Category Archives: Flu
For “Outbreak Week” we’ve already covered the deadliest pandemics in human history. But which outbreaks could be around the corner? Outbreaks: Protecting Americans from Infectious Diseases, 2013, the new report from Trust for America’s Health and the Robert Wood Johnson Foundation, lays out a few possibilities on which infectious diseases may pose the more serious threats in the future. Here are the greatest threats to the United States, according to Tom Inglesby, MD, Chief Executive Officer and Director of the UPMC Center for Health Security.
Middle East Respiratory Syndrome (MERS)
Spread across 12 countries, the virus has killed almost 40 percent of the people it’s infected. And while it may currently be confined to one region of the world, the high level of air travel between the Middle East and the United States increase the chance that it could find its way into the country, according to Inglesby, who said “we still don’t have a good handle on how it spreads, and there is no treatment for it or vaccine against it.”
Novel influenza virus
A new flu strain that, like the seasonal flu, is far reaching, but which would have a “far higher mortality rate.” Recent examples of major flu pandemics include the 2009 H1N1 outbreak; recent studies indicate the swine flu may have killed more than 200,000 people. The new H7N9 is also notable because of its high mortality rate.
Accident involving a lethal engineered virus
With scientists experimenting on viruses — enhancing their lethality or ability to spread — the risk grows of an accident releasing an engineered virus into the population.
It’s the most common infectious disease in the world and drug-resistant strains are only making the matter worse. “The level of drug resistance is growing and coping with this needs to be a real priority,” said Inglesby.
Not a pathogen, but a reason why pathogens could become even more dangerous. The U.S. Food and Drug Administration is taking steps to combat this growing issue, including new regulations on antimicrobial use in food animals and new restrictions on antibacterial soaps.
Deliberate biological threats
A biological attack, whether from another nation or as a terrorist act, could cause not only severe illness and death, but also communication problems that would hinder the ability of public health departments to respond.
Climate change is making this already existing problem even greater—with the regional climate shifts, places that haven’t had to deal with mosquito-based threats are now seeing them swarm in because of the warmer weather. Notable examples include the West Nile Virus and Dengue Fever. “We need to reinvigorate our strategy for mosquito control and the infectious diseases that come with mosquitoes.
Severe Flu-Like Illness Under Investigation in Texas
Health officials in Montgomery County, Texas, are investigating an outbreak of an influenza-like illness that has so far resulted in eight hospitalizations, with four of those patients having since died. Recent tests on the other four show that one seems to have the 2009 H1N1 influenza virus, two were negative for all flu viruses and results are so far unknown on the fourth patient. Close to 2,000 cases of the illness have been reported. So far the investigation suggests that none of the patients who died had been vaccinated against flu, and county residents who have not yet had the flu shot are being urged to get one. According to the county’s health director, the hospitalized patients range in age from 41 to 65, which is not typical; severe flu symptoms more likely occur in very young or very old patients. The U.S. Centers for Disease Control and Prevention (CDC) is assisting the health department in investigating the outbreak, and the county has established a telephone hotline and Facebook page to respond to questions from the public. According to news reports, the current outbreak resembles a cluster of severe respiratory infections in Dothan, Ala., in May; however tests showed that those hospitalized patients had a variety of common respiratory viruses and bacteria, with no unusual pathogens. Read more on flu.
CDC Issues Travel Advisory in Caribbean
The U.S. Centers for Disease Control and Prevention (CDC) has issued a travel health notice because of recent cases of chikungunya on the Caribbean island of St. Martin, which have been confirmed by the World Health Organization. According to the CDC, chikungunya is a very serious illness caused by a virus that spreads through mosquito bites. The most common symptoms are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. The mosquito that carries chikungunya virus can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas. There is currently no vaccine or medicine to prevent chikungunya. Travelers can protect themselves by following CDC recommendations on preventing mosquito bites. "Microbes know no boundaries, and the appearance of chikungunya virus in the Western hemisphere represents another threat to health security," said CDC Director Tom Frieden, MD, MPH, in the release. "CDC experts have predicted and prepared for its arrival for several years and there are surveillance systems in place to help us track it." Read more on infectious disease.
Life Expectancy Increases among Treated HIV-Positive People in North America
A new study in the journal PLOS ONE finds that a 20-year-old HIV-positive adult on antiretroviral therapy (ART) in the U.S. or Canada may be expected to live into their early 70's, a life expectancy approaching that of the general population. Researchers calculated the life expectancies of nearly 23,000 individuals on ART based on mortality rates in the early to mid-2000s. Changes in life expectancy from 2000-2007 among HIV-positive individuals were then evaluated using sociodemographic and clinical characteristics, such as drug use history and immune cell counts. The researchers found that life expectancy at age 20 increased from 36.1 to 51.4 years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007). Life expectancy was lower for individuals with a history of injection drug use, those who were non-white, and those who initiated ART with low CD4 count (a count of cells that activate the immune response) compared to those who started at a higher count. Read more on HIV.
“Outbreak” is a relative word. A modern outbreak could be a virus that kills a couple hundred thousand (such as the recent swine flu), or simply an infected shipment of food that left dozens sick. However, a look back through history reveals outbreaks so expansive—so deadly—that they essentially changed the course of history. Below are the five deadliest outbreaks and pandemics in history.
Ask yourself—are we prepared as a nation for the next big outbreak?
(Image source: WikiCommons)
A plague so devastating that simply saying “The Plague” will immediately pull it to the front of your mind, in the middle of the 14th century—from 1347 to 1351—the Black Death remade the landscape of Europe and the world. In a time when the global population was an estimated 450 million, at least 75 million are believed to have perished throughout the pandemic, with some estimates as high as 200 million. As much as half of Europe may have died in a span of only four years. The plague’s name comes from the black skin spots on the sailors who travelled the Silk Road and docked in a Sicilian port, bringing with them from their Asian voyage the devastating disease, now known to be bubonic plague.
New reports from the U.S. Centers for Disease Control and Prevention (CDC) show that 39 percent of adults and 41 percent of children six months and older got their flu shots for the 2013-2014 season by early November—a rate similar to flu vaccination coverage last season at the same time.
Other flu shot statistics of note this year include:
- Vaccination among pregnant women (41 percent) and health care providers (63 percent) is about the same as it was this time last year
- High rates were seen again this year among health care providers including pharmacists (90 percent), physicians (84 percent) and nurses (79 percent), but the CDC reported much lower vaccination rates among assistants or aides (49 percent) and health care providers working in long-term care facilities (53 percent)
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” says Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at CDC. “The bottom line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”
Seasonal influenza activity is increasing in parts of the United States. Further increases in influenza activity across the country are expected in the coming weeks. “If you have not gotten your flu vaccine yet this season, you should get one now,” said Schuchat.
The CDC’s report comes just ahead of the observance next week of National Influenza Vaccination Week (NIVW), which is scheduled each year for the second week in December because vaccination rates tend to fall off toward the end of November. It’s hardly too late to get the flu vaccine: flu season usually peaks January through March, and the virus—and the potential to catch it—often lasts as late as May.
People who haven’t had the flu shot should make it a priority to do so as soon as possible for at least two reasons. One, providers tend to return their unused vaccines toward the end of the year, which can make it hard to find a vaccine if you still need the shot (check this flu vaccine finder for providers in your area, and call ahead to be sure they have supplies on hand). Two, it takes two weeks for the flu vaccine to take full effect, so the sooner you get it the more protected you are against people harboring the flu during the upcoming holiday party season.
Still on the sidelines about getting the shot? The CDC has some impressive numbers from last year’s flu season: flu vaccination prevented an estimated 6.6 million influenza-associated illnesses and 79,000 hospitalizations during the 2012-2013 flu season.
>>Bonus Links: Learn more about preventing and treating influenza on NewPublicHealth.
>>Bonus Content: CDC's infographic on the benefits of the flu vaccine (full size PDF).
The flu season is pretty mild so far. The latest FluView report from the U.S. Centers for Disease Control and Prevention (CDC) shows that the current rate of flu cases across the country is below other years, and some states have yet to see any flu cases at all. But health experts worry those reports will make people who still haven’t gotten the vaccine complacent about getting their shot. And going without poses the risk of a multi-day illness; transmitting the flu to other people who may be more vulnerable to the virus than you; and the potential for serious side effects such as pneumonia and—in rare cases—death.
If you’re still shotless, health experts advise you to roll up your sleeves by Wednesday if at all possible. Here’s why: Immunity to the flu can take up to two weeks after you’ve received the injection. Get the shot by this Wednesday, November 13, and you’ll be protected by the day before Thanksgiving.
That’s the heaviest U.S. travel day of the year, when the possibility of encountering people with the flu at airports, train stations, or even at Thanksgiving dinner greatly increases.
“Visiting mom, grandma and that new baby can make for memorable holiday moments, as long as you don't bring the flu virus along to spoil the party,” says Jeff Golden, spokesman for the Madison, Wisc., health department which, like many other health departments, has sent out recent flu advisories.
CDC research adds another reason to get the shot this week. The agency has found that the momentum to get the flu vaccine wanes after Thanksgiving, perhaps because people assume that as the weather gets colder, if they haven't gotten influenza yet, they won’t. But that’s foolhardy thinking. The U.S. flu season runs from September through April, and the worst of it often hits in January and February. If you wait until cases increase, you may find that you don’t have enough time for the shot to protect you. And you may also find it hard to locate supplies of the vaccine. Knowing that interest in the shot drops after Thanksgiving, private and public clinics, as well as doctors’ offices, often return unused supplies toward the end of the year to free up storage space and in some cases get a refund on the unused doses. Health departments may then keep supplies centrally, but that location may not be convenient.
Wonder where to get the flu shot? Here are good ideas:
- Key in your zip code at flu.gov
- Dial 211, a resource for local services in many communities
- Check pharmacies to see if they have supplies on hand and what hours they give the shots
- Call your local health department to ask if they have clinic hours for the flu vaccination
- Key in “travel clinic” on a search engine to find private clinics in business districts, but call ahead to check on supplies and hours
Health departments may give the shot for free, or ask for payment on a sliding scale based on income. Pharmacies charge about $25, and private doctors’ offices may add a $10 or $20 administrative fee on top of that. The cost is typically covered by insurance, though you may have to file the paperwork yourself.
Medical Groups Issue New Definitions for Stages of Pregnancy
With a goal toward improving newborn outcomes and reducing non-medically related deliveries, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) are recommending four new definitions of ‘term’ deliveries:
- Early Term: Between 37 weeks 0 days and 38 weeks 6 days
- Full Term: Between 39 weeks 0 days and 40 weeks 6 days
- Late Term: Between 41 weeks 0 days and 41 weeks 6 days
- Post term: Between 42 weeks 0 days and beyond
Research over the past several years finds that every week of gestation matters for the health of newborns, and that babies born between 39 weeks 0 days and 40 weeks 6 days gestation have the best health outcomes, compared with babies born before or after this period. ACOG and SMFM encourage physicians, researchers, and public health officials to adopt these new precisely-defined terms in order to improve data collection and reporting, clinical research, and provide the highest quality pregnancy care. ACOG is a partner with the U.S. Department of Health and Human Services on “Strong Start,” a public awareness campaign to reduce unnecessary elective deliveries before 39 weeks’ gestation. Read more on maternal and infant health.
Poll Shows Americans Strongly Supporting Steps to Reduce Racial and Ethnic Inequality
A new poll conducted by the Center for American Progress and PolicyLink, and funded by The Rockefeller Foundation, finds that Americans are much more open to diversity and supportive of steps to reduce inequalities between racial and ethnic groups than has been previously thought. The poll was conducted by landline and cellphone in June and July among close to 3,000 U.S. citizens across the country. Some key findings of the poll include:
- Positive sentiments about opportunities from rising diversity tend to outweigh negative concerns.
- Sixty-nine percent of responders said that a bigger, more diverse workforce will lead to more economic growth and that diverse workplaces and schools will help make American businesses more innovative and competitive.
- More than 7 in 10 Americans support new steps to reduce racial and ethnic inequality in America through investments in areas such as education, job training and infrastructure improvement. Among Whites, the level of support was 63 percent.
Read more on health disparities.
CDC: Flu Season Slow So Far…But Should Pick Up Soon
While the flu season has seen relatively few cases so far, public health officials expect that to change soon and are heavily recommending that anyone who has yet to be vaccinated go ahead and do so. Joe Bresee, MD, chief of the epidemiology and prevention branch in the U.S. Centers for Disease Control (CDC) and Prevention's Influenza Division, said 135 to 139 million doses of vaccine should be available; the number of people who receive the vaccine annually has risen since 2009. "It's edging up in most groups, which is really gratifying, especially in some of the high-risk groups like pregnant women and kids. We are seeing good gains over the last four or five years," he said. "But we have a long way to go. Still only half of Americans get vaccinated. Vaccine is still the single best thing folks can do to prevent flu." Read more on the flu.
CDC Flu Reports to Resume Later Today
The U.S. Centers for Disease Control and Prevention (CDC) reported late yesterday that it has resumed analysis of influenza surveillance data and testing of influenza laboratory specimens collected during the 16-day government shut-down. An abbreviated FluView report summarizing the data for the most recent week (October 6-12) will be posted on Friday, October 18. At a later date, reports summarizing influenza surveillance data for September 22-October 5 will also be posted. Weekly Friday posting of the full FluView report for the 2013-2014 season will begin again on October 25. In the United States, flu season typically runs September through April and both private doctors and public health clinics currently have large supplies of this year’s flu vaccine on hand. Find a flu shot in your neighborhood by using the Health Map Vaccine Finder, run by Boston Children’s Hospital. Read more on flu.
Brain May Flush Out Toxins During Sleep
A new study funded by the U.S. National Institutes of Health finds that a good night’s rest may literally clear the mind. The study, conducted in mice, showed—for the first time, according to the researchers—that the space between brain cells may increase during sleep, allowing the brain to flush out toxins that build up during waking hours. The researchers say that suggests a new role for sleep in health and disease. The study, published in Science, shows that during sleep a plumbing system called the glymphatic system may open, letting fluid flow rapidly through the brain. The researchers studied the system by injecting dye into the cerebrospinal fluid of mice and watching it flow through their brains while simultaneously monitoring electrical brain activity. The dye flowed rapidly when the mice were either asleep or anesthetized, but barely flowed when the same mice were awake. The researchers also inserted electrodes into the brains of the mice to directly measure the space between brain cells and found it increased by 60 percent when the mice were asleep or anesthetized. Researchers say the applications may apply to general health as well as have implications for neurological disorders. Read more on research.
New Report Offers Suggestions for Creating Healthier Neighborhoods
Again and again, research shows that our environment—where we live and what behaviors it fosters—has a profound impact on our health. Realizing this, a new report from the Prevention Institute offers interviews with fifty leaders in multiple sectors, including transportation, housing and public health on how to create healthy, safe and equitable neighborhoods. The goal of the report, Towards a 21st Century Approach: Advancing a Vision of Prevention and Public Health, is to spark an active and ongoing national dialogue about the subject. It was made possible through funding from the Robert Wood Johnson Foundation. Read more on smart growth.
Add flu surveillance to the list of casualties of the current government shutdown.
Every flu season, states collect data on flu cases — including case reports and viral specimens — and send those to the Centers for Disease Control and Prevention (CDC) in Atlanta for recording and tracking. That tracking is critical in order to:
- provide information on how well-matched the seasonal flu vaccine is to the flu viruses found in the community;
- identify severe outbreaks that require increased supplies of antiviral medicines for people who contract the flu; and
- identify emerging strains that might require a new vaccine to be developed this season, which is what happened several years ago when CDC identified the H1N1 influenza virus toward the end of the flu season, and quickly ramped up for a new vaccine.
Flu season generally runs October through April, with the peak from about January to March. If the shutdown continues then, “as the flu season goes on, our knowledge of what’s happening will be impaired,” says William Schaffner, MD, Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine, and the immediate past president of the National Foundation for Infectious Diseases.
CDC director Thomas Frieden, MD, MPH, underscored his concern in a tweet on the first day of the government shutdown: “CDC had to furlough 8,754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.”
State AGs Urge FDA to Adopt New Regulations Covering E-cigarettes
The Attorneys General of 41 states are urging the U.S. Food and Drug Administration (FDA) to follow through on a pledge to issue regulations that would expand its oversight to include e-cigarettes. In a letter to FDA Commissioner Margaret Hamburg, they asked “the FDA to move quickly to ensure that all tobacco products are tested and regulated to ensure that companies do not continue to sell or advertise to our nation's youth.” The FDA was given authority to regulate cigarettes, cigarette tobacco and roll-your-own tobacco in 2009, as well as the authority to expand its authority after it issued new regulations. Last week a similar plea related to FDA authority was made to President Obama by the American Academy of Pediatrics and 14 other public health organizations, including the American Lung Association and American Heart Association. E-cigarettes continue to increase in sales (a projected $1.7 million in 2013) even while dropping in price. At the same time, there are no advertising restrictions for e-cigarettes. "Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes,” according to the Attorneys General’s letter. Read more on tobacco.
Expert: People Should Get Now-available Flu Vaccine As Soon As Possible
This season’s influenza vaccine is now available and people shouldn’t hesitate to go ahead and get it, according to Stephen Russell, MD, associated professor in the general internal medicine division at the University of Alabama at Birmingham and a lead physician at the university’s Medicine Moody Clinic. This year’s vaccine protects against four types of flu viruses (as opposed to the three of previous vaccines) and comes as either a traditional shot or a nasal spray. "Contrary to some beliefs, getting the flu shot in September is a good thing and will offer protection for the entirety of the flu season," he said. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people ages 6 months and older, particularly for seniors, pregnant women, caregivers and people with chronic medical conditions. "Many people will say they do not need the vaccine, as they have never had the flu before, but that is like saying you don't need to wear your seatbelt because you have never had a wreck," Russell said. "You may have been fine in the past, but that should not offer security or protection for future exposures to the flu." Read more on influenza.
Study: Losing 10 Percent of Weight Can Greatly Reduce Arthritic Knee Pain, Put Off Knee Replacement
Losing just 10 percent of their weight could go a long way toward easing the knee pain from osteoarthritis in overweight and obese people ages 55 and older, according to a new study in the Journal of the American Medical Association. That would mean better knee function, improved mobility, enhanced quality of life…and reducing the odds of needed a knee replacement. "We've had a 162 percent increase in knee replacements over the last 20 years in people 65 and over, at a cost of $5 billion a year," said lead author Stephen Messier. "From our standpoint, we think this would be at least a good way to delay knee replacements and possibly prevent some knee replacements." The study tracked 454 overweight and obese people in three groups—diet-only, exercise-only and a combination—finding that people who did the combination were the most successful at losing weight and thus reducing knee pain. "We're not talking about people getting down to ideal body weight," said Patience White, MD, the Arthritis Foundation’s vice president of public policy and advocacy. "They just have to lose 10 percent of their total weight. Someone who is 300 pounds only needs to lose 30 pounds. I think that's within reach for people." Read more on obesity.
AAP: Children Should Be Immunized Against Influenza As Soon As Possible this Season
Parents and caregivers should have all children ages 6 months or older immunized against influenza as soon as possible, according to new updated recommendations from the American Academy of Pediatrics (AAP). Immunization options include the trivalent vaccine that protects against three influenza strains and the new quadrivalent vaccine that protects against four strains. “Parents should not delay vaccinating their children to obtain a specific vaccine,” said pediatrician Henry Bernstein, DO, FAAP, the lead author of the flu recommendations. “Influenza virus is unpredictable, and what’s most important is that people receive the vaccine soon, so that they will be protected when the virus begins circulating.” Other vulnerable groups that should definitely be vaccinated include children with chronic health conditions, children of American Indian or Alaskan Native heritage, health care workers, pregnant women, women who may become pregnant or are breastfeeding and people who have contact with children in high-risk populations. The U.S. Centers for Disease Control and Prevention estimates that between 135 million and 139 million doses of vaccine will be manufactured for the 2013-14 influenza season. Read more on influenza.
HUD: $37M to Oklahoma for ‘Unmet Needs’ of Disaster Recovery
The U.S. Department of Housing and Urban Development (HUD) has allocated approximately $37 million in disaster recovery funds for the state of Oklahoma and the City of Moore, Okla., which were severely damaged by extreme storms—including an EF5 tornado—on May 20. Dozens were killed and more than $1 billion in property damage was caused. The grants are part of HUD’s Community development Block Grant Program, which supports long-term disaster recovery efforts in places of “unmet need.” “The May storms cost the lives of dozens of Oklahomans and over $1 billion in property damage. “We are steadily rebuilding, but many families are still struggling to get back on their feet,” said Oklahoma Governor Mary Fallin. “The disaster relief grants provided by HUD—along with continued work from state and local governments and non-profits—will make a big difference in the lives of those affected by this year’s tornadoes. They will be particularly helpful as we work to provide assistance to low income Oklahomans, many of whom are uninsured.” About $26.3 million of the funds will go toward Moore, with the rest going toward the state. Read more on disasters.
Boys Faced Higher Death Risk than Girls from Multiple Causes
Boys on average face a higher risk of death than girls—not just from traumatic events such as accidents, homicides and suicides, but also from cancers and diseases of the heart, lungs and nervous system. The study found that from 1999 to 2008 there were about 76,700 more deaths among boys than girls, and that boys from infancy to age 20 were 44 percent more likely to die. The findings appear in the latest edition of the journal Pediatrics. The findings are not entirely surprising, as past research has indicated that girls have a certain survival advantage and experts already knew that boys are at increased risk of developing certain chronic health conditions. Still, the question is why. "This could be a story of resilience and ability to overcome," said study author Chris Feudtner, MD, a pediatrician at the Children's Hospital of Philadelphia. "Maybe there's some robustness factor that males are missing." Feudtner said that learning why boys faced these higher risks—and for chronic diseases in particular—could help health care experts better understand and treat the conditions. Read more on mortality.