Category Archives: HIV
As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.
Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”
Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.
This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.
A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments.
EBOLA UPDATE: WHO Declares an International Health Emergency
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The West African Ebola outbreak, which has now killed 961 people, has been deemed an “extraordinary event” and an international health risk by the World Health Organization (WHO). "The outbreak is moving faster than we can control it," said WHO Director-General Margaret, according to Reuters. "The declaration...will galvanize the attention of leaders of all countries at the top level. It cannot be done by the ministries of health alone." Read more on Ebola.
NGA Picks Four States to Study Improving Outcomes in the Juvenile Justice System
The National Governors Association has selected Arkansas, Indiana, Michigan and Tennessee to examine new ways to improve outcomes for kids in the juvenile justice system. The four states will “explore strategic recommendations, focusing on improving information sharing across youth-servicing systems, limiting involvement of low-risk youth in the juvenile justice system and expanding community based-alternatives to incarceration,” according to a release. The goals are to lower recidivism rates, reduce costs and improve public safety. Read more on pediatrics.
Study: HIV Diagnosis Rate Down by One-Third Over the Past Decade
The rate of diagnosed HIV infections has dropped by approximately one-third over the past decade, according to a new study in The Journal of the American Medical Association. In 2011, approximately 16 of every 100,000 people in the United States ages 13 and older were diagnosed with HIV; in 2002 the rate was approximately 24 in every 100,000. The rate increased for young gay and bisexual men, but decreased among men, women, blacks, whites, Hispanics, heterosexuals and users of injected drugs. Read more on HIV/AIDS.
United States, Mexico to Enhance Safety of Certain Agricultural Products
The U.S. Food and Drug Administration (FDA) and Mexico’s National Service for Agro-Alimentary Public Health, Safety and Quality and Federal Commission for the Protection from Sanitary Risks have entered an agreement to form a partnership to improve and promote the safety of fresh and minimally processed agricultural products. Each year, Mexico exports approximately $4.6 billion in fresh vegetables; $3.1 billion in fresh fruit, excluding bananas; $1.9 billion in wine and beer; and $1.5 billion in snacks to the United States.
The preventive practices and verification measures will include:
- Exchanging information to better understand each other’s produce safety systems
- Developing effective culturally-specific education and outreach materials that support industry compliance with produce safety standards
- Identifying common approaches for training auditors who will verify compliance with such standards
- Enhancing collaboration on laboratory activities as well as outbreak response and traceback activities
“To be successful as regulators, the FDA must continue developing new strategies and partnerships that allow us to more comprehensively and collectively respond to the challenges that come with globalization,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. “The FDA is working with our Mexican government counterparts as well as stakeholders from industry, commerce, agriculture, and academia to ensure the safety of products for American and Mexican consumers.” Read more on food safety.
JAMA: Health Experts Call for End on Blood Donation Ban for Gay and Bisexual MenEx
perts writing in the Journal of the American Medical Association have called for the repeal of a 30-year ban on blood donations from gay and bisexual men. The U.S. Food and Drug Administration (FDA) instituted the ban for any man who had sex with another man in 1983, near the beginning of the AIDS crisis. Now, however, the experts said that technological and societal advances mean the ban should be lifted. "We think it's time for the FDA to take a serious look at its policy, because it's out of step with peer countries, it's out of step with modern medicine, it's out of step with public opinion, and we feel it may be legally problematic," said Glenn Cohen, who directs Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, who co-wrote the article with Jeremy Feigenbaum of Harvard Law School and Eli Adashi, MD, of Brown University's medical school. They also noted that the ban is not in line with other FDA policies regarding people considered high-risk donors due to their sexual behavior. Read more on HIV/AIDS.
CDC Re-Opens Clinical TB Lab; Safety Reviews of Other Labs Continues
Less than two weeks after closing laboratories due to two serious lapses with anthrax and avian flu virus and an intensive review by its CDC’s internal Laboratory Safety Improvement Working Group, the U.S. Centers for Disease Control and Prevention (CDC) has resumed the transfer of inactivated materials out of its high-containment Clinical Tuberculosis Laboratory. The moratorium on material transfers remains in effect for BSL-3 and BSL-4 laboratories, with those supporting direct patient care receiving priority review. The working group’s ongoing lab assessments focus on two main areas:
- Each lab must demonstrate that its protocols for key control points—such as inactivation of a pathogen—are not only being used but that they are being used by appropriately trained and supervised individuals.
- Each lab is expected to establish redundant controls, similar to the two-key system used in other contexts for critical control points. For example, in the TB lab when heat is used to kill a pathogen, a second trained lab technician will witness the process to make sure the right temperature is used for the right amount of time. Both individuals then sign off on the process.
Ukraine Crash Kills Scores of AIDS Researchers
Malaysian Flight 17, believed to have been shot down by a missile over Ukraine yesterday, included dozens of AIDs researchers headed to Melbourne for AIDS 2014, the annual international gathering of AIDS researchers. Global Health Now, a daily newsletter produced by the Johns Hopkins Bloomberg School of Public Health, interviewed Prof. Richard Boyd, director of the Monash Immunology and Stem Cell Laboratories in Melbourne, who said, "There were some serious HIV leaders on that plane. This will have ramifications globally because whenever you lose a leader in any field, it has an impact. That knowledge is irreplaceable.” Read more on HIV.
First Chikungunya Case Acquired in the United States reported in Florida
The first locally acquired case of Chikungunya was reported in Florida this week in a man who had not recently traveled outside the United States. The U.S. Centers for Disease Control and Prevention (CDC) is working with the Florida Department of Health to investigate how the patient contracted the virus and will also monitor for additional locally acquired U.S. cases of the virus.
“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” said Roger Nasci, PhD, chief of CDC’s Arboviral Diseases Branch. Chikungunya virus is transmitted to people by two species of mosquitoes, Aedes aegypti and Aedes albopictus. Both species are found in the southeastern United States and limited parts of the southwest; Aedes albopictus is also found further north up the East Coast, through the Mid-Atlantic States and is also found in the lower Midwest.
The CDC has asked state health departments to report cases of chikungunya to help track the virus in the United States. Local transmission occurs when a mosquito bites someone who is infected with the virus and then bites another person. People infected with chikungunya virus typically develop fever and joint pain. Other symptoms can include muscle aches, headaches, joint swelling or rash. Read more on infectious diseases.
HHS Releases Health Insurance Information for Immigrant Families
The U.S. Department of Health and Human Services (HHS) recently released information clarifying health insurance coverage options for immigrant families, including:
- In order to buy private health insurance through the Marketplace, individuals must be U.S. citizens or be lawfully present in the United States.
- People who recently gained U.S. citizenship or had a change in their immigration status may qualify for a Special Enrollment Period.
- Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for a tax credit or lower out-of-pocket costs for private insurance for their dependent family members who are eligible for coverage in the Marketplace or for Medicaid and CHIP coverage. Family members who aren't applying for health coverage for themselves won't be asked if they have eligible immigration status.
- Federal and state Marketplaces and state Medicaid and CHIP agencies can’t require people to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage.
- States can’t deny benefits because a family or household member who isn't applying hasn’t provided his or her citizenship or immigration status.
- Information provided to the Marketplace won’t be used for immigration enforcement purposes.
- If a person is not eligible for Marketplace coverage or can't afford a health plan, they can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents, including immigrant families, in the health center’s service area.
Read more on the Affordable Care Act.
Study: Common Asthma Treatment Suppresses Growth in Children
A common treatment for asthma may suppress growth in children, according to a new review of two studies that was published in The Cochrane Library journal. The studies included 45 trials on corticosteroid drugs, which are delivered via inhalers to both children and adults with asthma and generally used as first-line treatments for persistent asthma. "The evidence... suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment," said Linjie Zhang at the Federal University of Rio Grande in Brazil, according to Reuters. "But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma." The World Health Organization estimates that there are approximately 235 million people living with asthma. Read more on pediatrics.
Study: Busiest ERs Often Provide the Best Care
People with life-threatening emergencies have better odds of survival when treated at busier emergency departments, according to a new study in the Annals of Emergency Medicine. The study found that patients admitted to a hospital after an emergency had a 10 percent lower chance of dying in the hospital if they initially went to one of the nation's busiest emergency departments; that people with sepsis had a 26 percent lower death rate at the busiest emergency centers; and that lung failure patients had a 22 percent lower death rate. The researchers behind the study estimate that if all emergency patients received the level of care provided by the busiest emergency departments then approximately 24,000 fewer people would die each year. "It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said Keith Kocher, MD, MPH, the lead author of the new study and a University of Michigan Health System emergency physician, in a release. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter." Read more on health disparities.
HHS: $11M Toward Integrating HIV Services into Primary Care
As part of the ongoing National HIV/AIDS Strategy, the U.S. Department of Health and Human Services is making $11 million available for the integration of HIV services into primary care services in Florida, Massachusetts, Maryland and New York. The funds will go toward innovative partnerships between health centers and those states’ health departments. They are part of Partnerships for Care: Health Departments and Health Centers Collaborating to Improve HIV Health Outcomes, a multi-agency project that includes the U.S. Centers for Disease Control and Prevention and the Health Resources and Services Administration. Read more on HIV/AIDS.
Widely Used HIV Drug Linked to Higher Suicide Risk
People infected with HIV whose treatment includes the widely used antiretroviral drug efavirenz appear to have double the risk of suicidal thoughts, attempts and completion compared to HIV patients not taking the medication, according to a study by several researchers at the Harvard School of Public Health and the University of North Carolina at Chapel Hill. The study was published in the Annals of Internal Medicine.
“When efavirenz is used as a component of antiretroviral therapy, patients should be monitored carefully for exacerbation of depression or evidence of suicidal thoughts or behavior,” according to the study.
The drug has been previously linked to central nervous system side effects and suicide, but until now a clear link to suicidal thinking, attempted suicide, or completed suicide was not clear. The effects persist for the time patients are on the drug. The researchers recommend that patients with HIV use alternative drugs, if possible, if they are at risk for depression. Read more on HIV.
Nutrition Screenings Should Be Regular Part of Geriatric Health Assessment
Most older adults typically have one or more chronic health conditions that can affect their food intake and should be asked about their food intake during health exams, according to a new study in Nutrition in Clinical Practice. The researchers said that health care providers should also look for signs of malnutrition, such as loss of subcutaneous fat, muscle loss and fluid accumulation. Read more on aging.
Many American Teens Follow Pro-Marijuana Twitter Feeds and Receive Pro-Marijuana Tweets
Hundreds of thousands of American teens are following marijuana-related Twitter accounts and getting pro-marijuana tweets several times each day, according to researchers at the Washington University School of Medicine in St. Louis. The researchers say the tweets are cause for concern because young people are especially responsive to social media influences and because patterns of drug use tend to be established in a person’s late teens and early 20s. The study was published in the Journal of Medical Internet Research and relied on tweets sent and received between May 1 and Dec. 31, 2013, from a single popular pro-marijuana Twitter feed. During the study period, the feed posted an average of 11 pro-marijuana tweets per day. Read more on substance abuse.
‘I Got Tested’ Campaign Promotes Importance of Knowing Your HIV Status
A new public information campaign from Greater Than AIDS is using real-life stories to advocate the importance of knowing your HIV/AIDS status. The “I Got Tested” campaign will place materials in clinics to support providers in HIV outreach; provide free HIV testing in select Walgreens pharmacies; and promote hotlines and online resources provided by departments of health and agencies, as well as the U.S. Centers for Disease Control and Prevention. “Despite overwhelming evidence that early diagnosis and treatment play an important role both in the health of those who are positive and in reducing the spread of HIV, many Americans at highest risk for infection still have not been tested,” said Tina Hoff, Senior Vice President and Director of Health Communication and Media Partnerships at the Kaiser Family Foundation, a co-founding partner of Greater Than AIDS, in a release. “This campaign is about helping to reduce the stigma surrounding HIV testing, to encourage patients to ask their providers to get tested, and to connect people with services in their communities.” Read more on HIV/AIDS.
Court: NYC’s ‘Soda Ban’ is Illegal
New York City’s ban on large sugary drinks—often referred to as former Mayor Michael Bloomberg’s “soda ban”—is illegal, according to a 4-2 ruling from the state Court of Appeals. The court found that the local health board that passed the regulation overstepped its authority. "By choosing among competing policy goals, without any legislative delegation or guidance, the Board engaged in law-making and thus infringed upon the legislative jurisdiction of the City Council of New York," wrote Judge Eugene Pigott for the majority. The soda ban was one of several public health initiatives pushed by Bloomberg, along with a ban on cigarettes in certain public spaces and a ban on trans fats from restaurants. Read more on nutrition.
Study: 3 Hours of Television Per Day Can Double Risk of Early Death
Watching more than three hours of television per day may double a person’s risk of an early death, compared to someone who watches less than one hour per day, according to a surprising new study in the Journal of the American Heart Association. Researchers tracked more than 13,000 seemingly healthy adults in Spain, finding that for every two additional hours a person spent watching television, their risk of death from heart disease climbed 44 percent, their cancer death risk climbed 21 percent and their risk of premature death climbed 55 percent for all other causes. The study found no such link for other sedentary causes, including working at a computer and driving. Read more on physical activity.
FEMA Issues Advisories as Severe Weather Hits Parts of the U.S.
The Federal Emergency Management Agency (FEMA) has begun issuing advisories for states across the Southern United States expected to be impacted by severe weather.
According to the National Weather Service, a major winter storm is impacting the South and Southeast ahead of moving up the Eastern Seaboard on Wednesday.
FEMA is encouraging both residents and visitors in the track of the storms to follow the instructions of state, local and tribal officials, and monitor NOAA Weather Radio and their local news for updates and directions provided by local officials. Residents can find trusted sources for weather and preparedness information via Twitter on FEMA’s social hub.
Weather Emergency Alerts (WEA) are currently being sent directly to many cell phones on participating wireless carrier networks. These alerts are sent by public safety offices such as the National Weather Service about imminent threats like severe weather. They look like a text message and show the type and time of the alert, any action you should take and the agency issuing the alert. Check your cellular carrier to determine if your phone or wireless device is WEA-enabled. Read more on preparedness.
Dozens of Bills Introduced in Recent Years to Increase School Vaccine Exemptions
From 2009 to 2012, 36 bills were introduced in 18 states to change school immunization mandates, with the majority aimed at expanding exemptions, according to a recent review in JAMA by researchers from Emory University. None of the bills passed, but the researchers say continued efforts to change state vaccine rules are concerning. Among 36 bills introduced, 15 contained no administrative requirements, seven bills had one or two administrative requirements, and the remaining 14 contained between up to five administrative requirements in order for parents to exempt their children from school vaccine rules in a given state.
"Exemptions to school immunization requirements continue to be an issue for discussion and debate in many state legislatures," according to the study authors. Read more on vaccines.
Being in a Good Mood Can Lead to Safer Sex
HIV-positive men are more likely to have save sex when their mood improves, according to a new study by researchers at the Mailman School of Public Health at Columbia University. The study, published in the journal Psychology, included 106 sexually active, HIV-positive men who have sex with men who completed weekly surveys over six weeks that asked about their sexual behavior, depression, and wellbeing during the prior week. Overall, 66 percent of study participants reported having unprotected intercourse in the prior two months; 81 percent had multiple partners. Three-quarters of the study participants were black and Latino men, a group disproportionately affected by HIV.
The researchers found that the men who reported an increase in their wellbeing in a given week were more likely to have safe sex (66%), while those who reported higher-than-usual levels of depression were more likely to engage in the risk behaviors (69%). The researchers are now studying potential interventions that might help address risky behaviors during depressive phases. Read more on sexual health.
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.