Category Archives: Infectious disease
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.
Outbreaks can spread faster than you think. But luckily the development of new digital tools and technologies to assist with documenting, tracking and alerting the public of the spread of infectious disease is progressing even more rapidly. There are new databases, maps and communications technologies that make tracking down an outbreak and getting it under control a much quicker and more efficient process. Digital developments focusing on emergency preparedness and response can help protect more of the population from the next pandemic.
We’ve brought together a few examples of how the digital world is working to improve emergency response:
- At the University of Pittsburgh School of Public Health, a new initiative called Project Tycho is working to convert 125 years worth of data from paper documents into an open-access database. Project Tycho will save researchers around the world the time of finding reliable historical data from different sources for infectious diseases, which is critical to understanding underlying epidemic dynamics, according to Dr. Willem van Panhuis, an assistant professor of epidemiology at University of Pittsburgh School of Public Health.
- The Advanced Molecular Detection Initiative proposed in the President’s 2014 Budget could help make huge strides in controlling infectious disease. The initiative would bring together experts in laboratory science, epidemiology and bioinformatics to join forces like never before. By using genetic sequencing to examine infectious pathogens, these technologies are on the verge of revolutionizing medical professionals’ abilities to diagnose infectious diseases; investigate and control outbreaks; understand transmission patterns; develop and target vaccines; and determine antimicrobial resistance—all with increased timeliness and accuracy and decreased costs.
- Social media and crowdsourcing technologies have helped medical professionals develop tools to track the spread of disease and where outbreaks are occurring and even make the data available to the general public. HealthMap is one of the original examples of using digital technologies to track outbreaks while keeping the public informed.
- In efforts to spread the skills needed to deal with public health issues such as outbreaks, the CDC has made learning more fun through games such and applications such as CDCology and Solve the Outbreak for the iPad. CDCology is a pilot program through the CDC and supported by HHSIgnite (beta). The pilot website uses CDC staff-created, student-solved, virtual microtasks to tackle public health challenges at CDC. As they complete the short microtasks, the students gain valuable educational experience, insight and exposure to the field of public health. Solve the Outbreak puts you in the shoes of a member of the Epidemic Intelligence Service. Playing the game presents the opportunities to use clues, analyze data, solve the scenario and save lives in this virtual world, but also helps teach the public more about the process behind handling a real outbreak.
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.
Picture this: The world just ended. Well, not completely. But things aren’t looking up. An influenza strain has cut a deadly swath through nearly every continent. Or maybe the Black Death is making a special encore appearance. Or your now-undead neighbor—Phil, normally a great guy, invited you to a dinner party just last week—is shuffling around the front yard, trying to gnaw on your brains.
The point is it’s time for action. And since we’re talking theoretical, we might as well be talking fictional, too. Below is NewPublicHealth’s “Outbreak Dream Team”—pop culture characters with the diverse skills we’d need to respond to and cure a deadly epidemic. And maybe a dose of what’s really needed in the way of a public health workforce to keep us ready for whatever could happen next.
- In a nationwide (or global) public health emergency such as a pandemic, the President has to step up and provide leadership among different sectors and divisions of the government to coordinate a response and assure the nation of a secure path forward.
Laura Roslin, “Battlestar Galactica”
As a former Secretary of Education she has experience working with large groups with disparate goals. (Plus, she gets that education impacts health in so many ways). And as president of the roughly 50,000 humans left alive after a Cylon invasion wiped nearly everyone out, she’s adept at balancing public policy needs, working with everyone from public advocates to top military leaders. Some of her decisions are more-than-a-bit iffy, but you try pleasing everyone all the time when the last vestiges of humanity are spread across a fleet of ships drifting through space.
National Public Health Lead
- Equivalent to the Director of the U.S. Centers for Disease Control and Prevention (CDC). The CDC safeguards the nation’s health by preparing for, detecting, rapidly responding to and preventing health threats 24/7 to save lives and protect communities. The director’s job is to make sure that happens.
Ann Perkins, “Parks & Recreation”
As a practicing public health nurse and the PR Director of Pawnee's Health Department, Ann Perkins has dealt with infectious disease control from a hospital, a government and even a girlfriend perspective. Smart and determined, this go-getter can not only treat the symptoms of infectious diseases, she can detect and track them, coordinate response, and educate the community—all while maintaining a confident, calm and collected public face. While Leslie Knope leads the town through the city council, Ann has the potential to lead diverse teams and bridge health and health care to coordinate a swift and decisive response. If she can take on Pawnee's obesity epidemic one candy company at a time and teach sex ed to senior citizens, she can certainly handle a national outbreak or two. Plus, she gets bonus points for being (probably) the only true public health character on television.
The pop culture craze of zombie apocalypse films, televisions shows and books penetrated deeper than many might have expected—even the U.S. Center for Disease Control and Prevention (CDC) weighed in on the cultural phenomenon, with a 2011 blog post on preparing for a real zombie apocalypse. The post covers everything from the history of zombie outbreaks to how to assemble an emergency supply kit should one of these possible apocalyptic zombie scenarios play out in your community.
At the time, NewPublicHealth spoke with the CDC’s Dave Daigle, who dreamed up the zombie post. The CDC campaign was crafted to help spread information on emergency preparedness for the upcoming hurricane season, while the zombie cover was designed both to attract a younger demographic and to offer an off-kilter slant that would make people pay attention. The post contains strong recommendations to help people prepare for many types of emergencies, from natural disasters to disease outbreaks—for example, your supply kit should include water, food, medications, important documents, and so on. The CDC was able to reach an even larger audience by packaging this valuable information in a playful nod to the fantastical fears that a zombie outbreak could actually happen.
Among the tips from the CDC’s Preparedness 101: Zombie Apocalypse: "Plan your evacuation route. When zombies are hungry they won’t stop until they get food (i.e., brains), which means you need to get out of town fast!"
Once the post went live, the staff sat back while it was tweeted, retweeted, Facebooked, commented on and reported on by a growing list of mainstream print and online publications. The result was an overwhelming success:
- The initial tweet received 70,426 clicks
- “CDC” and “Zombie Apocalypse” trended worldwide on Twitter
- The CDC Emergency Facebook page gained more than 7,000 fans within the first month of its launch
- There were more than 3,000 articles, broadcasts and other media coverage of the blog
- The messages received an estimated 3.6 billion impressions with a marketing worth of $3.4 million—and all for a campaign that cost $87.00
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.
When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.
Well, maybe not all of them...
As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.
World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.
28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.
(Image source: WikiCommons, Sailko)
While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.
Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.
>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."
NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.
NPH: How are you able to detect polio outbreaks?
Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.
NPH: Why is there insufficient vaccination in those countries?
Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.
Youth Smoking Rates Reach Record Lows in 2013
Overall youth smoking declined significantly in 2013, and smoking rates fell to record lows for all three grades surveyed (grades 8, 10 and 12), according to the Monitoring the Future survey released annually by the National Institute on Drug Abuse and conducted by researchers at the University of Michigan’s Institute for Social Research. For all three grades combined, the percentage of students who reported smoking cigarettes in the past month fell from 10.6 percent in 2012 to 9.6 percent in 2013. The data is based on annual surveys of 40,000 to 50,000 students in about 400 different secondary schools. Read more on tobacco.
WHO and UNICEF Vaccinating Millions of Children in the Middle East Against Polio
The World Health Organization (WHO) and UNICEF are mounting the largest-ever immunization response in the Middle East, with a goal of vaccinating more than 23 million children against polio in Syria and neighboring countries over the next few weeks. The campaign is in response to an outbreak of polio in Syria, where 17 cases have so far been confirmed, and to the detection of the virus in sewage in other parts of the Middle East.
The campaign plans to vaccinate all children under age 5 in the targeted areas in the next few months, whether they are living at home or displaced by conflict. The vaccinations will be given at set sites or by workers going house to house, and the campaign will be carried out by national and local health authorities supported by UNICEF, WHO, the Syrian Arab Red Crescent and other partners. The total cost to UNICEF and WHO through April 2014 will be $39 million.
Prior to this outbreak, no polio cases have been recorded in Syria since 1999. The risk of spread to countries in the region and beyond is considered high, and health authorities from 21 countries have declared a public health emergency. Genetically-related polioviruses, which originated in Pakistan, were found in sewage samples in Egypt in December 2012 and in Israel in the West Bank and Gaza earlier in 2013. According to WHO, immunization activities have been significantly constrained in Syria in the past few months by the ongoing conflict, which has led to 500,000 to 700,000 children missing vaccinations.
Editor’s Note: NewPublicHealth also spoke with Sona Bari, WHO's senior communications officer, about the efforts underway to eradicate polio globally. The interview will run later today.
Read more on global health.
CDC Expects TB Test Shortage to Ease
Supplies of tuberculin skin tests are expected to return to normal in January, following shortages that health providers have been experiencing since 2012, according to the U.S. Centers for Disease Control and Prevention (CDC). Two tests are approved by the U.S. Food and Drug Administration to detect tuberculosis and diagnose active illness: Tubersol, made by Sanofi Pasteur Limited; and Aplisol, produced by JHP Pharmaceuticals, LLC. Shortages were first reported for Tubersol, which was out of production from late 2012 through April 2013, increasing the demand for Aplisol. In August, a CDC survey found 29 of 52 U.S. jurisdictions were reporting a shortage of at least one of the tests. Read more on the Centers for Disease Control and Prevention.
Epidemic of E. coli Infections Traced to One Strain of Bacteria
In the past decade, a single strain of E. coli, has become the main cause of bacterial infections in women and the elderly by invading the bladder and kidneys, according to a study published in the American Society for Microbiology's journal mBio. Besides becoming more resistant to antibiotics, the H30-Rx strain gained an unprecedented ability to spread from the urinary tract to the blood, leading to sepsis and posing a threat to the more than 10 million Americans who annually suffer from urinary tract infections. The study authors say the new findings could help trace the history of the “superbug” and possibly lead to the development of a vaccine. Read more on infectious disease.
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.