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Latest News: New restrictions on hydrocodone to take effect

WASHINGTON (AP) — The federal government is finalizing new restrictions on hundreds of medicines containing hydrocodone, the highly addictive painkiller that has grown into the most widely prescribed drug in the U.S.

The new rules mean that drugs like Vicodin, Lortab and their generic equivalents will be subject to the same prescribing rules as painkillers like codeine and oxycodone. Patients will be limited to one 90-day supply of medication and will have to see a health care professional to get a refill. In many states, only doctors will be able to prescribe the medications, not nurses or physician assistants.

"Today's action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available," said DEA chief Michele Leonhart, in a statement.

The move, announced in a federal notice, comes more than a decade after the Drug Enforcement Administration first recommended reclassifying hydrocodone due to its risks for abuse and addiction. For years, physician groups and the Food and Drug Administration opposed the move, saying it would burden health care providers and patients while driving up costs.

But last year the FDA changed its position, citing the national epidemic of overdoses and deaths tied to prescription painkillers known as opioids.

Deaths linked to the drugs more than tripled between 1999 and 2010, during which sales of opioids increased four-fold.

Anti-addiction groups praised the restrictions, but criticized the FDA for taking nearly a decade to embrace the changes.

"Had FDA responded in a timely and appropriate manner to DEA's urgent request, thousands of overdose deaths and tens of thousands of cases of opioid addiction might have been prevented," said Physicians for Responsible Opioid Prescribing, an advocacy group which has been critical of the government's approach to curbing abuse.

The new restrictions will go into effect in 45 days, according to a federal listing scheduled for publication Friday.

For decades, hydrocodone has been easier to prescribe than other opioids, in part because it was only sold in combination pills and formulas with other non-addictive ingredients like aspirin and acetaminophen.

The Controlled Substances Act, passed in 1970, put hydrocodone combination pills in the Schedule III class, which is subject to fewer controls than Schedule II drugs like morphine and methadone. Under Schedule III classification, a prescription for Vicodin could be refilled five times before the patient had to see a physician again.

That ease of access made it many health care professionals' top choice for treating chronic pain, including everything from back pain to arthritis to toothaches.

In 2012, U.S. doctors wrote more than 125 million prescriptions for hydrocodone-containing medications, making it the most prescribed drug in the country, according to figures from IMS Health.

News of the rescheduling was applauded by lawmakers from states that have been plagued by opioid abuse, including those who have been pushing regulators to make the change.

"Although there is much more that must be done to curb prescription drug abuse, I am confident that rescheduling hydrocodone will undoubtedly begin saving hundreds of thousands of lives immediately," said Senator Joe Manchin of West Virginia, in a statement.

Latest News: UN's top Ebola official wants preparations for 'flareup'

The United Nations' new pointman on Ebola said Friday he was preparing for a possible flareup of the epidemic in West Africa.

"We're either close to a plateau, but then we'll drop, or we're in a phase, an inflection point, where it is going to increase, and I absolutely cannot tell," David Nabarro told AFP during a stopover at Conakry airport en route to Monrovia. He was determined to "ensure that every piece of our apparatus is at its optimum so it could deal possibly with a flareup if that's necessary."

Latest News: Scientist Dawkins in Twitter storm over Down's Syndrome

Scientist Richard Dawkins apologised on Thursday for causing a "feeding frenzy" on Twitter after he said it would be immoral not to abort a foetus with Down's Syndrome.

Dawkins, who has been at the centre of a series of controversies on social media, responded to a user who said they would face a "real ethical dilemma" if they discovered they were expecting a baby with Down's Syndrome.

"Abort it and try again. It would be immoral to bring it into the world if you have the choice," the biologist wrote.

The comment drew criticism from users of the social media site.

"I would fight til my last breath for the life of my son. No dilemma," one user replied.

In a later blog, the author of The Selfish Gene and The God Delusion said his comment had been "tactlessly vulnerable to misunderstanding".

"If your morality is based, as mine is, on a desire to increase the sum of happiness and reduce suffering, the decision to deliberately give birth to a Down baby, when you have the choice to abort it early in the pregnancy, might actually be immoral from the point of view of the child's own welfare," Dawkins wrote.

Latest News: Double vaccines 'could end polio'
Girl getting polio vaccine

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Using both types of polio vaccine could speed up efforts to free the world of the disease, research suggests.

The oral vaccine is leading the fight to eradicate polio, but trials in India show an additional injection of inactivated virus boosts immunity.

The World Health Organization said the findings, published in the journal Science, were "truly historic".

The disease, which is spread through contaminated faeces, can cause paralysis and even death.

Fighting polio has been one of the biggest success stories in global health.

In 1988, there were 350,000 cases of polio in more than 125 countries.

The disease is now widespread in just three countries - Nigeria, Afghanistan and Pakistan - and cases have fallen by more than 99%.

The history of PolioPoliomyelitis has existed as long as human society, but became a major public health issue in late Victorian times with major epidemics in Europe and the United States. The disease, which causes spinal and respiratory paralysis, can kill and remains incurable but vaccines have assisted in its almost total eradication today.
Ancient Egyptian Polio suffererThis Egyptian stele (upright stone carving) dating from 1403-1365BC shows a priest with a walking stick and foot deformities characteristic of polio. The disease was given its first clinical description in 1789 by the British physician Michael Underwood, and recognised as a condition by Jakob Heine in 1840. The first modern epidemics were fuelled by the growth of cities after the Industrial Revolution.
Child polio sufferers, New York 1916New York had the first large polio epidemic, in 1916, with more than 9,000 cases and 2,343 deaths. The toll across the US was 27,000 cases and 6,000 deaths. Children were particularly affected, including by eye paralysis (above). Major polio outbreaks became more frequent during the century - in 1952, the US had a record 57,628 cases.
Iron Lung, 1938In 1928, Philip Drinker and Louie Shaw developed the "iron lung" to save the lives of those paralysed by polio and unable to breathe. Most patients would spend around two weeks in the device, but those permanently paralysed faced a lifetime of confinement. By 1939, around 1,000 of the machines were in use in the US. Today, the iron lung is all but gone, made redundant by vaccinations and modern mechanical ventilators.
Salk and SabinA major breakthrough came in 1952 when Dr Jonas Salk (left) began to develop the first effective vaccine against polio. Mass public vaccination programmes followed and had an immediate effect; in the US alone, cases fell from 35,000 in 1953 to 5,300 in 1957. In 1961, Albert Sabin (right) pioneered the more easily administered oral polio vaccine (OPV).
Schoolchildren in Holland receive the oral polio vaccine.Despite the availability of vaccines, polio remained a threat, with 707 acute cases and 79 deaths in the UK as late as 1961. The next year, Britain switched to Sabin's OPV vaccine, in line with most countries in the developed world. There have been no domestically acquired cases of the disease in the UK since 1982.
Map: Polio in 1988By 1988, polio had disappeared from the US, UK, Australia and much of Europe but remained prevalent in more than 125 countries. The same year, the World Health Assembly adopted a resolution to eradicate the disease completely by 2000.
Map: Polio in 2002The World Health Organization Americas region was certified polio-free in 1994, with the last wild case recorded in the Western Pacific region (which includes China) in 1997. A further landmark came in 2002, when the WHO certified the European region polio-free.
Map: Polio in 2012In 2012, polio remained officially endemic in four countries - Afghanistan, Nigeria, Pakistan and India, which was on the verge of being removed from the list, having not had a case since January 2011. Despite so much progress, polio remains a risk, with virus from Pakistan reinfecting China in 2011, which had been polio-free for more than a decade.
Vaccines

Two drops of the oral vaccine, which contains a weakened polio virus, is the preferred tool in eradication efforts because it is cheap and gives resistance in the digestive tract to lower transmission of the virus.

The injected vaccine works largely in the bloodstream.

"But the oral vaccine is less effective in exactly those places we'd like it to work," one of the researchers, Prof Nicholas Grassly, of Imperial College London, told the BBC.

It is thought other infections may interfere with the vaccine.

The solution has been multiple vaccination. As part of India's successful eradication campaign, some children received 30 doses by the age of five.

Vaccination campaign

Trials in India showed using an injection of inactivated virus as a booster jab was more effective than multiple drops.

However, the biggest challenge in banishing the disease for good is not the choice of vaccine, but getting to children in conflict-ridden areas.

The security issues can be huge and vaccination programmes are even used as a political weapon.

In 2012, the Taliban said vaccinations in the North and South Waziristan regions of Pakistan were banned until the US ended drone strikes.

Prof Grassly argues: "If you have limited access, you want the biggest return. If you can go in with inactivated and oral polio vaccine, you will achieve a lot more than if you just have brief access with oral polio vaccine."

The double-vaccine approach is already being used in parts of Nigeria and will soon be introduced into Pakistan also.

Dr Bruce Aylward, the World Health Organization assistant director general for polio, said: "The results of this study are truly historic in the context of global polio eradication.

"This study has revolutionised our understanding of inactivated polio vaccine and how to use it in the global eradication effort to ensure children receive the best and quickest protection possible from this disease."

Latest News: Doctors may face 'tougher sanctions'
Doctor with stethoscopeDoctors can be suspended or struck off medical registers if they cause serious harm

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The General Medical Council says it plans to toughen sanctions against doctors who harm patients.

Under the proposals, doctors could be forced to apologise or face stricter measures if they had failed to say sorry on previous occasions.

The medical regulator also wants to be able to restrict practice of those who have made mistakes and since retrained, even if their work has improved.

Views of the public and specialist groups are now being sought.

Suspensions and restrictions

Start Quote

These measures are a step in the right direction but they are not yet wide enough and comprehensive enough”

End Quote Peter Walsh Action Against Medical Accidents

The GMC, which regulates all doctors in the UK, says the intention is to protect patients in the small number of cases where the public expects stronger action.

It has powers to restrict practice, suspend or permanently remove doctors from a register that allows them to work.

Extensive guidelines are already in place but the regulator says certain situations merit much stricter measures.

For example, according to new proposals doctors who fail to raise concerns about a colleague's ability to practise safely could face harsher penalties than currently.

GMC chief executive Niall Dickson said: "Doctors are among the most trusted professionals, and rightly so.

"In the vast majority of cases one-off clinical errors do not merit action by the GMC.

"But if we are to maintain that trust, in the small number of serious cases where doctors fail to listen to concerns they should be held to account for their actions.

'Not wide enough'

"There have been occasions when we have been prevented form taking action in cases because the doctor has been able to show that they have subsequently improved their practice," Mr Dickson said.

"We believe that doctors and patients want stronger action in these serious cases."

Peter Walsh, from the charity Action Against Medical Accidents, told the BBC: "These measures are a step in the right direction but they are not yet wide enough or comprehensive enough to make it a genuinely patient-centred process. "

Health Secretary Jeremy Hunt said: "After the tragic failings at Mid Staffs [hospital], we are taking steps to improve patient safety and ensure doctors are held to account for poor care."

The consultation closes on 14 November and the the outcome will be published next year.

Latest News: Ireland tests suspected Ebola case after death

Irish authorities are testing a "suspected case of Ebola virus" after a person who travelled to an affected area in Africa was found dead, the health service said on Thursday.

"The public health department was made aware earlier today of the remains of an individual, discovered early this morning, who had recently travelled to the one of the areas in Africa affected by the current Ebola virus disease outbreak," the Health Service Executive (HSE) said in a statement.

"Until a diagnosis is confirmed, and as a precautionary measure, the individual's remains will stay in the mortuary pending the laboratory results."

The suspected case is in Donegal in northwest Ireland. Test results are expected late on Friday.

The outbreak of the Ebola virus in West Africa is the largest ever and has killed 1,350 people in Liberia, Guinea, Sierra Leone and Nigeria since March.

"We await the outcome of the laboratory tests before we will know whether or not this individual had contracted Ebola virus disease," said Darina O'Flanagan, the head of the HSE health protection surveillance centre.

"The appropriate public health guidelines are being followed at every stage in this process as a precaution."

Latest News: Instant noodles carry health risks for women: study

Women who eat instant noodles, like Ramen, at least two times a week face a greater risk of high blood pressure, elevated blood sugar and high cholesterol, US researchers said Thursday.

The study looked at data from 10,711 adults -- just over half of whom were women -- in the Korean National Health and Nutrition Examination Survey.

Researchers at Harvard University found that there was a 68 percent higher risk of metabolic syndrome among women, but not men, who ate instant noodles more than twice per week.

Metabolic syndrome is a group of conditions that raise the risk of heart disease and diabetes. It includes carrying too much fat around the waist.

"The consumption of instant noodles was associated with increased prevalence of metabolic syndrome in women, independent of major dietary patterns," said the study in the Journal of Nutrition.

In other words, it didn't matter if women ate a largely traditional diet of rice, fish and vegetables, or a diet heavier in meat and fried foods -- if they ate instant noodles twice weekly, they were at higher risk of health problems.

It was unclear why the effect was seen in women but not men.

Since the data was based on surveys, researcher Frank Hu, a professor of nutrition and epidemiology at Harvard, said it may be that women reported their diet more accurately than men, or that women were more sensitive to the effects of carbohydrates, fat and salts.

So how much is too much when it comes to instant noodles?

"Once or twice a month is not a problem," Hu was quoted as telling The New York Times.

"But a few times a week really is."

Latest News: Lack of leadership hurts Ebola fight in West Africa - MSF

By Stephanie Nebehay

GENEVA (Reuters) - Efforts to curb the deadly Ebola epidemic that swept across four West African states are being undermined by a lack of leadership and emergency management skills, the international head of Medecins sans Frontieres (MSF) said on Thursday.

In an interview, Joanne Liu also said the world's worst ever outbreak of Ebola has caused widespread panic and the collapse of health care systems particularly in Liberia, where pregnant women have lost babies while seeking a safe place to deliver.

She said Western nations must dispatch more experts in tropical medicine, especially field workers who know how to help communities prevent the often lethal virus from spreading.

And the World Health Organisation (WHO) must fulfil its leading role in coordinating the international response to the epidemic, the president of the global, Swiss-based medical charity told Reuters by telephone.

"I think they are in the process of bringing more people from the WHO but the reality is that this epidemic will be not be contained unless there are more players," Liu said.

"We are missing everything right now. We are missing a strong leadership centrally, with core nation capacity and disease emergency management skills. It's not happening."

The infectious disease has killed 1,350 people among 2,473 cases in four countries - Guinea, Liberia, Nigeria and Sierra Leone, according to the United Nations health agency.

MSF (Doctors Without Borders) has deployed 1,000 of its own staff in the stricken region, running centres that currently have 300 beds, according to Liu who spent 10 days in Guinea, Liberia and Sierra Leone earlier this month.

"All of our centres are overcrowded right now. We have an Ebola centre in Lofa county in Foya (Liberia) which is close to the epicentre. It was meant to be a centre with a capacity of 20 beds. We have more than 125 patients right now," Liu said.

"The same thing with our centre in Monrovia, which we opened only last weekend, with 125 beds and now it's already filled.

We're entertaining the idea of increasing the capacity, if not doubling it," she said.

"GLOBAL FEAR IN LIBERIA"

Security forces in the Liberian capital fired live rounds and tear gas on Wednesday to scatter a stone-throwing crowd trying to break an Ebola quarantine imposed on their neighbourhood. [ID:nL5N0QQ2FU]

"We are right now, I would say, in a state of global fear in Liberia," Liu said.

"It's paramount now to re-establish access to basic health care. Because we might be facing the ridiculous situation of having people dying more of non-Ebola pathologies than from Ebola. Right now in Monrovia for example, if you have malaria, nobody knows where to go and consult (for health care)."

Liu said that she had received an email from MSF staff with a sad and telling tale of pregnant women in Monrovia seeking a health care centre where they could safely give birth.

"We had this week six pregnant women who ended up walking for hours in the city trying to find a place to deliver and by the time they got to our centre, which was not the right place to be, the babies had died in their wombs," she said.

"I find this identifies very well what we are facing in terms of having a health care system being collapsed from the Ebola epidemic."

Western and African experts are needed to help with education to prevent spread of Ebola, trace contacts of infected people, and care for those in isolation wards, she added.

The U.S. Centers for Disease Control (CDC) is sending some 55 epidemiologists, but more are needed, Liu said.

"The U.S., Canada, France, Germany, those big nations who have big schools of tropical disease, who have know-how in working in highly contagious set-ups, who can mobilise, who have money," Liu said.

"But the reality is that all of us today are navigating in unknown waters. We've never faced something as big as this in the whole history of Ebola, it has never been as big, we have never faced Ebola in an urban setting."

(Editing by Mark Heinrich)

Latest News: Ebola: Care and recovery of 2 American aid workers

NEW YORK (AP) — Two American aid workers have recovered from Ebola and left an Atlanta hospital, after weeks of intensive treatment in a special isolation unit.

They were first two Ebola patients ever brought to the United States.

Dr. Kent Brantly was released from Emory University Hospital on Thursday, nearly one month after he first developed Ebola symptoms while working in West Africa's Liberia. He read a statement at a press conference at the hospital Thursday.

One of his colleagues in Liberia, Nancy Writebol, was quietly released Tuesday, hospital officials disclosed on Thursday.

Some questions and answers about their care and recovery:

Q: Are they cured?

A: Yes, doctors say. There is no more virus in their blood and their symptoms are gone, said Emory's Dr. Bruce Ribner. They will need some time to get their strength back, but they have recovered, he said.

Q: But could they still infect someone else?

A: No, Brantly and Writebol are not considered contagious. Emory's staff demonstrated that by hugging Brantly as he left the press conference. The Centers for Disease Control and Prevention says the release of the two patients poses no threat to the public. (The CDC does advise survivors to avoid sex for three months or use condoms because the virus can be found in semen for seven weeks.)

Q: They both got an experimental treatment. Did it work?

A: Brantly credited his recovery to a number of things, including the ZMapp drug. But Emory doctors and government health officials said it's simply not known whether ZMapp helped them get better, made no difference or hindered their recovery. A Spanish missionary priest who also got the experimental drug has died.

Q: Is there any more available?

A: The small supply is now exhausted; the last of it went to three health care workers in Liberia. It is expected to be many months before any more can be produced by its U.S. maker. The drug aims to boost the immune system to fight off the virus.

Q: Didn't Brantly get a blood transfusion, too?

A: Before he left Africa, Brantly was given blood from a 14-year-old boy who survived Ebola while in his care. The intent was to provide Brantly with antibodies to help fight the infection. And, again like ZMapp, doctors simply don't know if it had any effect.

Q: Well, then what cured them?

A: There's no simple answer. Since there's no specific treatment, care is focused on easing symptoms to give the body enough time to fight off an infection. Patients are given fluids, nutrients and medicines to counter the bleeding, vomiting, and severe diarrhea that can lead to organ failure and death. It probably helped that Brantly and Writebol were considered healthy and well-nourished just before they were infected and received prompt care.

Q: Do many people recover from Ebola?

A: Ebola is an unusually deadly disease, but some do recover —and with far less aggressive treatment than what Brantly and Writebol received in Atlanta. The mortality rate in the current outbreak in West Africa ranges from 30 percent to 90 percent depending on the area, according to the World Health Organization.

Q: Can the Americans get Ebola again?

A: Doctors believe they are immune from the Ebola virus that's caused the current outbreak in West Africa. They may not have much natural protection from other Ebola viruses, however.

Latest News: Global warming 'hiatus' means heat is hiding in ocean

An apparent slowdown in the Earth's surface warming in the last 15 years could be due to that heat being trapped in the deep Atlantic and Southern Ocean, researchers said Thursday.

The findings in the journal Science suggest that such cycles tend to last 20-35 years, and that global warming will likely pick up again once that heat returns to surface waters.

"Every week there's a new explanation of the hiatus," said co-author Ka-Kit Tung, a University of Washington professor of applied mathematics and adjunct faculty member in atmospheric sciences.

"We looked at observations in the ocean to try to find the underlying cause."

Tung and Xianyao Chen of the Ocean University of China studied deep-sea temperatures from floats that sample the water as deep as 6,500 feet (2,000 meters) depth. They found that more heat began to sink around 1999, just when the rapid warming of the 20th century began to flatline.

The movement of more heat into the water explains how surface temperatures could stay close to the same, even as mounting greenhouse gases trap more solar heat at the Earth's surface, researchers said.

They also found that contrary to earlier studies, the Pacific Ocean was not the hiding place for the heat.

"The finding is a surprise," Tung said.

"But the data are quite convincing and they show otherwise."

The change also coincided with an increase in saltier, denser water at the surface of the northern part of the Atlantic, near Iceland.

This dynamic caused changes in the speed of the huge current in the Atlantic Ocean that circulates heat throughout the planet, the study said.

"When it's heavy water on top of light water, it just plunges very fast and takes heat with it," Tung said.

"There are recurrent cycles that are salinity-driven that can store heat deep in the Atlantic and Southern oceans," Tung added.

"After 30 years of rapid warming in the warm phase, now it's time for the cool phase."

Researchers said the current slowdown may last another decade, then the rapid warming is likely to return.

The study was funded by the US National Science Foundation and the National Natural Science Foundation of China.

Latest News: Ethical experts urge 'fair' sharing of Ebola test drugs

The limited doses of Ebola trial drugs must not be reserved for the well-off or well-connected, two medical ethics experts said on Thursday as two American doctors treated with an experimental serum were pronounced cured.

"Fair selection of participants is essential," Ezekiel Emanuel of the University of Pennsylvania and Annette Rid of Kings College London wrote in The Lancet medical journal.

"Especially in a dire emergency such as this one, well-off and well-connected patients should not be further privileged."

The pair said the limited supply of ZMapp, an experimental cocktail of three antibodies, has been given "almost exclusively to health-care workers".

And while some have argued this was correct since they were putting themselves at risk to help others, they could be seen as having an unfair advantage over other, local helpers.

"Health-care workers are often well-off and have special ties to the medical establishment," said Emanuel and Rid.

No approved drug exists, though several are under development and the World Health Organisation last week gave the green light for experimental medicines to be used in fighting the killer disease.

Kent Brantly and Nancy Writebol, American doctors who received ZMapp after falling ill while treating Ebola patients in Liberia, have recovered and been discharged from hospital, it was announced on Thursday by the Emory University Hospital where they were treated.

Brantly and Writebol, three doctors in Liberia and a Spanish priest are known to have been given the trial treatment for a tropical virus that has killed 1,350 people, roughly half the number infected.

Despite the treatment, the priest died.

Emanuel and Rid said a handful of doses of ZMapp known to exist "has already been exhausted", and it would "take months" to produce new stock.

On Wednesday, University of Oxford epidemiologist Oliver Brady calculated in the journal Nature that 30,000 people would have required Ebola drugs by now had they been available.

Emanuel and Rid stressed that containing the virus, not focusing on a treatment, would end the outbreak.

Less than 10 percent of all candidate drugs ever make it through testing to enter the market, they said.

"In other words, it is more likely than not that the interventions will not improve symptoms for patients, and might even weaken them as they battle a life-threatening disease."

But if experimental drugs are given, it should be done only in clinical trials "so that researchers can learn whether they work or not," wrote the pair.

Latest News: Study: Combining vaccines boosts polio immunity

WASHINGTON (AP) — New research suggests a one-two punch could help battle polio in some of the world's most remote and strife-torn regions: Giving a single vaccine shot to children who've already swallowed drops of an oral polio vaccine greatly boosted their immunity.

The World Health Organization officials said the combination strategy already is starting to be used in mass vaccination campaigns in some hard-hit areas and is being introduced for routine immunizations in developing countries, too.

"It could play a major role in completing the job of polio eradication once and for all," said Dr. Hamid Jafari, WHO's director of polio operations, who led the study published Thursday in the journal Science.

Oral polio vaccine has played a critical role in the nearly three-decade effort to eradicate the paralyzing disease, as health workers have gone house-to-house, to refugee camps and to roadside checkpoints delivering the drops. The number of countries where polio regularly circulates dropped from 125 in 1988 to just three as of last year —Pakistan, Nigeria and Afghanistan.

But with travel, the threat is re-emerging in countries previously free of the highly contagious virus. The WHO in May declared an international public health emergency, citing outbreaks in at least 10 countries. Particularly of concern were Syria, Somalia and Iraq, where violence has complicated efforts to contain new cases.

Which vaccine to use in the eradication push has long been controversial. They each have different strengths. The United States and other wealthy countries have switched back to using only injected polio vaccine, which is made of "inactivated" or killed virus, for routine childhood immunizations after eradicating the disease within their borders. That's because the oral vaccine contains weakened live virus that children can shed in their stools, which on very rare occasions can trigger a vaccine-caused case of polio.

In developing countries where polio is still a threat, the oral version is cheaper, easier to use and can slow spread of the virus. But a particular type of immunity, intestinal immunity, wanes so that children in high-exposure areas need repeated doses.

Jafari's team tested whether using both vaccines would protect better than one. The study involved nearly 1,000 children, from babies to 10-year-olds, in northern India in 2011, the last year that country reported a case of polio. The children had previously received oral vaccine. This time, they were randomly assigned to receive either a dose of injected polio vaccine, another oral dose or no booster. Four weeks later they all received what researchers called a "challenge" dose of oral vaccine to see how their bodies shed the weakened live virus.

The shots acted as a better booster for the children's intestinal immunity than giving them yet more vaccine drops — and those youngsters shed far less virus, key to cutting transmission in an outbreak, Jafari's team reported.

A similar study in 450 children in southern India last year reached the same conclusion, researchers reported in The Lancet last month.

And last December, Kenya put the strategy to its first real-world test. Health workers used both injected and oral vaccine as they sought to immunize 126,000 young children living in Somali refugee camps and nearby areas who were at risk from a polio outbreak spilling over the Somalia-Kenya border. They reached most of the children, according to a report by the U.S. Centers for Disease Control and Prevention.

Similar campaigns are beginning in northeastern Nigeria and should start soon in Pakistan, said Jafari and Dr. Bruce Aylward, WHO's assistant director-general for polio.

The injected vaccine is more expensive, Aylward said — about $1 to $1.90 a shot, under specially negotiated prices for low-income countries, compared to about 15 cents a dose for oral vaccine. But he said it was worth the investment if adding the shots wound up eliminating polio in the last infected areas faster.

Using this strategy in these tough-to-reach areas makes sense, said CDC vaccine expert Dr. Steve Cochi.

"We want to take maximum advantage of each contact with a child," he said. "It's the start of the last stand for wild polio virus, and we're trying to hit it with both vaccines."

At the same time, the WHO has called on low- and middle-income countries that now use only oral polio vaccine to add one dose of the injected version to routine childhood immunizations next year.

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