Punjab family ravaged by Alzheimer’s banks on gene test

NEW DELHI: A curious case from Punjab has rattled not just Kuldeep Kaur and her family but even the experts who have been striving for over a year to solve her case. Kaur, a 32-year-old mother of two, was living a healthy life till September 2011 when she suddenly developed memory loss. She stopped recognizing people, forgot meals and became urinary incontinent — a pattern observed in her family including her father, grandfather, great grandmother and several other blood relatives.

Kaur had been suffering from an extremely rare disease called familial Alzheimer's that runs into families. This was declared two days ago in a genetic test conducted by a research group based in France.

"This is the first time we have come across any such patient. Her 26-year-old brother had approached us two years ago for genetic testing, fearing that he might also suffer from the same fate as his family members. We did some testing but the mutation in gene could not be identified. Finally, a research group in France offered to do the genetic testing for free and the results came in," said Dr Sunita Bijarniya Mahay, metabolic physician and geneticist at the Center of Genetic Medicine, Ganga Ram Hospital.

Now they will do predicting testing on the brother and Kuldeep's blood relatives, Dr Sunita said, to rule out or confirm the possibility of mutation of the same gene in them. "Though there is no cure for familial Alzheimer's, the tests would help them beat the angst. We can also try to manage the positive cases using best post possible medical intervention," she added.

According to Harmohan Singh, Kuldeep's brother, most of their family members could not survive beyond 50 years. "We always thought it was a family curse and would lead to the extermination of our whole generation. But the finding of the gene responsible for the deaths has given us new hope," he said. Singh was eight when his father passed away due to the same disease.

"Kuldeep's condition is also worsening each day. She has developed urinary incontinent and has become very weak. Her children have been the worst sufferers of the tragedy and no one knows what future they have. We are poor and it is really difficult for us to even think of getting the tests done on each family member," he said.

According to Dr I C Verma, director of the center of genetic medicine at Ganga Ram Hospital, India has the largest number of patients having genetic disorders because of large number of births (27 million per year), consanguineous marriages (within relations), high frequency thalessemia and sickle cell disease.

"Prenatal genetic testing, which can help in timely identification of these risk factors, is available at most centers in India. We are now trying to acquire high-end services like Microarray Analysis that can analyse the minutest change in chromosome and next generation sequencing to multiple genes for possible mutation in one go.

"These new technologies will lead to the identification of the cause of intellectual disability, muscle weakness , brain disorders and many other genetic disorders. This will also lead to the development of newer therapies," he said.

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Q&A: Scramble for vaccine as flu season heats up

WASHINGTON (AP) — Missed flu-shot day at the office last fall? And all those "get vaccinated" ads? A scramble for shots is under way as late-comers seek protection from a miserable flu strain already spreading through much of the country.

Federal health officials said Friday that there is still some flu vaccine available and it's not too late to benefit from it. But people may have to call around to find a clinic with shots still on the shelf, or wait a few days for a new shipment.

"We're hearing of spot shortages," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Colorado offers an example. Kaiser Permanente, which has 535,000 members in the state, stopped giving flu shots this week. But it expected to resume vaccinations when new shipments arrive, expected this weekend.

Some questions and answers about flu vaccines:

Q: Are we running out of vaccine?

A: It's January — we shouldn't have a lot left. The traditional time to get vaccinated is in the fall, so that people are protected before influenza starts spreading.

Indeed, manufacturers already have shipped nearly 130 million doses to doctors' offices, drugstores and wholesalers, out of the 135 million doses they had planned to make for this year's flu season. At least 112 million have been used so far.

The nation's largest manufacturer, Sanofi Pasteur, said Friday that it still has supplies of two specialty vaccines, a high-dose shot for seniors, and an under-the-skin shot for certain adults, available for immediate shipment. But it also is working to eke out a limited supply of its traditional shots — some doses that it initially hadn't packaged into syringes, said spokesman Michael Szumera. They should be available late this month.

And MedImmune, the maker of the nasal spray vaccine FluMist, said it has 620,000 extra doses available.

Q: Can't they just make more?

A: No. Flu vaccine is complicated to brew, with supplies for each winter made months in advance and at the numbers expected to sell. Although health officials recommend a yearly flu vaccination for nearly everybody, last year 52 percent of children and just 39 percent of adults were immunized. Most years, leftover doses have to be thrown out.

Q: Should I still hunt for a vaccine?

A: It does take two weeks for full protection to kick in. Still, health officials say it's a good idea to be vaccinated even this late, especially for older people, young children and anyone with medical conditions such as heart or lung diseases that put them at high risk of dangerous flu complications. Flu season does tend to be worst in January and February, but it can run through March.

Q: I heard that a new flu strain is spreading. Does the vaccine really work?

A: Flu strains constantly evolve, the reason that people need an updated vaccine every year. But the CDC says this year's is a good match to the types that are circulating, including a new kind of the tough H3N2 strain. That family tends to be harsher than other flu types — and health officials warned last fall that it was coming, and meant this winter would likely be tougher than last year's flu season, the mildest on record.

Q: But don't some people get vaccinated and still get sick?

A: Flu vaccine never is 100 percent effective, and unfortunately it tends to protect younger people better than older ones. But the CDC released a study Friday showing that so far this year, the vaccine appears 62 percent effective, meaning it's working about as well as it has in past flu seasons.

While that may strike some people as low, Frieden said it's the best protection available. "It's a glass 62 percent full," he said. "It's well worth the effort."

Q: What else can I do?

A: Wash your hands often, and avoid touching your eyes, nose and mouth. Viruses can spread by hand, not just through the air. Also, cough in your elbow, not your hand. When you're sick, protect others by staying home.

And people who are in those high-risk groups should call a doctor if they develop symptoms, added CDC spokesman Tom Skinner. They might be prescribed antiviral medication, which works best if given within the first 48 hours of symptoms.

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AP Medical Writers Lindsey Tanner and Mike Stobbe contributed to this report.

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Poisoned Lottery Winner's Kin Were Suspicious

Urooj Khan had just brought home his $425,000 lottery check when he unexpectedly died the following day. Now, certain members of Khan's family are speaking publicly about the mystery -- and his nephew told ABC News they knew something was not right.

"He was a healthy guy, you know?" said the nephew, Minhaj Khan. "He worked so hard. He was always going about his business and, the thing is: After he won the lottery and the next day later he passes away -- it's awkward. It raises some eyebrows."

The medical examiner initially ruled Urooj Khan, 46, an immigrant from India who owned dry-cleaning businesses in Chicago, died July 20, 2012, of natural causes. But after a family member demanded more tests, authorities in November found a lethal amount of cyanide in his blood, turning the case into a homicide investigation.

"When we found out there was cyanide in his blood after the extensive toxicology reports, we had to believe that ... somebody had to kill him," Minhaj Khan said. "It had to happen, because where can you get cyanide?"

In Photos: Biggest Lotto Jackpot Winners

Authorities could be one step closer to learning what happened to Urooj Khan. A judge Friday approved an order to exhume his body at Rosehill Cemetery in Chicago as early as Thursday to perform further tests.

Lottery Winner Murdered: Widow Questioned By Police Watch Video

Moments after the court hearing, Urooj Khan's sister, Meraj Khan, remembered her brother as the kind of person who would've shared his jackpot with anyone. Speaking at the Cook County Courthouse, she hoped the exhumation would help the investigation.

"It's very hard because I wanted my brother to rest in peace, but then we have to have justice served," she said, according to ABC News station WLS in Chicago. "So if that's what it takes for him to bring justice and peace, then that's what needs to be done."

Khan reportedly did not have a will. With the investigation moving forward, his family is waging a legal fight against his widow, Shabana Ansari, 32, over more than $1 million, including Urooj Khan's lottery winnings, as well as his business and real estate holdings.

Khan's brother filed a petition Wednesday to a judge asking Citibank to release information about Khan's assets to "ultimately ensure" that [Khan's] minor daughter from a prior marriage "receives her proper share."

Ansari may have tried to cash the jackpot check after Khan's death, according to court documents, which also showed Urooj Khan's family is questioning if the couple was ever even legally married.

Ansari, Urooj Khan's second wife, who still works at the couple's dry cleaning business, has insisted they were married legally.

She has told reporters the night before her husband died, she cooked a traditional Indian meal for him and their family, including Khan's daughter and Ansari's father. Not feeling well, Khan retired early, Ansari told the Chicago Sun-Times, falling asleep in a chair, waking up in agony, then collapsing in the middle of the night. She said she called 911.

"It has been an incredibly hard time," she told ABC News earlier this week. "We went from being the happiest the day we got the check. It was the best sleep I've had. And then the next day, everything was gone.

"I am cooperating with the investigation," Ansari told ABC News. "I want the truth to come out."

Ansari has not been named a suspect, but her attorney, Steven Kozicki, said investigators did question her for more than four hours.

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Obama, Karzai accelerate end of U.S. combat role in Afghanistan

WASHINGTON (Reuters) - President Barack Obama and Afghan President Hamid Karzai agreed on Friday to speed up the handover of combat operations in Afghanistan to Afghan forces, raising the prospect of an accelerated U.S. withdrawal from the country and underscoring Obama's determination to wind down a long, unpopular war.

Signaling a narrowing of differences, Karzai appeared to give ground in talks at the White House on U.S. demands for immunity from prosecution for any American troops who stay in Afghanistan beyond 2014, a concession that could allow Obama to keep at least a small residual force there.

Both leaders also threw their support behind tentative Afghan reconciliation efforts with Taliban insurgents, endorsing the establishment of a Taliban political office in Qatar in hopes of bringing insurgents to inter-Afghan talks.

Outwardly, at least, the meeting appeared to be something of a success for both men, who need to show their vastly different publics they are making progress in their goals for Afghanistan. There were no signs of the friction that has frequently marked Obama's relations with Karzai.

Karzai's visit came amid stepped-up deliberations in Washington over the size and scope of the U.S. military role in Afghanistan once the NATO-led combat mission concludes at the end of 2014.

"By the end of next year, 2014, the transition will be complete," Obama said at a news conference with Karzai standing at his side. "Afghans will have full responsibility for their security, and this war will come to a responsible end."

The Obama administration has been considering a residual force of between 3,000 and 9,000 troops - far fewer than some U.S. commanders propose - to conduct counterterrorism operations and to train and assist Afghan forces.

A top Obama aide said this week that the administration does not rule out a complete withdrawal after 2014, a move that some experts say would be disastrous for the weak Afghan central government and its fledgling security apparatus.

Obama on Friday left open the possibility of that so-called "zero option" when he several times used the word "if" to suggest that a post-2014 U.S. presence was far from guaranteed.

Insisting that Afghan forces were "stepping up" faster than expected, Obama said Afghan troops would take over the lead in combat missions across the country this spring, rather than waiting until the summer as originally planned. NATO troops will then assume a "support role," he said.

"It will be a historic moment and another step toward full Afghan sovereignty," Obama said.

Obama said final decisions on this year's troop cuts and the post-2014 U.S. military role were still months away, but his comments suggested he favors a stepped-up withdrawal timetable.

There are some 66,000 U.S. troops currently in Afghanistan. Washington's NATO allies have been steadily reducing their troop numbers as well despite doubts about the ability of Afghan forces to shoulder full responsibility for security.

'WAR OF NECESSITY'

Karzai voiced satisfaction over Obama's agreement to turn over control of detention centers to Afghan authorities, a source of dispute between their countries, although the White House released no details of the accord on that subject.

Obama once called Afghanistan a "war of necessity." But he is heading into a second term looking for an orderly way out of the conflict, which was sparked by the September 11, 2001, attacks on the United States by an al Qaeda network harbored by Afghanistan's Taliban rulers.

He faces the challenge of pressing ahead with his re-election pledge to continue winding down the war while preparing the Afghan government to prevent a slide into chaos and a Taliban resurgence once most NATO forces are gone.

Former Senator Chuck Hagel, Obama's nominee to become defense secretary, is likely to favor a sizable troop reduction.

Karzai, meanwhile, is eager to show he is working to ensure Afghans regain full control of their territory after a foreign military presence of more than 11 years.

Asked whether the cost of the war in lives and money was worth it, Obama said: "We achieved our central goal ... or have come very close to achieving our central goal, which is to de-capacitate al Qaeda, to dismantle them, to make sure that they can't attack us again."

He added: "Have we achieved everything that some might have imagined us achieving in the best of scenarios? Probably not. This is a human enterprise, and you fall short of the ideal."

Obama made clear that unless the Afghan government agrees to legal immunity for U.S. troops, he would withdraw them all after 2014 - as happened in Iraq at the end of 2011.

Karzai, who criticized NATO over civilian deaths, said that with Obama's agreement to transfer detention centers and the planned withdrawal of U.S. forces from Afghan villages, "I can go to the Afghan people and argue for immunity" in a bilateral security pact being negotiated.

Addressing students at Georgetown University later in the day, the Afghan leader predicted with certainty that the United States would keep a limited number of troops in Afghanistan after 2014, in part to battle al Qaeda and its affiliates.

"One of the reasons the United States will continue a limited presence in Afghanistan after 2014 in certain facilities in Afghanistan is because we have decided together to continue to fight against al Qaeda," Karzai said. "So there will be no respite in that."

Many of Obama's Republican opponents have criticized him for setting a withdrawal timetable and accuse him of undercutting the U.S. mission by reducing troop numbers too quickly.

Karzai and his U.S. partners have not always seen eye to eye, even though the American military has been crucial to preventing insurgent attempts to oust him.

In October, Karzai accused Washington of playing a double game by fighting the war in Afghan villages instead of going after insurgents who cross the border from neighboring Pakistan.

In Friday's news conference, Karzai did not back down from his previous comments that foreigners were responsible for some of the official corruption critics say is rampant in Afghanistan. But he acknowledged: "There is corruption in the Afghan government that we are fighting against."

Adding to tensions has been a rash of deadly "insider" attacks by Afghan soldiers and police against NATO-led troops training or working with them. U.S. forces have also been involved in a series of incidents that enraged Afghans, including burning Korans, which touched off days of rioting.

(Additional reporting by Roberta Rampton, Mark Felsenthal, Jeff Mason, Phil Stewart, Tabassum Zakaria, David Alexander; Editing by Warren Strobel and Will Dunham)

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Native leaders meet with Canadian PM amid protests

OTTAWA: Indigenous Canadians marched on the capital and other major cities threatening to bring the economy "to its knees" as their leaders met with officials to try to resolve a row over extreme poverty on reserves.

As many as 500 aboriginals protested in freezing rain outside parliament in Ottawa in support of a hunger strike by a northern Ontario chief. Hundreds more held rallies in Montreal and Winnipeg.

Canadian Prime Minister Stephen Harper, meanwhile, met with 20 native chiefs behind closed doors in a bid to stem an escalation of demonstrations and highway blockades across the country.

Aboriginal Affairs Minister John Duncan said after the meeting that the prime minister agreed to ongoing "high level dialogue on the treaty relationship".

But beyond this commitment it was unclear at the end of the day what, if anything, was accomplished except to highlight divisions among Canada's more than 600 tribes.

Attawapiskat Chief Theresa Spence, whose 32-day hunger strike has become a focal point for an aboriginal rights movement calling for improved living conditions on reserves, boycotted the emergency talks.

She and her supporters had insisted on the participation of Queen Elizabeth II's representative in Canada, Governor General David Johnston, describing his attendance as "integral when discussing inherent and treaty rights". Canada's more than 600 indigenous reserves were created by royal proclamation in 1763.

But Johnston declined, saying their plight is a political matter that must be taken up with elected officials.

"We're giving this opportunity for them to resolve the broken promises from the treaty. And all we're asking is a meeting and to sit down with them," Spence told a news conference earlier in the day.

"All we want is justice, equality and fairness which we're entitled (to)," she said, vowing to continue her hunger strike.

Chiefs from Manitoba and Ontario provinces, as well as the Northwest Territories, joined her boycott, insisting on a meeting with the prime minister on their terms and vowing to "bring the Canadian economy to its knees" if their demands were not met.

This could include blocking resource development on their ancestral lands, said Manitoba Grand Chief Derek Nepinak.

"We have the warriors that are standing up now, that are willing to go that far. So we're not here to make requests, we're here to demand attention," he said.

Nepinak was echoed by Grand Chief Gordon Peters of the Association of Iroquois and Allied Indians who called for protests to be stepped up with all major road and rail lines shut down.

Foreign investments in Canada not approved by First Nations could also be targeted, he told reporters.

Assembly of First Nations National Chief Shawn A-in-chut Atleo, after leading a delegation to meet with Harper, avoided speaking to reporters.

Ahead of the talks he said he would seek a commitment from the prime minister for a "long-term process" to address native concerns, including outstanding land claims, hundreds of missing and murdered native women, high unemployment among natives, and too few schools in native communities.

A fix, Atleo said, could also include natives getting a share of royalties from some C$650 billion in resource development planned for the coming decade.

In addition to complaints of severe poverty, natives also blasted changes last month to environmental and other laws they say impact their hunting and fishing rights, which allow tribes to lease reserve lands to non-natives.

Although the government insists the latter was meant to boost economic development, some fear it will result in a loss of native control of reserve lands and eventually lead to the end of aboriginal communities.

- AFP/al

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Carnatic music: Classic collaborations work

CHENNAI: Shannon Donald, who lives in Mumbai, doesn't mind going for a Carnatic concert these days. And that's not because she grew up listening to south Indian classical music. "I love the singing style now," says the singer, who was amazed to see musician Bombay Jayashri being a picture of composure at MTV's Coke Studio a year ago.

"I was a backing vocalist on the episode in which she sang with Bollywood singer Richa Sharma. Though we had a long day, when it came to shooting her parts, she nailed every note effortlessly," says Donald about Jayashri, who was nominated on January 10 for the 2013 Oscars for writing a Tamil song, 'Pi's Lullaby', for Ang Lee's fantasy epic, 'Life of Pi'.

For many like Jayashri, collaborating with artists from other fields is not just about covering more creative ground. Notching up unlikely fans for classical music is one of the benefits that Jayashri and other Carnatic artists treasure while jamming with world musicians.

"After the Coke Studio episode, more people know me and come for my concerts. It's a win-win situation," says Jayashri, who has worked with Egyptian singer Hisham Abbas, done jugalbandis with Hindustani musicians Ronu Majumdar and sung for Bharatanatyam dancer Leela Samson's performances.

"I do collaborations because I like doing new things," says Jayashri. According to fellow artists like flautist S Shashank, it could have been Jayashri's love for experimentation that helped 'Life of Pi' director Ang Lee zero in on her for the Oscar-nominated project.

"I got to work on guitarist John McLaughlin's album 'Floating Point' because I work with world musicians. The album was nominated for a Grammy award in 2009," says the flautist, who will release an album, 'Here and Now', with Danish guitar maestro John Sund.

What draws western musicians is the ability of Indian musicians to improvise, says Shashank who has worked with legendary Spanish guitarist Paco de Lucia and with jazz musicians. Shashank loves the freedom to explore the flute outside the traditional concert format of Carnatic, which is a text-laden system and favours the vocalist. "It is a great learning experience. Also, as India is flooded with film music this is the only way classical musicians, especially instrumentalists, can carve a niche for themselves and establish commercially."

These artists still face the criticism that they are diluting pure music. "When, the late Pandit Ravi Shankar did jugalbandis, he was accused of doing the same. Now, jugalbandis have become the norm," says Jayashri.

To mandolin player U Shrinivas, collaborations mean more recognition for classical music. "My audience is bigger. My students come from all over the world to learn to Carnatic music," he says. And to Shrinivas, who is happy and proud of Jayashri's Oscar nomination, this could well be the best time for Indian classical music.

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Flu season puts businesses and employees in a bind

WASHINGTON (AP) — Nearly half the 70 employees at a Ford dealership in Clarksville, Ind., have been out sick at some point in the past month. It didn't have to be that way, the boss says.

"If people had stayed home in the first place, a lot of times that spread wouldn't have happened," says Marty Book, a vice president at Carriage Ford. "But people really want to get out and do their jobs, and sometimes that's a detriment."

The flu season that has struck early and hard across the U.S. is putting businesses and employees alike in a bind. In this shaky economy, many Americans are reluctant to call in sick, something that can backfire for their employers.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said Friday. The only states without widespread flu were California, Mississippi and Hawaii. And the main strain of the virus circulating tends to make people sicker than usual.

Blake Fleetwood, president of Cook Travel in New York, says his agency is operating with less than 40 percent of its staff of 35 because of the flu and other ailments.

"The people here are working longer hours and it puts a lot of strain on everyone," Fleetwood says. "You don't know whether to ask people with the flu to come in or not." He says the flu is also taking its toll on business as customers cancel their travel plans: "People are getting the flu and they're reduced to a shriveling little mess and don't feel like going anywhere."

Many workers go to the office even when they're sick because they are worried about losing their jobs, says John Challenger, CEO of Challenger, Gray & Christmas, an employer consulting firm. Other employees report for work out of financial necessity, since roughly 40 percent of U.S. workers don't get paid if they are out sick. Some simply have a strong work ethic and feel obligated to show up.

Flu season typically costs employers $10.4 billion for hospitalization and doctor's office visits, according to the CDC. That does not include the costs of lost productivity from absences.

At Carriage Ford, Book says the company plans to make flu shots mandatory for all employees.

Linda Doyle, CEO of the Northcrest Community retirement home in Ames, Iowa, says the company took that step this year for its 120 employees, providing the shots at no cost. It is also supplying face masks for all staff.

And no one is expected to come into work if sick, she says.

So far, the company hasn't seen an outbreak of flu cases.

"You keep your fingers crossed and hope it continues this way," Doyle says. "You see the news and it's frightening. We just want to make sure that we're doing everything possible to keep everyone healthy. Cleanliness is really the key to it. Washing your hands. Wash, wash, wash."

Among other steps employers can take to reduce the spread of the flu on the job: holding meetings via conference calls, staggering shifts so that fewer people are on the job at the same time, and avoiding handshaking.

Newspaper editor Rob Blackwell says he had taken only two sick days in the last two years before coming down with the flu and then pneumonia in the past two weeks. He missed several days the first week of January and has been working from home the past week.

"I kept trying to push myself to get back to work because, generally speaking, when I'm sick I just push through it," says Blackwell, the Washington bureau chief for the daily trade paper American Banker.

Connecticut is the only state that requires some businesses to pay employees when they are out sick. Cities such as San Francisco and Washington have similar laws.

Challenger and others say attitudes are changing, and many companies are rethinking their sick policies to avoid officewide outbreaks of the flu and other infectious diseases.

"I think companies are waking up to the fact right now that you might get a little bit of gain from a person coming into work sick, but especially when you have an epidemic, if 10 or 20 people then get sick, in fact you've lost productivity," Challenger says.

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Associated Press writers Mike Stobbe in Atlanta, Eileen A.J. Connelly in New York, Paul Wiseman in Washington, Barbara Rodriguez in Des Moines, Iowa, and Jim Salter in St. Louis contributed to this report.

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CDC: Flu Outbreak Could Be Waning

The flu season appears to be waning in some parts of the country, but that doesn't mean it won't make a comeback in the next few weeks, according to the Centers for Disease Control and Prevention.

Five fewer states reported high flu activity levels in the first week of January than the 29 that reported high activity levels in the last week of December, according to the CDC's weekly flu report. This week, 24 states reported high illness levels, 16 reported moderate levels, five reported low levels and one reported minimal levels, suggesting that the flu season peaked in the last week of December.

"It may be decreasing in some areas, but that's hard to predict," CDC Director Dr. Thomas Frieden said in a Friday morning teleconference. "Trends only in the next week or two will show whether we have in fact crossed the peak."

The flu season usually peaks in February or March, not December, said Dr. Jon Abramson, who specializes in pediatric infectious diseases at Wake Forest Baptist Health in North Carolina. He said the season started early with a dominant H3N2 strain, which was last seen a decade ago, in 2002-03. That year, the flu season also ended early.

Click here to see how this flu season stacks up against other years.

Cheryl Evans/The Arizona Republic/AP Photo

Increasing Flu Cases: Best Measures to Ensure Your Family's Health Watch Video

Because of the holiday season, Frieden said the data may have been skewed.

For instance, Connecticut appeared to be having a lighter flu season than other northeastern states at the end of December, but the state said it could have been a result of college winter break. College student health centers account for a large percentage of flu reports in Connecticut, but they've been closed since the fall semester ended, said William Gerrish, a spokesman for the state's department of public health.

The flu season arrived about a month early this year in parts of the South and the East, but it may only just be starting to take hold of states in the West, Frieden said. California is still showing "minimal" flu on the CDC's map, but that doesn't mean it will stay that way.

Click here to read about how flu has little to do with cold weather.

"It's not surprising. Influenza ebbs and flows during the flu season," Frieden said. "The only thing predictable about the flu is that it is unpredictable."

Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn., said he was expecting California's seeming good luck with the flu to be over this week.

"Flu is fickle, we say," Schaffner said. "Influenza can be spotty. It can be more severe in one community than another for reasons incompletely understood."

Early CDC estimates indicate that this year's flu vaccine is 62 percent effective, meaning people who have been vaccinated are 62 percent less likely to need to see a doctor for flu treatment, Frieden said.

Although the shot has been generally believed to be more effective for children than adults, there's not enough data this year to draw conclusions yet.

"The flu vaccine is far from perfect, but it's still by far the best tool we have to prevent flu," Frieden said, adding that most of the 130 million vaccine doses have already been administered. "We're hearing of shortages of the vaccine, so if you haven't been vaccinated and want to be, it's better late than never."

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U.S., Afghanistan discuss "last chapter" in war aims: Panetta

WASHINGTON (Reuters) - U.S. Defense Secretary Leon Panetta and Afghan President Hamid Karzai discussed on Thursday the "last chapter" in building a sovereign Afghanistan that can provide its own security, including the nature of U.S. involvement after combat troops withdraw in 2014.

Panetta said he and Karzai made "very good progress" on the issues they discussed, but he declined to say whether they had agreed on the size of any residual U.S. force that would remain in Afghanistan to do counterterrorism operations and training once combat troops withdraw.

Panetta said both sides were committed to the goals approved at the NATO summit in Chicago in May, which calls for a continuing effort by members of the alliance to train, advise and assist Afghan forces. Karzai is scheduled to meet President Barack Obama on Friday for more talks on the remaining issues.

The Obama administration has been considering a residual force of between 3,000 and 9,000 troops in Afghanistan to conduct counterterrorism operations while providing training and assistance for Afghan forces. But the administration said this week it did not rule out a complete withdrawal after 2014.

While Karzai has been critical of U.S. troop activity in Afghanistan, it is unclear how Afghan forces would perform without U.S. helicopters, medical facilities, intelligence and other military support, of which Afghanistan has very little.

"After a long and difficult past, we finally are, I believe, at the last chapter of establishing ... a sovereign Afghanistan that can govern and secure itself for the future," Panetta told Karzai after a welcoming ceremony at the Pentagon that included an honor guard and 21-gun salute.

Panetta said 2013 would mark an important step in the war, with Afghans due to take over the lead role for security across the country.

"We've come a long way towards a shared goal of establishing a nation that you and we can be proud of, one that never again becomes a safe haven for terrorism," Panetta said. "Our partnership, forged ... through almost 11 years of shared sacrifice, is a key to our ability to achieve the final mission."

STRAINS IN RELATIONSHIP

Karzai's three-day visit to Washington follows a year of growing strains on the U.S.-Afghan partnership, including incidents in which Afghan soldiers or police attacked and killed U.S. or coalition troops. U.S. forces also were involved in a series of incidents that enraged Afghans, including burning Korans, which touched off days of rioting.

In addition to discussing the U.S. troop presence after 2014, the two countries are negotiating long-term support for the Afghan military. Afghan officials came with a list of military equipment, including aircraft, they hoped to obtain.

General Martin Dempsey, chairman of the Joint Chiefs of Staff, said he and Afghan Defense Minister Bismillah Khan Mohammadi discussed the equipment issue and agreed to start with a broader review of Afghanistan's threats and military needs.

"What we talked about yesterday was ... let's move beyond a wish list of equipment and start by discussing what is your vision for the future of the Afghan military against threats and requirements," Dempsey said.

"He was very open, very eager to enter into that kind of comprehensive strategic review, and from that will come ... a view of how to move from where they are today, which is clearly focused on counterinsurgency, to something they may wish to become in the future," he said.

Karzai, in remarks in Panetta's office, said he was confident that the two sides during his trip would "work out a modality for a bilateral security agreement" in the interests of both countries.

The United States is insisting on immunity for any U.S. troops that remain in Afghanistan. That question also may come up at Karzai's talks with Obama on Friday.

(Editing by Paul Simao and Peter Cooney)

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Fiji's military ruler drops draft constitution

SUVA: Fiji's military government has announced it will dump a draft constitution prepared by an academic panel and prepare its own version, a move New Zealand labelled a "backward step" for the Pacific nation.

Military leaders in the coup-plagued island state commissioned a panel led by Kenyan academic Yash Ghai to draw up a constitution last year but took issue with some recommendations put forward in the document.

President Ratu Epeli Nailatikau said Ghai's blueprint risked reigniting racial tensions in Fiji, where divisions exist between the indigenous population and ethnic Indians brought to the country in the colonial era.

He said it also threatened to undo reforms introduced by Prime Minister Voreqe Bainimarama, who seized power in a 2006 coup and has pledged to hold elections in 2014 after the new constitution has been adopted.

"The Ghai draft (constitution ) can lead to financial and economic catastrophe and ruin," Nailatikau said in a nationally televised address on Thursday night.

While the draft has not been officially released, leaked copies indicate Ghai wanted the military, a key player in the four coups the Pacific nation has endured since 1987, to stay out of politics after the 2014 elections.

He also called for a transitional government to take over ahead of the 2014 vote, meaning Bainimarama would have to cede power.

New Zealand Foreign Minister Murray McCully said the government had effectively "trashed" the work of Ghai's Constitutional Commission, which completed its draft after receiving more than 7,000 public submissions.

He said the international community would be watching closely to ensure the new constitution allowed for free and fair elections, rather than providing a blueprint for the military's version of democracy.

"This is not flash, it's a backward step of some proportions," McCully told Radio New Zealand.

"But it's been the history of this whole process. This is not going to be a simple straight line towards elections and international credibility, there are always going to be steps forward and steps back."

He added that the move by the military to draw up its own draft constitution was "rather larger a step back than any of us feel comfortable with, but it's what we've got to work with".

The new draft constitution is expected to be completed by the end of the month.

- AFP/al

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