Kaiser Daily Women's Health Policy Report Highlights Issues In Various States

The following highlights recent state news on women's health issues.
California: A state law that effectively bans vaccines that contain the preservative thimerosal from use in pregnant women and children younger than age three took effect Saturday, the Sacramento Bee reports (Griffith, Sacramento Bee, 7/4). California Gov. Arnold Schwarzenegger (R) in September 2004 signed the legislation (AB 2943), which restricts use of vaccines containing more than trace amounts of ethyl mercury in pregnant women and young children because of concern that the mercury could damage the developing brains of fetuses or children. The law requires physicians to stop administering vaccines containing more than trace amounts of thimerosal -- a preservative that is about 50% ethyl mercury -- to pregnant women and infants. The law allows state officials to waive thimerosal restrictions during a public health emergency, including a severe flu vaccine shortage (Kaiser Daily Women's Health Policy Report, 9/30/04). To comply with the law, the state has ordered 50,000 doses of thimerosal-free flu vaccine for children ages one to three and 15,000 such doses for pregnant women. State Health and Human Services Agency Secretary Kim Belshe issued a 12-month exception for vaccination against the mosquito-borne disease known as Japanese encephalitis. She said the "risks of fatal disease or brain injury far exceed any risk of mercury in the vaccine." There is no mercury-free substitute available. California distributes about 32,000 doses of the Japanese encephalitis vaccine annually, though there is no data available that show how many pregnant women and young children receive it, according to the Bee (Sacramento Bee, 7/4).

California: Bill Gross, founder and CEO of the bond and money market manager PIMCO, and his wife Sue have pledged $10 million to the University of California-Irvine's proposed stem cell research center, UCI announced Wednesday, the Los Angeles Times reports. The Grosses initially will give $2 million for staffing and equipment needs (Suarez, Los Angeles Times, 7/6). The other $8 million will be a matching gift for the proposed research center, Bill Gross said (AP/San Jose Mercury News, 7/5). UCI spokesperson Farnaz Khadem said the university hopes the other end of the matching $8 million donation for the $80 million facility will come from a California Institute for Regenerative Medicine grant (Los Angeles Times, 7/6). "We feel it is important to face your convictions and do the right thing -- even if controversy follows a cause you support," Gross said in a statement (Reuters, 7/5). Gross' family has donated $53 million to health and education groups over the last 18 months, including a $20 million donation to build a women's health tower at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. (Los Angeles Times, 7/6).

Minnesota: The AP/St. Paul Pioneer Press on Thursday profiled some of the groups receiving $4.75 million in state Department of Health grants as part of a public information campaign about fetal development, alternatives to abortion and other services for pregnant women (Lohn, AP/St. Paul Pioneer Press, 7/6). Gov. Tim Pawlenty (R) last year signed into law a bill (SF 917) that establishes a "positive alternatives" to abortion program and requires the health department to launch a public information campaign about fetal development, alternatives to abortion and other services for pregnant women. The measure allows state funding for organizations that mention abortion as an option but do not encourage abortion or arrange for abortion services. The law prohibits funding from going to organizations that give "inaccurate medical information." The health department earlier this month began awarding the grants for the two-year program to 37 not-for-profit groups that discourage abortion, encourage adoption and provide prenatal counseling and other health care services for pregnant women (Kaiser Daily Women's Health Policy Report, 7/3). The largest grant, of $285,000, went to Roseville, Minn.-based Cradle of Hope, which provides cribs to pregnant women in the state. The AP/Pioneer Press also profiled the North Side LifeCare Center in Minneapolis, which received a $129,180 grant to help expand its prenatal care and other services, and the Face to Face Health and Counseling Service in St. Paul, which does not have a position on abortion and received a $145,215 grant for pregnancy support services (AP/St. Paul Pioneer Press, 7/6).















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Actions Taken On HPV Vaccine Proposals In California, Texas; Washington

The following highlights recent state news related to human papillomavirus vaccines. Merck's HPV vaccine Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. GSK in April plans to file for FDA approval of Cervarix, and it expects approval by the end of this year. CDC has added Gardasil to its Vaccines for Children Program, which provides no-cost immunizations to children ages nine to 18 covered by Medicaid, Alaska Native and American Indian children, and some uninsured and underinsured children (Kaiser Daily Women's Health Policy Report, 3/1). Summaries appear below.

California: Assembly member Ed Hernandez (D) on Tuesday withdrew consideration of a bill (AB 16) that would require all California girls entering the seventh grade to receive an HPV vaccine so he can consider revisions to the measure, the Sacramento Bee reports (Benson, Sacramento Bee, 3/14). The legislation, which would take effect in July 2008, includes an exception for girls whose parents file a letter stating that participation is against their beliefs. It does not seek to allocate state funding to cover the cost of the vaccine (Kaiser Daily Women's Health Policy Report, 12/11/06). The measure was originally authored by Assembly Speaker Pro Tempore Sally Lieber (D), but she dropped the legislation because her family owned Merck stock, the San Francisco Chronicle reports. Assembly Health Committee members from both parties during a hearing on Tuesday expressed concerns about the legislation, including a lack of information on how parents could opt their daughters out of the requirement, how to pay for vaccinations and the novelty of the vaccines. Hernandez said he will "try to meet with every single (committee) member to address their concerns" and reintroduce a revised measure next month for the committee to consider (Yi, San Francisco Chronicle, 3/14).














Texas: The House on Wednesday voted 118-23 to pass a bill (HB 1098) that would halt any mandatory HPV vaccination program for girls in school, the Houston Chronicle reports (Elliott/Hernandez, Houston Chronicle, 3/14). Gov. Rick Perry (R) on Feb. 2 issued an executive order that mandates that all girls entering the sixth grade beginning in September 2008 receive an HPV vaccine. Perry has said the executive order will allow parents who do not want their daughters to receive an HPV vaccine "for reasons of conscience, including religious beliefs," to opt out of the requirement. Under the executive order, girls and women ages nine to 21 who are eligible for public assistance will be able to receive Merck's HPV vaccine Gardasil at no cost beginning immediately (Kaiser Daily Women's Health Policy Report, 3/13). The Senate is expected to hold a committee hearing on the measure soon, the Austin American-Statesman reports (Selby, Austin American-Statesman, 3/13). Perry's office did not say whether the governor would veto the measure if the Senate approved it (Frosh, New York Times, 3/14).

Washington: The House on Monday voted 73-22 to approve a bill (HB 1802) that would require all schools in the state to provide information about HPV and HPV vaccines, the Spokane Spokesman Review reports. Under the bill, all public and private schools would be required to give parents of children entering the sixth grade information on HPV, its symptoms and causes, and places where vaccines can be obtained. The bill, which is sponsored by Rep. Jeannie Darneille (D), now goes to the Senate (Spokane Spokesman Review, 3/14).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


View drug information on Cervarix [Human Papillomavirus Bivalent; Gardasil.

Maternal Depression Linked To Sudden Infant Death Syndrome

Depression during pregnancy, and after birth, is associated with Sudden Infant Death Syndrome (SIDS), particularly if the mother is depressed in the year before delivery, according to a new study, presented today and due to be published later this year in the Journal of Clinical Psychology.


SIDS has been linked to psychiatric disorders in 3 studies, but these have had a number of limitations. This study set out to investigate whether there is an association between SIDS and mental illness.


It compared two groups of women. The first were women registered with a general practice on the General Practice Research Database (GPRD) who had a live birth between 1987 and 2000 and who had an infant who died unexpectedly in the first year of life, with a diagnosis of SIDS.


The second (control) group was made up of women matched for age, registered with the same general practices on the GPRD with a live birth born in the same year as a SIDS baby, but whose babies survived the first year of life.


The researchers analysed the effect of maternal psychiatric disorders and other possible risk factors.


169 mother-infant cases of SIDS were matched with 662 mother-infant controls. SIDS was found to be independently associated with a history of depression in the year before birth, smoking, and male gender. There was also weaker evidence of an association of SIDS with depression in the 6 months after birth.


The researchers conclude that women with depression during and after pregnancy need their depression identified and treated. Healthcare professionals treating them need to provide clear advice on infant care practices that may prevent SIDS. Factors mediating the association between maternal depression and SIDS need further investigation.



Royal College of Psychiatrists

Women With Breast Cancer Carrying BRCA Genetic Mutations Have Similar Survival, Death Rates As Noncarriers, Study Says

Women diagnosed with breast cancer carrying the BRCA1 or BRCA2 gene mutations, which are thought to increase the risk of developing the disease, have similar survival and death rates as women not carrying the mutations, according to a study published Thursday in the New England Journal of Medicine, the Wall Street Journal reports.

For the study, Gad Rennert, chair of the medical faculty at Technion Israel Institute of Technology, and colleagues examined the 10-year survival rate of 1,545 women diagnosed with breast cancer (Pereira, Wall Street Journal, 7/12). The participants were treated at 22 hospitals in Israel, Reuters reports. The study found that the 10-year survival rate was 67% for women carrying a BRCA1 mutation, 56% for those carrying a BRCA2 mutation and 67% for the participants who did not carry the gene mutations. According to researchers, the difference in survival rates was not statistically significant.

Of the women without the gene mutations who died of breast cancer, 68% died within five years, compared with 88% of women with a BRCA1 mutation and 77% of women with a BRCA2 mutation, the study found. Researchers also found that the tumors among women with BRCA1 or BRCA2 mutations tended to be more aggressive (Emery, Reuters, 7/11). "As a result of the study, we can offer to the medical community the assurance that there is no difference in the prognosis between carriers and noncarriers," Rennert said (Wall Street Journal, 7/12).

Accompanying Editorial
Patricia Hartge of the National Cancer Institute in an accompanying NEJM editorial wrote, "Learning whether a patient who has just been given a diagnosis of breast cancer also bears one of the cancer-causing mutations in the BRCA1 or BRCA2 genes may add little to the clinician's ability to select a therapy or predict the course of the disease, once the grade and receptor status of the tumor and the age of the patient are taken into account" (Reuters, 7/11).

She added that one confusing statistic in the study involves a small number of participants who died within 10 years even though their tumors were small and had not spread to the lymph nodes. While the conclusion of the study is "generally comforting, there is this little disturbing footnote that is calling for further research on the subject," Hartge wrote (Wall Street Journal, 7/12).


The study is available online. The accompanying editorial also is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.