The United States has a higher rate of babies born too early – and therefore at greater risk of death or health problems – than more than 125 other countries, including Rwanda, Uzbekistan, China and Latvia, according to a report out today.

About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks.

Click to view interactive map and charts

While nearly two thirds of all pre-term births worldwide occur in Sub-Saharan African and Asia, the U.S. rate shows that “this is not just a developing country issue,” says Chris Howson, vice president for global programs at the March of Dimes.

His organization, along with the World Health Organization, Save the Children and the Partnership for Maternal, Newborn & Child Health, produced the report. It says about one million pre-term babies worldwide die shortly after birth, while others can suffer lifelong health problems.

Born Too Soon is a joint effort of almost 50 organizations, including the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

“This report sounds the alarm that prematurity is an enormous global health problem that urgently demands more research and resources,” said Craig Rubens, MD, PhD, executive director of GAPPS and contributor to the report.

“Even if every known intervention was implemented around the world, we would still see 13.8 million preterm births each year; we could only prevent 8 percent,” he said.

Maternal risk factors include being under- or over-weight, having diabetes or high blood pressure, smoking, being younger than 17 or over age 40.

Rates within countries can vary widely. In the U.S., for example, the pre-term birth rate for white women in 2009 was 10.9 percent, compared with 17.5 percent for African American women, the report says.

In the U.S. and some other developed countries, pre-term births are also linked with a higher use of fertility drugs, which are associated with mothers carrying twins, triplets or more, increasing the chance of early labor. Some births in the U.S. are also induced early, either because the mother is having health problems or for the convenience of the doctor or mother.

Because pre-term births are costly and dangerous, physician groups, organizations like the March of Dimes and even some employers have ongoing efforts to discourage women and their doctors from scheduling births before 39 weeks, unless there is a health reason to do so. The Obama administration launched a $40 million program in February aimed at reducing the number of premature births, especially elective deliveries.

Those elective early births are also the subject of a March of Dimes education campaign, which says even though the absolute numbers are small, the risk of death for babies born just one to two weeks early is twice as high as for those born at 39 weeks.

Howson says the groups that signed on to the report have made a variety of suggestions for lowering the rate worldwide, ranging from inexpensive injections that can be given to mothers in preterm labor to help develop fetal lungs to encouraging women to have health exams before they get pregnant to check for risk factors.

“A preterm baby indicates a failure in the system,” he says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The total of 1,008 reported as of April 21 is more than reported in all of 2011 and is the highest number of cases since 1,026 were reported in all of 2005.

At this rate, the state is on track to reach more than 3,000 cases for the year; levels that haven’t been seen in more than six decades, officials said.

“We’re very concerned about the risk to infants, especially because of how quickly whooping cough is spreading,” said Secretary of Health, Mary Selecky. “Whooping cough can be life threatening for infants, and they’re too young to get enough doses of vaccine to be protected. That’s why we want everyone else to make sure they’re vaccinated against whooping cough.”

Already this year 71 infants under a year old have been reported to have whooping cough. Eighteen of them have been hospitalized. No babies have died in 2012, but two babies died in 2010 and two in 2011.

Whooping Cough (Pertussis)

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Many cases in the current epidemic are being reported in school age children. The vaccine that young children get wears off over time, so all children age 11-12 should get a whooping cough booster shot, called Tdap, health officials said.

The Tdap vaccine is also recommended for pregnant women and women who recently gave birth.

Getting vaccinated before giving birth helps prevent the mother from spreading the illness to her newborn.

The Department of Health has release a public service announcement featuring Chelsey Charles, a mother whose 27-week-old infant  Kaliah died of whooping cough last year.

“It devastated our family,” Chelsey Charles says. “Don’t wait; go get your Tdap shot before it’s too late for somebody else.”

“This is what we’re trying to prevent,” says Dr. Maxine Hayes, State Health Officer. “When adults get sick with whooping cough it can be miserable, but when babies get the disease, they often must be hospitalized because it’s difficult for them to feed, sleep, and breathe.”

Selecky and Hayes urge all teens and adults to check their immunization status. Many health care providers use the state’s immunization registry and can check which vaccines have been given.

Most health insurance carriers cover the whooping cough vaccine; adults should double check with their health plan.

Whooping cough vaccines are available to all Washington children under 19 years old through health care provider offices participating in the state’s Childhood Vaccine Program.

More information on whooping cough disease and who should be vaccinated is available on Department of Health’s website (www.doh.wa.gov).

The number of reported cases is updated every Tuesday afternoon.

Free vaccine available

Dr. Hathaway earned her medical degree from the University of Washington School of Medicine after receiving a bachelor of science in neurobiology.

She completed an internship and residency in pediatrics at Primary Children’s Hospital, University of Utah in Salt Lake City, Utah, and she is  is certified by the American Board of Pediatrics.

She joined The Polyclinic Pediatrics from Seattle Children’s Hospitals Emergency Department and Urgent Care Clinics.

She previously worked as a medical assistant at the Seattle Cancer Treatment and Wellness Center.

In addition to providing general pediatric care from birth through adolescence, Dr. Hathaway has a special interest in preventative care through health promotion, disease prevention, and safety advocacy.

She is accepting new patients and may be reached at: 206-292-2249.

Since the beginning of the year, 640 cases of whooping cough have been reported and confirmed in 23 of the state’s 39 counties. At this time last year, only 94 cases had been reported, Sec. Selecky said.

Red represents cases so far this year; blue cases from last year;

The actual number of cases may be far higher, Selecky said, because only about 10 percent to 12 percent of cases are reported. “This is the tip of the iceberg,” she said.

Infants are most vulnerable to the disease, and there have been at four infant deaths in the state due to whooping cough over the past years.

“We’re very concerned about the continued rapid increase in reported cases,” said Secretary of Health Mary Selecky. “This disease can be very serious for young babies, who often get whooping cough from adults and other family members. We want all teens and adults who haven’t had Tdap [a pertussis vaccine] to be vaccinated to help protect babies that are too young for the vaccine.”

In the epidemic continues at its current rate, the state is on track to see the most cases it has seen since 1942, Sec. Selecky said.

Pertussis

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Related article: Vaccine Hesitancy

Seattle’s Child’s lead article this month is a piece by Laura Hirshfield on “Vaccine Hesitancy”. She writes:

“While there is a small, but vocal, minority of parents who outright refuse all vaccines, much more common are parents who choose to skip or delay their children’s vaccines. In a recent Seattle Children’s Research Institute survey, 77 percent of Washington pediatricians reported regularly seeing parents who ask to vary the recommended vaccine schedule.

“Health officials call these parents “vaccine hesitant” and link the statewide rise in outbreaks of whooping cough, a highly contagious, airborne disease, to the rising number of under-vaccinated kids.”

Read the full article on the Seattle’s Child website.

Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Sec. Selecky urged parents to make sure their children are fully vaccinated and up-to-date and that teens and adults to check to see whether they need a booster.

Because newborns cannot be vaccinated, pregnant women should make sure they are vaccinated because they can transfer some of their immunity to their newborn that will confer some protection during the first months of life.

In addition, being vaccinated will reduce the risk that they will contract the infection and spread it to their child.

“Many adults don’t realize they need to be vaccinated, or they assume they have been,” said State Health Officer Dr. Maxine Hayes. “We’re asking everyone to verify with their health care provider that they’re up-to-date on vaccines. We’re also asking everyone to use good health manners — like cover your cough and stay home when you’re sick — that will also help prevent spreading whooping cough.”

For full information about pertussis vaccines and about who should get vaccinated go to the Department of Health’s pertussis information page: http://www.doh.wa.gov/cfh/Immunize/diseases/pertussis/

Free vaccine available

Consumers should not to use skin creams, beauty and antiseptic soaps, or lotions that might contain mercury, U.S. Food and Drug Administration officials warn

The products are marketed as skin lighteners and anti-aging treatments that remove age spots, freckles, blemishes and wrinkles, says Gary Coody, national health fraud coordinator in the Food and Drug Administration’s Office of Regulatory Affairs.

Adolescents also may use these products as acne treatments, adds Coody. Products with this toxic metal have been found in at least seven states.

Click on image for photos of more products

The products are manufactured abroad and sold illegally in the United States—often in shops in Latino, Asian, African or Middle Eastern neighborhoods and online.

Consumers may also have bought them in another country and brought them back to the U.S. for personal use.

“If you have a product that matches these descriptions (and others listed below), stop using it immediately,” says Coody.

Signs and Symptoms of Mercury Poisoning

• irritability
• shyness
• tremors
• changes in vision or hearing
• memory problems
• depression
• numbness and tingling in hands, feet or around mouth

Source: Agency for Toxic Substances and Disease Registry

“Even though these products are promoted as cosmetics, they also may be unapproved new drugs under the law,” says Linda Katz, M.D., director of FDA’s Office of Cosmetics and Colors. FDA does not allow mercury in drugs or in cosmetics, except under very specific conditions, which these products do not meet.

“Sellers and distributors should not market these illegal products and may be subject to enforcement action, which could include seizure of the products and other legal sanctions,” says attorney Brad Pace, J.D., of the Heath Fraud and Consumer Outreach Branch within FDA’s Center for Drug Evaluation and Research.

Dangers of Mercury

“Exposure to mercury can have serious health consequences,” says Charles Lee, M.D., a senior medical advisor at FDA. “It can damage the kidneys and the nervous system, and interfere with the development of the brain in unborn children and very young children.”

You don’t have to use the product yourself to be affected, says FDA toxicologist Mike Bolger, Ph.D. “People—particularly children—can get mercury in their bodies from breathing in mercury vapors if a member of the household uses a skin cream containing mercury.” Infants and small children can ingest mercury if they touch their parents who have used these products, get cream on their hands and then put their hands and fingers into their mouth, which they are prone to do, adds Bolger.

How to Protect Yourself

• Check the label of any skin lightening, anti-aging or other skin product you use. If you see the words “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury,” stop using the product immediately.

• If there is no label or no ingredients are listed, do not use the product. Federal law requires that ingredients be listed on the label of any cosmetic or drug.

• Don’t use products labeled in languages other than English unless English labeling is also provided.

• If you suspect you have been using a product with mercury, stop using it immediately. Thoroughly wash your hands and any other parts of your body that have come in contact with the product. Contact your health care professional or a medical care clinic for advice.

• If you have questions, call your health care professional or the Poison Center  at 1-800-222-1222; it is open 24 hours a day.

• Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of household hazardous waste.

Tracking Skin Products Containing Mercury

Investigations in the past few years by FDA and state health officials have turned up more than 35 products that contain unacceptable levels of mercury.

FDA continues to add mercury-containing skin products to its import alerts, which authorize the agency’s field staff to refuse admission of shipments of these products.

But this is only a partial solution, says Coody. “Many of these products are coming into the country through channels we can’t easily track, such as international mail and personal baggage.

That’s why it’s so important for consumers and sellers to know about the dangers of possible mercury poisoning associated with the use of these skin products.”

Texas health officials say samples of face cream they tested contained mercury up to 131,000 times the allowable level. And a teenager in southern Texas who used a mercury-containing skin cream was recently hospitalized for mercury poisoning.

In Northern California, a 39-year old woman had more than 100 times the average amount of mercury in her urine and had symptoms of mercury poisoning, according to the California Department of Public Health.

For three years, the woman and her husband had been using an unlabeled mercury-containing face cream that was brought into the U.S. from Mexico by a relative.

Several other family members who did not use the cream, including a four-year-old child, also had elevated levels of mercury in their bodies.

Virginia, Maryland, and New York have also seen cases of elevated mercury levels in people exposed to skin products containing mercury.

In Minnesota, 11 of 27 imported skin products taken from store shelves contained mercury . Photos of some illegal mercury-containing products are shown here:

• Minnesota Department of Health 
• Maryland Department of Health and Mental Hygiene

This article appears on FDA’s Consumer Update page, which features the latest on all FDA-regulated products.

March 6, 2012