Category Archives: Vaccines
While immunizations are a ubiquitous symbol of public health, in the last decade or so many public health departments have shied away from using the icon on their home pages or even adding it to a top ten list of what they do in the hopes of making both citizens and policymakers realize that public health extends far beyond infectious disease. Yet as public health departments integrate their work with the private sector, who will do the vaccinating, how immunization records will be kept and who gets paid for the work are pivotal issues that local health officials are grappling with.
A well-attended session at the NACCHO Annual conference yesterday provided a few more questions than answers, but armed attendees with new information as implementation of the Affordable Care Act (ACA) begins and both public health and private providers see their roles change and merge. Significantly, the ACA is expected to enroll millions of children, and under new rules the Vaccines for Children program will no longer cover the cost for vaccines for children who can receive immunizations under their own insurance. That will reduce funding for some health departments.
Other changes ahead for vaccination coordination include the role of accountable care organizations (ACOs) in coordinating care under the ACA, electronic registries and billing for public health services, said Paul Etkind, MPH, DrPH, head of infectious diseases at NACCHO.
“Much of this has yet to play out, so there are many unknowns,” said Etkind, who added that vaccines are a good example of the need for up front conversations with providers about what public health has to offer and a good way for health departments to become part of ACOs. “Going forward there will be a greater emphasis on coordinating care between the public and private sectors, than in delivering the care in many cases and public health needs to be active players in this process.”
Percentage of Single-father Households Up Dramatically
In 1960 only about 1 percent of households with children under the age of 18 were headed by single fathers. Today that number is a record 8 percent, or about 2.6 million in 2011. About one quarter of all single-parent households are headed by fathers. The climb in single fathers is due to largely the same reason as the climb in single mothers, according to data from Pew Research Trends. These include a dramatic increase in non-marital births and high divorce rates. However, there are notable differences between households headed by a single father or a single mother, with perhaps the greatest being that single fathers are generally better off financially. Read more on housing.
One in Seven Skin Cancer Patients Returns to Tanning Booth
Even after being diagnosed with skin cancer, one in seven people who use indoor tanning will return to a tanning booth within the next year, according to a new study in JAMA Dermatology. Research consistently shows that indoor tanning, which can emit up to 15 times the ultraviolet A radiation of the sun, dramatically increases the risk of cancer. "The situation may be analogous to that of lung cancer patients who continue to smoke after diagnosis," said study author Brenda Cartmel, a cancer prevention researcher at the Yale School of Public Health in New Haven, Conn., to Reuters. "Just as tobacco is known to be addictive, our research suggests that some patients may become dependent on tanning, with new intervention approaches needed to change these behaviors." About 20 million American visit tanning beds each year; the majority of them are young white women. Read more on cancer.
Majority of OB/GYNs Do Not Follow Guidelines on Cervical Cancer Prevention
Fewer than one-third of U.S. obstetricians-gynecologists vaccinate eligible patients against HPV and only about half follow the guidelines for cervical cancer prevention, according to a new study in the American Journal of Preventive Medicine. The American Congress of Obstetricians and Gynecologists recommend Pap tests beginning at the age of 21 and then gradually decreasing the rate of testing, depending on patient age and history. "In the current survey and others, providers stated that the largest barrier to HPV vaccination was patients and parents declining to receive the vaccine," said lead investigator Rebecca Perkins, MD, of the Boston University School of Medicine, in a release. "However, studies indicate that most patients support HPV vaccination, and that a strong physician recommendation is the most important determinant of vaccine uptake in young women." Read more on vaccines.
HPV Vaccine Has Lowered HPV Infection Rates in Teen Girls
A new study published in The Journal of Infectious Diseases has found that since the HPV vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56 percent among female teenagers 14-19. About 79 million Americans—most in their late teens and early 20s—are infected with HPV. Each year, about 14 million people become newly infected. According to the U.S. Centers for Disease Control and Prevention (CDC), each year in the United States about 19,000 cancers caused by HPV occur in women, with cervical cancer the most common. About 8,000 cancers caused by HPV occur each year in men in the United States, with oropharyngeal (throat) cancers the most common. “This report shows that the HPV vaccine works well, and the report should be a wake-up call to our nation to protect the next generation by increasing HPV vaccination rates,” said CDC Director Tom Frieden, MD, MPH. “Unfortunately only one third of girls aged 13-17 have been fully vaccinated with HPV vaccine.” Routine vaccination at age 11-12 for both boys and girls is recommended in the US, but according to recent national immunization surveys, only about half of all girls in the United States and far fewer boys, have received the first dose of HPV vaccine. Read more on vaccines.
AMA Announces New Policy Aimed at Removing Sugared-Beverages from SNAP Program
The American Medical Association (AMA) passed a policy at its annual meeting yesterday calling on the association to work to remove sugar-sweetened beverages from the SNAP (Supplemental Nutrition Assistance Program) for low-income families. SNAP replaced the U.S. Food Stamp program several years ago. The new policy also encourages state health agencies to include nutrition information in routine materials sent to SNAP recipients. According to the AMA, 58 percent of beverages bought with SNAP dollars are sugar-sweetened ones. The AMA also passed a resolution recognizing obesity as a disease “requiring a range of medical interventions to advance obesity treatment and prevention.” “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” said AMA board member Patrice Harris, MD. Read more on obesity.
HUD Releases First-Ever Same Sex Housing Discrimination Study
The U.S. Department of Housing and Urban Development (HUD) has released the nation’s first-ever national study examining housing discrimination against same-sex couples in the private rental market. The study found that same-sex couples experience unequal treatment more often than heterosexual couples when responding to internet ads for rental units, and that gay male couples experience more discrimination than lesbian couples. “A person’s sexual orientation or gender identity should not be a reason to receive unfavorable treatment when searching for housing,” said Bryan Greene, HUD Acting Assistant Secretary for Fair Housing and Equal Opportunity. “HUD is committed to making sure that LGBT individuals have equal access to housing opportunities.” HUD’s study is based on nearly 7,000 email tests conducted in 50 metropolitan markets across the country between June and October of 2011. For each paired test, two emails were sent to the housing provider regarding the unit advertised online. The only difference between the emails was whether the couple was same-sex or heterosexual. Unfavorable treatment was measured by whether the tester was told the unit was available, asked to contact the landlord, invited to the see the apartment, or received any response at all. Read more on housing.
HHS Updates Guidelines to Prevention Disease Transmission from Organ Transplants
The U.S. Department of Health and Human Services (HHS) has updated its guidelines on reducing unexpected disease transmission through organ transplantation. The 2013 PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus and Hepatitis C Virus Transmission through Organ Transplantation updates the 1994 U.S. Public Health Service guidelines designed to improve patient safety. The recommendations include additional screening, revised risk factors and more sensitive laboratory testing. “Transmission of infections through organ transplants is a critical concern for patients, their families and healthcare personnel involved in transplant procedures,” said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH. “Putting these new recommendations into practice will allow doctors and patients to make better, more informed decisions when accepting organs for transplantation.” Read more on prevention.
HUD: $40M in Housing Counseling Grants to Improve Choices, Opportunities
The U.S. Department of Housing and Urban Development (HUD) is providing $40 million in housing counseling grants to help people find housing, to make more informed choices and to improve their ability to keep their existing homes. The grants will help more than 1.6 million households via 334 national, regional and local organizations. “Make no mistake: these grants will do a lot of good,” said HUD Secretary Shaun Donovan in a release. “The evidence is clear that housing counseling works. These grants are a smart investment to help families and individuals find and keep housing which helps promote neighborhood stability in the long term.” Read more on housing.
Majority of Adults Unaware of their Whooping Cough Vaccination Status
As the number of U.S. cases of pertussis—or whooping cough—rises, many adults are completely unaware of their need to remain up to date on their vaccinations. Only 20 percent say they’ve received the vaccine within the past decade and more than 60 percent do not even know their vaccination status. The lack of adult vaccinations can increase transmission rates to children; the majority of whooping cough deaths are children younger than 3 months. "Teens and adults who have received the [whooping cough] vaccine are less likely to get whooping cough themselves, and therefore less likely to spread whooping cough to other people, including infants who have not yet been protected by the recommended [whooping cough] vaccinations," said Matthew Davis, MD, director of the new University of Michigan National Poll on Children's Health. Read more on vaccines.
Mammography Rates Remained Steady After Change in Guidelines
The proportion of women undergoing screening for breast cancer every year did not change after U.S. Preventive Services Task Force released recommendations saying there wasn't enough evidence to support routine mammograms for women in their 40s, according to a new study published in the journal Cancer. In 2009, the Task Force changed their recommendations to state that women aged 50 to 74 should have a mammogram every other year, and screenings for women under age 50 should be evaluated by each woman with her doctor, according to individual risk factors. "When there are conflicting versions of guidelines, providers may err on the side of screening," said David Howard, a health policy researcher from Emory University in Atlanta, in an interview with Reuters. Read more on cancer.
Latest HIV Vaccine Study Halted
The National Institutes of Health halted a study testing an experimental HIV vaccine after an independent review board found the vaccine did not prevent HIV infection and did not reduce the amount of HIV in the blood. The trial, started in 2009, is the latest in a series of failed HIV vaccine trials, according to Reuters. The halted study included more than 2,500 volunteers in 19 U.S. cities. Study populations included men who have sex with men and transgender people who have sex with men. Read more on HIV.
CDC's Food Safety Report Card: Some Foodborne Illnesses Spiked in 2012
The Centers for Disease Control and Prevention (CDC) recently released the "nation’s annual food safety report card," and it shows that 2012 rates of infections from two types of foodborne bacteria—campylobacter and Vibrio—have increased significantly when compared to a baseline period of 2006-2008, while rates of most others have not changed during the same period. The data are part of the Foodborne Diseases Active Surveillance Network report. Campylobacter infections have been linked to tranmission in many foods, including poultry, raw milk and produce. These infections were at their highest level since 2000, up 14 percent since 2006-2008. Vibrio infections, often associated with raw shellfish, were up 43 percent.
“The U.S. food supply remains one of the safest in the world,” said CDC Director Tom Frieden, MD, MPH. “However, some foodborne diseases continue to pose a challenge. We have the ability, through investments in emerging technologies, to identify outbreaks even more quickly and implement interventions even faster to protect people from the dangers posed by contaminated food.” Read more on food safety.
Small Amounts of Daily Exercise Can Help Teens Quit Smoking
As little as 30 minutes of daily exercise can help kids quit smoking, according to a new study in the Journal of Adolescent Health. It can also help to reduce tobacco use. Researchers found that daily smokers were more likely to reduce or quit smoking if they combined a fitness program with a smoking cessation program, rather than just a cessation program alone. Every teen in the study smoked an average of half a pack of cigarettes each weekday and a full pack a day on weekends. And that was just one of the poor health habits of many of the participants. "It is not unusual for teenage smokers to engage in other unhealthy habits,” said author Kimberly Horn, associate dean for research at the George Washington University School of Public Health and Health Services. “Smoking and physical inactivity, for instance, often go hand in hand.” According to the U.S. Centers for Disease Control and Prevention, about 13 percent of Americans age 18 and under smoke tobacco. Read more on tobacco.
Study: Low Food Security, Exposure to Violence Closely Linked
There is a close correlation between low food security and exposure to violence, according to a new study in Public Health Nutrition. Researchers spoke with forty-four mothers of children age 3 and under who participated in public assistance programs, finding increased exposure to violence, which in turn increased the chance of negative mental health, an inability to continue school and an inability to make a living wage. The violence included child abuse, neglect and rape. The study clearly demonstrates the need to consider and include violence prevention efforts when establishing policies to deal with hunger. Read more on violence.
Size of Parents’ Social Groups Can Affect Whether Kids are Vaccinated
What they hear from friends and the people in their social group may affect whether parents have their children vaccinated, according to a new study in the journal Pediatrics. Parents who were less likely to vaccinate were also more likely to have large social groups and rely on books, pamphlets and the Internet for information on vaccines. "I think that what needs to be done is that everybody needs to understand the importance of vaccines,” said Joseph Anthony Bocchini, Jr., MD, chairman of Pediatrics Medicine at Louisiana State University Health Sciences Center in Shreveport. “And they're not only important for the people who receive them but they're also important for the community." About 95 percent of kindergarten-aged children are appropriately vaccinated, according to the U.S. Centers for Disease Control and Prevention. Read more on vaccines.
Study: Chickenpox Vaccine Provides Long-Term Protection
A new study published online in the journal Pediatrics confirmed that the chickenpox (varicella) vaccine is effective at preventing chicken pox, and that the effectiveness does not wane over a 14-year period. One dose provided excellent protection against moderate to severe disease. Consistent protection was important because chickenpox infection in older teens and adults can be much more serious than it generally is in childhood, according to the study author, in an interview with HealthDay. The study data also suggest that the vaccine may also reduce the risks of shingles, another type of infection caused by the chickenpox virus that tends to affect people later in life. The study followed a total of 7,585 children vaccinated with varicella vaccine in their second year of life in 1995 for 14 years to see if they developed either chickenpox or shingles. Read more on vaccination.
EPA Proposes Measures to Cut Air Pollution, Improve Population Health
Based on input from auto manufacturers, refiners, and states, the U.S. Environmental Protection Agency (EPA) proposed new standards for cars and gasoline that will significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. Once fully in place, experts say the standards will help avoid up to 2,400 premature deaths per year and 23,000 cases of respiratory ailments in children. The measures will also prevent 3,200 hospital admissions and asthma-related emergency room visits, and 1.8 million lost school days, work days and days when activities would be restricted due to air pollution. Total health-related benefits in 2030 are expected to be between $8 and $23 billion annually. The new standards will reduce gasoline sulfur levels by more than 60 percent, which will also enable vehicle emission control technologies to perform more efficiently. Read more on environmental health.
New Jersey Bans Children from Tanning Beds
New Jersey Governor Chris Christie signed a bill into law on Monday banning children under 17 from using commercial tanning beds. Tanning before age 35 has been shown to increase the risk for melanoma by 75 percent. The new law also bans children under 14 from getting spray tans in tanning salons, which could impact social norms around young teens wanting to look tan if their friends look tan. Read more on safety.
Analysis: ‘Big Box’ Stores Offer Best Costs on Prescription Drugs
People looking to save money on generic prescription drugs should ask their pharmacists about comparison shopping and should generally look to big box stories rather than smaller pharmacies, according to a new analysis by Consumer Reports. The report found the lowest prices at Costco and the highest at CVS Caremark. "Especially for the independent pharmacies, if they want to retain your business and loyalty, they will help you get the best price," said Lisa Gill, an editor at Consumer Reports. "It really comes down to a store's business model. For example, big box stores tend to use their pharmacies as a way to get consumers through the door with the expectation that they'll buy other things.” Read more on prescription drugs.
CDC: Sharp Increase in Valley Fever in Past Decade
The U.S. Centers for Disease Control and Prevention has identified changes in weather, an increase in population of changes in disease detection and reporting as possible explanations for the dramatic increase in Valley Fever from 1998 to 2011. In Arizona, California, Nevada, New Mexico and Utah there were about 22,000 cases in 2011; there were only 2,265 in 1998. The fungal respiratory infection, caused by a fungus found in the southwestern United States, is caused by flu-like symptoms that can lead to hospitalization. "Valley Fever is causing real health problems for many people living in the southwestern United States," said CDC Director Tom Frieden, MD, MPH. "Because fungus particles spread through the air, it’s nearly impossible to completely avoid exposure to this fungus in these hardest-hit states. It’s important that people be aware of Valley Fever if they live in or have travelled to the southwest United States." Read more on infectious disease.
CDC Study Offers More Proof of Non-link Between Vaccines, Autism
A new study in the Journal of Pediatrics offers yet more scientific proof that there is no link between vaccinations and autism. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found that exposure to vaccine antigens was the same for kids with and without autism. "This should give more reassurance to parents," said lead researcher Frank DeStefano, MD, director of the CDC's Immunization Safety Office. A small study in the Lancet in 1998 originally linked vaccinations and autism; the study has since been retracted. Still, about one-third of parents believe young children receive too many vaccinations and that they could lead to autism. Read more on vaccines.
Washington State Secretary of Health Mary Selecky has announced her retirement from state service. Selecky has served under three governors since her initial appointment as acting secretary in October 1998. She also served two terms as president of the Association of State and Territorial Health Officials, served on the board of the National Association of County and City Health Officials and is a past president of the Washington State Association of Local Public Health Officials. In 2010, Selecky received the American Medical Association's Nathan Davis Award for Outstanding Government Service.
NewPublicHealth Health spoke with Mary Selecky about her public health career and accomplishments.
NewPublicHealth: Your tenure has spanned many public health game changers. What stands out to you as the greatest triumphs and greatest threats in Washington State?
Mary Selecky: In terms of greatest triumphs, a key one is that we took on the issue of tobacco use in Washington State. Tobacco would be at the top of my list because of the health impact it has had and because it really is something that can be prevented by getting the right information out to people. It has taken us decades for the public to get it that smoking kills.
We had an announcement about tobacco yesterday, in fact. Among our 10th-graders, 9.5 percent used a cigarette in the last 30 days, and our rate has dropped from two years ago, even though across the nation the rate has flattened. So we’re doing something right. We’re a smoke-free state—not just tobacco-free but smoke free. And that really has the most profound influence on people’s health.
On the other hand, tobacco is also our greatest threat, because the tobacco companies continue to spend more than $140 million in this state to get you to use their product or to switch products, and we know they’ve moved to point-of-sale marketing. If you go into the smaller stores particularly, you’re greeted by all these tobaccos posters on the windows, inside the shop and on the counter. Those kinds of things are going on every single day—and every year there’s a new crop of 10th-graders. So it disturbs me that so many of our states have reduced tobacco prevention programs and that, as a result, nationally we’re not making much headway.
Earlier this month, the deans of twelve graduate schools of public health, including Harvard, Columbia and Johns Hopkins, sent a letter to the White House, signing as individuals, to protest the reported use by the CIA of a fake polio vaccination campaign in Pakistan to gain information on the whereabouts of Osama Bin Laden. In the letter the deans say that as a result of the fake campaign, medical groups running long-standing vaccination programs have been asked to leave Pakistan. And in December, at least eight polio vaccination workers were assassinated in Pakistan and the U.N. polio eradication program was suspended.
“[C]ontaminating humanitarian and public health programs with covert activities threatens the present participants and future potential of much of what we undertake internationally to improve health,” the deans wrote.
Suspension of vaccine efforts can also pose risks to countries beyond the developing world. According to Johns Hopkins research, Pakistan is one of only three countries where wild polio transmission still occurs.
>>Bonus Link: Read a New York Times article published in late December on other third world vaccination efforts that have come under threat in recent years.