiple first- and second-degree relatives).

According to the task force, only 2% of the general population is said to have BRCA gene mutations based on family history. The task force recommendation estimated that between 1 in 300 and 1 in 500 women have the BRCA gene mutations in the general population, but not everyone with the mutations will develop breast or ovarian cancer.

Of women aged 70 years or less with BRCA gene mutations, 35%–84% will develop breast cancer and 10%–50% will develop ovarian cancer, the task force noted.

In women found to have BRCA1 or BRCA2 gene mutation, MRI has proved to be more effective than other screening methods to detect breast cancer.

Options for women found to have BRCA gene mutations to reduce breast and ovarian cancer risk include mastectomy or oophorectomy, intensive screening, preventive chemotherapy, or a combination of preventive measures, according to the task force, which added that the benefits of taking these steps have not been confirmed.

The task force recommended that physicians work together with patients who have the gene mutations to decide on a course of action.

“A woman who gains an understanding of the risk she faces may feel less anxious and have a sense of better control of her future,” said USPSTF Chair, Ned Calonge, M.D.

Tools are available to assess BRCA1 and 2 gene mutation risk, but their effectiveness in the primary care setting has not yet been determined, according to the task force.

Further studies on this topic should include “the effectiveness of risk stratification and genetic counseling when delivered in different settings and by different types of providers, appropriate training for counselors, use of system supports, and patient acceptance of educational strategies,” the task force recommended.

Breast cancer mortality should be assessed in future studies based on women who undergo an MRI, and BRCA screening tools should be studied and validated for use in primary care to help physicians make appropriate referrals for genetic counseling, the task force added.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspsbrca.htm