Experts question use of Tamiflu: report

LONDON — Experts question the effectiveness of antiviral drug Tamiflu commonly used against the swine flu virus spreading across the globe, according to a study reported in Britain Tuesday.

An investigation by the British Medical Journal and Channel 4 News acknowledges that the drug oseltamivir, which trades as Tamiflu, has "a modest effect in reducing flu symptoms and infectivity in otherwise healthy adults."

But "researchers say there is insufficient published data to know if oseltamivir reduces complications in otherwise healthy adults," the media groups said in a joint statement.

Channel 4 News was to air the investigation Tuesday.

The use of flu drugs like oseltamivir has increased dramatically since the A(H1N1), or swine flu, pandemic began in April 2009, with government rushing to stockpile treatments while persuading people to have vaccinations.

The global death toll since the virus was uncovered in April approached 8,770 in early December, with confirmed infections in 207 countries, according to World Health Organisation figures.

Claims about the effectiveness of drugs like Tamiflu against flu complications have been a key factor in governments' choosing to spend millions of dollars to hoard them, the British Medical Journal and Channel 4 said.

The British government has spent about 500 million pounds on such drugs, they said.

But research on the drugs by scientists from Australia's Bond University was hampered by a "paucity of good data" available from Swiss pharmaceutical giant Roche that produces oseltamivir.

"As a result, they conclude that they have no confidence in claims that oseltamivir reduces the risk of complications of influenza in otherwise healthy adults, and believe it should not be used in routine control of seasonal influenza."

The researchers called on governments to set up studies to monitor the safety of drugs like Tamiflu, which are called neuraminidase inhibitors.

A team from the University of Birmingham concluded meanwhile that oseltamivir may reduce the risk of pneumonia in otherwise healthy people who contract flu.

"However, the absolute benefit is small, and side effects and safety should also be considered," the statement said.

Professor Nick Freemantle from the University of Birmingham said he saw "very little evidence to support the widespread use of oseltamivir in the otherwise healthy population who are developing signs of influenza-like illness."

"We have remarkably few resources in this country to spend on pharmaceuticals on health and it?s surprising to see such widespread use of oseltamivir," he said.

British Medical Journal editor-in-chief Fiona Godlee warned that the review left unresolved important questions about effectiveness of the drugs.

"Governments around the world have spent billions of pounds on a drug that the scientific community now finds itself unable to judge," she said.

Roche has estimated sales of 1.6 billion pounds this year alone from the drug, the statement said.

CDC: Swine flu is widespread only in 25 states

ATLANTA — Swine flu infections continue to wane, just as vaccine is becoming plentiful enough that some communities are allowing everyone to get it, not just those in priority groups.

Swine flu was widespread in only 25 states last week — mostly in the Northeast and Southwest, officials at the Centers for Disease Control and Prevention said Friday.

In late October, 48 states were reporting widespread cases of swine flu. But since then, there's been a decline across the country, and it appears that a fall wave of swine flu infections has peaked.

Meanwhile, a shortage of swine flu vaccine is easing, with 73 million doses now available, roughly twice as much as there was a month ago. And another 10 million doses are expected in the next week, said Dr. Thomas Frieden, the CDC's director.

Initially, limited supplies caused the CDC to advise state and local health officials to reserve doses for those at highest risk for severe complications from swine flu or those who take care of them. That group includes pregnant women, children and young adults, health-care workers and people with asthma and certain other health problems.

Demand for the vaccine is still high in many places, but enough has become available that some communities are now giving it to people outside the priority groups, Frieden said.

"The number of communities that do that will increase in the coming weeks," he predicted, at a press conference in Atlanta.

At least three states — Alaska, Arkansas and Oklahoma — have begun offering swine flu vaccine to all comers. And some communities have opened vaccinations up, including Broward County, Fla., and Sacramento County, Calif., said Paula Steib, spokeswoman for the Association of State and Territorial Health Officials.

Since it was first identified in April, swine flu has sickened an estimated 22 million Americans and killed 4,000. It has proved to be similar to seasonal flu but a bigger threat to children and young adults.

The swine flu pandemic has so far hit in two waves in the United States: First in the spring, then a larger wave that started in the late summer.

Flu is hard to predict, and health officials say they are worried of the possibility of a third wave this winter. The CDC said a new round of public service announcements about getting vaccinated are to begin next week.

On the Net:

• CDC report: http://www.cdc.gov/h1n1flu/update.htm

H1N1 activity waxes, wanes: WHO

It's too early to say whether H1N1 activity is peaking in the Northern Hemisphere, a flu expert with the World Health Organization said Thursday.

"It is quite possible to have a pandemic on the milder side," Keiji Fukuda, the WHO's top flu expert, told a news conference in Geneva.

"And if we are experiencing that and the number of serious cases is kept down, then it is something again for which we should all be thankful."

In the 20th century, pandemics ranged from mild to extreme, he noted.

The UN health body will probably decide when to declare an end of the H1N1 pandemic some time next year after extensive monitoring and international discussions with expert advisers, he said.

"I think it's a little bit early to begin those discussions now because we are still in a period where some countries are still increasing in terms of infections, even though in some countries, such as the United States and Canada, it looks like infections and cases are going down," Fukuda said.

WHO declared the pandemic on June 11 after the virus emerged in March. It has caused moderate symptoms in most people, but poses greater risk to pregnant woman, young people and patients with underlying health conditions.

Current estimates suggests the death rate from H1N1 is several times lower than that of seasonal influenza, but Fukuda noted that seasonal flu death estimates are based on calculations of excess deaths that occur during flu season, not confirmed flu deaths.

No spread of resistant strain

Health officials won't have a firm idea of how many people were killed by H1N1 for a few years, he said.

The WHO also said that Tamiflu-resistant H1N1 doesn't appear to have spread to hospital staff beyond two clusters of patients in Britain and the U.S.

In October and November, hospital wards in Wales and North Carolina reported a resistant form of swine flu that affected a total of 12 patients. All of them had severely suppressed immune systems because of underlying medical conditions.

So far, 150 million doses of H1N1 vaccine have been distributed in more than 40 countries. To date, WHO said no unexpected safety issues have emerged, and the safety profile is similar to seasonal flu vaccines.

H1N1 transmission

Also on Thursday, the Canadian Medical Association Journal published a modelling study that suggests the relatively low number of new cases of H1N1 may mean that mitigation strategies such as vaccination, social distancing and use of antiviral drugs such as Tamiflu may be paying off.

For the study, Dr. David Fisman of the Dalla Lana School of Public Health at the University of Toronto and his colleagues looked at laboratory-confirmed cases of H1N1 between April 13 and June 20 in Ontario.

The researchers performed 1,000 simulations to simulate disease transmission based on the lab-confirmed cases. They found the median incubation period was four days and symptoms lasted seven days.

People under the age of 18 recovered faster than older patients. Those over age 50 made up seven per cent of cases admitted to hospital but accounted for seven of 10 initial deaths. In general, the H1N1 virus was similar to seasonal flu.

"However, when combined with high attack rates in younger groups, there may be greater absolute numbers of hospital admissions and deaths than are observed in a typical influenza season," the study's authors wrote, noting this may also be attributed to better surveillance during a pandemic.

The relatively low estimate of the number of new cases created by a single infected person in a susceptible population suggests that "effective use of mitigation strategies may substantially reduce the final size of the pandemic," they concluded.

South Africa to treat all HIV-positive babies

PRETORIA, South Africa — South Africa announced ambitious new plans Tuesday for earlier and expanded treatment for HIV-positive babies and pregnant women, a change that could save hundreds of thousands of lives in the nation hardest hit by the virus that causes AIDS.

President Jacob Zuma — once ridiculed for saying a shower could prevent AIDS — was cheered as he outlined the measures on World AIDS Day. The new policy marks a dramatic shift from former President Thabo Mbeki, whose health minister distrusted drugs developed to keep AIDS patients alive and instead promoted garlic and beet treatments. Those policies led to more than 300,000 premature deaths, a Harvard study concluded.

The changes are in line with new guidelines issued a day earlier by the World Health Organization that call for HIV-infected pregnant women to be given drugs earlier and while breast-feeding. By treating all HIV-infected babies, survival rates should also improve for the youngest citizens in South Africa, one of only 12 countries where child mortality has worsened since 1990, in part due to AIDS.

Zuma compared the fight against HIV, which infects one in 10 South Africans, to the decades-long struggle his party led against the apartheid government, which ended in 1994 with the election of Nelson Mandela in the country's first multiracial vote.

"At another moment in our history, in another context, the liberation movement observed that the time comes in the life of any nation when there remain only two choices: submit or fight," Zuma said. "That time has now come in our struggle to overcome AIDS. Let us declare now, as we declared then, that we shall not submit."

In New York, U.N. Secretary-General Ban Ki-moon warned that new infections are outpacing the gains from treating people with the HIV virus. He said that more must be done urgently to reach the U.N. goal of providing universal access to HIV prevention, treatment, care and support by 2010.

"That means countering any form of HIV-related stigma and discrimination," Ban said in a statement. "It means eliminating violence against women and girls. It means ensuring access to HIV information and services."

Zuma was greeted with a standing ovation when he entered a Pretoria exhibition hall filled with several thousand people.

In some ways, Zuma is an unlikely AIDS hero. As his Zulu tradition allows, he has three wives — experts say having multiple, concurrent partners heightens the risk of AIDS. And in 2006, while being tried on charges of raping an HIV-positive family friend, he testified he took a shower after extramarital sex to lower the risk of AIDS. He was acquitted of rape.

The one-time chairman of the country's national AIDS council may never live down the shower comment. But Zuma has won praise for appointing Dr. Aaron Motsoaledi as his health minister. AIDS activists say Motsoaledi trusts science and is willing to learn from past mistakes.

South Africa, a nation of about 50 million, has an estimated 5.7 million people infected with HIV, more than any other country.

UNAIDS executive director Michel Sidibe, who took the podium shortly before Zuma, told the president: "What you do from this day forward will write, or rewrite, the story of AIDS across Africa."

Zuma said in his speech broadcast across South Africa on state radio and television that the policy changes would take effect in April. They include treatment for all children under 1 year old, regardless of their level of CD4 cells, a measure of immune system health.

Patients with both tuberculosis and HIV will get treatment if their CD4 count is 350 or less, compared to 200 now, which means treatment would start earlier. Pregnant women who are HIV-positive also would start treatment earlier. That is in line with the new WHO recommendations that doctors start HIV patients on drugs when their level of CD4 cells is about 350.

The expanded treatment was expected to be free, as it is now, although Zuma did not confirm that. He said all health institutions, not just specialist centers, would provide counseling, testing and treatment.

He also called on South Africans to get tested for HIV. But, contrary to speculation in recent days, he did not take an HIV test Tuesday.

"I have taken HIV tests before and I know my status," he said. "I will do another test soon as part of this new campaign. I urge you to start planning for your own tests."

Kurt Firnhaber, who runs Right to Care, one of the largest private providers of AIDS treatment, counseling and testing in South Africa, said Zuma outlined "steps that aren't rhetoric — if they're implemented."

He said the burden would now be on the government and foreign donors to find the money to meet Zuma's ambitious goals.

On Tuesday, in response to a plea from Zuma, the United States announced it was giving South Africa $120 million over the next two years for AIDS treatment drugs. That is in addition to $560 million the U.S. has already pledged to give South Africa in 2010 for fighting AIDS.

Mark Heywood, executive member of the Treatment Action Campaign, an independent group that has challenged the South African government on AIDS, said the Zuma speech marked a departure in thinking that would have a global impact. Heywood shared the stage with Zuma on Tuesday.

"It was a very good speech in all its aspects — the empathy he showed, what he said about prevention and the need to test for HIV was all very positive," Heywood said.

Zuma's government had earlier set a target of getting 80 percent of those who need AIDS drugs on them by 2011.

Setjhaba Ranthako brought his 4-year-old daughter Tshegofatso to hear Zuma's speech, saying education should start early.

"I've seen in President Zuma a person who's willing to listen, and say, `Here I am, come with your views, and let's turn your views into an effective campaign to combat the spread" of AIDS, said Ranthako, who works with a group that raises awareness about AIDS among men.

The crowd rose to their feet when Zuma finished his speech. Then he danced along with a choir that sang: "Zuma, you are blessed."

Associated Press Writer Celean Jacobson in Johannesburg contributed to this report.

Eight more people die in B.C. after getting H1N1 flu; 93 more severe cases

VANCOUVER, B.C. — Another eight deaths have been recorded in B.C. in the last week, bringing the provincial death toll to 42 since April.

Health officials say five people who had the virus died last week and the other three deaths hadn't yet been reported from previous weeks.

Of those deaths, 37 of the patients had underlying medical conditions, four had no other health problems and one case is still being investigated.

Four of the deaths happened in the Fraser health region while two occurred in the Interior and two on Vancouver Island.

In addition to the latest deaths, another 93 people have been admitted to hospital with severe flu symptoms, raising the provincial total since April to 957 cases.

The Health Ministry says most lab-confirmed cases of H1N1 in B.C. have been mild or moderate and the patients have either already recovered or are recovering.

Undergoing MyBlogLog Verification

Brains 'listen' to speech through skin: researchers

Our brains can be fooled into perceiving one speech sound as a completely different one if the sound is accompanied by an inaudible puff of air, Canadian researchers have found.

The research published this week in Nature suggests that our perception of language isn't made up of only sound and visual data, but tactile information such as airflow as well.

Bryan Gick and Donald Derrick at the University of British Columbia created an experiment where people were made to listen to recorded sounds while puffs of air were simultaneously applied to their hands or necks.

When the inaudible puff of air was applied, the subjects perceived speech sounds that don't normally come with a puff of air in English speech — "ba" and "da" — as different sounds that do — "pa" and "ta."

"'Ba' and 'pa' are only really distinguished by this puff of air, and we're used to hearing that, but we're not so used to feeling it on our skin, because you'd have to be pretty close to somebody to pick that information up," said Gick.

Gick said that because we don't normally feel puffs of air on our skin when we're listening to people, it's interesting that our brain would be fooled by this airflow information.

In a famous illusion known as the McGurk Effect, people can be fooled into thinking they're hearing "da" when they're actually hearing "ba" at the same time as seeing a face mouthing the syllable "ga."

Gick says one theory to explain this illusion is that the brain goes through a lifetime of learning to integrate visual and sound information to perceive speech, so it becomes fooled when that information is mismatched, as in the McGurk Effect.

Gick says his research suggests that this integration of different senses into the perception of speech may not be something that we learn through experience.

"It's much less frequent that you would hear somebody speak and feel these puffs of air on your skin at the same time. The fact that we can get the same kind of illusion with [air puffs] suggests that there might be something different going on," said Gick.

Gick said it's also interesting that our brains can be fooled by a puff of air that most people don't hear and don't realize they produce when they speak.

The research could lead to "possible future directions in audio and telecommunication applications and aids for the hearing impaired," Gick and Derrick wrote in Nature.

Swine flu 'levelling off' in Canada

The number of new swine flu cases in many communities across Canada appears to be levelling off, federal health officials said Wednesday.

"We say it is levelling off because in most communities, the number of positive tests has fallen and there have been fewer reports of flu outbreaks in schools," Canada's chief public health officer, Dr. David Butler-Jones, told a news conference in Ottawa.

"This is in line with what some Northern Hemisphere countries are seeing. However, in the last few weeks, the number of people with influenza-like illness seeking medical treatment was still four to seven times higher than what is usually seen at this time of year for seasonal flu."

No all-clear has been issued, since H1N1 infections occur in waves and don't hit all areas at the same time.

It's also impossible to tell whether a peak in new infections has occurred until after the fact. In the spring for example, the peak occurred two weeks later than health officials thought because of a delay in reporting cases and hospitalizations, Butler-Jones said.

While 90 per cent of seasonal flu deaths are in seriously ill or elderly people, with H1N1, half of the deaths have been in people under age 50.

For every 100,000 people who don't get the H1N1 vaccine, it's estimated 25,000 will become infected, 25 to 100 will end up in hospital and half a dozen will likely die, Butler-Jones said.

Public health officials in Canada and the U.S. have expressed particular concerns about the coming holiday season. People travel and meet to share festivities, but also, unfortunately, infectious diseases, Butler-Jones said in reiterating the importance of:

• Washing hands.
• Coughing and sneezing into one's sleeve and not the air.
• Thinking of food poisoning when handling dips.
• Getting vaccinated.

Vaccine distribution

By the end of this week, more than 15 million doses of the H1N1 vaccine will have been distributed to provinces and territories, enough to immunize half the population, Health Minister Leona Aglukkaq said. So far, one-quarter of Canadians — more than eight million people — have received the H1N1 vaccine, she said.

At least three million more doses will be available next week. In most parts of the country, H1N1 shots are available to all, and lineups have dwindled.

There have been 24 cases of confirmed anaphylaxis among people who received the H1N1 shot in Canada. Anaphylaxis is a severe allergic reaction that can cause a person's airways to close up and must be treated quickly with adrenalin, which is available at flu clinics.

Overall, there has been less than one case of severe allergic reaction for every 300,000 doses of vaccine given so far. The exact rate is 0.32 cases per 100,000 doses, Butler-Jones said.

For one lot of vaccine that was withdrawn in provinces last week, the rate was four per 100,000, which is still low, compared with the expected one reaction per 100,000 vaccinations, he said. Health Canada and the vaccine manufacturer, GlaxoSmithKline, are investigating.

There has been one death linked to anaphylaxis. It's not clear exactly what caused the death, which is also being investigated.

Butler-Jones and Aglukkaq credited Canada's intensive surveillance, down to the lot level, compared with other countries that are not so specific.

Mutated strain

As of Tuesday, provinces and territories reported 232 people in hospital and 68 in intensive care with swine flu. The total number of lab-confirmed deaths in Canada since the pandemic began in the spring is 304.

In Ontario alone, 47 people are on ventilators, and doctors are warning people against becoming complacent.

In China, eight more cases of a mutated form of the H1N1 virus have been found.

"These mutations have been seen in a number of countries," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said Wednesday.

"We've seen them here in the U.S. and people have seen them in a lot of other countries. They have been associated with severe disease, more often than you would expect by chance alone."

The mutated virus strain has not been reported in Canada, and public health officials said the jury is still out on whether it will be a significant problem.

Meanwhile, fewer outbreaks of other infections seem to be occurring in Canada, Butler-Jones said.

"In Canada, the usual outbreaks that we would see or be tracking we're not seeing — we don't seem to be seeing as many of them. So it may be as we hoped — as we expected — people doing the kinds of things that prevent influenza are also preventing a lot of other infections as well. I think we're all better for it."

Experimental MS surgery draws Canadian interest

The Multiple Sclerosis Society of Canada will be asking Canadian scientists to propose their own research into a procedure that has ignited the hopes of patients in Europe and North America.

The procedure is known as chronic cerebro spinal venous insufficiency, or CCSVI, and involves removing a blockage in the veins that carry blood to and from the brain.

An Italian vascular surgeon, Dr. Paolo Zamboni, a professor of medicine at the University of Ferrara in Italy, has reported success in reducing the symptoms of people who suffer from multiple sclerosis.

The Canadian MS organization has reacted to Zamboni's research with caution. On Monday, however, the society said that after receiving so many inquiries about the procedure, it has decided to offer a grant to researchers in Canada. Details of the program will be announced Tuesday.

In the meantime, the society urged people with MS to be patient and continue with their regular treatment until there is more evidence about the experimental procedure.

Multiple sclerosis is considered a neurodegenerative disease that attacks the brain and spinal cord, causing inflammation and damage that can lead to paralysis and sometimes blindness. Nerve fibres that send electrical signals in the brain are coated in a fatty sheath called myelin. Myelin acts as an insulator, like a plastic coating covering a copper wire.

The symptoms of MS are caused by the breakdown of myelin, which leads to problems in how messages are transmitted to the central nervous system.

Conventional wisdom suggests multiple sclerosis is an autoimmune disorder caused by immune cells attacking neurons and the brain.

But Zamboni thinks a drainage problem is to blame and that the condition can be treated or prevented by surgically unclogging veins to get blood flowing normally again.

So far, Zamboni has performed the angioplasty-like surgery, known as "la liberation" in Italian, on 120 MS patients, including his wife, whose multiple sclerosis provoked his interest in tackling the disease.
'Tremendous interest'

Yves Savoie, president and chief executive officer of the MS Society's Ontario division, said he's aware of the "tremendous interest across Canada and around the world caused by the recent news coverage of the CCSVI study," and shares the public's excitement and hope following the preliminary findings.

"Based on what has been published so far, we can only say that MS may occur in association with impaired venous drainage of the central nervous system," the MS Society said on its website, calling CCSVI a "hypothetical situation."

"This impairment, if truly present, could cause MS but it is possible that it is incidental to the disease. More study is needed."

Dr. Robert Zividinov of the University of Buffalo is leading a study that hopes to enroll more than 1,000 MS patients from the United States and Canada to undergo ultrasound and MRI neck scans to detect blocked or twisted veins.

Canadians with multiple sclerosis who want to know more about the procedure can go through St. Joseph's Healthcare in Hamilton, where researchers are able to analyze blood flow in and out of the brain.

Since CTV's current affairs program W5 and the Globe and Mail publicized Zamboni's research on the weekend, the Brain-Body Institute at St. Joseph's has received a "flood" of interest, Dr. John Bienenstock, director of the institute, said in an email.

Historic health care bill clears Senate hurdle

WASHINGTON — Invoking the memory of Edward M. Kennedy, Democrats united Saturday night to push historic health care legislation past a key Senate hurdle over the opposition of Republicans eager to inflict a punishing defeat on President Barack Obama. There was not a vote to spare.

The 60-39 vote cleared the way for a bruising, full-scale debate beginning after Thanksgiving on the legislation, which is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

The spectator galleries were full for the unusual Saturday night showdown, and applause broke out briefly when the vote was announced. In a measure of the significance of the moment, senators sat quietly in their seats, standing only when they were called upon to vote.

In the final minutes of a daylong session, Majority Leader Harry Reid, D-Nev., accused Republicans of trying to stifle a historic debate the nation needed.

"Imagine if, instead of debating whether to abolish slavery, instead of debating whether giving women and minorities the right to vote, those who disagreed had muted discussion and killed any vote," he said.

The Republican leader, Sen. Mitch McConnell of Kentucky, said the vote was anything but procedural — casting it as a referendum on the bill itself, which he said would raise taxes, cut Medicare and create a "massive and unsustainable debt."

For all the drama, the result of the Saturday night showdown had been sealed a few hours earlier, when two final Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate.

"It is clear to me that doing nothing is not an option," said Landrieu, who won $100 million in the legislation to help her state pay the costs of health care for the poor.

Lincoln, who faces a tough re-election next year, said the evening vote will "mark the beginning of consideration of this bill by the U.S. Senate, not the end."

Both stressed they were not committing in advance to vote for the bill that ultimately emerges from next month's debate.

Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval — a part of Reid's bill expected to come under significant pressure as the debate unfolds.

Even so, their announcements marked a major victory for Reid and the White House in a year-end drive to enact the most sweeping changes to the nation's health care system in a half-century or more.

At the White House, press secretary Robert Gibbs issued a statement saying the president was gratified by the vote, which he says "brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it."

The legislation would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their workforce. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.

Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.

At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.

The House approved its version of the bill earlier this month on a near party line vote of 220-215, and Reid has said he wants the Senate to follow suit by year's end. Timing on any final compromise was unclear.

All 58 Senate Democrats and two independents voted to advance the bill. All 39 votes in opposition were cast by Republicans. GOP Sen. George Voinovich of Ohio was the only senator not to vote. Montana Sen. Max Baucus, the chairman of the Senate Finance Committee who has labored on health care for more than a year, flew in from his home state on a government plane for the vote and was returning afterward to be with his ailing mother.

While timing made Landrieu and Lincoln the final two Democrats to announce their intentions, Sen. Paul Kirk of Massachusetts had a clear claim as the 60th vote.

Appointed to office this fall after the death of Kennedy, who championed health care issues for decades, Kirk said he spoke for those "who for so many years revered and loved and elected and re-elected (him) ... that I think they're all — they all, as we do, have him in our minds and our hearts tonight. ..."

Sen. Chris Dodd, D-Conn., echoed those sentiments later in the evening when he referred to Kennedy's "lifelong quest" for national health care and said "tonight and in the days to come we will pay him the highest compliment by fulfilling that" goal.

At a post-vote news conference, Reid said he had talked with Kennedy's widow, Vicki, about the vote. "We both said Ted would be happy," Reid said.

In hours of debate before the Saturday evening vote, a few Republicans piled copies of the 2,074-page bill on their desks while others criticized it as a government takeover of health care and worse.

"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., likening the bill's supporters to the imprisoned investor who fleeced millions.

In her remarks, Landrieu said, "I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done." She also touted the $100 million included in the legislation to help her state cover its costs under Medicaid, the state-federal health care program for the poor.

Lincoln referred repeatedly to the political controversy surrounding the issue. She said $3.3 million has already been spent by outside groups advertising either for or against health care legislation in her state, and said, "these outside groups seem to think that this is all about my re-election. I simply think they don't know me very well."

To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments. Hardest hit would be the private insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.

The bill raises payroll taxes on incomes over $200,000 for individuals and $250,000 for couples. Reid eased the impact of an earlier proposal to tax high-value insurance plans, which has emerged as one of the principal methods for restraining the growth in health costs.

The bill includes tax increases on insurance companies, medical device makers, patients electing to undergo cosmetic surgery and drugmakers.

Associated Press writer Donna Cassata contributed to this article.

Florida snowbirds take risks with HIV: study

Sexually active Canadian snowbirds may be taking unnecessary risks with sexually transmitted infections, according to preliminary research from the University of Waterloo.

People aged 50 and over account for a growing percentage of HIV cases in Florida, yet few older Canadians who winter in the state take precautions against STIs, said gerontology researcher Katie Mairs.

Speaking at an HIV conference in Toronto on Tuesday, Mairs said the results of a small-scale pilot study suggest Canadian snowbirds need to be better educated about the risks of HIV.

"Somebody needs to talk to them about it. The message needs to get out there," she said. Mairs surveyed 299 snowbirds over the age of 50 who winter in Florida and found most were sexually active, and almost half had dated at least one Floridian.

Few snowbirds getting tested

But only 47 of those surveyed — 17.7 per cent — had ever been tested for HIV, Mairs found. And HIV testing prevalence was unrelated to how often those surveyed were having sex, their number of sexual partners, condom use or whether respondents were dating in Florida versus Canada.

Less than a quarter of men and almost none of the women used condoms, the study also found. It's a relevant finding in Florida, where seniors account for 17 per cent of all HIV cases — the same as the proportion of those 65 and up among the general population. New cases among the age group are growing faster than in people under 40.

Mairs said the environment might be contributing to the less cautious attitude.

"They have less responsibility down there," she said. "They get together with their friends down there, going out more. It's that Florida lifestyle — have fun, be free."

Mairs plans to return in the winter to do a follow-up study to determine whether the risks of infection to Canadians over 50 are similar to the risks to Floridians.