Category Archives: Infectious disease
A new study published recently in the American Journal of Public Health 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. The researchers reviewed relevant laws and regulations for each year between 2001 and 2008 and rated them on their restrictiveness in granting exemptions. The study was funded by a grant from the Public Health Law Research program, a national program of the Robert Wood Johnson Foundation.
According to the study, state laws that make it difficult for children to be exempted from vaccines on religious or philosophical grounds could reduce the number of whooping cough cases, but did not have an impact on cases of measles, mumps, haemophilus influenza type B (Hib) or Hepatitis B.
“Our research shows that during the study period, if all states increased the restrictiveness of their non-medical exemption laws by one level, the number of U.S. whooping cough cases would decline by 1.14 percent, resulting in 171 fewer cases per year,” according to study author Y. Tony Yang, ScD, MPH, associate professor at the College of Health and Human Services at George Mason University.
The study found that the impact on whooping cough may be greater than for the other diseases studied simply because whooping cough affects more people. Researchers call this a “threshold effect,” which means laws may not have a significant impact unless they works to prevent a disease that affects a critical mass of people. During the study period, whooping cough was much more prevalent than the four other diseases studied—the average incidence rate for whooping cough was 18 per 100,000 individuals from 2001 to 2008. For Hib, Hepatitis B, measles, and mumps, the mean incidence rates were less than 1 per 100,000.
A new report from Trust for America’s Health finds that despite recommendations by medical experts about the effectiveness and safety of vaccines, an estimated 45,000 adults and 1,000 children die from vaccine-preventable diseases each year in the United States.
NewPublicHealth spoke with Litjen (L.J) Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition, to ask about ongoing efforts to improve immunization rates among all age groups across the nation. The Coalition works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public and facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies. The Coalition is supported by the U.S. Department of Health and Human Services.
NewPublicHealth: What are the critical gaps in immunization in the United States—for children and adults?
Litjen Tan: Immunization rates are really high in our childhood population, but generally not at all high in the adult population, though for some vaccines the rates are improving. We are also not doing very well for adolescents. On the broader level I think what the immunization rates reflect is the state of preventive care in the United States when you come out of childhood, which is why I think the Affordable Care Act really is a great boon. We’ve got this wonderful preventive care model for our kids; we take our kids in, we get them their shots, they get protected and we’ve got high coverage rates generally over 90 percent for all major vaccines. We have almost no vaccine-preventable disease in the United States except for instances linked to pockets of populations that haven’t been vaccinated—as we’ve seen recently with measles.
But then we get to adolescence we have this breakdown. Rates for HPV vaccination are not so good. Our meningococcal vaccination rates are not where they should be and neither are the tetanus, diphtheria and pertussis booster rates in adolescents. What happens with the adolescents is parents don’t necessarily bring them in for prevention checkups anymore. We bring them in when there’s a problem or when they need a school sports visit, and so we plant in adolescents this idea that care is no longer about prevention but care is now about acute care, and that persists into adulthood. This is the thinking that stops us from saying, “hey, do I need my vaccines? When should I get them?”
We need to make sure that our adolescents get the idea that vaccines prevent disease and that they actually do have vaccines that are recommended for them and then I think we’ll begin to see an appreciation of immunizations for adults as well.
NPH: Do we need to target both parents and the adolescents themselves?
Tan: Absolutely, but there’s a lot of discussion about how we do that. It gets a little tricky because we push autonomy of the adolescent, and we have a precedent in public health—discussions between providers and adolescents about sexually transmitted infections—but there are a lot of legislative and regulatory barriers against directly talking to an adolescent in the absence of a parent.
FDA Proposes New Rules for Proving Effectiveness, Safety of Antibacterial Soaps
A new proposed rule from the U.S. Food and Drug Administration (FDA) would require manufacturers of antibacterial hand soaps and body washes to prove not only that their products are more effective than normal soap when it comes to preventing illness and infections, but that they are also safe for daily long-term use. Products that can’t meet these standards would need to be reworked before coming to market. The regulatory move comes as research suggests that not only are antibacterial products not helpful, but they could also be harmful in the long term, leading to bacterial resistance and hormonal problems. Hand sanitizers, wipes and other antibacterial products used in health care settings would not fall under the new regulations. “Antibacterial soaps and body washes are used widely and frequently by consumers in everyday home, work, school, and public settings, where the risk of infection is relatively low,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research (CDER). “Due to consumers’ extensive exposure to the ingredients in antibacterial soaps, we believe there should be a clearly demonstrated benefit from using antibacterial soap to balance any potential risk.” Read more on infectious disease.
NIH, NFL to Research Ways to Diagnose, Treat Traumatic Brain Injuries
New research projects from the U.S. National Institutes of Health (NIH) will explore methods to diagnose and treat chronic traumatic encephalopathy, or CTE, in football players and others who experience head injuries and concussions. Current science only allows health care professionals to diagnose the traumatic brain injuries after death. "This is a public health problem," said Walter Koroshetz, deputy director of the NIH's National Institute of Neurological Disorders and Stroke. "We don't know the mechanics of the head injuries that lead to this, the number and severity that is required to get this. We don't know whether certain people based on their genes are more susceptible or not. There are a lot of questions to be answered." The National Football League will cover $12 million of the $14 million in research costs. Earlier this year the league agreed to pay as much as $765 million to former players who accused the league of covering up and downplaying the risks of brain injury. Read more on mental health.
Studies: Multivitamins, Supplements Don’t Improve Overall Wellness
Daily multivitamins and mineral supplements don’t prevent heart problems or memory loss, and are also not linked to longer lives, according to three new studies in the journal Annals of Internal Medicine. The researchers said the findings indicate that U.S. consumers should stop taking the dietary supplements, which are part of a multibillion-dollar U.S. industry. "We believe that it's clear that vitamins are not working," said Eliseo Guallar, MD, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, adding “"The probability of a meaningful effect is so small that it's not worth doing study after study and spending research dollars on these questions." Read more on nutrition.
“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.
Outbreaks can advance quickly and through a wide variety of vectors. 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 for most. This is where food safety and other precautions around wild animals can help. But never fear. We have compiled a list of the top five strangest things that can spread disease so you can be prepared.
(Image source: WikiCommons)
While their mythical status as vampires in another form might be what scares some people about bats, what’s even scarier is their potential to spread disease. A species of bats in China are believed to have helped spread SARS (severe acute respiratory syndrome), which killed more than 750 people worldwide between 2002 and 2003. Researchers found two SARS-like viruses in horseshoe bats found in China, suggesting that they could have been the origin of the human pandemic.
UC Santa Barbara Might Use Unapproved Vaccine to Combat Meningitis Outbreak
Health officials confirmed late last week that they are considering administering the unapproved vaccine Bexsero to halt the spread of a bacterial meningitis outbreak that has sickened four students at UC Santa Barbara. Three of the students have recovered fully, with the fourth requiring the amputation of both feet. The U.S. Centers for Disease Control and Prevention (CDC) is working with the California state and Santa Barbara County departments of public health to determine whether the vaccine would be effective against the strain; Bexsero, which is not yet approved for use in the United States, is for type B meningococcal disease. The U.S. Food and Drug Administration recently granted Princeton University permission to use the vaccine, after eight students became sick from a similar strain of what has struck UC Santa Barbara. Read more on infectious disease.
AAP Calls for Ban on U.S. Sale of Raw or Unpasteurized Milk
The risk of infection has led the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on Nutrition to not only recommend against the consumption of raw or unpasteurized milk by pregnant women, babies and kids, but to call for the complete ban of its sale in the United States. Pasteurization kills bacteria by heating the milk to a minimum of 161 degrees Fahrenheit for at least 15 seconds before cooling it quickly; at least 97 percent of U.S. dairy products are pasteurized. From 1998 through 2011 there were 148 disease outbreaks related to raw milk or raw milk products, leading to 284 hospitalizations and two deaths. "It's kind of like riding in a car with seatbelts," said Kathryn Boor, dean of Cornell University’s school’s Agriculture and Life Sciences, who was not involved in the study. "If you've got the opportunity for a safety barrier, which would be pasteurization, why wouldn't you use it?" Read more on food safety.
Study: Lack of Sleep in Kids Increases Blood Pressure
Lack of adequate sleep can lead to higher blood pressure even in children who are a healthy weight, according to a new study in the journal Pediatrics. Monitoring 143 Chinese youth in a sleep lab, the researchers determined that one fewer hour of sleep per night increased systolic blood pressure by 2 millimeters of mercury (mm/Hg) and diastolic blood pressure by 1 mm/Hg. All of the participants, ages 10-18, were normal weight and did not have sleep apnea. "Pediatricians must screen for diabetes, and [high blood pressure] in teenagers with sleep loss besides screening for snoring and sleep apnea in obese teenagers," said Sanjeev Kothare, MD, a pediatric sleep expert at NYU Langone Medical Center, who was not involved in the study. The National Sleep Foundation recommends 10-11 hours of sleep per night for children ages 5-12, and at least 8.5 hours per night for teenagers. Read more on pediatrics.
CDC: Measles Remains a Threat to U.S. Health Security
Fifty years after the creation of the measles vaccine, the disease continues to be a very real public health threat both in the United States and globally, according to the U.S. Centers for Disease Control and Prevention (CDC). While a recent study in JAMA Pediatrics confirmed U.S. measles elimination starting in 2000 and sustained through 2011, international travel means people from countries where the disease persists could still bring it to the United States. Approximately 158,000 globally died from measles in 2011, with an average of 430 children dying each day. These facts illustrate the need to be vigilant in reporting suspected cases to public health departments. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day,” said CDC Director Tom Frieden, MD, MPH. “Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security.” Read more on infectious disease.
HHS: $55.5M to Strengthen Training of U.S. Health Professionals, Especially in Nursing
The U.S. Department of Health and Human Services has announced the planned investment of millions to strengthen training for health professionals and add more professionals to the U.S. health care workforce, with a clear emphasis on nursing workforce development. About $45.4 million of the $55.5 million in FY 2013 will go toward nursing, including adding to the number of nurse faculty ($22.1 million), improving nurse diversity ($5.2 million), promoting interprofessional collaborative practice ($6.7 million) and supporting nursing education ($9.2 million). The more than 270 grants will also deal with overall public health, behavioral health and dentistry. Read more on nursing.
Switching to a Healthy Diet Adds About $1.50 Daily to Food Costs
Switching to a healthier may lighten your wallet a bit, but not so much that it isn’t worth it, according to a new study in the journal BMJ Open. Looking at 27 studies in 10 countries, researchers found that a diet that emphasizes fruits, vegetables, nuts and fish will add about $1.50 per day, or $550 per year, to an individual’s food budget. Healthy proteins such as boneless, skinless chicken breast were behind most of the additional costs. While this difference could be an issue for low-income families, middle-class families shouldn’t see much of a problem in making the healthy switch, according to study author Mayuree Rao, a junior research fellow in the department of epidemiology at the Harvard School of Public Health. "$1.50 is about the price of a cup of coffee and really just a drop in the bucket when you consider the billions of dollars spent every year on diet-related chronic diseases." Read more on nutrition.
NIH to Direct Additional $100M Toward Research in an HIV Cure
The National Institutes of Health (NIH) has announced plans to invest an additional $100 million over the next three fiscal years in research directed toward a cure for HIV. Over the past three decades, NIH-funded research has led to the development of more than 30 antiretroviral drugs and drug combinations targeting HIV. Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases, said that growing knowledge about HIV, along with the development of new treatment strategies, makes the moment “ripe to pursue HIV cure research with vigor.” “Although the HIV/AIDS pandemic can theoretically be ended with a concerted and sustained scale-up of implementation of existing tools for HIV prevention and treatment, the development of a cure is critically important, as it may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy,” he said in a statement. Read more on HIV/AIDS.
Hong Kong Announces First Human Case of H7N9 Avian Flu
H7N9 avian flu appears to have spread from mainland China, with Hong Kong reporting its first human case of the deadly avian flu strain. A 36-year-old Indonesian domestic helper is in critical condition after travelling to Shenzhen and buying, slaughtering and eating an apparently infected chicken. Earlier this year a report of human infection in Shanghai was quickly followed by the confirmation of more than 100 cases. While closing down live poultry markets in the area caused the number of new cases to drop, the World Health Organization has confirmed a total of 139 cases and 45 deaths. Ko Wing-man, Hong Kong's secretary for food and health, said Hong Kong has raised its level of preparedness for an avian flu pandemic to "serious," and the city has suspended the importation of live chickens from certain Shenzhen farms as it also investigates its own stock. Read more on infectious disease.
Study: ‘Benign’ or ‘Healthy’ Obesity May Not Exist
Despite what some health professionals believe, “benign obesity” may not exist, according to a new study in the Annals of Internal Medicine. People who are overweight or obese without health issues such as high blood pressure, diabetes or other metabolic issues are still at increased risk of major health problems when compared with metabolically healthy, normal-weight people. The researchers looked at the results of eight studies covering more than 61,000 people, finding that in follow-ups of at least 10 years later the people who were overweight but without the risk factors were still at an increased risk of 24 percent for heart attack, stroke and even death. One explanation could be that these overweight people without the risk factors actually do have the risk factors, only at low levels that are difficult to detect, and that then become gradually worse. The results indicate that physicians should look at both body mass and metabolic tests when determining a patient’s health. Read more on obesity.
FDA Approves Vaccine for H5N1 Strain of Avian Flu
The U.S. Food and Drug Administration (FDA) has approved the first adjuvanted pandemic influenza vaccine for the prevention of the H5N1 strain of the avian flu, also known as bird flu. While most influenza A viruses do not infect people, H5N1 does and has demonstrated a 60 percent mortality rate when a person becomes infected. The U.S. Department of Health and Human Services has added the vaccine to the National Stockpile. “This vaccine could be used in the event that the H5N1 avian influenza virus develops the capability to spread efficiently from human to human, resulting in the rapid spread of disease across the globe,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research. “Vaccines are critical to protecting public health by helping to counter the transmission of influenza disease during a pandemic.” Read more on infectious diseases.
Study: Excessive Television Watching Equals Excess Weight in Kids
Children and teenagers who spend excessive amounts of time watching television or in front of other screens are also more inclined to be overweight or obese, according to a new study in the journal Pediatrics. Researchers analyzed data on nearly 8,000 boys and girls, ages 9-16, finding that each additional hour a day spent watching television was linked to a body mass index (BMI) scale increase of about 0.1 points, or about half a pound. Kids who watch television or play video/computer games are not only for the most part physically idle, but also more likely to snack. While many parents believe their kids spend a reasonable amount of time in front of screens, the reality is that most kids in the United States and Canada surpass the recommended daily limit of two hours. "We don't pay attention to the fact that it's half an hour here, half an hour there, an hour here, an hour there," said Mark Tremblay, director of Healthy Active Living and Obesity Research at the Children's Hospital of Eastern Ontario Research Institute in Ottawa, Canada, who was not a part of the study. Read more on obesity.
Study: One in 10 U.S. Kids has ADHD
About one in 10 U.S. children have attention-deficit/hyperactivity disorder (ADHD), according to a new study in the Journal of the American Academy of Child and Adolescent Psychiatry. A 2011 poll of more than 95,000 parents found 11 percent of kids ages 4-17 had ADHD, up from 9.5 percent in 2007. The number of kids on ADHD medication also climbed about 1 percent, with research showing that half the kids with ADHD are diagnosed before the age of 6. "This finding suggests that there are a large number of young children who could benefit from the early initiation of behavioral therapy, which is recommended as the first-line treatment for preschool children with ADHD," study author and U.S. Centers for Disease Control and Prevention (CDC) researcher Susanna Visser. The study also found that while the number of kids with ADHD is still climbing, it is no longer climbing as fast—the rate was increasing about 6 percent a year in the mid-2000s, but was only 4 percent a year from 2007 to 2011. Read more on pediatrics.
CDC: U.S. Malaria Cases Reached 40-year High in 2011
U.S. malaria cases reach a 40-year high in 2011, with 1,925 total cases and five associated deaths, according to a supplement of the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR). The 2011 total was a 14 percent increase over the 2010 statistic. According to the CDC, the vast majority of the U.S. cases were acquired overseas, with about 69 percent coming from Africa, and 63 percent of those cases from West Africa. “Malaria isn’t something many doctors see frequently in the United States thanks to successful malaria elimination efforts in the 1940s,” said CDC Director Tom Frieden, MD, MPH. “The increase in malaria cases reminds us that Americans remain vulnerable and must be vigilant against diseases like malaria because our world is so interconnected by travel.” Preventative measures include antimalarial drugs, insect repellent, insecticide-treated bed nets, and protective clothing. Read more on infectious disease.
FDA Proposes New Rules to Combat Prescription Drug Shortages
The U.S. Food and Drug Administration (FDA) yesterday proposed a new plan to combat drug shortages by requiring drug and biotechnology firms to immediately notify the FDA of any potential disruptions in the supply of medically important drugs. These drug shortages can delay or even deny care to patients in critical need. There were 117 drug shortages in 2012, down from 251 in 2011, when the White House issued an executive order to solve the public health problem. The new plan calls for companies to promptly notify the FDA of a permanent discontinuance or a temporary interruption likely to disrupt the supply of a prescription drug. Early notification enables the FDA to work with manufacturers to investigate the reasons for disruptions; identify other manufacturers who can help make up for the shortfall; and expedite inspections and reviews of drugs that could help mitigate a shortage. The FDA also released a strategic plan that “highlights opportunities for drug manufacturers and others to prevent drug shortages by promoting and sustaining quality manufacturing.” “The complex issue of drug shortages continues to be a high priority for the FDA, and early notification is a critical tool that helps mitigate or prevent looming shortages,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research. “The FDA continues to take all steps it can within its authority, but the FDA alone cannot solve shortages. Success depends upon a commitment from all stakeholders.” Read more on prescription drugs.
March of Dimes: U.S. Preterm Birthrate at 15-year Low, But Country Still Gets a ‘C’ Grade
The U.S. preterm birthrate fell to a 15-year low of 11.5 percent in 2012, according to a new report from the March of Dimes. While that’s also a six consecutive year of lower rates, the national still received a “C” on the report card when compared to other countries. "Although we have made great progress in reducing our nation's preterm birth rate from historic highs, the U.S. still has the highest rate of preterm birth of any industrialized country. We must continue to invest in premature birth prevention because every baby deserves a healthy start in life," said Jennifer Howse, MD, president of the March of Dimes. Only six U.S. states received an “A” on the annual report card: Alaska, California, Maine, New Hampshire, Oregon and Vermont. An infant is premature if they are born before 37 weeks of pregnancy; the potential health complications include breathing problems, developmental delays, cerebral palsy and even death. Read more on maternal and infant health.