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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West African army chiefs to approve Mali troops plan

BAMAKO (Reuters) - West African defense chiefs will on Tuesday approve plans to speed up the deployment of African troops against Islamist rebels in northern Mali, with some regional soldiers seen arriving next week.

France has already poured hundreds of troops into Mali and carried out days of air strikes in a vast desert area seized last year by an Islamist alliance that combines al Qaeda's north African wing AQIM with Mali's home-grown MUJWA and Ansar Dine rebel groups.

Western and regional powers are concerned the insurgents will use Mali's north as a launchpad for international attacks.

"On January 15, the committee of Chiefs of Defense Staff will meet in Bamako to approve the contingency plan," the mission head of the ECOWAS grouping of West African states, Aboudou Toure Cheaka, told Reuters.

"I can tell you that in one week, the troops will effectively be on the ground," he said, adding their immediate mission would be to help stop the rebel advance while preparations for a full intervention plan continued.

He did not say how many soldiers would arrive.

The original timetable for the 3,300-strong U.N.-sanctioned African force - backed by western logistics, money and intelligence services - did not initially foresee full deployment before September due to logistical constraints.

Senegal, Burkina Faso, Niger, Nigeria and Guinea have all offered troops. But regional powerhouse Nigeria, which is due to lead the mission, has cautioned that even if some troops arrive in Mali soon, training will take more time.

The plan is being fast-tracked after France rushed to respond to a plea for help by Mali's government after mobile columns of Islamist fighters last week threatened the central garrison towns of Mopti and Sevare, with its key airport.

The French defense ministry said on Monday it aimed to deploy some 2,500 soldiers to Mali to bolster the Malian army and the eventual West African force.

"SAFEGUARD MALI"

French Prime Minister Jean-Marc Ayrault said France's goals were to stop the Islamist rebels, to "safeguard the existence of Mali" and pave the way for the African-led military operation.

U.S. officials said Washington was sharing information with French forces in Mali and considering providing logistics, surveillance and airlift capability.

"We have made a commitment that al Qaeda is not going to find anyplace to hide," U.S. Defense Secretary Leon Panetta told reporters as he began a visit to Europe.

As French aircraft bombarded mobile columns of Islamist fighters, other insurgents launched a counter-attack further to the south, dislodging government forces from the town of Diabaly, 350 km (220 miles) from Bamako.

French intervention has raised the threat for eight French hostages held by al Qaeda allies in the Sahara and for 30,000 French expatriates living in neighboring, mostly Muslim states. Concerned about reprisals at home, France has tightened security at public buildings and on public transport.

The U.N. said an estimated 30,000 people had fled the latest fighting in Mali, joining more than 200,000 already displaced.

U.N. Secretary-General Ban Ki-moon on Monday welcomed the French-led military intervention in Mali and voiced the hope that it would halt the Islamist assault.

Amnesty International said at least six civilians were killed in recent fighting in the town of Konna, where French aircraft had earlier bombarded rebel positions, and called on both sides to spare non-combatants.

France, which has repeatedly said it has abandoned its role as the policeman of its former African colonies, is among the toughest proponents of a speedier deployment of the African troops, and convened a U.N. Security Council meeting Monday to discuss the crisis.

French U.N. Ambassador Gerard Araud told reporters after the meeting that the U.S., Canada, Belgium, Denmark and Germany had also offered logistical support for France's Mali operation.

"I felt that all the members of the Security Council were expressing their support (for) and understanding of the French decision," Araud told reporters.

No Europeans or other African Union members will be allowed in the defense chiefs meeting in Bamako on Tuesday, a western diplomat told Reuters, requesting not to be named.

"They don't want any French pressure at the meeting," the diplomat said.

(Reporting by Bate Felix; Additional reporting by Michelle Nichols and Louis Charbonneau at the United Nations Richard Valdmanis in Dakar, Brian Love in Paris and David Alexander in Lisbon; Editing by Richard Valdmanis and Giles Elgood)

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British music retailer HMV enters administration

LONDON: Iconic British music retailer HMV announced on Monday that it will appoint an administrator, raising fears of more than 4,000 job losses.

Audit and consulting firm Deloitte will manage the struggling chain, the last major music retailer on the British high-street, as it seeks to attract possible buyers.

"The board regrets to announce that it has been unable to reach a position where it feels able to continue to trade outside of insolvency protection," said a statement issued Monday.

Administration is the process whereby a troubled company calls upon independent expert financial help in an attempt to remain operational.

HMV added that the board "understand that it is the intention of the administrators, once appointed, to continue to trade whilst they seek a purchaser for the business".

The 92-year-old institution employs around 4,350 staff, but has struggled to meet the challenge of online retailing and digital downloading and has been teetering on the brink for many months.

"The problem they have is their core product categories are disappearing, and that's a very hard thing to fight," said analyst Kate Calvert of Seymour Pierce brokers.

The company, which also operates in Ireland, Hong Kong and Singapore, announced in December that it was in danger of breaching bank loan arrangements, and its shares on the London Stock Exchange were suspended on Monday.

It has huge debts and last month reported sales were down 13.5 per cent, leading to a crash in the share price that left the company valued at just over £5 million.

It launched a huge, month-long sale on Saturday offering 25 per cent off a huge range of products to boost sales, but even that was not enough to keep the administrators from the door.

The first HMV store opened on London's Oxford Street in 1921 under the ownership of the Gramophone Company, which endowed it with its legendary trademark, the image of a dog listening to a gramophone -- His Master's Voice.

It became part of music history in 1962 when Brian Epstein cut a demo for The Beatles in the shop studio, which led to the Fab Four signing with EMI, the record label that owned HMV until 1996.

It is the latest British retailer to fall into administration.

Photography chain Jessops announced last week it had called in outside help, while retail chain Comet collapsed into administration late last year and shut its doors for the last time in December.

- AFP/jc

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Latehar encounter raises questions of efficacy of operations strategy

NEW DELHI: The killing of 10 security personnel, including nine CRPF men, in Latehar encounter has stirred a debate about mobilization of a large contingent in anti-Maoist operations.

In the Latehar operation, about 500 security force personnel — three CRPF companies and two companies of the Jharkhand Jaguar — were deployed. For about a month they chased the Maoists around Jharkhand's Karmatiya forest area. They cordoned off zones (gherabandi) following inputs about the presence of the Maoists in the area.

Veterans of anti-Maoist operations and a section of the CRPF are questioning the efficacy of such large scale mobilization.

Maoists are a guerrilla force thriving on surprise attacks on their targets. Experts across the world have stressed on the need of economy of force in anti-guerrilla operations. A small, highly trained and disciplined, lightly equipped and aggressive counter-insurgent unit has been found to be effective in such operations. It allows the unit mobility and enables them to launch a surprise attack on guerrillas.

"We've got best results in anti-Maoist operations when we, too, fought like guerrillas in small units backed by specific intelligence inputs," said a senior officer handling anti-Maoist operations. The strategy was key to debilitating the Maoists in Andhra Pradesh and West Bengal.

Security forces are often vulnerable to ambushes laid by Maoists. Small groups of security forces can equally make the Maoists vulnerable to ambushes disrupting their movement. The Red ultras draw strength from their mobility — assemble or disperse as required. Besides cadres, there is a web of movement of supplies, couriers and local contacts to and from Maoists.

Based on quality intelligence inputs from local police, security forces in AP, Bengal and Jharkhand, too, had succeeded in selecting specific targets and disrupting Maoist supply chains, and consequently restricting their movement. Small units of security forces armed with modern weapon had taken on Maoists in their bastion, inflicted casualties and managed to fade away, said an officer.

But, anti-Maoist operations currently are hamstrung by poor real-time intelligence. To offset this weakness, strategists plan mobilization of large contingent of forces over a long time. That helps Maoists track the movement of the force and gives them an advantage as in the Latehar encounter.

Moreover, during the operation, troops are replenished. Newly-inducted troops are unfamiliar with the terrain and with fellow fighters, both important in such operations. "That also leads to communication gap and the result is disastrous," said an officer.

In a similar large scale gherabandi operation last July, two CRPF men were killed and five, including an officer, were injured in an encounter near a government school in Jharkhand's Khunti district, about 100 km from Ranchi. Though Maoists were accused of the killings, home ministry sources admitted they were gunned down by another CRPF contingent who mistook them for rebels in fatigues.

Such incidents sag the morale of the security forces fighting an invisible enemy in hostile environment.

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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

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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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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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Pilgrims flock to the Ganges for world's biggest festival

ALLAHABAD: Hundreds of thousands of pilgrims led by naked ash-covered holy men begin entering the sacred river Ganges on Monday at the start of the world's biggest religious festival.

The Kumbh Mela in the Indian town of Allahabad will see up to 100 million Hindus gather over the next 55 days to take a ritual bath in the holy waters, believed to cleanse sins and bestow blessings.

At dawn on Monday at a time chosen by astrologers as auspicious, hundreds of gurus, some brandishing swords and tridents, will run into the swirling and freezing waters for the first bath, signalling the start of events.

Assorted holymen, seers and self-proclaimed saints from all over the country have assembled for a colourful spectacle that offers a rare glimpse of the dizzying variety of Indian spiritualism.

"Our biggest wish is that there is peace and that people should look after each other," one Naga Sadhu, a devout, fierce and famously nude sect of followers of the Hindu god Shiva, told AFP.

For most, however, attending the Kumbh Mela is a religious holiday enjoyed in an almost carnival atmosphere, where prayers and blessings are offered and sought alongside family or friends camping together at the vast festival site.

"You feel somewhat connected to somebody who is there above, and that's what it's all about," Mayank Pandey, a 35-year-old computer science professor, explained to AFP.

The Kumbh Mela takes place every 12 years in Allahabad in northern Uttar Pradesh state, with smaller but similar events every three years in other locations around India.

It has its origins in Hindu mythology, which tells how a few drops of the nectar of immortality fell on the four places that host the festival -- Allahabad, Nasik, Ujjain and Haridwar.

For men like Ram Krishna Verma, a 42-year-old farmer from the state of Chattisgarh who has travelled 700 kilometres, it is a time of religious duty as he has come to scatter the ashes of his late mother.

"She died two months ago," he told AFP. "This is the final resting place."

The "Mother Ganges" is worshipped as a god and is seen as both the giver and taker of life. Most devotees dunk their heads under the water, some drink it and others bottle it and take it home as a gift.

"Those who are poor will become rich and those who don't have children will get children," explained Bhim Sen, a 61-year-old farmer from southern India. "I pray to the Ganges that my wishes will become fulfilled."

Police expect 250,000 people on Monday with 20 million anticipated on February 15, the most auspicious day. Overall, organisers are counting on about 100 million coming, the same number as in 2001.

The management of the festival requires a monumental effort -- and a budget of 16 trillion rupees (US$290 million) -- but officials say everything is in place for a safe and successful event.

Top state police officer Arun Kumar said the biggest concern was crowd control and the 12,000 officers on duty would be monitoring to guard against stampedes -- a frequent and deadly occurrence at Indian religious festivals.

"We will be measuring the pressures in the crowd," Kumar, who is in charge of law and order, told AFP on Sunday. "We are totally prepared to handle this Mela."

Organisers have set up 35,000 toilets, 14 medical centres, 22,000 street lights, 150 kilometres of temporary roads, 18 bridges, and new sewage facilities.

Nearly 7,000 buses as well as hundreds of special trains are expected to ferry people to and from Allahabad where the heavily polluted Yamuna river flows into the equally dirty Ganges.

Despite its important role in Hinduism, the Ganges is tainted by industry and the settlements along its banks, which quickly turn the clear waters from the Himalayas into a murky, frothy brown downstream.

Local authorities have cracked down on untreated effluent from nearby factories and new drainage facilities in Allahabad have cut the immediate flow of raw sewage.

- AFP/jc

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Hijacked Indian sailors' families SOS Pakistan activist

NOIDA: After failing to get any help from the Centre, the families of 17 Indian crew members whose ship was hijacked by Somali pirates in March last year have sought help of a Pakistan-based NGO for their early release. Somali pirates had threatened they would start killing the Indian crew members if their families failed to arrange the ransom demanded by them by December 31, 2012.

The families have also moved Supreme Court demanding intervention by the central government for early release of the crew members. The case will be heard on Monday. The 17 Indian sailors are held hostage on board MV Royal Grace, a chemical tanker, and now their hopes lie with Pakistani activist Ansar Burney's efforts to help free them. Besides the Indians, there is a Pakistani, a Bangladeshi and two Nigerians sailors on board.|

Burney, who runs the Ansar Burney Trust, was earlier successful in getting the crew of MV Suez freed in June 2011 during another hijack by Somali pirates. Families of the crew members allege that they have been facing government apathy right from the start. "When we approached East India Shipping, the placement firm, its officials went to Dubai and met Burney ," Sheeja Singh, sister of one of the crew members, said. "The Pakistan and Nigerian governments is making efforts to rescue their citizens ," she said.

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