WHO is pleased to join the World Alliance for Breastfeeding Action in celebrating World Breastfeeding Week from 1 to 7 August 2009. This year’s theme stresses the importance of breastfeeding as a life-saving intervention, especially during emergencies.

Emergencies – whether caused by conflict or natural disasters – are extraordinary events that can jeopardize the health and survival of large populations. Children are among the most vulnerable groups during emergencies, and small children are the most vulnerable of all, as they face a triple risk of death from diarrhoeal disease, pneumonia and undernutrition.
Breastfeeding during emergencies saves lives

The life-saving role of breastfeeding during emergencies is firmly supported by evidence and guidance. The Global Strategy for Infant and Young Child Feeding outlines actions to improve infant and young child feeding in emergencies. In all situations, the best way of preventing malnutrition and mortality among infants and young children is to ensure that they start breastfeeding within one hour of birth, breastfeed exclusively (with no food or liquid other than breast milk, not even water) until six months of age and continue breastfeeding with appropriate complementary foods up to two years or beyond. Even in emergency situations, the aim should be to create and sustain an environment that encourages frequent breastfeeding for children up to at least two years of age.
Protect and support breastfeeding

Unfortunately, a widespread misconception assumes that stress or inadequate nutrition, commonly seen during emergencies, can compromise a mother’s ability to breastfeed successfully. News stories from devastated areas often include reports of mothers who have given birth and are “not producing enough breast milk”. During emergencies, unsolicited or uncontrolled donations of breast-milk substitutes may undermine breastfeeding and should be avoided. Instead, the focus should be on active protection and support of breastfeeding by, for example, establishing safe “corners” for mothers and infants, one-to-one counselling and mother-to-mother support.

As part of emergency preparedness, hospitals and other health care services should have trained health workers who can help mothers establish breastfeeding and overcome difficulties. The Baby-friendly Hospital Initiative and the WHO/UNICEF Breastfeeding Counselling: A training course may be included in emergency preparedness plans. The Infant Feeding in Emergencies Core Group, which involves a range of partners including WHO, has developed Operational Guidance for Emergency Relief Staff and Programme Managers, which provides concise and practical guidance on how to ensure appropriate infant and young child feeding in emergency preparedness and response. The Operational Guidance reflects the WHO Guiding Principles for feeding infants and young children during emergencies, and has integrated the International Code of Marketing of Breast-milk Substitutes to highlight the problem of donations of breast milk substitutes, bottles and teats in emergencies.

The theme of World Health Day 2009 was Save lives: make hospitals safe in emergencies. I am pleased that this year’s breastfeeding week builds upon this theme and extends it with actions in the community. Emergencies amplify the risk of infant and young child mortality. With appropriate action, we can protect these precious lives through one of the most “natural” of all life-saving interventions.

The U.S. Food and Drug Administration today announced an update to a previous safety alert on four botulinum toxin drug products, noting that all of them now have boxed warnings on their labels and have developed Medication Guides for patients, as directed by the agency in April 2009.

The boxed warning cautions that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism. Those symptoms include potentially life-threatening swallowing and breathing difficulties and even death.

These symptoms have mostly been reported in children with cerebral palsy being treated with botulinum toxin for muscle spasticity, a use of the drugs that has not been approved by FDA. Symptoms have also been reported in adults treated both for approved and unapproved uses.

The affected products are:
- Botox (new established name: onabotulinumtoxinA)
- Botox Cosmetic (new established name: onabotulinumtoxinA)
- Myobloc (new established name: rimabotulinumtoxinB)
- Dysport (abobotulinumtoxinA) was approved in April 2009 with the boxed warning and is not making any name or label changes at this time.

No definitive serious adverse event reports of distant spread of toxin effect have been associated with dermatologic use of Botox/Botox Cosmetic at the recommended doses (for frown lines between the eyebrows or severe underarm sweating). As well, no definitive serious adverse event reports of distant spread of toxin effect have been associated with Botox when used at approved doses for eyelid twitches or for crossed eyes.

The revised labels also emphasize that the different botulinum toxin products are not interchangeable, because the units used to measure the products are different. To help reduce the potential for dosing errors, the botulinum toxin products have changed their established drug names (often referred to as the drug’s “generic” name). Neither the brand names nor the formulations of the products have changed.

The U.S. Food and Drug Administration today approved the 4 milligram maximum dose of Livalo (pitavastatin), a drug intended to improve blood cholesterol levels in persons with elevated or abnormal blood cholesterol levels.

Like other statins, Livalo is intended for patients when diet and exercise fail to lower their cholesterol levels. Statins improve elevated blood cholesterol levels primarily by inhibiting a liver enzyme called HMG Co-A reductase, thus reducing the liver’s ability to make cholesterol.

“Elevated or abnormal cholesterol levels are associated with an increased risk for heart disease and stroke,” said Eric C. Colman, M.D., deputy director, Division of Metabolism and Endocrinology Products, in the FDA’s Center for Drug Evaluation and Research. “Today’s approval offers patients and their health care professionals another alternative way to treat high cholesterol.”

Livalo was approved on the basis of five clinical trials comparing its efficacy and safety to that of three currently marketed statins.

The most frequently reported adverse reactions from taking Livalo were muscle pain, back pain, joint pain and constipation.

Livalo is manufactured by Kowa Pharmaceuticals America Inc. of Montgomery, Ala.

Common variants of the gene that determines human blood type are associated with an increased risk of pancreatic cancer, according to a study by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health, and colleagues from many universities and research institutions. The study, published online Aug. 2, 2009, in Nature Genetics, is consistent with an observation first made more than 50 years ago.

In the study, the researchers discovered that genetic variation in a region of chromosome 9 that contains the gene for ABO blood type was associated with pancreatic cancer risk. Individuals with the variant that results in blood types A, B, or AB were at an increased risk of pancreatic cancer, compared to those with the variant for blood type O. This finding is consistent with previous research, some of it dating back to the 1950s and 1960s, that had shown increased risks of gastric and pancreatic cancer among individuals of the A and B blood groups (i.e., blood types A, B, and AB). The latest results provide a genetic basis for those earlier observations.

A person’s blood type depends on which form or forms of the ABO gene they inherit from their parents. The protein produced by the ABO gene determines the type of carbohydrates (complex sugars) that are present on the surface of red blood cells and other cells, including cells of the pancreas. The proteins encoded by the A and B forms of the gene transfer different carbohydrates onto the cell surfaces to make A and B blood types. The O form encodes a protein that is unable to transfer carbohydrates. Studies by other researchers have shown that ABO protein encoding in pancreatic tumor cells is different than in normal pancreatic cells.

To discover genetic variations that contribute to pancreatic cancer risk, the research team conducted a genome-wide association study (GWAS). In a GWAS, researchers analyze common variants, called single-nucleotide polymorphisms (SNPs), in the genomes of people with a disease and people without the disease. Initially, the research team studied the genomes of 1,896 patients with pancreatic cancer and 1,939 control subjects to identify SNPs with a strong association with pancreatic cancer. The team then verified its findings by studying the genomes of another 2,457 people with pancreatic cancer and 2,654 people without the disease. In the end, they identified several SNPs on the long arm of chromosome 9 that were associated with pancreatic cancer risk and mapped to the ABO gene.

“Only by working across disciplines and with more than a dozen research groups were we able to make this important discovery of the potential role of the ABO gene in pancreatic cancer risk,” said co-author Patricia Hartge, Sc.D., of NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “Although it will take much more work, this finding may lead to improved diagnostic and therapeutic interventions that are so desperately needed.”

Pancreatic cancer is the fourth leading cause of cancer death in the United States. It is difficult to detect, and in many people it is not diagnosed until after the disease has spread to other parts of the body. Less than five percent of Americans with pancreatic cancer survive five years past diagnosis. Risk factors include smoking, diabetes, race, and a family history of the disease.

“Pancreatic cancer is the newest beneficiary of so-called high-throughput genotyping that, over the past two years, has yielded scores of genetic hot-spots linked to risk for cancer and other diseases,” said co-author Stephen J. Chanock, M.D., chief of NCI’s Laboratory of Translational Genomics in DCEG. “As more variants are discovered and follow-up studies are conducted to examine the biological effects of these variants, a better understanding will emerge of the inherited risk factors and mechanisms that lead to the development of pancreatic cancer.”

The study was part of PanScan, a GWAS of pancreatic cancer conducted by the Pancreatic Cancer Cohort Consortium, composed of 14 academic centers. The investigators are conducting whole-genome scans to identify common genetic variants that may be markers of susceptibility to pancreatic cancer.