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We've declared this week "Outbreak Week" on NewPublicHealth, and we're using it as an opportunity to crystallize discussion among the public health community and beyond about whether we're prepared as a nation to handle the next big outbreak. Spread the word, not the germs.
Here are the highlights of our coverage this week:
- Top 5 Things You Didn't Know Spread Disease: We all know to be wary of mosquitos and ticks, but there are plenty of other ways diseases can spread that may not be top of mind. Are you prepared?
- The 5 Deadliest Outbreaks and Pandemics in History: A modern outbreak could be a virus that kills a couple hundred thousand, 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.
- Outbreak Week Q&A on Vaccines with Litjen (L.J) Tan: 45,000 adults and 1,000 kids die each year from vaccine-preventable diseases. Where are the gaps and how can we close them?
- State Vaccine Exemptions' Impact on Vaccination Rates: A new study finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease.
- INFOGRAPHIC: A Close Look at How Prepared We Are For the Next Outbreak: From antibiotic-resistant superbugs to the seasonal flu to Salmonella, infectious diseases are a serious health threat that also cost individuals and the health care industry billions.
- Outbreaks on the Big Screen: When outbreaks hit the big screen is it good for public health or does it make people panic?
- Where Polio Remains a Threat: Outbreak Week Q&A with Sona Bari: Bari of the World Health Organization discusses polio's resurgence as a critical global health issue and efforts to eradicate the disease globally.
- Throwback Thursday: Zombie Apocalypse: The CDC urged folks to prepare for the zombie apocalypse — with a goal of boosting overall preparedness for real health threats and disasters, back in 2011. Did it work?
- Outbreak Response Dream Team: Which pop culture characters would you want on your team with the diverse skills to respond to and cure a deadly, worldwide epidemic?
- Digital Outbreak Response: A roundup of how the digital world is working to improve emergency preparedness and outbreak response.
CDC’s Top Accomplishments for 2013 Include Progress in Curtailing Outbreaks
A review by the U.S. Centers for Disease Control and Prevention (CDC) of progress in 2013 include improvements in preventing and curtailing infectious disease and foodborne illness outbreaks in the United States and globally:
- More than 12,000 facilities now track health care-associated infections using CDC’s National Healthcare Safety Network (NHSN), and bloodstream infections in patients with central lines have decreased by 44 percent and surgical-site infections have decreased by 20 percent since 2008.
- 2013 marks the 10th anniversary of the U.S. President’s Plan for Emergency AIDS Relief(PEPFAR). In 2013, PEPFAR prevented the one millionth baby from being infected with HIV and has 6.7 million people on treatment, with HIV incidence falling in nearly all PEPFAR countries.
- CDC published its first estimates of which foods were causing foodborne illnesses in the United States, referred to as Attribution Estimates. These estimates help regulators, industry and consumers more precisely target and implement effective measures to prevent food contamination, and allow people to use it to help guide their own food safety practices.
- CDC scientists traced the newly discovered Heartland virus that infected two men from northwestern Missouri to populations of lone star ticks in the region. This discovery helps CDC stay one step ahead of what could become another public health threat carried by ticks.
- In conjunction with public health officials in Eurasia’s Republic of Georgia, CDC helped identify a new poxvirus (related to smallpox) that sickened shepherds in Akhmeta, Georgia. The successful investigation shows that rapid detection saves precious time during response to emerging health threats.
- CDC researchers found that two new antibiotic regimens using existing drugs successfully treat gonorrhea infections. This is especially important given growing antibiotic resistance and dwindling treatment options for gonorrhea.
Read more on infectious disease.
‘Consumer Reports’ Study Finds Harmful Bacteria in Many Samples of Chicken Sold in the United States
A new investigation of the safety of chicken breasts sold in retail stores across the United States by Consumer Reports found potentially harmful bacteria on 97 percent of the samples tested. And about half of the chicken samples had at least one type of bacteria that was resistant to three or more classes of antibiotics. “We are looking to the government to ensure the safety and sustainability of the entire food supply,” said Urvashi Rangan, PHD, executive director of the Consumer Reports Food Safety and Sustainability Center. “We need to attack the root causes of the problems. Without a government focus on effective solutions, meat safety will continue to be compromised.” Consumer Reports has several recommendations for the U.S. government aimed at reducing bacterial contamination in the food supply:
- Congress should give the U.S. Department of Agriculture (USDA) the authority to mandate a recall of meat and poultry products.
- The FDA should prohibit antibiotic use in food animals except for the treatment of sick ones. (According to Consumer Reports, FDA’s action last week giving voluntary guidance to drug companies to end labeling of antibiotics for growth promotion uses is an important first step, but is far from what is needed overall.)
- The USDA should classify strains of salmonella bacteria that are resistant to multiple antibiotics and known to have caused disease as “adulterants,” so that inspectors look for those strains routinely and when found, the products cannot be sold.
- The USDA should move quickly to set strict levels for allowable salmonella and campylobacter in chicken parts.
- The USDA’s proposed rule to increase maximum line speeds and reduce the number of USDA inspectors at slaughter plants should be dropped.
Read more on bacteria.
Health Insurers Extend Deadline for Many 2013 Health Insurance Premium Payments
The trade association for many health insurance plans has announced that many plans will be extending the deadline for consumers to pay their first month’s premium. Consumers who select their plans by December 23 and pay their premiums by January 10 will be able to have coverage effective January 1. Under current rules and guidance, consumers who want to begin coverage on January 1 must select a plan by December 23 and pay the first month’s premium by December 31. The short time period in which to complete these steps, particularly around the holidays, combined with the ongoing technical issues with the Affordable Care Act insurance purchasing site healthcare.gov have raised concerns that some consumers’ coverage may not be able to begin on January 1. The association, America’s Health Insurance Plans, is urging consumers to check with the plan they have selected for more details about their specific coverage policy. Read more on the Affordable Care Act.
From antibiotic-resistant superbugs to the seasonal flu to Salmonella, infectious diseases are a serious health threat that also cost individuals and the health care industry billions. A new report from Trust for America’s Health and the Robert Wood Johnson Foundation, Outbreaks: Protecting Americans from Infectious Diseases, assesses gaps in our public health system that could severely limit our ability to effectively respond to an outbreak.
NewPublicHealth created an infographic that illustrates many of the key findings of the new report.
BSR: More and More, Private Sector Being Asked to Improve Population Health
Traditionally, health efforts fall under the purview of human resources—not corporate social responsibility (CSR)—in the business world. However, companies are playing an increasingly important role in not only health improvement efforts for their own employees, but also in population health for their larger communities. Increasingly, consumers are demanding this from companies to support their CSR work, as reported by Fast Company. That's also the subject of a BSR report, A New CSR Frontier: Business and Population Health. The report looked at the role of businesses in overall public health for more than 350 major companies, including Coca-Cola, Walmart, Microsoft, Chevron, and General Mills. The report found three major trends:
- Society expects companies to play a bigger role in population health
- Companies are responding to those expectations, but primarily with employees and customers
- Health and wellness are still largely the domain of human resources, even though departments such as philanthropy, marketing and research & development should be involved
"The pullback of government as an influence for population health has created gaps and stakeholders are expecting more from the private sector," said Mark Little, director of health care advisory services at BSR. "The overarching single headline is that business now has new responsibilities that are recognized by stakeholders. We do believe there is a new frontier for CSR."
Support for this report was provided by a grant from the Robert Wood Johnson Foundation. Read more on business.
AAP Offers New Guidelines to Reduce Risk of Antibiotic Resistance
This week is “Get Smart About Antibiotics Week,” and the American Academy of Pediatrics (AAP) has released new guidance that would limit the over-prescription of antibiotics that is contributing to the growing public health issue of antibiotic resistance. The guidance, formulated in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), focuses on the three common upper respiratory tract infections in children that are unlikely to be helped by antibiotics: ear infections, sinus infections and sore throats. The report includes clinical criteria to help physicians determine whether an upper respiratory tract infection is viral or bacterial, which will improve care while limiting opportunities for bacteria to become resistant to antibiotics. “Our medicine cabinet is nearly empty of antibiotics to treat some infections,” said CDC Director Tom Frieden, MD, MPH. “If doctors prescribe antibiotics carefully and patients take them as prescribed we can preserve these lifesaving drugs and avoid entering a post-antibiotic era.” Read more on prescription drugs.
Study: Half of Teens with Mental Disorders Receive No Treatment
Despite ever-increasing knowledge about psychiatric conditions and their links to other health issues, more than half of American teenagers with psychiatric disorders do not receive treatment, according to a new study in the journal Psychiatric Services. The study found that treatment rates varied by disorder. For example, adolescents with ADHD received care more than 70 percent of the time, while adolescents with phobias or anxiety disorders were the least likely to receive mental health care. The analysis also found racial disparities, with white youths far more likely to receive care than black youths. The lack of qualified child mental health professionals also hinders access to care, with pediatricians, school counselors and probation officers being asked to provide care for which they are not actually trained, according to E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. "We need to train more child psychiatrists in this country," she said. “And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work." The study included data from the National Comorbidity Survey Adolescent Supplement, as well as a survey of more than 10,000 U.S. teenagers. Read more on mental health.
Study: Acetaminophen Use and Even Light Drinking Dramatically Raises Kidney Dysfunction Risk
Acetaminophen use when paired with even moderate or light drinking can increase the risk of kidney dysfunction by 123 percent, according to a new study released today at the American Public Health Association’s 141st Annual Meeting in Boston. Using data from the 2003-2004 National Health and Nutrition Examination Survey, researchers analyzed data on more than 10,000 people who were asked questions about their alcohol consumption, use of acetaminophen and health conditions. “Pain is the most common symptom among the general public and is also most frequently self-treated with acetaminophens,” noted Harrison Ndetan, lead researcher of the study. “Where this becomes a greater concern is among young adults, who have a higher prevalence of alcohol consumption. These findings highlight a serious concern among health professionals who deal frequently with pain patients, particularly those with mild pain who are more susceptible to consuming both.” Read more on substance abuse.
Flight Attendants: Expanded Use of Electronic Devices In-flight Needs Reworked Safety Messaging for Flyers
The decision by the Federal Aviation Administration (FAA) last week to let passengers use electronic devices—but not make cell phone calls—during all phases of a flight has flight attendants concerned that the ruling could compromise passenger safety if flyers are distracted by the devices when the cabin crew makes its safety announcements before takeoff.
Most airlines will introduce the new rule on devices by the end of the year. To qualify they have to assure the FDA that their fleet’s airplanes can tolerate any potential radio interference from the devices. Flight attendants would like heavy devices stored under seats or in the overhead bins during takeoff and landing for added safety. In a statement released just after the FAA ruling, the Association of Flight attendants said “AFA will work diligently alongside the FAA and industry to find creative, science-based approaches to ensure that passengers comply with the new operator policies and that their attention is not diverted from the important safety information provided by cabin crew during routine pre-flight briefings and unexpected emergencies, and that risks posed by loose items in the cabin are safely managed during the most critical portions of [a] flight.” Read more on injury prevention.
Two Questions Could Help Diagnose Strep, Reduce Unnecessary Antibiotic Prescriptions
“Do you have a cough and have you had a fever in the last 24 hours?” These two simple questions could help people determine whether they need to see a doctor for strep throat, which could in turn limit unnecessary antibiotic prescriptions, according to a new study in the Annals of Internal Medicine. While high fevers can indicate strep, coughs do not. The study found the questions, when paired with an accounting of how common strep infections were in a particular area, where nearly as effective as lab tests at determining whether a patient actually had a strep infection. "This enables us to use the test of time," said co-study author Dr. Kenneth Mandl, a professor of bioinformatics at Harvard. "If we determine that you're low risk and most cases will not have an important complication from strep anyway, then you can be followed clinically rather than come in for a test right away, and you may improve." About 15 million people in the United States see a doctor for a sore throat each year, with 70 receiving antibiotics; estimates indicate that only 20-30 percent of children and 5-15 percent of adults actually benefit from the medications. Read more on prescription drugs.
Study: Erratic Bedtimes Linked to Kids’ Behavior Problems
Children with erratic bedtimes also exhibit more behavior problems at home and at school, according to a new study in the journal Pediatrics. Researchers analyzed date on more than 10,000 children who were part of long-term sleep studies, finding that kids without a regular bedtime scored worse on a measure of behavior problems including acting unhappy, getting into fights and being inconsiderate. "If you are constantly changing the amounts of sleep you get or the different times you go to bed, it's likely to mess up your body clock," said study leader Yvonne Kelly, from University College London. "That has all sorts of impacts on how your body is able to work the following day," Kelly, from University College London.” However, the researchers also found that when a child went from no set bedtime to a scheduled bedtime, their behavior improved. Read more on pediatrics.
Overweight Teens at Increased Risk of Later Esophageal Cancer
People who are overweight or obese as teens have nearly twice the risk of developing esophageal cancer later in life when compared to their peers with healthy weights, according to a new study in the journal Cancer. The study also found that social status, economic status and education levels can all be factors in the development of gastric cancers; poor teens are at twice the risk of developing stomach cancer, as are teens with nine years of fewer of education. The study included more than 1 million male Israeli teens. "We look at obesity as dangerous from cardiovascular aspects at ages 40 and over, but here we can see that it has effects much earlier," said study author Zohar Levi, MD, of the Rabin Medical Center in Israel. However, the study did not prove cause-and-effect, so further research is needed to determine whether losing weight or gaining higher social or economic status later in life can reduce the risks. Read more on cancer.
USDA: California Plants Linked to Salmonella Can Stay Open
After making “immediate substantive changes to their slaughter and processing,” three California poultry processing plants tied to a salmonella outbreak in 17 states will remain open, the U.S. Department of Agriculture (USDA) has determined. The plants will implement new food safety controls and the USDA will monitor the plants products for the next three months. The outbreak has sickened 278 people since May; the normal hospitalization rate is about 20 percent, but antibiotic resistance means about 42 percent of the people sickened in this outbreak were hospitalized. Read more on food safety.
Four U.S. Regions on Alert for Severe Weather this Weekend
Severe weather is expected to impact at least four regions of the United States this weekend. That includes a tropical storm—downgraded from a hurricane for now—in the Gulf Coast; a tornado threat in the Midwest; early snow in the West that, in part because trees still have leaves that can be weighed down by wet snow, could lead to power outages; and spreading fires in California fueled by dry weather. The Federal Emergency Management Agency (FEMA) has already recalled some furloughed staff to prepare for the storms expected on the Gulf Coast. Read more on preparedness.
Study: Unnecessary Antibiotic Prescriptions Remain High, Endanger Public Health
Despite ongoing efforts by the U.S. Centers for Disease Control and Prevention (CDC) and other public health organizations, doctors continue to overprescribe antibiotics for sore throats, increasing the risk of the development of antibiotic-resistant bacteria, according to a new study in JAMA Internal Medicine. “Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent,” said senior author Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at Brigham and Women’s Hospital. “For acute bronchitis, the right antibiotic prescribing rate should be near zero percent and the national antibiotic prescribing rate was 73 percent.” The researchers said the findings demonstrate the need to study and implement new interventions to reduce unnecessary antibiotic prescriptions. Read more on infectious disease.
Daily Walks Can Reduce Breast Cancer Risk for Older Women
Post-menopausal women can reduce their risk of developing breast cancer through physical activity as simple as a daily walk, according to a new study in Cancer Epidemiology, Biomarkers & Prevention. More intense exercise may have an even more profound impact. "The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study. "Go for a nice, leisurely walk an hour a day to lower risk.” However, the study authors noted that they found only a correlation, not a causation, so further study is needed. Experts believe the reason exercise reduces breast cancer risk is related to hormones; they also recommend maintaining a healthy body weight and minimizing the consumption of alcohol as ways to reduce the risk of breast cancer. Read more on cancer.
Average Monthly Cost of Mid-tier Insurance Under Affordable Care Act Estimated at $328
The average monthly cost of a mid-tier health insurance plan under the Affordable Care Act will be $328, and government subsidies will also help reduce that cost for most Americans, according to a new report from the U.S. Department of Health and Human Services. The health exchanges open for enrollment next week and the federal government hopes to enroll as many as 7 million people within the first year. The cost varies from state to state, with Minnesota projected to have the least expensive plan at $192 per month and Wyoming projected to have the highest at $516. Read more on access to health care.
NIH Initiative Will Help Move Science from the Laboratories to the Commercial Sector
The U.S. National Institutes of Health (NIH) has awarded $31.5 million in grants to establish three inaugural NIH Centers for Accelerated Innovations that will work to improve how basic science discoveries move from laboratories to commercial products. The Centers are funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) and will focus on technologies to improve the diagnosis, treatment, management and prevention of heart, lung, blood and sleep disorders and diseases. “These centers essentially will offer a one-stop shop to accelerate the translation of early-stage technologies for further development by the private sector and ultimate commercialization,” said Gary H. Gibbons, MD, director of NHLBI. As a result, the public will gain access sooner to new biomedical products that improve human health while also benefiting from the economic growth associated with the creation of new companies and the expansion of existing ones.” Read more on research.
‘Cycling’ Drugs Could Help Combat Antibiotic-resistant Bacteria
“Cycling” between antibiotics may extend their life and effectiveness, while also enabling doctors to stay ahead of drug-resistant bacteria, according to a new study in the journal Science Translational Medicine. "You cycle between drugs that have reciprocal sensitivities," said study co-author Morten Sommer, a lead researcher with the Novo Nordisk Foundation Center for Biosustainability at the Technical University of Denmark. "If you become resistant to drug A, you will become more sensitive to drug B. That way, you can cycle between drug A and drug B without increasing resistance in the long term.” With the increased use—and overuse—of antibiotics, antibiotic-resistant bacteria are becoming an increasingly serious public health problem, leading researchers and health care professionals in search of new ways to combat the problem. More than 2 million people are made ill and more than 23,000 people die every year in the United States due to antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.
Study: 40 Percent of Antibiotics Released from 1980-2009 Withdrawn from Market
Safety concerns, lack of effectiveness when compared to existing drugs and weak sales led more than 40 percent of the antibiotics released between 1980 and 2009 to be withdrawn from the market, according to a new study in the Journal of Law, Medicine and Ethics. The rate was three times as high as that for any other type of drug. “This study raises the question whether or not money would be better spent on higher quality antibiotics, rather than a larger quantity” and whether “approving a flood of new lower-quality antibiotics might actually trigger much higher levels of resistance,” said author Kevin Outterson, JD, LLM, professor at Boston University School of Law and co-director of the Boston University Health Law Program. Antibiotic use can lead to bacteria becoming resistant to a strain. A recent report from the U.S. Centers for Disease Control and Prevention found that as many as 50 percent of prescriptions for antibiotics are either not needed or prescribed inappropriately. Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process. Read more on prescription drugs.
Locations of Drinking Can Influence Types of Partner Violence
Where and when a person drinks can affect the type of partner violence that can follow, according to a new study from the journal Addiction. The study looked at six drinking locations: restaurants, bars, parties at someone else's home, quiet evenings at home, with friends in one's own home and in parks/other public places. Researchers from the Prevention Research Center in California and Arizona State University found that men drinking in bars and at partners away from home and women drinking in parks/other public places were linked with an increased rate of male-to-female violence. They also found that men drinking during quiet evenings at home was associated with increased female-to-male violence. The findings could help prevent partner violence by encouraging people in risky relationships not to drink in particular places/situations, which could prove more effective than counseling people simply to drink less. Read more on alcohol.
Multiple Myeloma Group Hopes Opening Records to Hundreds of Patients Will Advance Research
The Multiple Myeloma Research Foundation's (MMRF) Researcher Gateway is opening global online access to genetic and research data on hundreds of patients in an effort to help identify biological targets for future treatments, improve enrollment in studies by pairing them with the right patients and enhance researcher collaboration. The MMRF Research Gateway is a $40-million program funding by the foundation and drug company partners. The main component of the effort will be the Commpass study which will enroll 1,000 new multiple myeloma patients and monitor them throughout the course of the disease; cancer tissue banks typically include only one sample per patient. "There is going to be new information generated there that you would never get unless you followed patients through first relapse and second relapse and beyond," said George Mulligan, director of translational medicine for Millennium Pharmaceuticals, Japan's Takeda Pharmaceutical Co.’s oncology unit, which is one of the co-sponsors. "The size of it in patient numbers and the breadth and richness of it on a biological level, it's going to grow over time and mushroom into something that's going to be really special.” About 86,000 people are diagnosed with multiple myeloma each year, with about 20,000 of those from the United States. Read more on research.
Antibiotic-resistant Infections on the Rise; Threat Called "Urgent"
Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The report ranked the threats according to seven factors, including health impact, economic impact, how common the infection is and how easily it is spread. It classified carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile as “urgent." C. difficile alone causes about 250,000 hospitalizations and at least 14,000 deaths each year. Excessive antibiotic use is the number one cause of the increase in antibiotic-resistant infections, with as many as 50 percent of prescriptions either not needed or prescribed inappropriately. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.” Antibiotic-resistant infections also add as much as $20 billion in excess direct health care costs and account for as much as $35 billion in lost economic productivity. Read more on prescription drugs.
Survey: Nearly 80 Percent of College Students Oppose Concealed Handguns on Campus
Nearly 80 percent of the students in 15 Midwestern colleges and universities oppose allowing concealed handguns on their campuses, according to a new study in the Journal of American College Health. Ball State University researchers surveyed 1,649 undergraduate students, finding 78 percent were against the handguns and would not apply for a permit if they were legal. “Firearm morbidity and mortality are major public health problems that significantly impact our society,” said study co-author Jagdish Khubchandani, a member of Ball State’s Global Health Institute and a community health education professor in the university's Department of Physiology and Health Science. “The issue of allowing people to carry concealed weapons at universities and colleges around the U.S. has been raised several times in recent years. This is in spite of the fact that almost four of every five students are not in favor of allowing guns on campus.”
The study also found that:
- About 16 percent of undergraduate students own a firearm and 20 percent witnessed a crime on their campus that involved firearms
- About 79 percent of students would not feel safe if faculty, students and visitors carried concealed handguns on campus
- About 66 percent did not feel that carrying a gun would make them less likely to be troubled by others
- Most students also believed that allowing concealed carry guns would increase the rate of fatal suicides and homicides on campus
Read more on violence.
‘Bath Salts’ Drugs Led to 23,000 ER Visits in 2011
The use of “bath salts” drugs accounted for almost 23,000 emergency department visits in the United States in 2011, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The report is the first national study to analyze the link between the street drugs and emergency department visits. "Although bath salts drugs are sometimes claimed to be 'legal highs' or are promoted with labels to mask their real purpose, they can be extremely dangerous when used," said Elinore McCance-Katz, MD, SAMHSA's chief medical officer. The drugs can cause heart problems, high blood pressure, seizures, addiction, suicidal thoughts, psychosis and even death. About two-thirds of the visits also involved at least one other drug, with 15 percent of the visits also being linked to marijuana or synthetic forms of marijuana. There were approximately 2.5 million U.S. emergency department visits linked to drug misuse or abuse in 2011. Read more on substance abuse.