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.

CDC: 200,000 Lives Lost Each Year to Preventable Heart Disease, Stroke
Healthier living and improved preventative efforts could help save more than 200,000 U.S. lives lost each year to preventable heart disease and stroke, according to a new report from the U.S. Centers for Disease Control and Prevention. That’s approximately one in four of heart disease deaths. More than half of those deaths were people younger than 65, with blacks twice as likely as whites to die of the preventable conditions and men more likely than women. Still, the overall rate fell approximately 30 percent from 2001 to 2010. To further improve these rates, health care providers should encourage healthy habits such as not smoking, increasing physical activity, eating a healthy diet, maintaining a healthy weight and taking medicines as directed. At the community level, health departments can promote healthier living spaces, including tobacco-free areas and safe walking areas, as well as access to healthy food options. Read more on heart health.

Patients More Likely to Take Multiple Medications When Combined in Single Pill
Patients are more likely to take multiple medications if they are combined into a single pill—or “polypill”—according to a new study in the Journal of the American Medical Association. This finding could be especially important for people dealing with chronic conditions such as heart disease, who are often prescribed a combination of blood pressure medication, cholesterol medication and aspirin to break up blood clots. Only about half the patients in prosperous countries take all three prescribed pills and as few as 5 percent of patients in developing countries do so. One of the obstacles is simply remembering to take the many medications on time. "The simplification of the delivery of care we provide to our patients is a significant part of the improvement we can gain by this type of strategy," said David May, MD, chair of the board of governors for the American College of Cardiology. "Oftentimes we become enamored with the idea of how much improvement we get with this or that medication, on top of the other drugs a patient has been prescribed. The short answer is, if they don't take it, you don't get any improvement." Read more on prescription drugs.

Common Hospital Infections Cost $10B Annually
In addition endangering patients’ health and lives, the five most common hospital-acquired infections cost the U.S. health care system an estimated $10 billion annually, according to a new study in the journal JAMA Internal Medicine. About one in 20 patients contract an infection after being admitted to a hospital, according to the U.S. Centers for Disease Control and Prevention, and studies indicate that as many as half may be preventable. The found that central line-associated bloodstream infections averaged about $45,000 per case, pneumonia infections that lead to ventilators cost about $40,000 per case and surgical site infections—a result of about one in 50 operations—cost about $21,000 per case. In a previous study, Trish Perl, MD, a professor of medicine and pathology at the Johns Hopkins School of Public Health in Baltimore, found that eliminating surgical site infections alone would save the four hospitals in the Johns Hopkins Health System approximately $2 million in revenue each year. Perl was not involved in the new study. Read more on infectious diseases.

Ahead of the annual pilgrimage of Muslims to Mecca and Medina in Saudi Arabia this October, the Saudi health ministry is limiting the number of foreign and local pilgrims in order to lower the risk of the spread of H7N9, a new form of avian flu identified several months ago in China, and MERS, or Middle East respiratory syndrome corona virus (MERS/MERS-CoV), a potentially fatal virus that emerged last year. The largest numbers of cases of the virus—and deaths—have been in Saudi Arabia. According to a recent post on the Network for Public Health Law’s (NPHL) blog by Daniel G. Orenstein, JD, deputy director of NPHL’s Western Region, so far neither the U.S. Centers for Disease Control and Prevention nor the World Health Organization have issued travel restrictions about the Hajj.

However, the post does note that the emergence of the two viruses has prompted the U.S. Food and Drug Administration (FDA) to take action under its legal authority to increase U.S. readiness to treat potential outbreaks of H7N9 and MERS. Under the Pandemic and All Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), the FDA recently issued Emergency Use Authorizations (EUAs) for diagnostic tests for both viruses. EUAs enable the FDA to temporarily allow use of unapproved medical products such as antibiotics, vaccines and diagnostic tests needed during emergencies.

Orenstein says that “issuing the EUAs illustrates the flexibility and adaptability of FDA authority as clarified under PAHPRA. As epidemiologic research develops further on these viruses, FDA will be able to respond quickly, hopefully mitigating the impact on population health.”

>>Read more: Read the full post on the Network for Public Health Law’s blog.

Kaiser Family Foundation Finds Modest Increase for Family’s Share of Employer-Sponsored Health Insurance
Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to a new Kaiser Family Foundation survey of more than 2,000 employers. That rise is moderate by historical standards according to the survey; since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).

The survey also found that large deductibles of at least $1,000 are common in employer-sponsored plans, especially for employees at smaller firms. This year, 38 percent of all covered workers face such a deductible. At small firms, 58 percent of covered workers now face deductibles of at least $1,000, including nearly a third (31 percent) who face deductibles of at least $2,000, up from 12 percent in 2008.

Additional findings of the survey:

• Nearly all large employers (at least 200 workers) offer at least one wellness program and more than a third (36 percent) of large employers who offer them also provide some kind of financial incentive for workers to participate, such as lower premiums or a lower deductible, receiving a larger contribution to a tax-preferred savings account, or gift cards, cash or other direct financial incentives.
• Among large firms offering health benefits, more than half (55 percent) offer some kind of biometric screenings to measure workers' health risks. Of these, 11 percent reward or penalize workers financially based on whether they achieve specific biometric outcomes.

"This will be an important issue to watch next year, as employers [under the Affordable Care Act can] ask workers to pay more because of their lifestyles and health conditions," said Kaiser Vice President Gary Claxton, the study's lead investigator and director of the Foundation's Health Care Marketplace Project.

Read more on access to health care.

CDC: $75.8M to Help Health Departments Prepare for, Respond to Infectious Diseases
The U.S. Centers for Disease Control and Prevention (CDC) has awarded approximately $75.8 million in grants to help state, territorial and certain local health departments prepare for—and respond quickly to—an array of infectious diseases. The grants are through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement. They will go to such critical areas as surveillance, detection, and outbreak response efforts in infectious disease areas such as foodborne diseases, influenza and healthcare-associated infections. “With many infectious diseases first identified at the local level, this funding ensures that state health departments are able to effectively prevent, detect and respond to such public health threats,” said Beth P. Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases.” Read more on infectious diseases.

Study: Quitting Smoking Even After Becoming Pregnant Reduces Risk, Complications of Low Birth Weight
While women who quit smoking right before or right after becoming pregnant will on average gain more pregnancy-related weight, and are also less likely to have babies who are born small, according to a new study in the journal Obstetrics and Gynecology. Low birth weight increases the risk for infections; breathing and respiratory disorders; delayed growth and social development; and learning disabilities. Other studies have also linked smoking during pregnancy to premature birth, birth defects and stillbirth. "The big thing to get out of this study is that quitting early in pregnancy is as helpful in respect to the birth weight of your baby as never having smoked while you were pregnant," said Amber Samuel, MD, a maternal-fetal medicine expert at Emory University School of Medicine in Atlanta. "I think that can be an inspiration to moms who are looking to make a change in their lives." Read more on maternal and infant health.

Three Cases of Dengue Fever Reported in Florida
The Florida Department of Health is reporting three confirmed cases of Dengue Fever in Central Florida. Dengue Fever is an infectious disease transmitted by mosquitoes. While common in Africa, it’s very rare in the United States. The health department has reported that the three patients have not traveled internationally recently, and that they likely contracted the disease from mosquitoes in their home state. The last case of Dengue Fever in Central Florida was in 2011. Symptoms of Dengue Fever, which is treated with supportive care and can in some cases lead to death, include high fever, headache, rash and joint pain.

The Wall Street Journal recently reported on a severe outbreak of Dengue Fever in Southeast Asia that has been especially harsh this year because of an early rainy season, higher than average temperatures and the fact that the virus has mutated in some cases into a more severe version of the disease. Travelers to the region who become infected risk carrying the virus to their home countries, where the virus can spread if an infected person is bitten by a mosquito that then bites other humans.

Guidelines issued by the Florida Department of Health for mosquito control are effective for other diseases transmitted by mosquitoes, including West Nile Virus and some forms of encephalitis, which both have been seen this summer in the United States. The guidelines include:

• Drain water from garbage cans, house gutters, buckets, pool covers, coolers, toys, flower pots or any other containers where sprinkler or rain water has collected.
• Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren't being used.
• Empty and clean birdbaths and pet's water bowls that are kept outside at least once or twice a week.
• Protect boats and vehicles from rain with tarps that don’t accumulate water.

Read more on infectious disease.

Hurricane Sandy Rebuilding Task Force Releases Report, Recommendations
The Hurricane Sandy Rebuilding Task Force yesterday released its Rebuilding Strategy designed to be a model on how communities can prepare for and respond to extreme weather events. It also includes recommendations on how to continue to help area rebuild from the devastation of Hurricane Sandy. “This Rebuilding Strategy will protect families, small businesses and communities across the region, and the taxpayers’ investment in them, from the risks posed by sea level rise and more extreme weather events – risks that are made worse by the reality of a changing climate,” according to U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan, who chairs the task force. The goals include aligning federal funding with local rebuilding visions; cutting red tape and getting assistance to families, businesses and communities efficiently and effectively; and coordinating the efforts of the federal, state and local governments, with a region-wide approach to rebuilding. Read more on Hurricane Sandy.

Survey: Hispanic Teens More Likely Than White, Black Teens to Abuse Drugs
Hispanic teens are more likely than their white and black counterparts to abuse both legal and illegal drugs, according to a new report, The Partnership Attitude Tracking Study 2012: Hispanic Teens and Hispanic Parents. A survey found that about 54 percent of Hispanic teens had used an illicit drug; 43 percent of white teens and 45 of black teens reported using an illicit drug in the same survey. At the heart of the issue could be that Hispanic teens on average view the drugs as less harmful, said Sean Clarkin, director of strategy and programs at The Partnership at Drugfree.org. "They see drug use among their peers and in their community, and the messages they are not getting from their parents—these all may be contributing to this feeling that drug use is normal," he said. The key to improving on these troubling rates is improved guidance an education on the dangers of drug abuse. Read more on substance abuse.

Chemicals in Plastic Food Containers Could be Adding to Childhood Obesity Problem
Unhealthy foods kept in plastic food wraps and containers may be even more unhealthy for kids because of the chemicals in the plastic, according to two new studies in the journal Pediatrics. The studies linked phthalates to increased insulin resistance in children and bisphenol A (BPA) with high body-mass index (BMI). Leonardo Trasande, MD, an associate professor of pediatrics and environmental medicine at the NYU School of Medicine and author of the phthalates study, said certain chemicals can affect how the body reacts to glucose influence the release of insulin. "There is increasing concern that environmental chemicals might be independent contributors to childhood diseases related to the obesity epidemic," he said. "Our research adds to these growing concerns." He recommends against using certain types of plastic containers and against microwaving any plastic containers. He also says parents should wash plastic containers by hand instead of putting them in the dishwasher, and should throw them out when they’ve been damaged. Hugh Taylor, MD, chair of the Yale School of Medicine's department of obstetrics, gynecology and reproductive sciences, said that while the two studies "point out the vulnerability of children to environmental chemicals,” parents should also be working to move their kids’ diets to healthier and natural food. Read more on obesity.

CDC: As Many as 300,000 Infected with Lyme Disease Annually
The actual number of U.S. cases of Lyme disease is as much as ten times higher than the reported figure, according to the U.S. Centers for Disease Control and Prevention (CDC). Three ongoing CDC studies put the number of cases of the tick-borne illness at around 300,000 annually. This major difference between reported and actual cases emphasizes the need for greater and more diverse prevention efforts. Traditional preventive measures at the personal level include wearing repellent, checking for ticks daily, showering soon after being outdoors and alerting a doctor if you get a fever or rash. “We know people can prevent tick bites through steps like using repellents and tick checks. Although these measures are effective, they aren’t fail-proof and people don’t always use them,” said Lyle R. Petersen, MD, MPH, director of CDC’s Division of Vector-Borne Diseases. “We need to move to a broader approach to tick reduction, involving entire communities, to combat this public health problem.” Read more on infectious disease.

Study Links Kids’ Trouble Sleeping, Poor School Performance
Trouble sleeping is tied to trouble in the classroom for kids, according to a new study in the journal Sleep Medicine. Researchers analyzed kids age seven to 10 in Sao Paulo, Brazil schools, finding that 13 percent with difficulty sleeping were failing Portuguese, compared to 9 percent for kids who did not have sleep problems. They also found that 25 percent of kids with trouble sleeping were failing math, compared to eight percent for kids who have no trouble sleeping. U.S. experts estimate that approximately 25 percent of U.S. kids have trouble sleeping, either due to sleep disorders such as insomnia and nightmares, or from other factors such as erratic bedtime hours and anxiety. While noting that the study was "far from perfect," Carl Bazil, MD, a neurologist and director of the division of epilepsy and sleep at New York Presbyterian/Columbia University Medical Center in New York City, said “It's a first step in emphasizing that sleep in children is something that's important, not only to prevent them from being sleepy but to make sure that they learn. I think this study will help raise awareness that sleep is particularly important in children." Read more on pediatrics.

Kids’ Chronic Stomach Pain Could Be Sign of Anxiety Disorder
Kids with chronic stomach pain without a clear medical explanation— such as inflammatory bowel disease or celiac disorder—are more likely to suffer from an anxiety disorder, according to a new study in the journal Pediatrics. Previous research indicates as many as one in four youth have what is known as functional abdominal pain. Lynn Walker, from the Vanderbilt University School of Medicine in Nashville, Tenn., and researchers found that about 51 percent of people with stomach pain as children had experienced an anxiety disorder and 30 percent at the present met the diagnostic criteria for a diagnosis; only 20 percent of people without stomach pain had experienced an anxiety disorder and 12 percent currently had one. In addition to helping identify present and later anxiety disorders, knowing and treating the issue is also critical for kids because of how the chronic pain can impact their lives and education. "It's very prevalent, and it's one of the most common reasons that children and adolescents end up in their pediatrician's office. It's one of the most common reasons kids are missing school," said Eva Szigethy, MD, head of the Medical Coping Clinic at the Children's Hospital of Pittsburgh Inflammatory Bowel Disease Center. Read more on pediatrics.

Study: Genetic Overlap in Common Mental Disorders
A shared, common inherited genetic variation was seen in an analysis of five major mental disorders, which could ultimately help improve the classification and treatment of the disorders, according to a new study in the journal Nature Genetics. The greatest overlap was between schizophrenia and bipolar disorder with about 15 percent, followed by bipolar disorder and depression with about 10 percent; attention-deficit/hyperactivity disorder and depression with about 10 percent; and schizophrenia and autism with about 3 percent. Researchers noted that as they only looked at common gene variants, the actually genetic overlap could be much greater. "Such evidence quantifying shared genetic risk factors among traditional psychiatric diagnoses will help us move toward classification that will be more faithful to nature," said Bruce Cuthbert, director of the U.S. National Institute of Mental Health's (NIMH) adult translational research and treatment development division, as well as coordinator of an NIMH project to develop a mental disorders classification system for research based more on underlying causes. Read more on mental health.

FDA: Nationwide Voluntary Recall of Drug to Treat Low Calcium
The U.S. Food and Drug Administration has announced a nationwide voluntary recall of all products for sterile use manufactured by Specialty Compounding, LLC, of Cedar Park, Texas, related to possible bacterial bloodstream infections due to calcium gluconate infusions. The drug, which is used to treat low calcium levels, has been linked to 15 infections in two Texas hospitals. Facilities, health care providers and patients who have received the products after May9 should immediately quarantine them and return them to the manufacturer. The products were shipped to patients, hospitals and physicians’ offices, depending on the area of the country. “The FDA believes that use of these products would create an unacceptable risk for patients," said Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research. "Giving a patient a contaminated injectable drug could result in a life-threatening infection.” Read more on infectious disease.

MERS Unlikely to Cause Pandemic; Global Cooperation Still Needed
Middle East respiratory syndrome (MERS), which emerged last year in Saudi Arabia, was compared to severe acute respiratory syndrome (SARS) and found to be less infectious, in a new study published in The Lancet Infectious Diseases. The study examined the question of whether MERS has the potential to cause a pandemic, and how quickly. The study authors concluded that MERS does not yet have pandemic potential, and in fact appears to be less infectious than SARS. There have been 81 laboratory-confirmed cases of MERS infections, 45 of which were fatal. MERS is more likely to affect older men with chronic disease, and were most often transmitted in health care settings—but unlike SARS, the virus was less likely to also infect healthy health care workers. Researchers call for healthcare facilities to prepare to provide safe care for patients with acute respiratory infections, and take measures to help prevent the spread of the disease. Read more on infectious disease.

CDC: HPV Vaccination Rates for Adolescent Girls Remain Stagnant
Just over half (53.8%) of girls age 13-17 years old received the human papilloma virus (HPV) vaccine in 2012, with no increase over the rate in 2011. Since 2006, the Advisory Committee on Immunization Practices has recommended routine vaccination of adolescent girls at ages 11 or 12 years with 3 doses of HPV vaccine. HPV causes 70 percent of cervical cancers. If HPV vaccine had been offered during healthcare visits when girls were already in the office to get a different vaccine, HPV vaccination coverage could have reached 90 percent. Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million will become newly infected each year. Each year, 26,000 new cases of cancer are diagnosed that can be traced back to HPV infection. Read more on vaccines.

New Breathalyzer-like Device Tells You If Your Workout is Working
New technology being prototyped in Japan measures how well you're burning body fat and help you gauge the success of your diet and exercise program, using a smartphone and pocket-sized, bluetooth enabled device. The device measures exhaled breath for acetone, a metabolite produced from fat burning. The researchers tested the device in 17 healthy men and women, reporting their findings online July 25 in the Journal of Breath Research, and finding that the device was as effective as more established "gold standard" measures. Further research is needed on larger, more diverse populations, but if it pans out, "Enabling users to monitor the state of fat burning could play a pivotal role in daily diet management," Hiyama said in a journal news release. Read more on technology.

FDA Invites Public Comment on Menthol Cigarettes
The U.S. Food and Drug Administration (FDA) is taking a closer look at menthol cigarettes. The health agency issued an Advance Notice of Proposed Rulemaking (ANPRM) to gather more information to guide potential regulatory options, such as setting new tobacco standards. The ANPRM is available for public comment for 60 days. “Menthol cigarettes raise critical public health questions,” said FDA Commissioner Margaret A. Hamburg, MD. “The FDA is committed to a science-based approach that addresses the public health issues raised by menthol cigarettes, and public input will help us make more informed decisions about how best to tackle this important issue moving forward.” About 30 percent of U.S. adult smokers and about 40 percent of youth smokers use menthol cigarettes, according to the FDA. Read more on tobacco.

Skipping Breakfast, Increased Risk for Heart Disease Linked in Men
Skipping breakfast is linked to a dramatic increase in the risk for heart disease in men, according to a new study in the journal Circulation. Researchers found that the men who miss the morning meal are more likely to gain weight, develop diabetes and have hypertension. That all adds up to a 27 percent higher risk of heart attack or heart disease. Possible reasons include a likelihood to “feast” on higher calorie meals later in the day or that fact that the breakfast food skipped includes, on average, healthier types of food that lower the risk for heart disease.  "We've focused so much on the quality of food and what kind of diet everyone should be eating, and we don't talk as often on the manner of eating," said Suzanne Steinbaum, MD, a preventive cardiologist at Lenox Hill Hospital in New York City. "This study is not even discussing the type of food. It's just talking about behavior and lifestyle choice. Part of heart-healthy living is eating breakfast because that prevents you from doing a lot of other unhealthy things." Read more on heart health.

CDC Investigating Multi-state Intestinal Infection; 200 Sick so Far
The U.S. Centers for Disease Control and Prevention (CDC) is looking into a multi-state outbreak of cyclosporiasis, an intestinal infection that can cause watery diarrhea, vomiting and body ache, as well as headache, fever, weight loss and fatigue. CDC has identified more than 200 cases in states including Iowa, Nebraska, Texas and Wisconsin. The agency has yet to identify a cause. If left untreated it can last for up to a month; most immune systems can handle the infection without treatment, but older adults and people with weakened immune systems are at increased risk. Read more on infectious disease.

Zachary Thompson, director of Dallas County Department of Health and Human Services, greeted the 1,000-plus attendees at last week’s annual conference of the National Association of County and City Health Officials (NACCHO) and expressed how honored he was to meet so many local health department leaders from across the country.

NewPublicHealth spoke with Thompson about Dallas’ particular health challenges and innovations the department has developed to help improve health in the community.

>>Read more NewPublicHealth coverage of the NACCHO Annual Meeting.

NewPublicHealth: Dallas ranks 67 out of 232 Texas counties in the County Health Rankings. What efforts are underway to help improve population health in the county?

Zachary Thompson: Dallas County is looking at various things, including adding more bike lanes and more parks where people can exercise. There’s a health assessment going on now to look at how all of the major stakeholders can come together to improve our health rankings. We have a great public health improvement work group that is working on ways to improve overall health in Dallas County.

NPH: West Nile virus was a major issue in Dallas last year. What are you doing this year to help keep the city safe?

Thompson: We had no deaths from West Nile virus in 2010 and 2011, then 20 deaths in 2012, which may have been a once-in-fifty-years event. Last year’s outbreak got everyone’s attention that West Nile virus is endemic in our community, and so we took the lessons learned and increased our resources.

We know what we improved on. We began to do year-round mosquito testing in 25 municipalities, and began meeting regularly with all the municipalities to assess their needs. Everyone has been on board with the overall integrated mosquito plan. So far this year we’ve had no human cases of West Nile virus. We definitely focused on preventive education—we started that earlier. We’ve also added additional ground-based truck spraying capabilities in the event that we needed to increase our spraying activity if we have a similar outbreak as last year. We have made insect repellent available for all senior citizens. Hopefully last year’s outbreak will have been a rare occurrence, but we’re prepared in any case.