Hospitals crack down on workers refusing flu shots

CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.

"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.

Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.

Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.

In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.

"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."

Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."

For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.

The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."

The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.

According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.

The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.

Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.

Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.

Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.

While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.

"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.

Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."

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Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Poll: After Newtown, Most Back Some Gun Controls

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A majority of Americans favor such gun control measures as banning assault weapons and expanding background checks on those who buy guns and ammunition, with support for banning high-capacity ammunition magazines at a new high in ABC News/Washington Post polls.

With Vice President Joe Biden set to present recommendations that were prompted by the Newtown, Conn., school shootings last month, this latest poll shows overwhelming support for certain moves: Eighty-eight percent favor background checks on firearms buyers at gun shows; 76 percent support checks on buyers of ammunition and 71 percent back a new federal database that would track all gun sales.

For full results, charts and tables, CLICK HERE

Sixty-five percent also support banning high-capacity ammunition magazines, a high in three ABC/Post polls to test the idea since early 2011, and up by 6 percentage points since just after the Newtown shootings. Among other suggestions, 58 percent favor banning the sale of so-called assault weapons, 55 percent support the National Rifle Association’s call for armed guards in schools and 51 percent would ban semi-automatic handguns.

Notably, support for the most popular of these measures – expanded background checks, a gun database and banning high-capacity magazines – includes a majority of people who live in gun-owning households, a group that accounts for 44 percent of all adults in this country.

The intensity of support for all these proposals is also notable; “strong” support for each measure outstrips strong opposition, in most cases by overwhelming margins (save the two less-popular items, armed school guards and a semi-automatic handgun ban). For instance, 50 percent “strongly” favor banning assault weapons, twice the number who strongly opposes it. And 76 percent strongly support background checks at gun shows, while only 8 percent say they’re are strongly opposed.

Fifty-five percent in this poll, produced for ABC by Langer Research Associates, express worry about a mass shooting in their own communities, and 52 percent say the Newtown shootings have made them more likely to support some forms of gun control.

As noted, support for banning high-capacity magazines is at a new high in polling since 2011. But there’s no consistent change on other proposals. Support for background checks on gun show buyers is essentially the same as it was in the late 1990s; support for banning assault weapons is numerically up from its low in 2009  but still well below its levels in the mid- to late 1990s; and support for banning semi-automatic handguns has been essentially steady in recent years.

ACTION – Looking ahead to the possibility of legislative action, most Americans give the issue at least a high priority for the president and Congress to address, but not “the highest,” and more give greater priority to  ”addressing gun violence” (68 percent) than specifically “enacting stricter gun control laws” (59 percent).

While they reach majorities, both of these are lower on the list than other top-shelf issues, including the economy, cutting federal spending, restructuring the tax system and slowing the rate of growth in spending on Social Security and Medicare.

The higher priority for “addressing gun violence” versus “enacting stricter gun control laws” (in a split-sample test) likely reflects some compunctions about whether gun control measures will work. The public, for instance, divides on whether stricter gun laws or armed guards in schools would be more effective (43-41 percent), and as many or more blame gun violence on inadequate treatment of the mentally ill, and on irresponsibility among gun owners, as on other causes.

FACTORS – Many factors receive broad blame for gun crimes. Leading the list, more than eight in 10 see inadequate treatment of the mentally ill, inadequate background checks and lack of individual responsibility by gun owners as contributors to gun violence, and more than half, in each case, say these contribute “a great deal” to the problem.

Sixty-nine to 73 percent also see the availability of semi-automatic handguns, high-capacity ammunition clips and assault weapons as contributors – yet as many say the same about the prevalence of violence in TV programs, movies and video games. The fewest numerically, 38 percent, believe violence in the media contributes “a great deal” to gun violence.

There are three items on which more people say the issue contributes to gun violence than favor legislative action: Sixty-nine percent see access to semi-automatic handguns as a contributor, versus 51 percent who favor banning such weapons; 73 percent say assault weapons are a contributor, versus 58 percent who favor banning those; and 70 percent see high-capacity magazines as a factor in gun violence, while slightly fewer, 65 percent, would ban them. The gaps apparently exist at least in part because support for action is lower among those who see these as contributing “somewhat” but not a great deal to gun violence – a group that includes more pro-gun individuals, such as people in gun-owning households, men and political conservatives.

GROUPS – There are striking differences among groups on some, but not all, gun control issues. Support for gun control measures generally is higher among women than men, with the gap peaking on a ban on semi-automatic handguns, supported by 60 percent of women versus 40 percent of men.

In addition to the expected partisan and ideological divisions, support for gun control also is higher in several cases among senior citizens vs. the youngest adults, among city dwellers vs. those in suburbs or rural areas, in Democratic-voting blue states vs. more-Republican red states, and in non-gun households vs. those in which someone owns a firearm. There also are regional divisions, with support for gun control typically highest in the Northeast and lowest in the South.

These differences, however, generally fade on the issues on which agreement is most broad – background checks, a gun database and banning high-capacity magazines.

Patterns are different in support for armed guards in schools; this idea is more popular with conservatives versus liberals (63 versus 44 percent), in red versus blue states (67 versus 49 percent) and among Republicans versus Democrats and independents (65 versus 52 percent). It also gets more support from parents with minor children, 62 percent, versus 51 percent among other adults. In the biggest gap, the proposal for armed school guards is nearly 30 points more popular with people who see the NRA’s leadership favorably than among those who see it unfavorably, 69 versus 40 percent.

There are other differences among groups that inform views on gun control. Women, for instance, are 13 points more apt than men to say the Newtown shootings have made them more likely to support some forms of gun control, and 16 points more likely to be worried that a mass shooting could occur in their own area. That worry is a prime factor in support for stricter gun laws.

THE NRA – While recent polls have found the NRA to be popular overall with a majority of Americans, this survey finds a less positive assessment of the association’s leadership -  more see it unfavorably than favorably by an 8-point margin, 44 versus 36 percent, although many don’t know enough to say.

There’s a mixed result on the NRA’s influence on gun policy; on the one hand more, 38 percent, say it has too much influence versus too little (24 percent) or about the right amount (30 percent). At the same time, that makes a majority, netted, saying its influence is too little or about right.

The NRA’s leadership, naturally, has far more support among people in gun-owning versus non-gun-owning households – a 52 percent versus 22 percent favorable rating. Similarly, 49 percent in non-gun households say the NRA has too much influence over gun laws. In gun households 27 percent, agree.

METHODOLOGY – This ABC News/Washington Post poll was conducted by telephone Jan. 10-13, 2013, among a random national sample of 1,001 adults, including landline and cell-phone-only respondents. Results have a margin of sampling error of 3.5 points, including design effect. Partisan divisions are 33-24-37 percent, Democrats-Republicans-independents.

The survey was produced for ABC News by Langer Research Associates of New York, N.Y., with sampling, data collection and tabulation by Abt-SRBI of New York, N.Y.

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France bombs Islamist strongholds in north Mali

BAMAKO/PARIS (Reuters) - French fighter jets pounded Islamist rebel strongholds deep in northern Mali on Sunday as Paris poured more troops into the capital Bamako, awaiting a West African force to dislodge al Qaeda-linked insurgents from the country's north.

The attacks on Islamist positions near the ancient desert trading town of Timbuktu and Gao, the largest city in the north, marked a decisive intensification on the third day of the French mission, striking at the heart of the vast area seized by rebels in April.

France is determined to end Islamist domination of northern Mali, which many fear could act as a base for attacks on the West and for links with al Qaeda in Yemen, Somalia and North Africa.

Defense Minister Jean-Yves Le Drian said France's sudden intervention on Friday had prevented the advancing rebels from seizing Bamako. He vowed that air strikes would continue.

"The president is totally determined that we must eradicate these terrorists who threaten the security of Mali, our own country and Europe," he told French television.

Residents and rebel leaders had reported air raids early on Sunday in the towns of Lere and Douentza in central Mali, forcing Islamists to withdraw. As the day progressed, French jets struck targets further to the north, including near the town of Kidal, the epicenter of the rebellion.

In Gao, a dusty town on the banks of the Niger river where Islamists have imposed an extreme form of sharia law, residents said French jets pounded the airport and rebel positions. A huge cloud of black smoke rose from the militants' camp in the city's north, and pick-up trucks ferried dead and wounded to hospital.

"The planes are so fast you can only hear their sound in the sky," resident Soumaila Maiga said by telephone. "We are happy, even though it is frightening. Soon we will be delivered."

Paris said four Rafale jets flew from France to strike rebel training camps, logistics depots and infrastructure around Gao with the aim of weakening the rebels and preventing them from returning southward.

"We blocked the terrorists' advance and from today what we've started to do is to destroy the terrorists' bases behind the front line," French Foreign Minister Laurent Fabius told LCI television.

France has deployed about 550 soldiers to Mali under "Operation Serval" -- named after an African wildcat -- split between Bamako and the town of Mopti, 500 km (300 miles) north.

In Bamako, a Reuters cameraman saw more than 100 French troops disembark on Sunday from a military cargo plane at the international airport, on the outskirts of the capital.

The city's streets were calm, with the sun streaking through the dusty air as the seasonal Harmattan wind blew from the Sahara. Many cars had French flags draped from the windows to celebrate Paris's intervention.

"We thank France for coming to our aid," said resident Mariam Sidibe. "We hope it continues till the north is free."

AFRICAN TROOPS EXPECTED

More than two decades of peaceful elections had earned Mali a reputation as a bulwark of democracy, but that image unraveled in a matter of weeks after a military coup in March which left a power vacuum for the Islamist rebellion.

France convened a U.N. Security Council meeting for Monday to discuss Mali. French President Francois Hollande's intervention has won plaudits from leaders in Europe, Africa and the United States but it is not without risks.

It raised the threat level for eight French hostages held by al Qaeda allies in the Sahara and for the 30,000 French expatriates living in neighboring, mostly Muslim states.

Concerned about reprisals, France has tightened security at public buildings and on public transport. It advised its 6,000 citizens to leave Mali as spokesmen for Ansar Dine and al Qaeda's north Africa wing AQIM promised to exact revenge.

In its first casualty of the campaign, Paris said a French pilot was killed on Friday when rebels shot down his helicopter.

Hours earlier, a French intelligence officer held hostage in Somalia by al Shabaab extremists linked to al Qaeda was killed in a failed commando raid to free him.

Hollande says France's aim is simply to support a mission by West African bloc ECOWAS to retake the north, as mandated by a U.N. Security Council resolution in December.

With Paris pressing West African nations to send their troops quickly, Ivory Coast President Alassane Ouattara, who holds the rotating ECOWAS chairmanship, kick-started the operation to deploy 3,300 African soldiers.

Ouattara, installed in power with French military backing in 2011, convened a summit of the 15-nation bloc for Saturday in Ivory Coast to discuss the mission.

"The troops will start arriving in Bamako today and tomorrow," said Ali Coulibaly, Ivory Coast's African Integration Minister. "They will be convoyed to the front."

The United States is considering sending a small number of unarmed surveillance drones to Mali as well as providing logistics support, a U.S. official told Reuters. Britain and Canada have also promised logistical support.

Former French colonies Senegal, Niger and Burkina Faso have all pledged to deploy 500 troops within days. In contrast, regional powerhouse Nigeria, due to lead the ECOWAS force, has suggested it would take time to train and equip the troops.

HOUSE-TO-HOUSE SEARCHES

France, however, appeared to have assumed control of the operation on the ground. Its airstrikes allowed Malian troops to drive the Islamists out of the strategic town of Konna, which they had briefly seized this week in their southward advance.

Calm returned to Konna after three nights of combat as the Malian army crushed any remaining rebel fighters. A senior army official said more than 100 rebels had been killed.

"Soldiers are patrolling the streets and have encircled the town," one resident, Madame Coulibaly, told Reuters by phone. "They are searching houses for arms or hidden Islamists."

Analysts expressed doubt, however, that African nations would be able to mount a swift operation to retake north Mali -- a harsh, sparsely populated terrain the size of France -- as neither the equipment nor ground troops were prepared.

"My first impression is that this is an emergency patch in a very dangerous situation," said Gregory Mann, associate professor of history at Columbia University, who specializes in francophone Africa and Mali in particular.

While France and its allies may be able to drive rebel fighters from large towns, they could struggle to prise them from mountain redoubts in the region of Kidal, 300 km (200 miles) northeast of Gao.

Human Rights Watch said at least 11 civilians, including three children, had been killed in the fighting. A spokesman for Doctors Without Borders in neighboring Mauritania said about 200 Malian refugees had fled across the border to a camp at Fassala and more were on their way.

In Bamako, civilians tried to contribute to the war effort.

"We are very proud and relieved that the army was able to drive the jihadists out of Konna. We hope it will not end there, that is why I'm helping in my own way," said civil servant Ibrahima Kalossi, 32, one of over 40 people who queued to donate blood for wounded soldiers.

(Additional reporting by Adama Diarra, Tiemoko Diallo and Rainer Schwenzfeier in Bamako, Pascal Fletcher in Johannesburg, Joe Bavier in Abidjan, Catherine Bremer, Leila Aboud and John Irish in Paris and Phil Stewart in Washington; Writing by Daniel Flynn; Editing by Will Waterman and Roger Atwood)

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Pakistan sacks provincial government after Shiite killings

QUETTA: Pakistani Prime Minister Raja Pervez Ashraf on Monday sacked the provincial government in Baluchistan after meeting Shiite Muslim protesters demanding protection after a massive bomb attack.

Members of the minority community have refused to bury those killed on Thursday in Pakistan's worst sectarian bombings when suicide attackers killed 92 people at a crowded snooker hall in the provincial capital Quetta.

More than 120 were wounded in the attacks claimed by Sunni Muslim militant group Lashkar-e-Jhangvi in an area dominated by Shiites from the Hazara ethnic minority.

Shiite leaders said protesters would not call off their sit-in and bury their dead until they see official notification about steps announced by Ashraf after day break. Local TV stations showed footage of them still protesting.

The families have refused to bury loved ones until the authorities agree to put the security and administration of the city under army control.

The prime minister flew to Quetta on Sunday to listen to their grievances and announced live on television that he had accepted all their demands, including the sacking of the provincial government and the suspension of its legislature.

"We have decided to impose governor's rule in Baluchistan for two months, the provincial government will be sacked," Ashraf said after offering his condolences to grieved families.

"It is a national tragedy and the entire nation is saddened over it."

The governor can call on the army to help control the law and order situation whenever needed, the prime minister said.

He also directed the authorities to arrest the culprits behind attacks against the Shiite community and urged the families to bury their dead.

Refusing to bury the dead is an extreme protest in Islamic society, where the deceased are normally buried the same day or the next day.

The provincial government has been widely criticised in Baluchistan for being unable to control not just sectarian violence, but other attacks linked to a nearly nine-year separatist insurgency and to Islamist militants.

The sacked chief minister, Aslam Raisani, was criticised for making a trip to London while security deteriorated.

Shiites, who account for around 20 per cent of Pakistan's 180 million people, last year suffered record levels of violence according to Human Rights Watch.

- AFP/jc

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Stern test for Mamata, Congress in Bengal bypolls

NEW DELHI: The three byelections to the West Bengal assembly that will be held on February 23 could be the first test for the Mamata Banerjee-led ruling Trinamool Congress (TMC) that came to office in May 2011 with a massive mandate on whether its popularity continues or has started to dip. The bypolls will be followed by panchayat elections in the state likely in May.

The three byelections have to be held in Nalhati (Birbhum district), Rezinagar (Murshidabad district) and English Bazar (Malda district). While Nalhati fell vacant when President Pranab Mukherjee's son Abhijit moved out to contest from his father's parliamentary constituency, the other two MLAs — Humayun Kabir (Rezinagar) and Krishnendu Chaudhury (English Bazar) — left Congress and moved to Trinamool with ministerial berths.

The bypoll results scheduled for February 28 will also test the Congress's strength in Malda and Murshidabad which have been party strongholds even when it lost out in most of the state. Congress strongman Adhir Choudhury, who was made MoS railways after TMC left the UPA, will also be put to test over the bypolls. CM Mamata Banerjee's ploy of luring Congress members into TMC with offers of ministership was to weaken Choudhury, known for his considerable hold over the Murshidabad-Malda region.

With the Banerjee government coming under severe criticism over issues like law and order and fixing of minimum support price for paddy, all parties, including the ruling TMC, are keenly awaiting the by-election results.

"While TMC leaders are expecting to win all the three seats which have high Muslim population, the fight is between Congress and CPM in English Bazar and Rezinagar. The main contest for the Nalhati seat is likely to be between TMC and Left," a senior Congress leader in the state said.

Nalhati was held by Forward Bloc, a constituent of the Left Front in the state, before Abhijit Mukherjee won the seat for first time in 2011.

However, with the Congress and TMC having parted ways, the 2011 story of non-Left votes consolidating in the state is already history. The picture was clear when Abhijit had a wafer thin margin of 2,500 votes when he got elected from his father's parliamentary seat of Jangipur last year.

The Congress fear, however, is that the Left may gain if the Trinamool slides, whereas it should have benefited in these Muslim dominated constituencies. But Congress in Bengal has failed to get its Muslim support base back, which will now go back to CPM if it turns away from TMC. This was evident in Jangipur, a senior Congress leader said.

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

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Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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Dreamliner Nightmare: Another 787 Fuel Leak

Japan Airlines said a Boeing 787 Dreamliner jet leaked fuel while undergoing tests today at the airport near Tokyo, marking the latest in a string of highly-publicized problems for the jetliner as it undergoes a safety review by the U.S. government.

The Dreamliner being examined leaked around 25 gallons of fuel from a nozzle in the left wing, according to a spokesperson for Japan Airlines. It was reportedly the same aircraft that spilled fuel onto the runway at Logan International Airport in Boston earlier this week, The Associated Press reported.

On Monday, firefighters battled an electrical fire on a grounded Japan Airlines 787, also at Logan.

"We are aware of the event and are working with our customer," Boeing spokesman Marc Birtel said in an email to the Los Angeles Times.

The jetliner, which was unveiled as a luxurious and fuel-efficient way to travel, has recently been beset by problems.

Boeing Dreamliner Breaks Out in Flames in Boston Watch Video

Dreamliner Set to Change the Face of Flight Watch Video

Japan's All Nippon Airways has reported a fuel leak, a 3-foot-long crack in a cockpit window and a malfunctioning computer in its fleet of 787s.

The Federal Aviation Administration announced a comprehensive review of the carbon-fiber plane to ensure it is safe to fly, however officials did not waver in their support of the aircraft.

"I would fly on one today," Transportation Secretary Ray LaHood said at a joint news conference with Boeing on Friday.

The plane will not be grounded by the FAA, and will continue to fly during the review, FAA administrator Michael Huerta said.

"Nothing suggests the airplane is not safe," Huerta said. "We believe this is a safe aircraft. To validate the work during the certification process, we'll work with Boeing to check on systems design and production.

"We want to make sure that the approved quality-control process is in place. We want to see the entire picture and not focus on individual events, to determine the root causes of these events," he said.

Huerta said the review will focus on the Dreamliner's electrical system, including the battery and the power distribution panels, and how electrical and mechanical systems interact with one another.

Aviation experts say that, except for the fire, the issues have all been minor.

"If there was something seriously wrong with this plane there is no question they would ground it," ABC News aviation consultant John Nance said. "That's not the problem here, there's nothing seriously wrong with the 787."

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Russia rejects Assad exit as precondition for Syria deal

MOSCOW/BEIRUT (Reuters) - Russia voiced support on Saturday for international peace envoy Lakhdar Brahimi but insisted Syrian President Bashar al-Assad's exit cannot be a precondition for a deal to end the country's conflict.

Some 60,000 Syrians have been killed during the 21-month-old revolt and world powers are divided over how to stop the escalating bloodshed. Government aircraft bombed outer districts of Damascus on Saturday after being grounded for a week by stormy weather, opposition activists in the capital said.

A Russian Foreign Ministry statement following talks on Friday in Geneva with the United States and Brahimi reiterated calls for an end to violence in Syria, but there was no sign of a breakthrough.

Brahimi said the issue of Assad, who the United States, European powers and Gulf-led Arab states insist must step down to end the civil war, appeared to be a sticking point.

Russia's Foreign Ministry said: "As before, we firmly uphold the thesis that questions about Syria's future must be decided by the Syrians themselves, without interference from outside or the imposition of prepared recipes for development."

Russia has been Assad's most powerful international backer, joining with China to block three Western- and Arab-backed U.N. Security Council resolutions aimed to pressure him or push him from power. Assad can also rely on regional powerhouse Iran.

Russia called for "a political transition process" based on an agreement by foreign powers last June.

Brahimi, who is trying to build on that agreement, has met three times with senior Russian and U.S. diplomats since early December and met Assad in Damascus.

Russia and the United States disagreed over what the June agreement meant for Assad, with Washington saying it sent a clear signal he must go and Russia contending it did not.

Qatar on Saturday made a fresh call for an Arab force to end bloodshed in Syria if Brahimi's efforts fail, according to the Doha-based al Jazeera television.

"It is not a question of intervention in Syria in favor of one party against the other, but rather a force to preserve security," Qatar's Prime Minister and Foreign Minister, Sheikh Hamad bin Jassim al-Thani, said in an al Jazeera broadcast.

CONFLICT INTENSIFIES

Moscow has been reluctant to endorse the "Arab Spring" popular revolts of the last two years, saying they have increased instability in the Middle East and created a risk of radical Islamists seizing power.

Although Russia sells arms to Syria and rents one of its naval bases, the economic benefit of its support for Assad is minimal. Analysts say President Vladimir Putin wants to prevent the United States from using military force or support from the U.N. Security Council to bring down governments it opposes.

However, as rebels gain ground in the war, Russia has given indications it is preparing for Assad's possible exit, while continuing to insist he must not be forced out by foreign powers.

Opposition activists say a military escalation and the hardship of winter have accelerated the death toll.

Rebel forces have acquired more powerful anti-tank and anti-aircraft weapons during attacks on Assad's military bases.

Assad's forces have employed increasing amounts of military hardware including Scud-type ballistic missiles in the past two months. New York-based Human Rights Watch said they had also used incendiary cluster bombs that are banned by most nations.

STALEMATE IN CITIES

The weeklong respite from aerial strikes has been marred by snow and thunderstorms that affected millions displaced by the conflict, which has now reached every region of Syria.

On Saturday, the skies were clear and jets and helicopters fired missiles and dropped bombs on a line of towns to the east of Damascus, where rebels have pushed out Assad's ground forces, the Syrian Observatory for Human Rights said.

The British-based group, which is linked to the opposition, said it had no immediate information on casualties from the strikes on districts including Maleiha and farmland areas.

Rebels control large swathes of rural land around Syria but are stuck in a stalemate with Assad's forces in cities, where the army has reinforced positions.

State TV said government forces had repelled an attack by terrorists - a term it uses for the armed opposition - on Aleppo's international airport, now used as a helicopter base.

Reuters cannot independently confirm reports due to severe reporting restrictions imposed by the Syrian authorities and security constraints.

On Friday, rebels seized control of one of Syria's largest helicopter bases, Taftanaz in Idlib province, their first capture of a military airfield.

Eight-six people were killed on Friday, including 30 civilians, the Syrian Observatory said.

(Writing by Oliver Holmes; Editing by Tom Pfeiffer and Doina Chiacu)

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Britain to provide France with logistical support in Mali

LONDON: Britain will provide France with logistical military assistance during its intervention in Mali, but will not deploy any personnel in a combat role, the prime minister's office said Saturday.

"The Prime Minister has agreed that the UK will provide logistical military assistance to help transport foreign troops and equipment quickly to Mali," David Cameron's office said in a statement.

"We will not be deploying any British personnel in a combat role," added Number Ten.

It later confirmed to AFP that two military transport planes would be sent to the restive West African country.

According to a statement about a telephone conversation between Cameron and French President Francois Hollande on Saturday, the two leaders "also agreed that the peacekeeping mission from West African countries needs to be strongly supported by countries in the region and deployed as quickly as possible".

The pair discussed the need to work with the Malian government, regional neighbours and international partners "to prevent a new terrorist haven developing on Europe's doorstep".

They also stressed the need to "reinvigorate the UN-led political process," according to the release.

"The National Security Council, which was already due to meet on Tuesday, will now consider the situation in Mali and discuss what needs to be done to secure a lasting political settlement in Mali," it added.

France sent its air force on Friday to help Malian troops hold back a rebel advance towards the capital Bamako, and on Saturday Paris announced that a French military pilot had been killed.

Cameron earlier said he was "deeply concerned about the recent rebel advances in Mali, which extend the reach of terrorist groups and threaten the stability of the country and the wider region.

"I welcome the military assistance France has provided to the Malian government, at their request, to halt this advance," he added.

The British leader insisted that military intervention "is reinforced by an inclusive political process leading to elections and a return to full civilian rule."

Meanwhile in Somalia, a failed commando raid to free a French hostage held since 2009 left two French soldiers dead while "all indications" were that hostage Denis Allex also died, French officials said.

"Last night's tragic events underline how essential it is that we work together to combat terrorism in Africa," Cameron said in extending his condolences to the families of those killed.

Britain and France were at the forefront of the international military effort to unseat veteran Libyan leader Muammar al-Gaddafi in 2011.

-AFP/ac

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Samjhauta accused involved in 2002 Gujarat riots?

NEW DELHI: The accused in the series of blasts linked to Hindu terror had also participated in the 2002 Gujarat riots that claimed over 1,600 lives. Investigations by the National Investigation Agency (NIA) have found that some of those accused in blasts such as the Samjhauta Express, Hyderabad's Mecca Masjid, Ajmer Dargah and Malegaon had gone to Gujarat during the 2002 riots on the instructions of slain RSS pracharak Sunil Joshi.

The new revelation shows that the radicalized group's tilt towards violence had begun much before they started exploding bombs in Muslim-dominated places like Malegaon and Hyderabad.

Sources said, Lokesh Sharma, who has been arrested in connection with the Samjhauta Express and 2006 Malegaon blasts, has revealed during interrogations that following the burning of 59 kar sevaks in a train near Godhra in February, 2002, by Muslim fundamentalists, there was lot of pent-up anger among right-wing Hindu groups even in Madhya Pradesh. As the riots broke out in Gujarat, Joshi asked Lokesh to head to Gujarat and participate in the riots, sources said.

"Lokesh has said that he duly followed the orders and also killed several people during the riots as part of a mob," said an official privy to the interrogation. Lokesh, however, is not aware if Joshi himself or others in the group also took part in the riots.

NIA, however, suspects that if Joshi had sent Lokesh, he could have asked others close to him to carry out a similar task. Other accused in NIA's custody, however, have not revealed any information as yet on this. Rajender Chaudhary, Manohar Singh, Dhan Singh and Lokesh Sharma are in NIA custody in connection with several blasts.

"Initially, however, there actions were not well organized or coordinated and most acted independently. Although, their extreme radicalization had begun after the 1992 Babri Masjid demolition," said the official.

However, the first recorded anti-minority crime against the group members traces back to 2001, when they had shot a nun in the face from a running bike on Ujjain-Dewas road in MP. This was followed by participation in Gujarat riots, and then lobbing a grenade at a mosque in Jammu in 2004 that led to death of two persons and 15 others getting injured.

It was in 2004 that the group first got organized under the leadership of Pragya Singh Thakur, who had called the accused to Ujjain Kumbh Mela and discussed carrying out coordinated attacks on minority religious places and gatherings. What followed was a series of attacks and blasts ranging from 2005 bid on the life of acquitted accused in 2001 Parliament attack case SAR Geelani in Delhi, blasts in Malegaon in 2006, Samjhauta Express, Ajmer Dargah and Mecca Masjid in 2007, and again in Malegaon in 2008.

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