With no screening, ovarian cancer remains hard to detect

Ovarian cancer is estimated to affect more than 22,000 women each year and is the fifth leading cause of cancer deaths among women, according to American Cancer Society.

Unlike other gynecologic cancers, there are no screening tests for ovarian cancer. While some women diagnosed with ovarian cancer have elevated levels of the CA 125 protein, the associated blood test is not accurate enough for ovarian cancer screening, as many noncancerous conditions can increase the CA 125 level.

Ovarian cancer is hard to detect in its early stages due to its vague symptoms. Women may experience constipation, bloating, early satiety after eating and back pain. While ovarian cancer tends to occur in post menopausal women, anyone can be at risk. A number of factors, including smoking, endometriosis, polycystic ovary disease, and obesity can raise a woman’s risk for the disease.

About 20 percent of all ovarian cancers are caused by a genetic mutation. The genes most likely to increase the risk of ovarian cancer are BRCA1 and BRCA2. These genes also affect a woman’s risk of breast cancer. Genetic mutations that cause Lynch syndrome, an inherited condition associated with colon cancer, also raise a woman’s risk of ovarian cancer.

Over the past two decades, there were few options to treat ovarian cancer other than surgery and chemotherapy. And recurrence of the disease was common.

“Ovarian cancer, thankfully, does respond really nicely to surgery and chemotherapy. But unfortunately, in roughly 70 percent of patients, we do see recurrence,” says Dr. Andrea Wahner Hendrickson, a Mayo Clinic oncologist.

But thanks to research by Wahner Hendrickson and her colleagues, patients now have additional—and sometimes more effective—options for treatment, including individualized medical therapy and immunotherapy.

Currently there are more than 1,350 clinical trials for ovarian cancer, including a vaccine trial aimed at preventing recurrence.

Since not all tumors respond to every treatment, Dr. Wahner Hendrickson recommends all ovarian cancer patients undergo genetic testing to see which therapy might work best or them.

“Thanks to the innovations, I think there’s a lot of promise and hope in the treatment of ovarian cancer,” says Wahner Hendrickson.

She encourages women of all ages to see their physician if they experience abnormal signs or symptoms.

https://bit.ly/2rCzrVB

Puma results from key trial delayed

• Puma Biotechnology doesn’t expect to be able to report data from a key study of its cancer drug Nerlynx until the fourth quarter of this year at the earliest, a delay that sparked a sell-off in the company’s shares Thursday.
• The company disclosed on a first quarter earnings call held Wednesday evening that a slower-than-anticipated event rate in the study, which is testing Nerlynx in third-line HER2-positive metastatic breast cancer, would likely push back the readout date.
• Puma cautioned that the event rate, or confirmed data on patients’ progression-free survival, could slow further, potentially delaying data release into 2019. Puma shares closed Thursday trading down 21%, reaching the lowest level in almost a year.

Puma based its assumptions for the event rate in the NALA study of Nerlynx (neratinib) on historical controls, according to Alan Auerbach, CEO of Puma

“The endpoint on [the] blinded trial is centrally-confirmed progression-free survival. So, whereas we were expecting in some cases to be seeing a monthly event rate in double-digits, we’re seeing one that’s in the single-digits,” Auerbach said on the May 9 earnings call.

The company had previously expected to read out results in late June.

Nerlynx was approved in the U.S. last year to prevent recurrence of HER2-positive breast cancer following adjuvant treatment with trastuzumab and is Puma’s only commercialized product. Net product revenue from sales totaled $36 million in the first quarter of this year, up 79% from the fourth quarter of 2017. The company projects net revenues of between $175 million and $200 million for 2018.

For global sales, Puma has licensed Nerlynx to Pint Pharma in Latin America, CANbridge in China, Medison Pharma in Israel, and Specialised Therapeutics Asia in South East Asia.

Nerlynx is also being tested in a Phase 2 basket trial in a variety of tumors with HER2 and HER3 mutations. This study, known as SUMMIT, aims to look at the influence of both mutation and cancer type on response.

The NALA delay isn’t the first for Nerlynx. In February, the EU’s Committee for Medicinal Products for Human Use (CHMP) gave Nerlynx a negative opinion as an extended adjuvant treatment of early-stage HER2-positive breast cancer. The CHMP based their decision on concerns the benefit seen in trials would not translate to everyday practice, and that the side effects could be difficult to manage.

In March, Puma requested a re-examination of the CHMP’s opinion; once it has received grounds from the company, the CHMP will reassess and issue a final opinion, which Puma anticipates in late June or early July this year, according to Auerbach.

Puma also plans to submit Nerlynx for approval for the extended adjuvant indication in a number of countries during the second half of 2018.

https://bit.ly/2IBmYMf

Overcoming procrastination

Cognitive Behavioral Techniques for Changing Your Trading Psychology – Part One: Overcoming Procrastination

I recently had the pleasure of joining four accomplished colleagues in the psychotherapy world for a presentation on brief therapy for the American Psychiatric Association’s annual meeting.  One of the presenters, Dr. Seth Gillihan, was kind enough to pass along a copy of his recent book, Cognitive Behavioral Therapy Made Simple.  It’s a self-help text detailing specific, research-backed techniques for changing patterns of thought and behavior.

As I read the book, I was struck by how relevant many of the exercises are for traders in financial markets.  In this short series of posts, I will outline several common areas of challenge for traders and techniques for working on those, as outlined in the book.  We will begin with procrastination, the tendency to avoid things that we know we need to do.

Dr. Gillihan points out that many factors can contribute to procrastination, including fear of falling short in our performance and avoidance of discomfort.  One common area of procrastination among traders is putting off the work of preparing for the trading day, whether it’s completing a journal or laying out plans for the coming session.  Some of the techniques Dr. Gillihan outlines in the book for overcoming procrastination are:

a)  Using a Calendar – The more specific we are about the work we want to do and when we want to do it, the more likely it is that we’ll get the tasks done.  I like scheduling daily activities for the same time each day, turning work routines into positive habit patterns.  Scheduling activities a day ahead and reviewing the coming day’s calendar in the evening helps prime us for action.  For unpleasant tasks, I schedule a reward period following the completion of the task.

b)  Working in Shorter, Uninterrupted Segments – Dr. Gillihan points to what is known as the Pomodoro technique, in which work is broken down into 25 minute segments that are uninterrupted.  This has the natural advantage of making a large workload more doable and it provides mini-breaks for renewing our energy and willpower.  I use the breaks between work segments as mini-rewards, when I can take a snack, play with one of the cats, etc.

c)  Mindfulness – Many times procrastination results from distraction and (negative) thoughts about the future.  We tend to avoid what we anticipate will be uncomfortable.  By bringing our attention and awareness to the present through methods like meditation, we can remove mental clutter and focus on doing one thing at a time.  Very often, breaking through and completing one or two subtasks can lead to momentum and completing a larger project.

d)  Self-Reminders – A powerful technique is to vividly remind ourselves of the negative consequences of behaviors we wish to avoid.  This works well in alcohol treatment, where the mental rehearsal of the negative consequences of drinking helps a person avoid relapse and helps them reach out for support.  Reminding ourselves that procrastination prevents us from being the best traders we can be can become a helpful prod toward action.

Another technique that works well for me is a shift of environment.  When I want to complete a difficult task, such as editing a writing project, I will bring my computer to a Starbucks or the food court of a large grocery store and I commit to not leaving until the work is completed.  In the new environment, there are no other distractions (phone, emails, interruptions from people) and I find it easy to enter into a focused work mode.  Sometimes the environmental shift is as simple as playing music in the background while I work, providing stimulation that doesn’t distract.  (I’m listening to JWeihaas as I’m writing this).

Our actions play an important role in shaping our experience of ourselves.  We cannot act as decisive traders if the majority of our time is spent in procrastination mode.  Avoiding any single task may seem to have few consequences.  A pattern of avoidance, however, reduces our productivity and effectiveness.  Ultimately, we are either in control of the time and challenges of life or those control us.  How we approach our efforts daily shapes the mindset that emerges in our trading.

There is much to be said for using daily calendars as repeated experiences of efficacy.

https://bit.ly/2IzfDg5

Depression Diagnoses Up 33% (Up 47% For Millennials): Why There Is An Upside

In the movie Life of Brian, Eric Idle once sang "always look on the bright side of life," followed by lots of whistling. But is there a silver lining to the report just released by the Blue Cross Blue Shield Association (BCBSA) entitled Major Depression: The Impact on Overall Health that showed steady increases in depression diagnoses from 2013 to 2016?

At first glance, there seems nothing but bad news. An analysis of insurance claims data from over 41 million Blue Cross Blue Shield commercially insured members yielded the following curves:

This graph shows the diagnosis rate of major depression diagnosis by gender from 2013 to 2016. (Image courtesy of Blue Cross Blue Shield Association)

 

As you can see at the right edge of this graph, in 2016, 6.0% of female members and 2.8% of male members (for a total of 4.4%, which is over 9 million members) had a diagnosis code for major depression. This represented a 33% increase since 2013 (hence the big red upward arrow that says 33%).
Of all the age groups, the rise was highest among teens from 12 to 17 years old (increasing by 63% from 1.6 to 2.6%) followed by Millennials (ages 18 to 34), increasing by 47% from 3.0% to 4.4%.  But before you blame Millennials and younger folks for the rise in depression diagnoses, because it may seem so easy to blame Millenials for everything ("oh, it's raining today, darn Millennials"), realize that other older age groups experienced substantial rises as well (increases of 26% and 23% for those 35-49 and 50-64 years in age.)

 

Here are the 2016 rates by state:

This map shows the rates of major depression diagnosis by state.

This is one map that doesn't follow a clear "Blue States" and "Red States" pattern. As shown by the brown color, Rhode Island (6.4%), Maine (6.1%), and Utah (6.0%) had the highest overall rates. Hawaii (2.1%) in dark blue had the lowest. Both the highest Millennial (6.8%) and adolescent (4.6%) rates were highest in Utah while Hawaii had the lowest (1.8% and 1.1%, respectively).
So far, not very good news. The findings from this report add to the growing evidence that depression has been rising in the United States since at least the early 2000's, if not before then. For example, a study published in Psychological Medicine  found that the prevalence of depression increased from 6.6% to 7.3% between the years 2005 and 2015 with an even greater increase (8.7% to 12.7%) among those ages 12 to 17. As BCBSA Chief Medical Officer Trent Haywood, MD, JD, explained, "Various studies and measures all suggest that there is an underlying trend that depression has been and continues to be a growing problem."
Here's more not-good-news. This isn't a simple "fix it with a song" problem. Broken and worsening systems may be contributing to this rise in depression. Haywood mentioned that "increasing social isolation, utilization of social media, competition between people, divorce rates, and other issues" may be helping fuel the upward trends. Yes, folks, it's a systems problem. A review article in the Journal of Affective Disorders also cited growing income and social inequality as contributing factors and that "modern populations are increasingly overfed, malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated." In other words, people are becoming more and more like sleep-deprived potatoes that are buried in the ground and use social media to yell at each other.
So where's the sunshine on these seeming cloudy days? Well, keep in mind that this study measured the number of people who received major depression diagnoses (as indicated by insurance codes used for major depression) and not the actual number of people who had major depression. This is an important distinction. If you were suffering from major depression, you would not have been counted if you did not revealed your symptoms to a doctor or other relevant health care personnel and that person did not indicate in your insurance billing records that you had major depression. Studies, such as one published in JAMA Internal Medicine, have shown that a large percentage of people who have depression symptoms don't ever seek help and get proper treatment. Therefore, could the increase in depression diagnoses in part represent a greater percentage of people seeking medical attention for depression?

 

Perhaps. Recent years have seen depression become more "mainstream." Celebrities such as Beyoncé, Miley Cyrus, Lady Gaga, Kristen Bell, and The Rock have openly discussed their struggles with depression. As I mentioned recently for Forbes, NBA star DeMar DeRozen even filmed a mental health public service announcement that is airing this month during the NBA playoffs. Reports like the Blue Cross Blue Shield one may be raising awareness and could be decreasing stigma connected with depression. After all, it is saying that if you have been diagnosed with depression, you are among at least 9 million other people. As Haywood emphasized, "our findings raise awareness so that there is an opportunity to intervene."

Actor Jon Hamm has openly discussed battling chronic depression. (Photo by Theo Wargo/Getty Images)

 

It's also quite notable that a major insurer like BCBSA is recognizing depression as an important growing problem. Our current health care system doesn't always make it easy for depression to be detected and recognized. Nowadays doctors are often too busy and too overwhelmed to spend enough time with patients to find out how their lives are going. As I have detailed before for Forbes, fifteen minutes is barely enough time to take a "more involved" toilet visit and wash your hands properly (which you should always do after using the toilet). How can it be long enough to really talk to a patient? And here's a shocker, our health care system can be quite reactive rather than proactive, waiting for something to boil over or blow up before it is addressed. As Haywood explained, "there needs to be more active rather than passive management of lifestyles, social media, and social relationships. Sleep hygiene, nutrition, and fitness are often unrecognized issues." The BCBSA report also found that members who had a depression diagnosis also had over twice the average annual healthcare spending ($10,673) of those who did not ($4,283). So depression is costing everyone moolah. It's time for the health care system to extend more into the community and help address the systems that may be contributing to depression.
Thus, the BCBSA report is not all "this is bad, this is bad, this is bad, and it's getting badder." It could be that more people are seeking help for their depression. The report also further raises awareness and shows that a major insurer recognizes depression as an important problem and that it's worth more than just a whistle.

https://bit.ly/2Iaz13I

Establishing New Lung Cancer Standard of Care

H. Jack West, MD: Hello. I am Jack West, medical director of the Thoracic Oncology Program at the Swedish Cancer Institute, in Seattle. Welcome to Medscape Oncology Insights. Joining me today is Hossein Borghaei, chief of the Thoracic Medical Oncology Program at Fox Chase Cancer Center in Philadelphia. Welcome.

Hossein Borghaei, DO: Thank you.

West: We just attended the 2018 American Association for Cancer Research (AACR) meeting, and unusual for a meeting that is more of a showcase for early clinical and preclinical work, major clinical studies were presented in the plenary session devoted entirely to lung cancer. I want to focus first and foremost on the KEYNOTE-189 study, which I think is going to have real clinical implications.^[1]

In this trial for patients with advanced nonsquamous, non–small cell lung cancer with any level of PD-L1 expression, patients could not have EGFRmutations or ALK rearrangements. A little over 600 patients were randomized 2:1 to receive either chemotherapy, cisplatin or carboplatin, with pemetrexed. Two thirds of patients received pembrolizumab and one third received placebo.

Overall survival was the primary endpoint, and we knew it was positive from a press release a couple of months ago, but we did not know whether it was clinically significant. It turns out it was hugely significant, with a hazard ratio of 0.49 in the overall intent-to-treat population. This is essentially a doubling of survival across the entire time course reported.

Leena Gandhi, lead author of the study that was presented at AACR and published at the same time in the New England Journal of Medicine, also noted that in the subsets of patients (zero or less than 1% PD-L1 expression, 1%-49%, or PD-L1 50% or greater), all benefited significantly in terms of overall survival.

The results were similar for progression-free survival and response rate, namely huge differences in the general population favoring the pembrolizumab arm, with real—but not as impressive—differences in the lowest PD-L1 subgroup, more benefits in the 1%-49% group, and the most benefit in the 50% or greater group.

For toxicity, we saw a little more nephritis than we might have expected. We have had carboplatin and pemetrexed plus pembrolizumab as an FDA-approved option since May 2017, based on the trial you were very much involved in, KEYNOTE-021 cohort G, but approval has not yet had a big impact.^[2,3,4] People have been more reserved because the overall survival benefit was not as clear and it was a randomized phase 2. What do you see as the impact of this study, in terms of adoption of this regimen?

Borghaei: I want to emphasize two things. First, KEYNOTE-189 did not have any patients with molecularly driven tumors; we need to keep that in mind. Second, nobody with any evidence of brain metastases was allowed in the trial. We have to be careful with those two subpopulations.

I think the reason KEYNOTE-021 cohort G was not accepted right away, as you suggest, was that it was a randomized phase 2, the survival data were not quite as clear, and we really did not know how the different subgroups of patients, based on the PD-L1 expression, truly did.

We were all waiting for additional information, which KEYNOTE-189 has provided. I think this study establishes this regimen as the standard of care because of the significant overall survival advantage, practically in all of the subgroups of patients, and the fact that responses were better in all subgroups. I agree with you that the PD-L1 negatives did not have as much of a benefit, but it was still better than standard chemotherapy.

For the nonsquamous histology, KEYNOTE-189 becomes a de facto standard of care, such that if I am designing another clinical trial in this patient population, this is going to be my control. The key thing to study is how to improve on these results. There are lingering questions: What is going to happen to patients who have EGFR mutations or ALK translocations? Do they have as much of a benefit from this? Can we do a study to look at that?

What is the real long-term benefit from all of this? By that, I mean that we have data now from earlier immuno-oncology drugs that there is a 5-year survival benefit for a very small subpopulation. Are we likely to see that 5-year survival improving significantly, or to any extent, with the addition of chemo-IO? For me, this really becomes one of the standards of care that I discuss with my patients in the clinic.

West: There was a very significant absolute difference in 1-year survival: nearly 70% in the chemotherapy-pembrolizumab arm versus just under 50% in the chemotherapy-alone arm. The response rate with chemotherapy alone and placebo was 19%. Some people have grumbled that that is disappointing for a control arm these days, especially when it is nonsquamous and in a world where we have second-line immunotherapy.

In this trial, 50% of patients who were eligible crossed over to pembrolizumab. To me, that is a little disappointing when we have immunotherapy available and of proven benefit after chemotherapy. What would you say about the control arm? Is that a real concern or are these differences so substantial that it really washes out?

Borghaei: I am not really concerned about it. From time to time, you get trials like this where the control arm does not seem to do quite as well. We have to keep in mind that this is a randomized study; everybody had the same eligibility and received the same chemotherapy backbone. It is hard to argue that something happened with the chemotherapy in the control arm. Could the hazard ratio be slightly less? Maybe, but the magnitude of benefit is so great that it is really hard to argue that this is not an effective regimen.

West: Again, even if the hazard ratio were 0.57, we would still have the same general conclusions.

Borghaei: As far as 50% not getting an effective drug, I do wonder about that, but multiple different questions come into play. Remember from a trial many, many years ago in the era of platinum-doublet, we learned that up to 35%-40% of patients never make it to second-line therapy.^[5] Is that playing a role here? I do not know.

West: Certainly, there are data from not that long ago that we just do not deliver second-line treatment in more than 55% or 60% at most. The problem with that is that was in the docetaxel-based chemotherapy, with modest efficacy and challenging tolerability. Now, we have multiple trials of checkpoint inhibitors that have all consistently shown major survival benefits and good tolerability.^[6]

Very few of these patients who were initially eligible for first-line chemoimmunotherapy should be ineligible for subsequent immunotherapy. In my clinic, I would say that over 85%-90%, and as close to 100% as possible, are going to get immunotherapy if eligible.

Borghaei: I agree with that, and I have made that argument at various meetings, but again, when you see data like these, you have to wonder what percentage of the patients who were in the control arm really could not go on. We have never captured that kind of information.

The other part is that we now have some data from KEYNOTE-024 suggesting that for some patients, patients with really high PD-L1, maybe immunotherapy after chemo is not quite as good.^[7] Maybe patients should get immunotherapy right off the bat. That is an area that I think requires more investigation and more analysis.

It is possible that something like that is in play when it comes to the crossover in some patients not really getting the active drug. Also, where you do the studies sometimes matters. I mean, was the study done in places where perhaps an active IO agent was not available after chemotherapy? We do not know.

West: Were there any real issues with tolerability or was that pretty much as expected?

Borghaei: Toxicity was what you would expect, except for nephritis, which was a little bit of a surprise because we did not see that in the phase 2 study. Again, clinically, I have not necessarily noticed any increased rate of nephritis, but it is what the study suggests, and I think it is something for investigators and for doctors to keep in mind when they are treating their patients. I do not see any major safety concerns.

West: Great. We are going to do a few subsequent videos on the implications for the specific subgroups, because I think that these different groups, whether they are negative for PD-L1, low, or high, have different options, both now and in the near-term future. I look forward to people following that.

https://wb.md/2rCsMuz

Dexcom’s newest diabetes device can read your blood sugar without any blood

I have Type 1 diabetes, which means my body doesn’t produce any insulin. So I have to inject insulin to regulate my blood sugar and check my levels by using a glucometer. This means I have to stick my finger with a needle anywhere from 5 to 10 times a day.

Dexcom provided me with a review unit of its new G6 continuous glucose monitor that’s approved by the FDA to require no blood at all.

CGMs allow diabetics to see their blood sugar throughout the day and night with a sensor that is inserted under the skin. Previously, CGMs needed a blood glucose reading in order to calibrate the device.

The new Dexcom G6 comes factory-calibrated and requires no finger stick. I’ve been wearing the device for nine days and I am really impressed with it.

The insertion is painless

CNBC | Jeniece Pettitt

CNBC’s Erin Black inserts the Dexcom G6 sensor

The G6 comes with a new auto-applicator that allows one-button insertion. And wow, was it smooth. I didn’t feel a thing.

CNBC | Jeniece Pettitt

Side-by-side comparison of Dexcom G5 and G6 applicators

This is a huge improvement from Dexcom G5 inserter that required you to push the needle under the skin yourself. It’s definitely the most painless thing I’ve had to put in my body in the 20 years of using syringes, insulin pens and pumps.

CNBC | Jeniece Pettitt

The Dexcom G6 CGM auto-applicator.

The insertion device itself is big. And I did feel bad about throwing it away after its one-time use. But because the device is so accurate, I don’t need to check my blood sugar as much, which means I’ve been using fewer glucose strips in my meter. So I feel it will even out in the end.

The sensor took a few days to become accurate

CNBC | Erin Black

After the sensor warmed up, it was off by 25 mg.

After the sensor finished its two-hour warm up, I double-checked the reading it gave me with my glucometer. It was 25 points off.

Now I did just finish a workout, which is a highly volatile time for my blood sugars usually. But even when I checked before going to bed that night, it was still 20 points off. As I used it, the number got closer and closer to accurate, and by day 3 it was matching my meter exactly. On the fifth day of using it, I found myself not worrying about double-checking it anymore.

CNBC | Erin Black

After 2 days, the sensor could accurately read my blood sugar.

The sensor now lasts 10 days instead of 7. Some users like to reuse G5 and previous sensors to cut on costs of buying more. But the G6 has a hard shut off after 10 days and can’t be re-used.

The transmitter is more comfortable and smaller than the G5

CNBC | Jeniece Pettitt

Looking at the G5 and G6 transmitters side by side, they don’t look that different. But once I have the transmitter snapped into the sensor it felt much smaller. The design is sleeker with a 28% lower profile and it sits flush against the sensor. I found it much easier to sleep on it than the previous versions.

The Dexcom App has some cool new features

CNBC | Jeniece Pettitt

The Dexcom G6 app displays real time glucose data.

If you had a G5, you’ll have to download the new G6 app. It looks pretty much the same. The numbers are a little smaller. At first, I found it harder to read than the old app.

CNBC | Jeniece Pettitt

The Urgent Low Soon feature on the Dexcom G6 app.

This version has a new feature called Urgent Low Soon that warns users in advance of a dangerous low (55 mg/dL). I appreciated this feature a lot because some lows aren’t as urgent as others.

It also features an alert schedule that allows you to customize alerts and alarms for different times of the day. These alerts notify you when you are heading high or low.

You can still share your data with 5 other people, which is a must-have feature for parents of children with Type 1. The app is available on iOS and most Android devices.

If you don’t use the app, the G6 comes with a new receiver. Since I use my phone to monitor the sensor, I didn’t even take the receiver out of the box.

The G6 system requires a prescription and cost varies by insurance

CNBC | Erin Black

The Dexcom G6 Continuous Glucose Monitoring system

It is hard to say how much the G6 system will cost you, as it will vary under different insurance plans. Dexcom also accepts out-of-pocket payments, and while the company hasn’t revealed the price yet, my G5 costs around $800 up front plus $35 for each sensor, so you can expect to spend a couple thousand dollars a year total.

But I think the benefit of having one outweighs the cost.

Being able to peer inside your body and know what your blood sugar is 24/7 is amazing feature, and this device allows me to do it more discreetly and with fewer finger pricks. It’s the best CGM I’ve ever tried and I think that you’ll like it too.

All this being said — if your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

The Dexcom G6 Continuous Glucose Monitoring System will be available in June 2018.

https://cnb.cx/2rDX93D

CDC update: 35 people sickened from salmonella outbreak from eggs

Thirty-five people have been sickened by a salmonella outbreak linked to the recall of nearly 207 million eggs, the Centers for Disease Control and Prevention said in an update this week.

One of the world’s largest producers of eggs, Indiana-based Rose Acre Farms, issued the recall in mid-April. They were distributed from a farm in Hyde County, N.C., and sold by retailers under different brand names: Coburn Farms, Country Daybreak, Crystal Farms, Food Lion, Glenview, Great Value, Nelms, Publix, Sunshine Farms and Sunups. Also, they were delivered directly to restaurants.

People began getting sick last November and illnesses that occurred after March 23 might not yet be reported, the CDC said.

The agency gave the last update on April 16, when it reported 23 people were ill.

In the updated figures, people affected range from 1 to 90 years old. Eleven people were hospitalized and there were no fatalities.

Most of the illnesses were reported in eight states along the East Coast; New York, Pennsylvania, New Jersey, West Virginia, Virginia, North Carolina, South Carolina and Floridareported cases. One case was also reported in Colorado.

The CDC urges consumers to throw the recalled eggs away or return them to where they were purchased. People are also advised to wash and sanitize drawers or shelves in refrigerators where recalled eggs were stored.

Eggs in the recall possess the plant number P-1065 printed on the carton as well as a pack date between 011 and 102. Eggs sold at Publix and branded as Sunups are marked with plant number P-1359D, pack date 048A or 049A and best-by dates of APR 02 and APR 03.

The FDA said the eggs can potentially be contaminated with Salmonella Braenderup, which is an organism that could cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy individuals infected with Salmonella Braenderup can experience fever, diarrhea, nausea, vomiting and abdominal pain.

Rose Acre Farms grew from 1,000 hens in the 1930s to 17 facilities in eight states.

https://bit.ly/2rAZCNg