NEW YORK, Sept 1, (RTRS): Full-term babies born a bit on the early or late side are at higher risk of cerebral palsy, according to a new study in nearly 1.7 million Norwegian children.
“It is important to emphasize that the absolute risk is still very low and the vast majority of children being born some weeks away from 40 weeks (full-term) will not develop cerebral palsy,” Dr Dag Moster of the University of Bergen in Norway, one of the study’s authors, told Reuters Health.

Cerebral palsy is a collective term for several disorders that involve the brain and nervous system that first appear in early childhood. It is the most common reason for disability in childhood and is thought to occur because the brain has been damaged during fetal development or early infancy.
According to the March of Dimes, two to three out of every 1,000 children born have cerebral palsy; the non-profit group estimates that there are 800,000 children and adults with the condition in the United States.

Preterm birth is well known to increase cerebral palsy risk, but most children with the condition aren’t born prematurely, Moster and his colleagues point out in the latest issue of the Journal of the American Medical Association.

To investigate whether being born later might influence risk as well, they looked at nearly 1.7 million children born in Norway at 37 to 44 weeks’ gestation between 1967 and 2001. A total of 1,938 of these children were known to have cerebral palsy.

The lowest risk of cerebral palsy, the researchers say, was seen in children born at term (40 weeks), with about one in every 1,000 of these children having cerebral palsy.

The risk of having cerebral palsy was higher with earlier or later delivery. The risk for children born at 37 weeks was nearly 2 in 1,000; it was 1.25 in 1,000 for children born at 38 weeks; 1.36 in 1,000 for children born at 42 weeks; and 1.44 for children born after 44 weeks.

The reason for these increased risks at 37 or 38 weeks’ gestation, or at 42 weeks or beyond, are not clear, Moster said.

One possibility is that a newborn’s brain may be more vulnerable if he or she is born shortly before or after the normal 40-week mark. “An alternative explanation may be that fetuses prone to develop cerebral palsy have a disturbance in timing of birth making them more prone to be delivered either early or late,” Moster said.

Until the biological reason for the link between pregnancy duration and cerebral palsy risk becomes clear, the researchers say, “it would be hasty to assume that interventions on gestational age at delivery could reduce the occurrence of cerebral palsy.”
“Women having a normal delivery outside 40 weeks,” Moster said, “still have a very small risk...that their child will develop cerebral palsy.”

Monkeypox: Some thirty years after authorities doled out the last dose of smallpox vaccine, the world faces another multiplying menace: monkeypox.
A new study suggests that the monkeypox virus, which the smallpox vaccine also grants immunity against, is now at least 20 times as common as it was shortly after victory over smallpox had been declared.

“The eradication of smallpox was one of the greatest achievements known to man,” lead researcher Anne Rimoin of the University of California, Los Angeles School of Public Health told Reuters Health. “But a consequence of ceasing smallpox vaccinations is that now the world’s population is vulnerable to other (related viruses) such as monkeypox.” While the infection is somewhat less serious than smallpox, it can still scar and even kill its victims. And in contrast to its cousin, monkeypox is not only able to jump between humans, but can infect through contact with small animals that harbor the virus. As a result, its control could be all the more challenging, warned Rimoin.

Converging political, social, economic and environmental factors make African nations — in particular, the Democratic Republic of the Congo — especially vulnerable to the infection, she explained. The virus’s favorite animal hosts such as squirrels and monkeys are endemic there, and civil war has forced many people to rely heavily on hunting wildlife for sustenance. Some have even migrated deep into the animals’ forest habitats to seek refuge from the violence.

“The virus has probably been on the rise for years, but the country lacked surveillance,” Rimoin noted. “To find disease, you have to look for it.”

So she and her colleagues, who included many local Congolese, did just that. Using Chinese bicycles like pack mules to transport supplies, and with funding from the US National Institutes of Health, they surveyed nine local health zones for signs of monkeypox between November 2005 and November 2007. They identified 760 cases of laboratory-confirmed monkeypox.

Compared to similar surveillance conducted in the 1980s, Rimoin’s team found a 20-fold increase in monkeypox cases — far more than they ever expected to find. In a single health zone, the average number of yearly cases rose from less than 1 to roughly 14 per 10,000 people.

Most of the victims were born after smallpox vaccination was officially discontinued in 1980. Vaccinated individuals were more than five times less likely to become infected with monkeypox compared to those without the vaccine’s protection, the researchers report in the Proceedings of the National Academy of Sciences. “What we’re seeing is a harbinger of things to come,” said Rimoin. She warned that the virus could grow more widespread with further deforestation, continued movement of people from rural to urban areas, bushmeat trafficking and importation of exotic pets.

“And every new infection provides the virus with the opportunity to evolve into a more serious or transmissible virus,” she added.

It’s already clear that the Democratic Republic of the Congo isn’t the only home for the virus. The Republic of the Congo and Sudan also reported cases in recent years. And in 2003, monkeypox arrived in the US Midwest with imported African rodents, before spreading among prairie dogs and sickening 90 people.

Experts fear an even more virulent and efficient virus could return to the Western world.
“The higher the rate of new infections, the greater the chance that travelers from the US will be exposed, and that the disease will be imported into the US — possibly establishing itself in US rodent populations,” Dr Dan DiGiulio of Stanford University School of Medicine in California, who was not involved in the study, noted in an email to Reuters Health.

So what can be done to keep the virus at bay? Rimoin suggested that behavioral interventions may be the most effective strategy at this point, including teaching people at risk of infection what animals may be most likely to carry monkeypox and how to handle them to avoid infection, as well as isolating infected individuals.

Continued active surveillance is also important to better identify the animal reservoirs and rates of animal-to-human versus human-to-human transmission. “Once we understand more about this virus and what it may mean for us,” she said, “we may be able to consider specific interventions, perhaps vaccinating groups that are at significant risk of infection.”

DiGiulio added the need for animal importation policies, and research into effective antiviral treatments and vaccine development.

“Three decades after the eradication of smallpox, pox viruses still deserve our close attention,” said Rimoin. “And we shouldn’t only worry about its accidental introduction but also as a deliberate terrorist release.”