Category Archives: Flu
AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:
- Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
- Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
- Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
- Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
- Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
- Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.
Read more on prevention.
New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.
The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.
Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.
The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.
Interactive Map Helps Communities Prepare for Peaks in Flu Cases
Flu season for most of the country should peak in January, according to a new website that utilizes modern weather prediction technology to turn real-time influenza estimates into 94 local forecasts of future flu activity. The website was developed by infectious disease experts at Columbia’s Mailman School of Public Health. By predicting when areas are likely to see the highest incidence of flu cases, public health officials can better manage medicine and other supplies.
The website features:
- Interactive U.S. map that displays the relative severity of seasonal flu in cities across the country flu and incidence numbers for each
- Influenza incidence predictions by city for the coming weeks
- Map that illustrates the proportion of flu cases by region
- Charts that compare the timing and severity of the four most recent flu seasons
- Exportable data for each week of the flu season (beginning in 9/29 for the 2013-2014 season)
Read more on influenza.
Minority Children Less Likely to Be in Car, Booster Seats Properly
Minority children are less likely than white children to be put into car seats and booster seats as recommended, according to a new study in the journal Pediatrics. Potential reasons for the disparity include both access to resources and social norms. "We expected that differences in family income, parental education, and sources of information would explain the racial disparities in age-appropriate restraint use and they did not," lead author Michelle L. Macy, MD, according to Reuters. According to a survey of 600 parents with kids ages one to 12, among four- to seven-year-olds, twice as many non-white kids sat in the front seat as white kids; 10 percent of the kids in that age group overall had sat in the front seat. The study also found that 3 percent of kids under age four and 34 percent ages eight to 12 had sat in the front seat, although there were no differences based on race for these groups. Read more on safety.
Study: Access to Firearms Increases Risk of Suicide and Homicide
A person with access to a gun is three times more likely to commit suicide and about twice as likely to be murdered than someone without such access, according to a new study in the journal Annals of Internal Medicine. Researchers analyzed 15 previous gun studies—13 from the United States—looking at intentional acts of violence. They also adjusted the past studies for the likelihood of mental illness. "If you have a firearm readily available and something bad has happened to you, you might make a rash, impulsive decision that will have a bad outcome," said lead author Andrew Anglemyer, a specialist in study design and data analytics in clinical pharmacy and global health sciences at the University of California, San Francisco. "These are just normal gun owners, and we are seeing that gun owners are making very bad, impulsive decisions." Each year the United States sees approximately 31,000 deaths due to firearms. Read more on violence.
TFAH: Not Enough Americans are Getting the Flu Vaccine
Only a little more than a third of U.S. adults ages 18-64 got their flu shot last season, according to a new analysis by the Trust for America’s Health (TFAH). The report also found that 66.2 percent of adults ages 65 and older and 56.6 percent of children ages 6 months to 17 years were vaccinated. The U.S. Centers for Disease Control and Prevention (CDC) recommends that all American above the age of 6 months be vaccinated each year. “The trend of low vaccination rates among younger adults is particularly troubling this year, when they are more at risk than usual for the effects of the H1N1 strain of flu that’s circulating,” said Jeffrey Levi, PhD, executive director of TFAH. The overall vaccination rate came out approximately 45 percent for the 2012-13 flu season, which while still far short of CDC goals surpassed the previous season’s overall rate of 41.8 percent. Read more on influenza.
FDA: New Regulations on Acetaminophen to Help Curb Liver Toxicity
The U.S. Food and Drug Administration (FDA) is making changes to regulations on acetaminophen to help combat the dangers of liver toxicity, calling for manufacturers of prescription combination products to limit the amount of acetaminophen to no more than 325 milligrams in each tablet or capsule, as well as update the labels on those drugs to warn about the potential risk for severe liver injury. Acetaminophen is found in opioids such as codeine (Tylenol with Codeine), oxycodone (Percocet), and hydrocodone (Vicodin). “FDA is taking this action to make prescription combination pain medications containing acetaminophen safer for patients to use,” said Sandra Kweder, MD, deputy director of the Office of New Drugs in FDA’s Center for Drug Evaluation and Research. “Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the United States; many of which result in liver transplant or death.” Read more on prescription drugs.
Study: Specialized School Health Programs Also Improve Healthy Behaviors at Home
Broad school health programs can improve children’s health and healthy behaviors at both school and in the home, according to a new study in the journal Pediatrics. Researchers tailored programs for the specific needs of individual elementary schools in ten disadvantaged neighborhoods in Edmonton, with activities such as yoga and dance classes, and then tracked their activity compared to kids at schools without the programs. They found that students with the health programs increased their average daily steps during a typical week by 21 percent, compared to 7 percent for the kids without the programs. "It shows that if you deliver a school program well, kids not only will be active more during the school hours when they are in the hands of the teachers but they're also being trained and understand that it's important to be physically active at other times," said Paul J. Veugelers, who worked on the study at the University of Alberta's School of Public Health in Edmonton. Read more on physical activity.
HHS Moves to Strengthen Federal Background Checks for Gun Ownership
The U.S. Department of Health and Human Services (HHS) is taking steps to strengthen the federal background check system for the purchase of firearms by removing legal barriers under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule that could stop states from reporting information to the National Instant Criminal Background Check System (NICS). The NICS is designed to ensure that felons, people convicted of domestic violence and people involuntarily committed to a mental institution cannot purchase firearms. A 2012 Government Accountability Office report found that 17 states had submitted fewer than 10 records of people prohibited from owning a firearm for mental health reasons. “There is a strong public safety need for this information to be accessible to the NICS, and some states are currently under-reporting or not reporting certain information to the NICS at all,” said HHS Secretary Kathleen Sebelius. “This proposed rulemaking is carefully balanced to protect and preserve individuals’ privacy interests, the patient-provider relationship, and the public’s health and safety.” Read more on mental health.
CDC: ‘Widespread’ Flu Activity in Almost Half of the Country
Half of the 50 U.S. states are already reporting influenza cases this season, according to the U.S. Centers for Disease Control and Prevention (CDC). The majority of the cases have been attributed to the H1N1 virus, which killed an estimated 284,000 people across 74 countries in 2009-2010. Almost half of the country has also classified flu activity as “widespread” this season. Texas, which on December 20 issued an “influenza health alert,” has already seen 25 deaths, according to health officials. "We are seeing a big uptick in disease in the past couple of weeks. The virus is all around the United States right now," said Joe Bresee, MD, chief of Epidemiology and Prevention in the CDC's Influenza Division, adding, "There is still a lot of season to come. If folks haven't been vaccinated, we recommend they do it now.” Read more on influenza.
Slower Eating Leads to Fewer Calories
Normal-weight individuals looking for methods to maintain their healthy weight should consider simply eating slower, according to a new study in the Journal of the Academy of Nutrition and Dietetics. Researchers found that both normal-weight and obese or overweight people who ate at relaxed, slow-speed conditions reported feeling less hungry afterward than they did after eating fast-paced meals. However, only the normal-weight study participants consumed “significantly” fewer calories during the slower meals, according to the researchers: 88 fewer calories, compared to 58 fewer calories for obese or overweight participants. Study author Meena Shah, a professor in the department of kinesiology at Texas Christian University, in Fort Worth, said one explanation for the findings could be that “slower eating allows people to better sense their feelings of hunger and fullness.” Read more on obesity.
More Than One Million People Now Enrolled for Health Insurance Coverage under the Affordable Care Act
The Centers for Medicare and Medicaid Services (CMS), which administers the health insurance provisions of the Affordable Care Act (ACA) reported late last week that more than one million people have now enrolled for coverage under the ACA.
CMS also reported that December enrollment as of December 27 was seven times that of October and November. Open enrollment will continue through March, with rolling dates for first day of coverage. Read more on the Affordable Care Act.
U.S. Flu Cases on the Rise
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported last week that rates of flu are on the rise in the United States, with the 2009 H1N1 virus the predominant strain. The good news is that this year’s flu vaccine is protective against H1N1.
According to CIDRAP, officials from the Centers for Disease Control and Prevention have said that the 2009 H1N1 virus has a greater impact on younger adults and older children than seasonal flu strains typically do.
The numbers of U.S. flu cases are usually highest January through March, which means that people who have not had flu shots yet still have time to protect themselves. Full immunity from the vaccine can take up to two weeks from the time of the injection. Use the CDC’s Flu Vaccine Finder to find a flu shot in your neighborhood. Read more on outbreaks.
New Orleans Health Commissioner to become Federal Health IT Administrator
New Orleans Health Commissioner Karen DeSalvo, MD, has been appointed the new National Coordinator for Health Information Technology (IT), replacing Farzad Mostashari, who left the position earlier this year. In a memo to employees of the U.S. Department of Health and Human Services (HHS), which oversees the office of the National Coordinator, HHS Secretary Kathleen Sebelius noted that Dr. DeSalvo boosted the use of health IT as "a cornerstone of [New Orleans’s] primary care efforts and a key part of the city's policy development, public health initiatives and emergency preparedness." Dr. DeSalvo will begin her post in mid-January. Under Dr. DeSalvo's leadership, New Orleans also received the inaugural Robert Wood Johnson Foundation Roadmaps to Health Prize.
For “Outbreak Week” we’ve already covered the deadliest pandemics in human history. But which outbreaks could be around the corner? Outbreaks: Protecting Americans from Infectious Diseases, 2013, the new report from Trust for America’s Health and the Robert Wood Johnson Foundation, lays out a few possibilities on which infectious diseases may pose the more serious threats in the future. Here are the greatest threats to the United States, according to Tom Inglesby, MD, Chief Executive Officer and Director of the UPMC Center for Health Security.
Middle East Respiratory Syndrome (MERS)
Spread across 12 countries, the virus has killed almost 40 percent of the people it’s infected. And while it may currently be confined to one region of the world, the high level of air travel between the Middle East and the United States increase the chance that it could find its way into the country, according to Inglesby, who said “we still don’t have a good handle on how it spreads, and there is no treatment for it or vaccine against it.”
Novel influenza virus
A new flu strain that, like the seasonal flu, is far reaching, but which would have a “far higher mortality rate.” Recent examples of major flu pandemics include the 2009 H1N1 outbreak; recent studies indicate the swine flu may have killed more than 200,000 people. The new H7N9 is also notable because of its high mortality rate.
Accident involving a lethal engineered virus
With scientists experimenting on viruses — enhancing their lethality or ability to spread — the risk grows of an accident releasing an engineered virus into the population.
It’s the most common infectious disease in the world and drug-resistant strains are only making the matter worse. “The level of drug resistance is growing and coping with this needs to be a real priority,” said Inglesby.
Not a pathogen, but a reason why pathogens could become even more dangerous. The U.S. Food and Drug Administration is taking steps to combat this growing issue, including new regulations on antimicrobial use in food animals and new restrictions on antibacterial soaps.
Deliberate biological threats
A biological attack, whether from another nation or as a terrorist act, could cause not only severe illness and death, but also communication problems that would hinder the ability of public health departments to respond.
Climate change is making this already existing problem even greater—with the regional climate shifts, places that haven’t had to deal with mosquito-based threats are now seeing them swarm in because of the warmer weather. Notable examples include the West Nile Virus and Dengue Fever. “We need to reinvigorate our strategy for mosquito control and the infectious diseases that come with mosquitoes.
Severe Flu-Like Illness Under Investigation in Texas
Health officials in Montgomery County, Texas, are investigating an outbreak of an influenza-like illness that has so far resulted in eight hospitalizations, with four of those patients having since died. Recent tests on the other four show that one seems to have the 2009 H1N1 influenza virus, two were negative for all flu viruses and results are so far unknown on the fourth patient. Close to 2,000 cases of the illness have been reported. So far the investigation suggests that none of the patients who died had been vaccinated against flu, and county residents who have not yet had the flu shot are being urged to get one. According to the county’s health director, the hospitalized patients range in age from 41 to 65, which is not typical; severe flu symptoms more likely occur in very young or very old patients. The U.S. Centers for Disease Control and Prevention (CDC) is assisting the health department in investigating the outbreak, and the county has established a telephone hotline and Facebook page to respond to questions from the public. According to news reports, the current outbreak resembles a cluster of severe respiratory infections in Dothan, Ala., in May; however tests showed that those hospitalized patients had a variety of common respiratory viruses and bacteria, with no unusual pathogens. Read more on flu.
CDC Issues Travel Advisory in Caribbean
The U.S. Centers for Disease Control and Prevention (CDC) has issued a travel health notice because of recent cases of chikungunya on the Caribbean island of St. Martin, which have been confirmed by the World Health Organization. According to the CDC, chikungunya is a very serious illness caused by a virus that spreads through mosquito bites. The most common symptoms are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. The mosquito that carries chikungunya virus can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas. There is currently no vaccine or medicine to prevent chikungunya. Travelers can protect themselves by following CDC recommendations on preventing mosquito bites. "Microbes know no boundaries, and the appearance of chikungunya virus in the Western hemisphere represents another threat to health security," said CDC Director Tom Frieden, MD, MPH, in the release. "CDC experts have predicted and prepared for its arrival for several years and there are surveillance systems in place to help us track it." Read more on infectious disease.
Life Expectancy Increases among Treated HIV-Positive People in North America
A new study in the journal PLOS ONE finds that a 20-year-old HIV-positive adult on antiretroviral therapy (ART) in the U.S. or Canada may be expected to live into their early 70's, a life expectancy approaching that of the general population. Researchers calculated the life expectancies of nearly 23,000 individuals on ART based on mortality rates in the early to mid-2000s. Changes in life expectancy from 2000-2007 among HIV-positive individuals were then evaluated using sociodemographic and clinical characteristics, such as drug use history and immune cell counts. The researchers found that life expectancy at age 20 increased from 36.1 to 51.4 years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007). Life expectancy was lower for individuals with a history of injection drug use, those who were non-white, and those who initiated ART with low CD4 count (a count of cells that activate the immune response) compared to those who started at a higher count. Read more on HIV.
“Outbreak” is a relative word. A modern outbreak could be a virus that kills a couple hundred thousand (such as the recent swine flu), or simply an infected shipment of food that left dozens sick. However, a look back through history reveals outbreaks so expansive—so deadly—that they essentially changed the course of history. Below are the five deadliest outbreaks and pandemics in history.
Ask yourself—are we prepared as a nation for the next big outbreak?
(Image source: WikiCommons)
A plague so devastating that simply saying “The Plague” will immediately pull it to the front of your mind, in the middle of the 14th century—from 1347 to 1351—the Black Death remade the landscape of Europe and the world. In a time when the global population was an estimated 450 million, at least 75 million are believed to have perished throughout the pandemic, with some estimates as high as 200 million. As much as half of Europe may have died in a span of only four years. The plague’s name comes from the black skin spots on the sailors who travelled the Silk Road and docked in a Sicilian port, bringing with them from their Asian voyage the devastating disease, now known to be bubonic plague.
New reports from the U.S. Centers for Disease Control and Prevention (CDC) show that 39 percent of adults and 41 percent of children six months and older got their flu shots for the 2013-2014 season by early November—a rate similar to flu vaccination coverage last season at the same time.
Other flu shot statistics of note this year include:
- Vaccination among pregnant women (41 percent) and health care providers (63 percent) is about the same as it was this time last year
- High rates were seen again this year among health care providers including pharmacists (90 percent), physicians (84 percent) and nurses (79 percent), but the CDC reported much lower vaccination rates among assistants or aides (49 percent) and health care providers working in long-term care facilities (53 percent)
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” says Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at CDC. “The bottom line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”
Seasonal influenza activity is increasing in parts of the United States. Further increases in influenza activity across the country are expected in the coming weeks. “If you have not gotten your flu vaccine yet this season, you should get one now,” said Schuchat.
The CDC’s report comes just ahead of the observance next week of National Influenza Vaccination Week (NIVW), which is scheduled each year for the second week in December because vaccination rates tend to fall off toward the end of November. It’s hardly too late to get the flu vaccine: flu season usually peaks January through March, and the virus—and the potential to catch it—often lasts as late as May.
People who haven’t had the flu shot should make it a priority to do so as soon as possible for at least two reasons. One, providers tend to return their unused vaccines toward the end of the year, which can make it hard to find a vaccine if you still need the shot (check this flu vaccine finder for providers in your area, and call ahead to be sure they have supplies on hand). Two, it takes two weeks for the flu vaccine to take full effect, so the sooner you get it the more protected you are against people harboring the flu during the upcoming holiday party season.
Still on the sidelines about getting the shot? The CDC has some impressive numbers from last year’s flu season: flu vaccination prevented an estimated 6.6 million influenza-associated illnesses and 79,000 hospitalizations during the 2012-2013 flu season.
>>Bonus Links: Learn more about preventing and treating influenza on NewPublicHealth.
>>Bonus Content: CDC's infographic on the benefits of the flu vaccine (full size PDF).
The flu season is pretty mild so far. The latest FluView report from the U.S. Centers for Disease Control and Prevention (CDC) shows that the current rate of flu cases across the country is below other years, and some states have yet to see any flu cases at all. But health experts worry those reports will make people who still haven’t gotten the vaccine complacent about getting their shot. And going without poses the risk of a multi-day illness; transmitting the flu to other people who may be more vulnerable to the virus than you; and the potential for serious side effects such as pneumonia and—in rare cases—death.
If you’re still shotless, health experts advise you to roll up your sleeves by Wednesday if at all possible. Here’s why: Immunity to the flu can take up to two weeks after you’ve received the injection. Get the shot by this Wednesday, November 13, and you’ll be protected by the day before Thanksgiving.
That’s the heaviest U.S. travel day of the year, when the possibility of encountering people with the flu at airports, train stations, or even at Thanksgiving dinner greatly increases.
“Visiting mom, grandma and that new baby can make for memorable holiday moments, as long as you don't bring the flu virus along to spoil the party,” says Jeff Golden, spokesman for the Madison, Wisc., health department which, like many other health departments, has sent out recent flu advisories.
CDC research adds another reason to get the shot this week. The agency has found that the momentum to get the flu vaccine wanes after Thanksgiving, perhaps because people assume that as the weather gets colder, if they haven't gotten influenza yet, they won’t. But that’s foolhardy thinking. The U.S. flu season runs from September through April, and the worst of it often hits in January and February. If you wait until cases increase, you may find that you don’t have enough time for the shot to protect you. And you may also find it hard to locate supplies of the vaccine. Knowing that interest in the shot drops after Thanksgiving, private and public clinics, as well as doctors’ offices, often return unused supplies toward the end of the year to free up storage space and in some cases get a refund on the unused doses. Health departments may then keep supplies centrally, but that location may not be convenient.
Wonder where to get the flu shot? Here are good ideas:
- Key in your zip code at flu.gov
- Dial 211, a resource for local services in many communities
- Check pharmacies to see if they have supplies on hand and what hours they give the shots
- Call your local health department to ask if they have clinic hours for the flu vaccination
- Key in “travel clinic” on a search engine to find private clinics in business districts, but call ahead to check on supplies and hours
Health departments may give the shot for free, or ask for payment on a sliding scale based on income. Pharmacies charge about $25, and private doctors’ offices may add a $10 or $20 administrative fee on top of that. The cost is typically covered by insurance, though you may have to file the paperwork yourself.