Nursing is a profession, not a job just anybody can do: doctor

SINGAPORE: Singapore's Director of Medical Services in the Ministry of Health has paid tribute to the role of nurses in Singapore's healthcare system.

Writing on the Health Ministry's Facebook page, Professor K Satkunanantham said he had to write the post as a doctor and as the Director of Medical Services, because of the events that unfolded over the last couple of days.

He stressed that nursing is not a job that just anybody can do - it is a profession.

Prof Satku explained that it takes a special kind of person to be a nurse - someone who is compassionate, caring, and who is willing to put the interests of others above their own.

He said nurses are often specially trained, and need to keep up with new developments in their field.

They work in difficult situations, and have to remain professional in the face of challenges.

As a surgeon, Prof Satku said he has worked with very highly-trained nurses, without whom much of his work would have been impossible.

In the operating theatre, nurses ensure that the most complex operations are carried out smoothly.

In the wards, nurses work to ensure the well-being of patients and continue to do so long after everyone else has gone home.

Prof Satku said nurses are often under-appreciated and taken for granted.

He said Singapore's healthcare system would not function without nurses as hospitals, clinics and hospices rely on them.

Prof Satku thanked all those in the nursing profession.

On Friday, on the concluding day of the debate on the White Paper, Deputy Prime Minister Teo Chee Hean issued a corrigendum to the document in Parliament in relation to footnote 12 on page 40 of the White Paper.

The footnote included two sentences - "Certain low-skilled jobs like personal services, retail, and nursing are hard to offshore. They will still be needed even as the economy upgrades".

Mr Teo said this segment will be deleted.

Mr Teo said this classification of low-skilled jobs is not correct and apologised to those whose professions have been unintentionally misrepresented.

Mr Teo said he personally has the greatest respect for the nursing profession. He said it is a noble and caring profession that all depend on and appreciate.

Mr Teo said the matter was brought to his attention by friends in the nursing profession and unions.

- CNA/xq

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President rejected Afzal Guru's mercy petition on Feb 3: Union home secretary

NEW DELHI: President Pranab Mukherjee had rejected the mercy petition of Parliament attack convict Afzal Guru on February 3, leading to his hanging on Saturday, Union home secretary R K Singh said.

"The President rejected Afzal Guru's mercy petition on February 3 and after that we followed the jail manual and his hanging took place today," he told reporters.

Asked about Afzal's burial, the home secretary said "we will follow the jail manual and act according to the law".

Singh said with the hanging of Afzal Guru, the proceedings of the 2001 Parliament attack case has come to its logical conclusion.

"Law and justice took its own course," he added.

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After early start, worst of flu season may be over

NEW YORK (AP) — The worst of the flu season appears to be over.

The number of states reporting intense or widespread illnesses dropped again last week, and in a few states there was very little flu going around, U.S. health officials said Friday.

The season started earlier than normal, first in the Southeast and then spreading. But now, by some measures, flu activity has been ebbing for at least four weeks in much of the country. Flu and pneumonia deaths also dropped the last two weeks, the Centers for Disease Control and Prevention reported.

"It's likely that the worst of the current flu season is over," CDC spokesman Tom Skinner said.

But flu is hard to predict, he and others stressed, and there have been spikes late in the season in the past.

For now, states like Georgia and New York — where doctor's offices were jammed a few weeks ago — are reporting low flu activity. The hot spots are now the West Coast and the Southwest.

Among the places that have seen a drop: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., which put up a tent outside its emergency room last month to help deal with the steady stream of patients. There were about 100 patients each day back then. Now it's down to 25 and the hospital may pack up its tent next week, said Terry Burger, director of infection control and prevention for the hospital.

"There's no question that we're seeing a decline," she said.

In early December, CDC officials announced flu season had arrived, a month earlier than usual. They were worried, saying it had been nine years since a winter flu season started like this one. That was 2003-04 — one of the deadliest seasons in the past 35 years, with more than 48,000 deaths.

Like this year, the major flu strain was one that tends to make people sicker, especially the elderly, who are most vulnerable to flu and its complications

But back then, that year's flu vaccine wasn't made to protect against that bug, and fewer people got flu shots. The vaccine is reformulated almost every year, and the CDC has said this year's vaccine is a good match to the types that are circulating. A preliminary CDC study showed it is about 60 percent effective, which is close to the average.

So far, the season has been labeled moderately severe.

Like others, Lehigh Valley's Burger was cautious about making predictions. "I'm not certain we're completely out of the woods," with more wintry weather ahead and people likely to be packed indoors where flu can spread around, she said.

The government does not keep a running tally of flu-related deaths in adults, but has received reports of 59 deaths in children. The most — nine — were in Texas, where flu activity was still high last week. Roughly 100 children die in an average flu season, the CDC says

On average, about 24,000 Americans die each flu season, according to the CDC.

According to the CDC report, the number of states with intense activity is down to 19, from 24 the previous week, and flu is widespread in 38 states, down from 42.

Flu is now minimal in Florida, Kentucky, Maine, Montana, New Hampshire and South Carolina.

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Online:

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

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Northeast Shuts Down as Blizzard Batters Millions

A blizzard of possibly historic proportions battered the Northeast Friday into Saturday, and forecasters feared as much as two feet of snow and strong winds could shut down densely populated cities such as New York and Boston, where cars were ordered off the streets.

State officials declared states of emergencies throughout the region, and utilities estimated more than a half-million customers were without power by late Friday night.

Some wondered if the storm could top Boston's all-time single-storm snowfall record of 27.6 inches, set in 2003.

By 9 p.m. Friday, according to the National Weather Service, the storm was spinning off the coast of Long Island, N.Y., and expected to move north-northeastward past New England's coast before its effects tapered off on Saturday afternoon.

"Storm total snowfall accumulations of 1 to 2 feet ... with locally higher amounts are possible across much of the Northeast," the National Weather Service said. "The heaviest snow is forecast to fall across parts of eastern Massachusetts ... Connecticut and Rhode Island where snowfall amounts higher than two feet are possible. In addition to the heavy snowfall ... wind gusts as high as 70 mph are possible ... especially near the coasts."

By 9 p.m. Friday, parts of Connecticut and New York had the highest actual snowfall totals listed by the National Weather Service, with 13 inches measured in Ogdensburg and East Setaukey, N.Y., and Lisbon and North Branford, Conn.

Peak wind gusts included a 71-mph measurement in Buzzards Bay, Mass., the National Weather Service said.

Power outages also were reported across the region. As of 11 p.m. Friday, for instance, approximately 300,000 Massachusetts customers were without power, ABC News station WCVB reported. Utilities also reported approximately 170,000 without power in Rhode Island, 30,000 in Connecticut and nearly 20,000 in New York.

The blizzard conditions came together after a storm from the west joined forces with one from the south to form a nor'easter.

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The storm showed the potential for such ferocity that, before it even hit with full force, Massachusetts Gov. Deval Patrick declared a state of emergency Friday afternoon and signed an executive order banning vehicular traffic on roads in his state effective at 4 p.m. ET. It was believed that the last time the state enacted such a ban was during the blizzard of 1978. Violating the ban could result in a penalty of up to a year in jail and a $500 fine.

"[It] could definitely be a historic winter storm for the Northeast," said Adrienne Leptich of the National Weather Service in Upton, N.Y. "We're looking at very strong wind and heavy snow and we're also looking for some coastal flooding."

Airlines began shutting down operations Friday afternoon at major airports in the New York area as well as in Boston, Portland, Maine, Providence, R.I., and other Northeastern airports. By early evening Friday, more than 4,300 flights had been cancelled on Friday and Saturday, according to FlightAware. Airlines hoped to resume flights by Saturday afternoon, though normal schedules were not expected until Sunday.

The snow fell heavily Friday afternoon in New York City. Mayor Michael Bloomberg said clearing the roads was his main concern, and the city readied 1,700 snow plows and 250,000 tons of salt to clear the streets.

New York City was expecting up to 14 inches of snow, which started falling early this morning, though the heaviest amounts were expected to fall at night and into Saturday. Wind gusts of 55 mph were expected in New York City.

"Stay off the city streets. Stay out of your cars and stay at home while the worst of the storm is on us," Bloomberg said Friday.

Connecticut Gov. Dannel P. Malloy declared a state of emergency, deploying National Guard troops across the state to assist in rescues and other emergencies. Schools and state courthouses were closed, and all flights after 1:30 p.m. at Bradley Airport, north of Hartford, Conn., were cancelled. The state's largest utility companies planned for the possibility that 30 percent of customers -- more than 400,000 homes and businesses -- would lose power.

Malloy also directed drivers to stay off the state's major highways.

"Please stay off of 95, 91, 84, Merritt Parkway and any other limited-access road in the state," he said Friday evening.

PHOTOS: Northeast Braces for Snowstorm

Boston, Providence, R.I., Hartford, Conn., and other New England cities canceled school today.

"Stay off the streets of our city. Basically, stay home," Boston Mayor Tom Menino warned Thursday.

On Friday, Menino applauded the public's response.

"I'm very pleased with the compliance with the snow emergency," he said. "You drive down some of the roadways, you don't see one car."

Friday evening, Gov. Patrick also applauded the public's cooperation with the statewide vehicle ban, noting the clear roads were helping utility crews get their work done.

"It's been a great, great help and I thank everyone," Patrick said. "I know it's been an imposition."

As of 4:30 p.m. Friday, according to the Department of Defense, 837 National Guard soldiers and airmen under state control had been activated in Connecticut, Massachusetts and New York in anticipation of the storm -- 552 in Massachusetts, 235 in Connecticut and 50 in New York. The extra hands were helping with roadways, transportation, making wellness checks on residents and other emergency services.

Beach erosion and coastal flooding was possible from New Jersey to Long Island, N.Y., and into New England coastal areas. It was feared some waves off the coast could reach more than 20 feet.

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Opposition leader's funeral brings day of reckoning for Tunisia

TUNIS (Reuters) - Tunisia's political crisis looked likely to deepen on Friday with strikes and protests planned around the funeral of assassinated opposition politician Chokri Belaid.

Belaid's killing on Wednesday has brought thousands of people onto the streets of the capital Tunis and other cities in violence-marred protests.

Unions have called a general strike for Friday, setting the stage for further confrontation two years on from the pro-democracy revolution that inspired the Arab Spring.

Tunisia is riven by tensions between the dominant Islamists and their secular opponents, and by disillusionment over the lack of social progress since the overthrow of dictator Zine al-Abidine Ben Ali in January 2011.

In response to Belaid's assassination, Prime Minister Hamdi Jebali, an Islamist, said on Wednesday he would dissolve the government, name a non-partisan cabinet of technocrats and hold early elections. But his partners opposed the move and it is yet to be approved by parliament.

No one has claimed responsibility for the killing of Belaid, a lawyer and secular political figure, who was shot by a gunman as he left home for work on Wednesday.

But a crowd set fire to the headquarters of Ennahda, the Islamist party of Prime Minister Jebali, who leads a coalition with two junior secularist parties. Ennahda denies any involvement.

While Belaid had only a modest political following, his criticism of Ennahda policies spoke for many Tunisians who fear religious radicals are bent on snuffing out freedoms won in the first of the revolts that rippled through the Arab world.

"Criminals assassinated Chokri's body, but will not assassinate Chokri's struggle," his widow Besma said on Thursday.

"My sadness ended when I saw thousands flocking to the streets...at that moment I knew that the country is fine and men and women in my country are defending democracy, freedom and life."

All three ruling parties and sections of the opposition rebuffed Jebali's plan to create a small, technocrat government to take over day-to-day matters until elections could be held, demanding they be consulted before any such move.

"In the likely event that there is no agreement, civil unrest will increase, reaching a level that cannot be contained by the police," said Firas Abi Ali of the London-based Exclusive Analysis think-tank.

"If unrest continued for more than two weeks, the army would probably reluctantly step in and back a technocrat government, as well as fresh elections for a new Constituent Assembly."

The economic effect of political uncertainty and street unrest could be serious in a country which has yet to draft a post-revolutionary constitution and which relies heavily on the tourist trade.

The cost of insuring Tunisian government bonds against default rose to its highest level in more than four years on Thursday and ratings agency Fitch said it could further downgrade Tunisia if political instability continues or worsens.

(Writing by Robin Pomeroy; Editing by Angus MacSwan)

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Part of Circle Line to close on 17 March, shuttle service to be provided

SINGAPORE: The stretch between the Mountbatten and Dakota stations on the Circle Line (CCL) will not be operational on Sunday 17 March, from 5.30am to 10am.

This is to allow engineers to continue doing cable replacement works.

The Land Transport Authority (LTA) and SMRT said train services between Mountbatten and Paya Lebar stations will run as a shuttle service during that period.

During the shuttle service, normal service trains will stop at either Mountbatten or Paya Lebar station.

Commuters continuing their journey on the CCL will need to alight at one of these two stations and board the shuttle train at the opposite platform.

Commuters can then get off at the other station and continue their journey on the normal service train.

LTA and SMRT said the cable replacement at all 30 CCL stations is expected to be completed by December 2013, about half a year earlier than the 18-month timeline previously announced.

Works are currently ongoing for the first phase covering CCL stations from Dhoby Ghaut to Esplanade.

This will be followed by stations from Mountbatten to Tai Seng, Promenade to Stadium, Bartley to Marymount, Caldecott to one-north and Kent Ridge to HarbourFront.

The last phase will involve cables along Marina Bay and Bayfront.

- CNA/xq

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Southern diet, fried foods, may raise stroke risk

Deep-fried foods may be causing trouble in the Deep South. People whose diets are heavy on them and sugary drinks like sweet tea and soda were more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain why blacks in the Southeast — the nation's "stroke belt" — suffer more of them.

Blacks were five times more likely than whites to have the Southern dietary pattern linked with the highest stroke risk. And blacks and whites who live in the South were more likely to eat this way than people in other parts of the country were. Diet might explain as much as two-thirds of the excess stroke risk seen in blacks versus whites, researchers concluded.

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.

People who ate about six meals a week featuring these sorts of foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week.

Results were reported Thursday at an American Stroke Association conference in Honolulu.

The federally funded study was launched in 2002 to explore regional variations in stroke risks and reasons for them. More than 20,000 people 45 or older — half of them black — from all 48 mainland states filled out food surveys and were sorted into one of five diet styles:

—Southern: Fried foods, processed meats (lunchmeat, jerky), red meat, eggs, sweet drinks and whole milk.

—Convenience: Mexican and Chinese food, pizza, pasta.

—Plant-based: Fruits, vegetables, juice, cereal, fish, poultry, yogurt, nuts and whole-grain bread.

—Sweets: Added fats, breads, chocolate, desserts, sweet breakfast foods.

—Alcohol: Beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee.

"They're not mutually exclusive" — for example, hamburgers fall into both convenience and Southern diets, Judd said. Each person got a score for each diet, depending on how many meals leaned that way.

Over more than five years of follow-up, nearly 500 strokes occurred. Researchers saw clear patterns with the Southern and plant-based diets; the other three didn't seem to affect stroke risk.

There were 138 strokes among the 4,977 who ate the most Southern food, compared to 109 strokes among the 5,156 people eating the least of it.

There were 122 strokes among the 5,076 who ate the most plant-based meals, compared to 135 strokes among the 5,056 people who seldom ate that way.

The trends held up after researchers took into account other factors such as age, income, smoking, education, exercise and total calories consumed.

Fried foods tend to be eaten with lots of salt, which raises blood pressure — a known stroke risk factor, Judd said. And sweet drinks can contribute to diabetes, the disease that celebrity chef Paula Deen — the queen of Southern cuisine — revealed she had a year ago.

The National Institute of Neurological Disorders and Stroke, drugmaker Amgen Inc. and General Mills Inc. funded the study.

"This study does strongly suggest that food does have an influence and people should be trying to avoid these kinds of fatty foods and high sugar content," said an independent expert, Dr. Brian Silver, a Brown University neurologist and stroke center director at Rhode Island Hospital.

"I don't mean to sound like an ogre. I know when I'm in New Orleans I certainly enjoy the food there. But you don't have to make a regular habit of eating all this stuff."

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Tunisia pledges new govt after opposition leader's killing

TUNIS: Tunisia's premier has pledged to form a government of technocrats ahead of new elections, after the murder of opposition leader Chokri Belaid sparked deadly protests and attacks on the ruling party's offices.

Furious demonstrators built barricades in central Tunis on Wednesday and clashed with police, and four opposition groups including Belaid's Popular Front bloc said they were pulling out of the national assembly.

One policeman was killed after being hit on the chest by rocks in Tunis, the interior ministry said, while an ambulance carrying Belaid's body to the city centre was accompanied by crowds who pressed against the vehicle to protect it.

Islamist Prime Minister Hamadi Jebali said in a televised address after Belaid was shot dead outside his home in Tunis on Wednesday that he would form a new, non-political administration ahead of fresh elections.

"I have decided to form a government of competent nationals without political affiliation, which will have a mandate limited to managing the affairs of the country until elections are held in the shortest possible time," he said.

Jebali did not specify that he was dissolving the existing government, nor did he set a date for the reshuffle which must be confirmed by the national assembly.

President Moncef Marzouki denounced the killing of Belaid, an outspoken critic of his government, as an "odious assassination".

The ruling Islamist Ennahda party, which Belaid's family accused of being behind the killing, rejected any involvement.

Ennahda chief Rached Ghannouchi said that the "cowardly" murder was the result of a settling of political scores. The killers "want a bloodbath but they won't succeed," he told AFP.

The four opposition groups blamed Interior Minister Ali Laraydeh from Ennahda for Belaid's murder and demanded his sacking "because he knew he was threatened and he did nothing," according to Nejib Chebbi, leader of one of the blocs.

Belaid's Popular Front and other opposition parties called for a general strike to protest against the assassination.

The United States led Western nations who reacted with dismay at the killing, while Human Rights Watch said the authorities should ensure those responsible were brought to justice.

"There is no justification for an outrageous and cowardly act of violence like this. There is no place in the new Tunisia for violence," US State Department spokeswoman Victoria Nuland said.

German Foreign Minister Guido Westerwelle expressed his "horror" at the attack while French President Francois Hollande condemned a murder that "robs Tunisia of one of its most courageous and free voices."

The violent scenes triggered by Belaid's murder were reminiscent of the uprising that ousted veteran dictator Zine El Abidine Ben Ali just over two years ago, with thousands protesting outside the interior ministry.

Belaid's brother, Abdelmajid, bluntly accused the Ennahda chief of the murder of the 48-year-old leftist leader, who headed the Party of Democratic Patriots, part of the Popular Front.

"I accuse Rached Ghannouchi of assassinating my brother," Abdelmajid told AFP.

The slain politician's wife said her husband had received daily death threats and was murdered before her eyes.

"I saw his blood flowing, I saw his little smile. I saw that they want to kill democracy," Basma Belaid told France's Europe 1 radio.

Belaid had last week accused Ennahda "mercenaries" of attacking his supporters and on Tuesday warned that militias were being created "to terrorise citizens and drag the country into a spiral of violence."

His supporters flooded the streets of Tunis and other cities, including Sidi Bouzeid, birthplace of the 2011 revolution, where tear gas was fired as about 200 people tried to storm the police headquarters.

Protesters torched the Ennahda office near Sidi Bouzeid, ransacked another in Gafsa and set fire to a party office in the northeastern town of Kef.

In Kasserine, on the border with Algeria, hundreds of people calling for "vengeance" took to the streets.

Marzouki deplored the killing in an impassioned speech at the European Parliament.

"This odious assassination of a political leader who I knew well and who was my friend... is a threat, it is a letter sent that will not be received," he said, insisting the murder would not plunge Tunisia into violence.

Belaid, whose funeral will be on Friday after the main weekly prayers, was a populist known for his iconic smile and black moustache.

A lawyer who spoke with the working class accent of northwestern Tunisia, he defended human rights, was jailed under Ben Ali, and was a member of executed Iraqi dictator Saddam Hussein's legal defence team.

- AFP/xq

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French president to negotiate $12bn Rafale jet deal in India next week

BANGALORE: France's Dassault Aviation hopes to conclude its $12-billion deal to sell Rafale jets to India this year, with negotiations set to be taken up by President Francois Hollande next week.

"The ideal would be to sign it in 2013," Dassault chief executive Eric Trappier told AFP in an interview about the world's biggest defence deal at India's air show in Bangalore.

"It's not that surprising that it takes a bit of time," he said, pointing out that the contract involved production of 126 state-of-the-art fighters in France and India over a 15-20 year period.

He also confirmed Indian negotiators had detailed their needs for an additional 63 planes beyond the initial order of 126, as reported after a visit by foreign minister Salman Khurshid to Paris in January.

"It's to let us know that they'll need the assembly lines for a long time," he said.

Hollande is to visit New Delhi on February 14-15 on his first trip to India since being elected in May. Trappier will be in the delegation.

"I don't think there are military aircraft sales without good political relations," said Trappier.

Dassault is one of the big names at this week's Aero India as it shows off the Rafale which beat competition from six rivals from Russia, the US and Europe last year.

Exclusive negotiations are under way to determine the final price and amount of technology transfers, with defence minister A K Antony giving an indication of the complexities involved in a Wednesday news conference.

The deal will have to pass through "six or seven layers" of vetting before being presented to the finance ministry and the cabinet committee on security.

Antony, seen as a clean operator in India's notoriously dirty politics, also said his officials would ensure "no malpractice is there" and denied budget cuts in his ministry would have an impact on "the mother of all contracts".

France is desperate to make its first foreign sale of the Rafale, which has struggled to find buyers after investments of tens of billions of euros.

The conclusion of the deal has been repeatedly delayed. India initially set a target of the end of last year, which slipped to the end of the current fiscal year in March.

Hollande will be followed days later in Delhi by British Prime Minister David Cameron who has lobbied on behalf of the Eurofighter, a rival jet made by a partly British consortium which is ready to step in if Dassault fails.

Under the proposed Rafale deal, the first 18 aircraft are to be made in France with the remainder to be produced under licence by Hindustan Aeronautics Limited (HAL), the state-run Indian aerospace behemoth.

Dassault must conclude licence deals with about 20-30 different Indian partners, according to Trappier. "We've done more than half of the work so far," he said.

The French group has also formed a joint venture with the Indian conglomerate Reliance, which has no former military production experience but will be involved as a supplier.

Indian Foreign Minister Khurshid likened the negotiations to a fine French wine while in Paris.

"The contract details are being worked out. A decision has already been taken, just wait a little for the cork to pop and you'll have some good wine to taste," he said.

The Rafale has carried out bombing missions in Afghanistan, Libya and most recently in Mali, where it is currently flying sorties targeting Islamist militants.

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New whooping cough strain in US raises questions

NEW YORK (AP) — Researchers have discovered the first U.S. cases of whooping cough caused by a germ that may be resistant to the vaccine.

Health officials are looking into whether cases like the dozen found in Philadelphia might be one reason the nation just had its worst year for whooping cough in six decades. The new bug was previously reported in Japan, France and Finland.

"It's quite intriguing. It's the first time we've seen this here," said Dr. Tom Clark of the Centers for Disease Control and Prevention.

The U.S. cases are detailed in a brief report from the CDC and other researchers in Thursday's New England Journal of Medicine.

Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. It was once common, but cases in the U.S. dropped after a vaccine was introduced in the 1940s.

An increase in illnesses in recent years has been partially blamed on a version of the vaccine used since the 1990s, which doesn't last as long. Last year, the CDC received reports of 41,880 cases, according to a preliminary count. That included 18 deaths.

The new study suggests that the new whooping cough strain may be why more people have been getting sick. Experts don't think it's more deadly, but the shots may not work as well against it.

In a small, soon-to-be published study, French researchers found the vaccine seemed to lower the risk of severe disease from the new strain in infants. But it didn't prevent illness completely, said Nicole Guiso of the Pasteur Institute, one of the researchers.

The new germ was first identified in France, where more extensive testing is routinely done for whooping cough. The strain now accounts for 14 percent of cases there, Guiso said.

In the United States, doctors usually rely on a rapid test to help make a diagnosis. The extra lab work isn't done often enough to give health officials a good idea how common the new type is here, experts said.

"We definitely need some more information about this before we can draw any conclusions," the CDC's Clark said.

The U.S. cases were found in the past two years in patients at St. Christopher's Hospital for Children in Philadelphia. One of the study's researchers works for a subsidiary of Johnson & Johnson, which makes a version of the old whooping cough vaccine that is sold in other countries.

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JournaL: http://www.nejm.org

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