Category Archives: Global Health

May 5 2014
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Public Health News Roundup: May 5

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CDC Confirms First U.S. Case of MERS Virus
The U.S. Centers for Disease Control and Prevention (CDC) has confirmed the first U.S. case of MERS, a respiratory virus first identified in the Middle East two years ago. The virus was diagnosed in a U.S. patient who recently traveled from Saudi Arabia. The patient is being treated at a hospital in Indiana and people who traveled with the patient on an airplane from the Middle East are being contacted and told to see a doctor if respiratory symptoms develop. In some Middle Eastern countries, the virus has spread from person to person through close contact, but the CDC says there is no evidence of the sustained spread of the virus in general settings. "The virus has not shown the ability to spread easily in a community setting," said Ann Schuchat, MD, director of CDC's National Center for Immunization and Respiratory Diseases, during a telephone press conference on Friday.

"In this interconnected world we live in, we expected MERS to make its way to the United States....We have been preparing since 2012 for this possibility,” said Tom Frieden, MD, director of the CDC in a statement.

The CDC says that anyone who experiences respiratory illness within 12 weeks of traveling to Saudi Arabia, or becomes ill after contact with someone who recently traveled to Saudi Arabia, should contact their doctor. The CDC has not recommended that anyone change their travel plans based on the MERS virus. So far there have been 401 confirmed cases of the MERS virus in twelve countries, including the United States; 93 people have died of the virus. Camels have been identified as carriers of MERS, but it's not known how the virus is being spread to people. Read more on infectious disease.

WHO: World Polio Threat an ‘Extraordinary Event’ That Requires a Coordinated International Response
Despite the near cessation of the international spread of wild polio virus in the low transmission seasons (January to April) from January 2012 through 2013, a new report from the World Health Organization (WHO) finds that the current international spread of polio can now be considered an “extraordinary event.” WHO experts say the public health risk—the WHO Emergency Committee unanimously agreed that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met—requires a coordinated international response. So far in 2014 there has already been international spread of wild polio virus from 3 of the 10 States that are currently infected: in central Asia (from Pakistan to Afghanistan), in the Middle East (Syrian Arab Republic to Iraq) and in Central Africa (Cameroon to Equatorial Guinea). Pakistan, Cameroon and the Syrian Arab Republic pose the greatest risk in 2014, according to the WHO. Read more on global health.

Study: Even Outbreaks May Not Change the Minds of Parents Opposing Childhood Vaccines
Parents who choose not to have their children receive mandatory immunizations may not change their minds even in the face of outbreaks of childhood illnesses, according to a new study. Researchers studied a pertussis outbreak in Washington State from October 2011 through December 2012, finding “no significant increase” in the vaccination rates of approximately 80,000 infants ages 3 to 8 months, according to HealthDay. Paul Offit, MD, chief of the division of infectious diseases at the Children's Hospital of Philadelphia, said parents using “personal belief” exemptions to not have their children vaccinate is likely beyond the resurgence of diseases that were once all but eradicated in the United States. "The problem is not theoretical,” he said. "You are starting to see eroding of herd immunity with outbreaks of measles and pertussis. The main reason is people are choosing not to vaccinate their children. It's becoming a more dangerous world from the standpoint of infectious diseases. Measles and pertussis are back. These are serious diseases that before vaccine caused a lot of death.” Offit was not a part of the recent study. Read more on vaccines.

Apr 29 2014
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Public Health News Roundup: April 29

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Study: MERS Virus Outbreak Linked to Camels
New evidence strongly implicates camels as the carrier and cause of an ongoing outbreak of Middle East Respiratory Syndrome (MERS) that has infected 300 people and killed approximately 100 since the first documented case in Saudi Arabia in September 2012. According to a new study in the journal mBio, scientists at the Center for Infection and Immunity at Columbia University's Mailman School of Public Health, King Saud University, and EcoHealth Alliance have extracted a complete, live, infectious sample of MERS coronavirus from two Saudi Arabian camels. "The finding of infectious virus strengthens the argument that dromedary camels are reservoirs for MERS-CoV," says first author Thomas Briese, PhD, associate director of the Center for Infection and Immunity and associate professor of Epidemiology at the Mailman School, in a release. "The narrow range of MERS viruses in humans and a very broad range in camels may explain in part the why human disease is uncommon: because only a few genotypes are capable of cross species transmission.” Co-author Abdulaziz N. Alagaili, PhD, director of the Mammals Research Chair at King Saud University, added that the next step is “investigating potential routes for human infection through exposure to camel milk or meat products.” Read more on infectious disease.

This Friday RWJF to Discuss How to Make Sure Patients Are Getting the Right Care
As much as 30 percent of health care delivered in the United States is unnecessary, won’t help improve help or may even harm health, according to some health care experts. The Robert Wood Johnson Foundation’s (RWJF) Choosing Wisely effort has, for the past two years, worked to identify more than 250 tests and procedures that that physician groups say are overused in their own field. This Friday, May 2 from 12-1 p.m. ET, Susan Dentzer, senior policy adviser to RWJF, will lead a discussion with physicians and a patient about how to shift the cultural mindset from “more care is better” to “the right care, and no more. Go here to RSVP.

Study: As Many as 5.3M Americans Have Untreated Chronic Viral Hepatitis
Despite public health efforts over the past several years, untreated chronic viral hepatitis continues to be a serious problem, according to a new commentary being published in the Annals of Internal Medicine. The disease affects between 3.5 and 5.3 million Americans and contributes to the rise of incidences in progressive liver disease, liver failure and liver cancer. The U.S. Department of Health and Human Services (HHS) in 2011 unveiled the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis in the United States in order to advance both the prevention and treatment of viral hepatitis. The updated 2014-2016 HHS Viral Hepatitis Action Plan expands on the 2011 plan and will include additional metrics to help monitor the plan’s major goals. Read more on HHS.

Apr 7 2014
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Public Health News Roundup: April 7

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CDC Identifies Rare U.S. Case of Lassa Fever
A severe viral disease common in West Africa has been confirmed in a person returning to the United States from the region, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Minnesota Department of Health (MDH). The patient was admitted to a Minnesota hospital for Lassa fever on March 31, with the CDC confirming diagnosis on April 3 and the patient now recovering and in stable condition. The last case of Lassa fever in the United States, of which there have been seven confirmed and all related to travel, was in Pennsylvania in 2010. The virus is not transmitted through direct contact with a sick person’s blood of bodily fluids and cannot by transmitted by casual contact; there are up to 300,000 cases and 5,000 deaths each year in West Africa. “This imported case is a reminder that we are all connected by international travel. A disease anywhere can appear anywhere else in the world within hours,” said CDC Director Tom Frieden, MD, MPH. Read more on infectious disease.

Public Health Officials in Developing Countries Use Social Marketing to Promote Health Behaviors
Public health officials in developing countries are successfully using social marketing strategies to educate people about the importance of behaviors related to water and sanitation, according to a new study in the journal Social Science & Medicine. In a systematic review of 32 studies, researchers led by W. Douglas Evans, PhD, a professor of prevention and community health at Milken Institute School of Public Health at the George Washington University, looked at how public health officials utilized social marketing tools such as door-to-door visits and public education campaigns for school children to promote behaviors such as regular hand washing and water purification. Read more on global health.

Depression, Anxiety Linked to Poor Diabetes Management
Depression and anxiety can be significant impediments to proper management of diabetes, according to a new study in the journal BioMed Central. Researchers from The University of Texas School of Public Health examined 500 Mexican-American adults from the Cameron County Hispanic Cohort in Brownsville, Texas, each of whom had been diagnosed diabetes and were taking medication for diabetes. Each t was interviewed about symptoms of depression and anxiety, and researchers also took measurements for body mass index (BMI), waist circumference, physical activity, fasting glucose and average blood sugar levels over time. “Unfortunately, greater depression and anxiety are associated with higher BMI and greater waist circumference, both indicators of obesity, as well as engaging in less physical activity and having less favorable indicators of glycemic control,” said Darla Kendzor, PhD, principal investigator and assistant professor at the School of Public Health Dallas Regional Campus, part of The University of Texas Health Science Center at Houston. Eighty one percent of Mexican-Americans are obese or overweight nationwide, with a nationwide diabetes rate of 16.3 that climbs to 30 percent for those who live along the U.S.-Mexico border. Read more on obesity.

Mar 24 2014
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‘We Cannot Choose the Air We Breathe’: Q&A with Jezza Neumann

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Tomorrow, March 25, the day after World Tuberculosis Day, the Public Broadcasting Program Frontline will present TB Silent Killer a new documentary that looks at tuberculosis in Swaziland, the country with the highest incidence of the disease.

While many people, especially in the United States, think tuberculosis has long since been eradicated, there are in fact more than 8 million new infections every year, many of them virulent new drug-resistant strains that are passed—throughout the world—through a cough or a sneeze. According to the World Health Organization, tuberculosis has become the second-leading cause of death from an infectious disease on the planet.

Jezza Neumann, the filmmaker who created TB Silent Killer, tells the story of several people in Swaziland suffering daily from the disease, including ten-year-old Nokubegha, whose mother recently died of a multidrug resistant strain of tuberculosis and whose 17-year-old brother cares for her.

“In Swaziland, a quarter of all adults are HIV-positive, which means their immune systems are compromised and especially susceptible to TB infection,” said Neumann, “But globalization and international travel mean that these infections have the potential to spread all over the world.”

NewPublicHealth spoke by phone with Jezza Neumann a few days before the documentary was scheduled to air on Frontline (Check local PBS schedules here.)

NewPublicHealth: Why did you choose tuberculosis as your topic?

Jezza Neumann: The idea being to make films that make a difference and give voice to the voiceless. In doing so, we’ve made and kept relationships with nonprofits and NGOs and other organizations and look to find the issue that’s hidden in the background that no one is hearing about, that’s not getting the platform that it needs.

One of the organizations we’d worked a lot with is MSF, Medecins Sans Frontieres, or Doctors Without Borders as it’s known over here. The press officer at the U.K. office knew that Doctors Without Borders had been struggling to get the issue of tuberculosis out on the mainstream. People had done small reports but she knew there was a big impact possible with a documentary because the reality is if you combine the facts, stats and figures in documents with a film that has a human face and a human cost of those facts, stats and figures, it becomes something so much bigger. The documentary becomes a platform that has a life far further reaching than just the transmission.

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Feb 17 2014
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Public Health News Roundup: February 17

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Study: Increasing Young Men’s Knowledge of Emergency Contraception Could Increase Access, Use
Increasing young men’s knowledge of emergency contraception could increase access to the drug and help prevent unwanted pregnancies, according to a new study in Journal of Family Planning and Reproductive Health Care. Emergency contraception, commonly known as "the morning after pill," prevents pregnancy after unprotected sex or when other methods of contraception fail. Nine U.S. states allow pharmacists to dispense emergency contraception without a prescription under certain conditions. The study gauged the knowledge of 101 males and 97 females ages 18 to in 2008 and 2009. "About half of the women understood basic facts about emergency contraception, how you get it, how you use it, and the fact that male partners were also able to buy it over-the-counter for their female partners," said Sheree Schrager, a member of the study team and a researcher at Children's Hospital Los Angeles, California. “But young men had significantly lower knowledge then the young women did, and this is an opportunity for providers to reach out to young men in the hopes of reaching more young women to use emergency contraception.” According to the researchers, unplanned pregnancies are more common in poor communities, where there are also greater health and economic consequences. Read more on sexual health.

U.S., Global Partners to Joint in Prevention, Detection and Response to Infectious Disease
The United States has joined with 26 countries and other global partners to, over the next five years, work to prevent, detect and effectively respond to naturally occurring, accidental and intentional infectious disease threats. Additional partners in the Global Health Security Agenda include the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). “While we have made great progress in fighting and treating diseases, biological threats can emerge anywhere, travel quickly, and take lives,” said Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism.  “The recent outbreaks of H7N9 influenza and Middle East Respiratory Syndrome are reminders of the need to step up our efforts as a global community. The Global Health Security Agenda is about accelerating progress toward a world safe and secure from infectious disease threats.” The U.S. Centers for Disease Control and Prevention (CDC) has pledged $40 million in FY 2014 to advancing Global Health Security Agenda objectives, and its FY 2015 budget will include an additional $45 million to prevent avoidable catastrophes, detect threats early and mobilize effective responses to contain outbreaks. Read more on global health.

CDC: States with Indoor Tanning Laws See Far Less Use by Female High School Students
States with indoor tanning laws—especially those requiring parental permission or setting age restrictions—see lower rates of indoor tanning by female high school students, according to a new study in the American Journal of Public Health. The study was conducted by the U.S. Centers for Disease Control and Prevention. Studies have connected the increased exposure to ultraviolet radiation from indoor tanning to increased risk of melanoma; each year the United States sees 60,000 new melanoma diagnoses and approximately 3.5 million treatments for nonmelanoma skin cancer. The study determined that the odds of female students engaging in indoor tanning in states with any indoor tanning laws were 30 percent less than those in states without such laws, and that the odds in states with systems access, parental permission and age restriction laws were 42 percent less than those in states without any laws. “State indoor tanning laws, especially age restrictions, may be effective in reducing indoor tanning among our nation’s youth,” said Gery Guy, PhD, health economist and the study’s lead author. “We need to address the harms of indoor tanning, especially among children. Indoor tanning laws can be part of a comprehensive effort to prevent skin cancers and change social norms around tanned skin.” Read more on cancer.

Jan 24 2014
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Faces of Public Health: Daniel Zoughbie, Microclinic International

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Building on epidemiologic evidence that suggests that healthy behaviors are transmittable across social networks, Microclinic International, a nonprofit international organization based in San Francisco, leverages human relationships to address both non-infectious and infectious diseases such as diabetes and HIV/AIDS. The theory behind the Microclinic International is that if negative behaviors such as smoking, unsafe sex and overeating can be contagious, so can positive, healthy behaviors.

The organization operates through “microclinics” that consist of small groups of people who share access to education, technology and social support as they work together to prevent and manage a deadly disease. Founder Daniel Zoughbie says the organization is “built on social relationships and social capital rather than bricks and mortar.” Microclinic works with local partners through community-based workshops with trained facilitators.

NewPublicHealth spoke with Zoughbie about Microclinic’s potential to reduce incidence of disease, both in the United States and abroad.

NewPublicHealth: What gave you the idea for Microclinic?

Daniel Zoughbie: When I was a college junior at UC Berkeley I wanted to do a junior-senior year project that would involve rigorous research, but also have an immediate impact on a community in need. My grandmother passed away from diabetes many years ago and I realized that a disease like diabetes is relatively simple to prevent and manage, and yet it is a leading cause of death and disability around the world.

So, I came up with the microclinic concept and piloted it in the West Bank with scholarship funds I was awarded at Berkeley. From the initial success of that pilot project I was able to expand to Jordan and recruit colleagues who worked with me to help build the organization. And then we expanded further. Today we’re running three microclinic projects in Kenya, supported by Google and other funders, in Jordan, supported by organizations including the health ministry and Her Majesty Queen Rania Royal Health Awareness Society, and in Appalachia, Kentucky supported by funders that include the U.S. Centers for Disease Control and Prevention and Humana.

NPH: What is the concept behind Microclinic?

Zoughbie: One of the most significant spaces for the prevention and management of major disease epidemics is actually not the formal health care infrastructure of hospitals and clinics alone—it is the spaces of homes and businesses and places where friends and family come together and can positively influence behaviors, such as eating healthy food, walking together, engaging in physical activity and helping each other monitor health conditions. Or, these kinds of spaces can be transformed into places where diseases spread. Families can sit sedentary in front of televisions. They can eat junk food together, and choose not to check on each other in terms of health monitoring and taking medications.

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Jan 20 2014
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Public Health News Roundup: January 20

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Arab Countries at Risk of Halting Progress in Life Expectancy, Child Mortality
If left unaddressed, the increasing problems of chronic disease, diet-related risk factors and road injury deaths could hamper the progress that countries in the Arab world have made in life expectancy and child mortality over the past two decades, according to a new study in The Lancet. The Institute for Health Metrics and Evaluation (IHME)-led study analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), finding that all 22 nations of the Arab League saw life expectancy increase for women from 1990 to 2010, and all but one saw increases for men (Kuwait, which was already at 76.8 in 1990 and dipped to only 76.1). However, societal changes linked to income levels are also bringing with them new issues. For example, higher-income countries where food is more abundant are seeing poorer diets and decreased physical activity. “The Arab countries are in transition from places where infectious diseases are the main cause of concern to places where heart disease, cancer, and diabetes are the main worries,” said IHME Director Christopher Murray, MD. “Right now, in the low-income countries, they are suffering from a double burden of non-communicable and infectious diseases. And that causes an incredible strain on their health systems.” Read more on global health.

Study: Cutting Fast Food Not Enough—Education Nutrition Also Needed to Combat Childhood Obesity
Cutting back or even cutting out fast food alone is not enough to combat the childhood obesity epidemic, with increased focus on the rest of diet also necessary, including proper education on nutrition, according to a new study in the American Journal of Clinical Nutrition. The study was supported by the Robert Wood Johnson Foundation. Researchers analyzed data from the U.S. National Health and Nutrition Examination Survey, looking at information on nearly 4,500 U.S. kids ages 2 to 18 from 2007 to 2010. The study found that nearly 40 percent of kids consumed up to 30 percent of their total calories from fast food, with 10 percent consuming more than 30 percent. They also found that kids who ate more fast food also tended to make unhealthy eating choices outside of fast food restaurants. "The fact that fast-food diners—especially adolescents—tend to choose nutrient-poor foods outside of the fast-food meal demonstrates the need for better nutrition education and a focus on the whole diet to meet health needs," said Connie Diekman, director of university nutrition at Washington University in St. Louis. Read more on nutrition.

FDA Approves First Post-natal Test to Diagnose Development Delays, Intellectual Disabilities
The U.S. Food and Drug Administration (FDA) has granted approval for the marketing of a first-of-its-kind test to help diagnose developmental delays and intellectual disabilities in children. The post-natal blood test analyzes the entire genome in search of chromosomal variations of different types, sizes, and genome locations; disabilities such as Down syndrome and DiGeorge syndrome are linked to chromosomal variations. “This new tool may help in the identification of possible causes of a child’s developmental delay or intellectual disability, allowing health care providers and parents to intervene with appropriate care and support for the child,” said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. Read more on mental health.

Jan 13 2014
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Public Health News Roundup: January 13

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Study: School Assaults Lead to Nearly 90,000 ER Visits Annually
Assaults at school account for almost 90,000 emergency-room visits annually, according to a new study in the journal Pediatrics. In a review of data on students ages 5-19, researchers determined that an average of 92,000 annual emergency visits were a result of deliberate injury, with student-on-student assault accounting for about 88,000. About 40 percent of the injuries were bruises or scratches, with few leading to later hospitalization. "[The number of injuries] appears to be concerningly high, especially when you realize that such a substantial number of injuries are occurring in the school setting, where safety measures are already in place," said lead author Siraj Amanullah, MD, an assistant professor of emergency medicine and pediatrics at Brown University's Alpert Medical School. "There is a need to continue addressing this issue at various levels—at home, at school and in the medical care setting—and there is a need to ramp up our existing prevention and safety strategies.” Read more on violence.

WHO: India Can Now Be Declared Polio-Free
With now three years passed since its last reported cased of polio—January 13, 2011—the country of India can now be declared polio-free, according to the World Health Organization (WHO). The certification process should be completed by the end of March. The country’s last victim was a two-year-old girl in West Bengal. This now leaves Afghanistan, Pakistan and Nigeria as the only countries where polio remains endemic. As part of our recent Outbreak Week, NewPublicHealth recently spoke with Sona Bari, WHO’s senior communications officer, about the efforts underway to eradicate polio globally. Read more on infectious disease.

Translation Errors Plague ACA’s Spanish-language Site, Impede Enrollment
Problems with the Spanish-language version of the Affordable Care Act’s website are making it difficult for many of the site’s users to navigate the site and enroll for coverage. In addition to launching late and sending users to English-language forms when they are clearly looking for Spanish-language content, CuidadoDeSalud.gov is also full of grammatical and other language mistakes. "When you get into the details of the plans, it's not all written in Spanish. It's written in Spanglish, so we end up having to translate it for them," said Adrian Madriz, a health care navigator who helps with enrollment in Miami. Several states with large Hispanic populations have fallen short in their goals to enroll Spanish-speakers, with critics pointing to the website as a major impediment. For example, while it’s not know how many of California’s 4.3 million residents who only speak Spanish intend to seek coverage under the Affordable Care Act, through the end of November only 5,500 had successfully enrolled. Read more on the Affordable Care Act.

Dec 20 2013
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Outbreaks and Pandemics: What’s Next?

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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.

Tuberculosis
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.

Antibiotic resistance
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.

Mosquito-borne illness
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.

>>Follow our complete coverage of Outbreak Week and join the conversation on Twitter with #outbreakweek.

Dec 18 2013
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Where Polio Remains a Threat: Q&A with Sona Bari, World Health Organization

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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.

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