CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.
As of Monday, June 22, 2009, 70 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 41 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others.
The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (5), Connecticut (1), Delaware (1), Georgia (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (2), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).
Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 75% are female. Thirty persons have been hospitalized, 7 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
Advice to Consumers
The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. If consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home they should throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. The recall does not include Nestle Toll House morsels, which are used as an ingredient in many home-made baked goods, or other already baked cookie products.
Individuals who have recently eaten prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local health authorities.
Consumers should be reminded they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.
Advice to Retailers, Restaurateurs, and Food-service Operators
Retailers, restaurateurs, and personnel at other food-service operations should not sell or serve any Nestle Toll House prepackaged, refrigerated cookie dough products subject to the recall.
Learn more about this and other recent outbreaks & incidents >>
Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)
Friday, June 26, 2009
Monday, June 22, 2009
Japanese Medical Librarian Tours Atherton Library
On May 21st, Yumi Yamashita from the Kyoto Prefectural University
of Medicine visited Atherton Library on her week-long tour of local
medical and health sciences libraries.
In Honolulu to present a poster session at the Medical Libraries
Association conference (“Exploring the information needs in
Japanese Medical University Library”), Ms. Yamashita was
determined to visit as many libraries as possible during her brief stay.
She had actually visited Meader Library the previous day not
realizing it is not the health sciences library. Linda arranged to pick
her up the following day, Thursday,and brought her here to the
Hawaii Loa campus.
After being introduced to Atherton staff, Linda gave her a tour of
the library, the ETC, and the rest of the Academic Center.
Ms. Yamashita was very impressed by the size of our nursing print
and e-journal collections and by our use of technology in the library.
She had the opportunity to view the MLA conference YouTube
video created by Linda and An last year. An then gave her a brief
tutorial on using Windows MovieMaker and uploading videos to
YouTube. Afterwards, Linda made the arrangements for Ms.
Yamashita to tour the Hawaii Medical Library at the Queen’s
Medical Center and then drove her there.
According to Linda, Ms. Yamashita was awed by the beauty of our
surroundings andexclaimed upon her arrival on campus -
“This is Hawaii!”
Thursday, June 18, 2009
New Report Finds 10 Early Lessons Learned from the H1N1 Outbreak
Washington, D.C. - Trust for America's Health (TFAH), the Center for Biosecurity, and the Robert Wood Johnson Foundation (RWJF) issued a new analysis today, Pandemic Flu: Lessons From the Frontlines, which found that the initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials, but it also showed how quickly the nation's core public health capacity would be overwhelmed if an outbreak were more severe or widespread.
"H1N1 is a real-world test of our initial emergency response capabilities -- all of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago," said Jeff Levi, PhD, Executive Director of TFAH. "However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."
The Pandemic Flu: Lessons from the Frontlines report reviews 10 early lessons learned from the response to the H1N1 (swine) flu outbreak, 10 ongoing core vulnerabilities in U.S. pandemic flu preparedness, and case studies of challenges communities around the country faced when responding to the outbreak. The 10 early lessons learned from the 2009 H1N1 outbreak in the report were that:
Investments in pandemic planning and stockpiling antiviral medications paid off;
Public health departments did not have enough resources to carry out plans;
Response plans must be adaptable and science-driven;
Providing clear, straightforward information to the public was essential for allaying fears and building trust;
School closings have major ramifications for students, parents and employers;
Sick leave and policies for limiting mass gatherings were also problematic;
Even with a mild outbreak, the health care delivery system was overwhelmed;
Communication between the public health system and health providers was not well coordinated;
WHO pandemic alert phases caused confusion; and
International coordination was more complicated than expected.
"Its critical to understand what worked as planned in the H1N1 response, as well as to look at what needs to be strengthened, fixed, or better funded. This report is a contribution to that effort," said Thomas Inglesby, MD, Deputy Director, Center for Biosecurity of UPMC.
The report also identified some surprises encountered during the H1N1 outbreak, including that much of the world's pandemic planning had revolved around the potential threat of the H5N1 (bird) flu virus, which had been circulating in Asia and elsewhere for nearly a decade. It also reveals that planners anticipated there would be six weeks of lead time between the time a novel flu virus was identified and its spread to the United States.
In addition, according to the analysis in Pandemic Flu: Lessons from the Frontlines, there are a number of systemic gaps in the nation's ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following 10 core areas must be addressed:
1. Maintaining the Strategic National Stockpile -- making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used;
2. Vaccine development and production -- enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;
3. Vaccinating all Americans -- ensuring that all Americans would be able to be inoculated in a short period of time;
4. Planning and Coordination -- improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;
5. School closings, sick leave, and community mitigation strategies -- improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that communities are prepared to limit public gatherings and close schools as necessary;
6. Global coordination -- building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak;
7. Resources -- providing enough funding for the on-the-ground response, which is currently under funded and overextended;
8. Workforce -- stopping layoffs at state and local health departments and recruiting the next generation of public health professionals;
9. Surge capacity -- improving the ability for health providers to manage a massive influx of patients; and
10. Caring for the uninsured and underinsured -- ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.
The full analysis is available on TFAH's Web site at www.healthyamericans.org. The report was supported by a grant from RWJF.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org
"H1N1 is a real-world test of our initial emergency response capabilities -- all of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago," said Jeff Levi, PhD, Executive Director of TFAH. "However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."
The Pandemic Flu: Lessons from the Frontlines report reviews 10 early lessons learned from the response to the H1N1 (swine) flu outbreak, 10 ongoing core vulnerabilities in U.S. pandemic flu preparedness, and case studies of challenges communities around the country faced when responding to the outbreak. The 10 early lessons learned from the 2009 H1N1 outbreak in the report were that:
Investments in pandemic planning and stockpiling antiviral medications paid off;
Public health departments did not have enough resources to carry out plans;
Response plans must be adaptable and science-driven;
Providing clear, straightforward information to the public was essential for allaying fears and building trust;
School closings have major ramifications for students, parents and employers;
Sick leave and policies for limiting mass gatherings were also problematic;
Even with a mild outbreak, the health care delivery system was overwhelmed;
Communication between the public health system and health providers was not well coordinated;
WHO pandemic alert phases caused confusion; and
International coordination was more complicated than expected.
"Its critical to understand what worked as planned in the H1N1 response, as well as to look at what needs to be strengthened, fixed, or better funded. This report is a contribution to that effort," said Thomas Inglesby, MD, Deputy Director, Center for Biosecurity of UPMC.
The report also identified some surprises encountered during the H1N1 outbreak, including that much of the world's pandemic planning had revolved around the potential threat of the H5N1 (bird) flu virus, which had been circulating in Asia and elsewhere for nearly a decade. It also reveals that planners anticipated there would be six weeks of lead time between the time a novel flu virus was identified and its spread to the United States.
In addition, according to the analysis in Pandemic Flu: Lessons from the Frontlines, there are a number of systemic gaps in the nation's ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following 10 core areas must be addressed:
1. Maintaining the Strategic National Stockpile -- making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used;
2. Vaccine development and production -- enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;
3. Vaccinating all Americans -- ensuring that all Americans would be able to be inoculated in a short period of time;
4. Planning and Coordination -- improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;
5. School closings, sick leave, and community mitigation strategies -- improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that communities are prepared to limit public gatherings and close schools as necessary;
6. Global coordination -- building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak;
7. Resources -- providing enough funding for the on-the-ground response, which is currently under funded and overextended;
8. Workforce -- stopping layoffs at state and local health departments and recruiting the next generation of public health professionals;
9. Surge capacity -- improving the ability for health providers to manage a massive influx of patients; and
10. Caring for the uninsured and underinsured -- ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.
The full analysis is available on TFAH's Web site at www.healthyamericans.org. The report was supported by a grant from RWJF.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org
Friday, June 5, 2009
Global Testing Shows No Variation in Swine Flu Virus
Experts worry that it could mutate and become more dangerous as it travels from country to country
THURSDAY, June 4 (HealthDay News) -- In what would seem to be some encouraging news in the ongoing H1N1 swine flu outbreak, a leading federal health official said Thursday that samples of the virus from points around the globe are genetically identical to the strain found in the United States.
"We have tested isolates from a wide geographic area, from the Americas, Europe, from Asia and New Zealand and we are not seeing variations in isolates from the genetic testing we do here," Dr. Anne Schuchat, the Centers for Disease Control and Prevention's interim deputy director for science and public health program, said during a press conference.
While infections caused by the virus continue to be relatively mild and patients recover quickly, health officials have warned that the virus could mutate into a more virulent form, putting greater numbers of people at risk.
The World Health Organization said Tuesday that it was weighing whether to declare a global pandemic, with more cases of the H1N1 swine flu surfacing in the Southern Hemisphere -- where flu season is just beginning -- and outside North America.
The vast majority of infections and deaths have occurred in Mexico -- the source of the outbreak -- and the United States. But person-to-person transmission in now being reported in countries such as Australia (501 cases) and Chile (313 cases), as well as Great Britain, Spain and Japan, according to published reports.
"We still are waiting for evidence of really widespread community activity in these countries, and so it's fair to say that they are in transition and are not quite there yet, which is why we are not in phase 6 yet," WHO flu chief Dr. Keiji Fukuda said during a press conference at the agency's headquarters in Geneva, Switzerland.
Phase 6 is the highest alert on WHO's scale, representing a global epidemic. In terms of the geographic spread of swine flu, the world is "at phase 5 but getting closer to phase 6," Fukuda said, the Associated Press reported.
The WHO also was debating whether to add a second measure that indicates how dangerous the H1N1 swine flu virus is -- rather than just how widespread -- after several countries expressed concerns that declaring a global pandemic could cause mass confusion and panic even though it's still not clear how dangerous the virus will be, the news service said.
To date, the virus has caused 19,273 cases of infection in 66 countries, but just 117 deaths, 97 of them in Mexico, the WHO reported Wednesday.
Since the outbreak started in April, health officials in the United States have said that infections have been mild for the most part. Testing has found that the H1N1 virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza.
The U.S. Centers for Disease Control and Prevention was reporting Wednesday a total of 11,054 cases in all 50 states and the District of Columbia and Puerto Rico, including 17 deaths. The agency said that confirmed cases of H1N1 swine flu represent about one in 20 of actual cases, bringing the total probable number of cases in the United States to about 200,000.
During the next few months, CDC scientists will be looking to see if the virus mutates or becomes resistant to antiviral medications, or is more easily spread among people. The flu season is winding down in the Northern Hemisphere but is just beginning in the Southern Hemisphere.
Some older people may have partial immunity to the H1N1 swine flu virus because of possible exposure to another H1N1 flu strain that circulated prior to 1957, according to the CDC.
A vaccine for the swine flu virus could be ready by October, if research and testing proceed as planned this summer, agency officials said.
U.S. Human Cases of H1N1 Flu Infection(As of June 3, 2009, 11:00 AM ET)
States & Territories* # confrm'd & pr'bable cases Deaths
Alabama 94
Alaska 1
Arkansas 9
Arizona 547 4 deaths
California 804
Colorado 68
Connecticut 196
Delaware 135
Florida 194
Georgia 32
Hawaii 94
Idaho 16
Illinois 1151 3 deaths
Indiana 146
Iowa 92
Kansas 87
Kentucky 90
Louisiana 122
Maine 12
Maryland 63
Massachusetts 566
Michigan 287
Minnesota 66
Mississippi 34
Missouri 41 1 death
Montana 15
Nebraska 43
Nevada 113
New Hampshire 50
New Jersey 74
New Mexico 108
New York 646 4 deaths
North Carolina 21
North Dakota 18
Ohio 29
Oklahoma 87
Oregon 159
Pennsylvania 226
Rhode Island 16
South Carolina 49
South Dakota 9
Tennessee 103
Texas 1403 3 deaths
Utah 369 1 death
Vermont 7
Virginia 36
Washington 574 1 death
Washington, D.C. 20
West Virginia 3
Wisconsin 1905
Wyoming 18
Territories
Puerto Rico 6
TOTAL*(52)
11,054 cases
17 deaths
*includes the District of Columbia and Puerto Rico
Source: U.S. Centers for Disease Control and Prevention
SOURCES: June 4, 2009, teleconference with Anne Schuchat, M.D., U.S. Centers for Disease Control and Prevention's interim deputy director for science and public health program; Associated PressHealthDay
THURSDAY, June 4 (HealthDay News) -- In what would seem to be some encouraging news in the ongoing H1N1 swine flu outbreak, a leading federal health official said Thursday that samples of the virus from points around the globe are genetically identical to the strain found in the United States.
"We have tested isolates from a wide geographic area, from the Americas, Europe, from Asia and New Zealand and we are not seeing variations in isolates from the genetic testing we do here," Dr. Anne Schuchat, the Centers for Disease Control and Prevention's interim deputy director for science and public health program, said during a press conference.
While infections caused by the virus continue to be relatively mild and patients recover quickly, health officials have warned that the virus could mutate into a more virulent form, putting greater numbers of people at risk.
The World Health Organization said Tuesday that it was weighing whether to declare a global pandemic, with more cases of the H1N1 swine flu surfacing in the Southern Hemisphere -- where flu season is just beginning -- and outside North America.
The vast majority of infections and deaths have occurred in Mexico -- the source of the outbreak -- and the United States. But person-to-person transmission in now being reported in countries such as Australia (501 cases) and Chile (313 cases), as well as Great Britain, Spain and Japan, according to published reports.
"We still are waiting for evidence of really widespread community activity in these countries, and so it's fair to say that they are in transition and are not quite there yet, which is why we are not in phase 6 yet," WHO flu chief Dr. Keiji Fukuda said during a press conference at the agency's headquarters in Geneva, Switzerland.
Phase 6 is the highest alert on WHO's scale, representing a global epidemic. In terms of the geographic spread of swine flu, the world is "at phase 5 but getting closer to phase 6," Fukuda said, the Associated Press reported.
The WHO also was debating whether to add a second measure that indicates how dangerous the H1N1 swine flu virus is -- rather than just how widespread -- after several countries expressed concerns that declaring a global pandemic could cause mass confusion and panic even though it's still not clear how dangerous the virus will be, the news service said.
To date, the virus has caused 19,273 cases of infection in 66 countries, but just 117 deaths, 97 of them in Mexico, the WHO reported Wednesday.
Since the outbreak started in April, health officials in the United States have said that infections have been mild for the most part. Testing has found that the H1N1 virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza.
The U.S. Centers for Disease Control and Prevention was reporting Wednesday a total of 11,054 cases in all 50 states and the District of Columbia and Puerto Rico, including 17 deaths. The agency said that confirmed cases of H1N1 swine flu represent about one in 20 of actual cases, bringing the total probable number of cases in the United States to about 200,000.
During the next few months, CDC scientists will be looking to see if the virus mutates or becomes resistant to antiviral medications, or is more easily spread among people. The flu season is winding down in the Northern Hemisphere but is just beginning in the Southern Hemisphere.
Some older people may have partial immunity to the H1N1 swine flu virus because of possible exposure to another H1N1 flu strain that circulated prior to 1957, according to the CDC.
A vaccine for the swine flu virus could be ready by October, if research and testing proceed as planned this summer, agency officials said.
U.S. Human Cases of H1N1 Flu Infection(As of June 3, 2009, 11:00 AM ET)
States & Territories* # confrm'd & pr'bable cases Deaths
Alabama 94
Alaska 1
Arkansas 9
Arizona 547 4 deaths
California 804
Colorado 68
Connecticut 196
Delaware 135
Florida 194
Georgia 32
Hawaii 94
Idaho 16
Illinois 1151 3 deaths
Indiana 146
Iowa 92
Kansas 87
Kentucky 90
Louisiana 122
Maine 12
Maryland 63
Massachusetts 566
Michigan 287
Minnesota 66
Mississippi 34
Missouri 41 1 death
Montana 15
Nebraska 43
Nevada 113
New Hampshire 50
New Jersey 74
New Mexico 108
New York 646 4 deaths
North Carolina 21
North Dakota 18
Ohio 29
Oklahoma 87
Oregon 159
Pennsylvania 226
Rhode Island 16
South Carolina 49
South Dakota 9
Tennessee 103
Texas 1403 3 deaths
Utah 369 1 death
Vermont 7
Virginia 36
Washington 574 1 death
Washington, D.C. 20
West Virginia 3
Wisconsin 1905
Wyoming 18
Territories
Puerto Rico 6
TOTAL*(52)
11,054 cases
17 deaths
*includes the District of Columbia and Puerto Rico
Source: U.S. Centers for Disease Control and Prevention
SOURCES: June 4, 2009, teleconference with Anne Schuchat, M.D., U.S. Centers for Disease Control and Prevention's interim deputy director for science and public health program; Associated PressHealthDay
Some OTC Sleep, Cold Meds Could Harm Aging Brain
Drugs containing benadryl linked to slowed thinking, delirium in elderly, report finds.
THURSDAY, June 4 (HealthDay News) --Older people taking common over-the-counter drugs for pain, cold symptoms or help with sleep may increase their risk for cognitive impairment, including delirium, University of Indiana researchers report.
These drugs include Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM and Unisom.
All of these over-the-counter (OTC) drugs contain benadryl (diphenhydramine), a molecule that blocks the neurotransmitter acetylcholine. Acetylcholine is essential for normal functioning of the central and peripheral nervous systems, the researchers explained.
"Before taking any medication prescribed by your doctor or an OTC medication, make sure there is no negative impact of this medication on your brain," said lead researcher Dr. Malaz Boustani.
His group analyzed data from 27 prior studies on the relationship between anticholinergic effects and brain function, as well as looking into anecdotal data. The team found a consistent link between anticholinergic effects and cognitive impairment in older adults.
"Any OTC medication with the term 'PM' will indicate the presence of benadryl, which is bad for the brain," Boustani concluded.
He noted that the effects of benadryl can add up, so the more medications you take that contain benadryl the worse it may be for cognition. "There is a relationship with the number of medications and the burden on your aging brain," the researcher said.
People aged 65 and older who take these medications also run the risk of developing delirium, Boustani said. Delirium is a decline in attention-focus, perception and cognition, or "acute brain failure," as Boustani calls it. Delirium typically increases the odds of dying or being institutionalized, he said.
In addition, taking these medications for 90 days or more may triple your risk of developing Alzheimer's disease, Boustani said.
Given the risks, older adults should look for drugs that don't contain benadryl, he said.
"A lot of these medications are not recognized for these side effects," he contended. "It's time for the FDA to start taking this negative impact of these medications on the aging brain seriously."
The report is published in the May online issue of the Journal of Clinical Interventions in Aging.
According to Boustani, researchers in brain pharmacoepidemiology at Indiana University's Center for Aging Research is conducting a study of 4,000 older adults to see if the long-term use of medications with anticholinergic effects is associated with the development of severe cognitive impairment, such as Alzheimer's disease.
Dr. Clinton Wright, an associate professor of neurology at the Miller School of Medicine at the University of Miami, agreed that more study is needed to assess the effects of these drugs on the brain.
"These findings don't surprise me at all," Wright said. "People tend not to think of their OTC medications as medication, but any medication that has anticholinergic effects can affect people's cognition."
Wright believes the drugs should carry a warning of this potential side effect.
Deborah G. Bolding, a spokeswoman for GlaxoSmithKline, the maker of Sominex, defended the product and said it complies with all current FDA regulations. However, she would not comment specifically on whether diphenhydramine is associated with an increased risk of delirium in older adults.
"Sominex is a mild sleep aid designed to help individuals through periods of nervous tension or stress, which are accompanied by sleeplessness. It has been proven safe and effective in medical tests when taken as directed, and has been safely used by millions of satisfied customers," Bolding said.
"For all formulations, Sominex's active ingredient is diphenhydramine hydrochloride. This is marketed under a final FDA monograph as an over-the-counter sleep aid," she added.
SOURCES: Malaz Boustani, M.D., associate professor, medicine, Indiana University School of Medicine, Indianapolis; Clinton Wright, M.D., associate professor, neurology, Miller School of Medicine, University of Miami; Deborah G. Bolding, spokeswoman, GlaxoSmithKline; May 2009, Journal of Clinical Interventions in Aging, online
THURSDAY, June 4 (HealthDay News) --Older people taking common over-the-counter drugs for pain, cold symptoms or help with sleep may increase their risk for cognitive impairment, including delirium, University of Indiana researchers report.
These drugs include Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM and Unisom.
All of these over-the-counter (OTC) drugs contain benadryl (diphenhydramine), a molecule that blocks the neurotransmitter acetylcholine. Acetylcholine is essential for normal functioning of the central and peripheral nervous systems, the researchers explained.
"Before taking any medication prescribed by your doctor or an OTC medication, make sure there is no negative impact of this medication on your brain," said lead researcher Dr. Malaz Boustani.
His group analyzed data from 27 prior studies on the relationship between anticholinergic effects and brain function, as well as looking into anecdotal data. The team found a consistent link between anticholinergic effects and cognitive impairment in older adults.
"Any OTC medication with the term 'PM' will indicate the presence of benadryl, which is bad for the brain," Boustani concluded.
He noted that the effects of benadryl can add up, so the more medications you take that contain benadryl the worse it may be for cognition. "There is a relationship with the number of medications and the burden on your aging brain," the researcher said.
People aged 65 and older who take these medications also run the risk of developing delirium, Boustani said. Delirium is a decline in attention-focus, perception and cognition, or "acute brain failure," as Boustani calls it. Delirium typically increases the odds of dying or being institutionalized, he said.
In addition, taking these medications for 90 days or more may triple your risk of developing Alzheimer's disease, Boustani said.
Given the risks, older adults should look for drugs that don't contain benadryl, he said.
"A lot of these medications are not recognized for these side effects," he contended. "It's time for the FDA to start taking this negative impact of these medications on the aging brain seriously."
The report is published in the May online issue of the Journal of Clinical Interventions in Aging.
According to Boustani, researchers in brain pharmacoepidemiology at Indiana University's Center for Aging Research is conducting a study of 4,000 older adults to see if the long-term use of medications with anticholinergic effects is associated with the development of severe cognitive impairment, such as Alzheimer's disease.
Dr. Clinton Wright, an associate professor of neurology at the Miller School of Medicine at the University of Miami, agreed that more study is needed to assess the effects of these drugs on the brain.
"These findings don't surprise me at all," Wright said. "People tend not to think of their OTC medications as medication, but any medication that has anticholinergic effects can affect people's cognition."
Wright believes the drugs should carry a warning of this potential side effect.
Deborah G. Bolding, a spokeswoman for GlaxoSmithKline, the maker of Sominex, defended the product and said it complies with all current FDA regulations. However, she would not comment specifically on whether diphenhydramine is associated with an increased risk of delirium in older adults.
"Sominex is a mild sleep aid designed to help individuals through periods of nervous tension or stress, which are accompanied by sleeplessness. It has been proven safe and effective in medical tests when taken as directed, and has been safely used by millions of satisfied customers," Bolding said.
"For all formulations, Sominex's active ingredient is diphenhydramine hydrochloride. This is marketed under a final FDA monograph as an over-the-counter sleep aid," she added.
SOURCES: Malaz Boustani, M.D., associate professor, medicine, Indiana University School of Medicine, Indianapolis; Clinton Wright, M.D., associate professor, neurology, Miller School of Medicine, University of Miami; Deborah G. Bolding, spokeswoman, GlaxoSmithKline; May 2009, Journal of Clinical Interventions in Aging, online
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