Category Archives: Infectious disease
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.
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.