Crowds of public health officials thronged Mary Selecky, Secretary of the Washington State Department of Health since 1999 and a former ASTHO president, at the ASTHO annual meeting, likely for her wisdom as a long time health director grappling with some of the most critical problems facing public health.

NewPublicHealth caught up with Mary Selecky at the recent ASTHO meeting.

NewPublicHealth: What is the rest of the country learning from the recent pertussis (whooping cough) outbreak in Washington State?  

Mary Selecky: We have more than 4,000 cases confirmed. Sixty percent of cases are in school age kids, 20 percent in adults and 20 percent in kids under age five. The most worrisome statistics are the numbers of babies hospitalized. [Editor’s Note: Babies get whooping cough vaccines at ages two, four and six months and don’t have full immunity until after the last vaccine.] Most adults get a mild case—they don’t know they have it, they have a dry hacky cough and they’re spreading pertussis germs. One of our very fundamental pieces of information is to make sure your kids are vaccinated and up to date, and that teens and adults have gotten a booster shot. We know we’re reaching the public because our insurance companies are telling us that double the  amount of people have gotten the booster from last year. We know we’re getting some penetration there, but clearly not enough.  

It has not really gone away. We’re still seeing about 100 new cases every week. We are slowing down—it’s a little bit less every week. Nevertheless, 100 cases per week is still ten times more than it was a year ago. We reached out to the CDC to have their epidemiology investigators to come in and look at our data and see what is happening. They were able to show us that our 13- and 14-year-olds are getting hit hardest and many were vaccinated, so we are evaluating when the booster shot was given and how soon after they got pertussis and what we can learn.

We’re seeing more whooping cough in the U.S. than we have seen in multiple decades. Our own numbers are more than we’ve seen since 1941. It’s a bug, easily passed person to person. We do have an effective vaccine but what the CDC is able to glean may indicate that we need to give a booster more often.

NPH: While the CDC investigates, what’s your recommendation as a state health director? 

CDC: Vaccination of U.S. Kids Remains High
The 2011 National Immunization Survey (NIS) shows that vaccination rates for preventable diseases remain high for U.S. children aged 19-35 months. Coverage is at least 90 percent for many of the routine vaccines, with less than 1 percent having received no vaccinations. High immunization coverage is necessary to protect against serious outbreaks, according to the Centers for Disease Control and Prevention. Read more on vaccines.

IOM Report: U.S. Healthcare is Too Complex and Costly
A new report from the Institute of Medicine (IOM) concludes that the U.S. healthcare system is too complex and costly to sustain itself. The report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, recommends focusing on improvements in three major areas— the rising complexity of modern health care, unsustainable cost increases and outcomes below the system’s potential—while also utilizing new technologies and techniques whenever possible. Read more on access to healthcare.

‘Cool’ Kids More Likely to Smoke
A new study in the Journal of Adolescent Health shows that popular high school students are more likely to smoke cigarettes than are their non-popular peers. Researchers at the University of Southern California (USC) and University of Texas looked 1,950 9th and 10th graders in seven Southern California high schools. The findings line up with previous USC studies. “That we’re still seeing this association more than 10 years later, despite marginal declines in smoking, suggests that popularity is a strong predictor of smoking behavior,” said Thomas W. Valente, PhD, professor of preventive medicine at the Keck School of Medicine of USC. Valente was lead author on the study and has researched the topic extensively. Read more on tobacco.

MMWR Reports U.S. May Reach Record Number of Pertussis Cases this Year
The number of pertussis whooping cough cases in the United States may hit a record high this year, according to a new Morbidity and Mortality Weekly Report. In a call with reporters on Thursday, Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said that nine infants have died of the disease this year. As of Thursday, almost 18,000 cases had been reported, which is more than twice the number last year at this time, according to Schuchat. Read more about immunization to protect against pertussis.

Stress Can Impact Breast Cancer Metastasis
Researchers at Vanderbilt University have published an article in PLos Biologyshowing that, in mice, stress can impact the metastasis of breast cancer to bone, but treating the mice with a beta blocker drug reduced the number of bone lesions. The authors also say that efforts to reduce stress and depression in patients with cancer may have unappreciated benefits in terms of metastasis prevention. Read more on cancer.

AHRQ Issues New Guide for Use of Interactive Preventive Care Record
The Agency for Healthcare Research and Quality has released a new guide with information for healthcare professionals to follow when using interactive preventive care records as components of electronic health records. The guide has specific sections for heads of practices and informatics and support staff. Read more on health care.

A highlight of last week's Public Health Systems Research Interest Group meeting, which followed the AcademyHealth Annual Research Meeting, was a “Critical Opportunities” reception during which several presenters pitched their ideas for a law that could be used to improve or solve critical public health issues. The presenters were timed, given only five minutes to share the background of the issue to be addressed, their idea for the law, evidence that it could work and the feasibility of implementing the change. Attendees were encouraged to vote on their favorite to see which Critical Opportunity ranked highest--see below for the results!

This was the second such event since this year’s debut of Critical Opportunities for Public Health Law, an initiative of the Public Health Law Research Program (PHLR), a Robert Wood Johnson Foundation program at Temple University. The goal is to make the case for laws that can improve current critical public health needs by:

• Identifying important ways to use law to improve the public’s health
• Enhancing public and professional recognition of law as a vital force for better public health
• Guiding public health law research

NewPublicHealth caught up with two of the invited presenters, who also accrued the most votes on their topics--Tamar Klaiman, assistant professor at the Jefferson School of Population Health in Philadelphia, and Georgia Heise, DrPh, director of the Three Rivers District Health Department in Kentucky, and recently elected vice president of the National Association of County and City Health Officials.

NewPublicHealth: What did you both present on?

Tamar Klaiman: The policy that I addressed is about requiring physicians to offer new parents TDAP (pertussis) vaccines because infants who are [less than] six months of age are at the highest risk of mortality from pertussis, and so parents can protect their children by being vaccinated. Around 80 percent of pertussis cases in infants, when they can track where the pertussis came from, come from parents. The policy that I talked about is having providers offer pertussis vaccine to new parents prior to leaving the hospital or birth center with the newborn.

NPH: Why would that be valuable?

Tamar Klaiman: Newborns are not fully protected against pertussis until after their 6-month booster so vaccinating parents offers the best protection. So it’s a very low risk, high reward policy.

NPH: Are there states that are already implementing this law?

Tamar Klaiman: None as far as I know.

NPH: Georgia, what’s your critical opportunity?

Georgia Heise: I talked about voluntary public health department accreditation for local health departments. Accreditation encompasses a myriad of standards that cover the mission of public health and what health departments should be doing. This would standardize public health across the nation and force into place a lot of preventive measures and assessments and best practices that the health department would be doing things that would actually make a difference in population health.

NPH: Why is this a critical opportunity?

Georgia Heise: I think that across the United States we operate on a medical model, which means we don’t really put enough funding into anything that would teach people how to be healthy or keep them healthy. We put a lot of money into taking care of somebody once they’re sick or dying. We need to push in the opposite direction and focus on keeping people healthy, and these accreditation standards are a framework for health departments to start that. There’s now an opportunity for health departments to become accredited at the national level. It’s in place and ready to go, however, not all the health departments have opted in yet.

Results of the Critical Opportunities Vote at AcademyHealth

About 100 people texted their votes for the presentations at the Interest Group meeting. The results were as follows:

• Requiring physicans to vaccinate parents of newborns against pertussis (whooping cough) to better protect young babies: 50 percent of votes
• A law requiring that states health departments be accredited and that funding be provided to go through the accreditation process: 24 percent of votes
• Establishing comprehensive laws to deal with designer drugs such as synthetic marijuana that would be broad enough to encompass new drugs as they are introduced: 18 percent of votes
• Creating standards for public health department contracts with private entities: 9 percent of votes

>>Watch YouTube videos of Critical Opportunities presentations at the Public Health Law Research Program meeting earlier this year.

Study: Antibiotics Down, ADHD Drugs Up Among Kids

Fewer antibiotic prescriptions were dispensed by pharmacies for kids 17 and younger but prescriptions for ADHD drugs were up, according to a study by Food and Drug Administration researchers and published in Pediatrics. The researchers reviewed outpatient retail prescription databases. In addition to decreases in antibiotic prescriptions for children, the study also found decreases in allergy, pain and depression drugs as well as a 42 percent drop in cough and cold medicines for kids. The FDA issued an advisory in 2008 against using cough and cold drugs in very young kids.

In addition to increases in ADHD drugs, the study found higher rates of asthma drugs and contraceptives. Read more on prescription drugs.

Delaying Infant Vaccines Triples in Portland, Oregon

A new study in Pediatrics looks at the practice of delaying infant vaccinations, which experts say can increase the risk of communicable disease outbreaks. The study found that in 2009, about 9.5 percent of parents in the Portland, Ore., area did not consistently follow the recommended vaccine schedule for infants and children up to nine months old, up from 2.5 percent in 2006. Children whose parents delayed shots had more visits to providers for shots, fewer total shots, and did not generally catch up later with the recommended vaccination schedule.

The researchers say negative media attention about vaccine safety likely contributed to the increase in parents delaying or limiting the number of immunizations, and say there are no known benefits to delaying vaccines in infants. Read more on vaccines.

FDA Panel Backs HIV Drug to Prevent Transmission of the Virus

Reuters is reporting that an FDA advisory committee has recommended that the HIV drug Truvada be approved for the prevention of HIV for people at highest risk of contracting the infection, such as men who have sex with other men. The agency is expected to rule on the recommendation next month. While the drug has been effective in preventing transmission of the infection in clinical trials, drawbacks include the high cost of the drug and a risk for serious kidney problems when the drug is used long term. Read more on HIV.

Washington State Declares Whooping Cough Epidemic

This week the governor of Washington State, Chris Gregoire, made emergency funds available to the state Department of Health to help curb the outbreak of whooping cough (pertussis) underway in Washington. The state’s Health Secretary declared a whooping cough epidemic last month. Gregoire also urged health care professionals to get vaccinated and vaccinate their patients, and announced federal approval for health officials to re-direct some funds to buy several thousand doses of pertussis vaccine for adults.

“I’m especially concerned about the vulnerable babies in our communities that are too young to be fully immunized,” said Gregoire. “These actions will help state and local health leaders get vaccine into people’s arms so we can stem the tide.” According to the Department of Health 1,132 cases of whooping cough have been reported in the state through April 28—that’s compared to 117 over the same time last year. There were 965 cases reported in all of 2011. Read more on vaccine-preventable illnesses.

Stores Recall Thousands of Water Slides Linked to One Death, Two Critical Injuries

In cooperation with the U.S. Consumer Product Safety Commission (CPSC), Wal-Mart Stores Inc., and Toys R Us Inc., are announcing the recall of about 21,000 inflatable Banzai in-ground pool water slides. During use, the slide can deflate, allowing the user to hit the ground underneath the slide and become injured. The slide is also unstable and can topple over in both still and windy conditions and carries inadequate warnings and instructions. The CPSC says it is aware of one death, a paralyzing injury and a neck fracture linked to use of the slides.

CPSC urges consumers to immediately stop using the product and return it to the nearest Wal-Mart or Toys R Us for a full refund. Consumers can also cut the two safety warning notices out of the slide and just return that portion.

The CPSC has also recently published a roundup of recalls this past year of products most likely to be used in the spring and summer, such as playground sets, gas grills and kiddy bikes. Read more on injury prevention.

Required Vaccines for School Entry Improves Coverage Rates for Pre-Teens

Pre-teens living in states that require vaccinations for incoming middle school students are more likely to be immunized than those in states that simply require parents to receive information about the vaccines, according to a study in Pediatrics.

Researchers at the Centers for Disease Control and Prevention reviewed school entry requirements in all 50 states and the District of Columbia for the 2008-2009 school years and compared them to adolescent vaccination rates for three vaccines: TdaP, meningitis and HPV. Compared to states with no requirements, vaccination coverage was significantly higher for the meningitis (71 percent versus 53 percent) and TdaP (80 percent versus 70 percent) vaccines.

Read more on vaccines

National Dialogue Begins on Improving Transportation Access for Active, Wounded and Veteran Military Members, and Families

The Department of Transportation has announced a month-long web-based dialogue May 7 to June 8, to help facilitate discussion about local transportation needs, challenges and opportunities facing military veterans, wounded service people and military service members and their families. Military families, veterans and organizations that support them are invited to participate in the discussion to create options to improve access to transportation. Registered participants will be able to offer an idea, a comment or vote on ideas they see on the site. A public report will be issued after the dialogue period ends.

Read more on military health issues.

Dog Food Likely Tainted with Salmonella Linked to Human Illnesses

The Centers for Disease Control and Prevention is reporting that at least sixteen people have been sickened by dry dog food made by Diamond Pet Foods that may be tainted by salmonella. Humans may have become infected by touching the food or a pet that ate the food. The company has recalled the products. CDC is advising that:

• Consumers should check their homes for recalled dog food products and discard them promptly. Contact Diamond Pet Foods for more information at (800) 442-0402 or www.diamondpetrecall.com.
• Follow tips listed on Salmonella from Dry Pet Food and Treats to help prevent an infection with Salmonella from handling dry pet food and treats.
• People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers. For sick animals, contact your veterinary-care providers.

Read more on salmonella

This week is National Infant Immunization Week, an annual observance to promote vaccinations in kids two and younger.

Last September the Centers for Disease Control and Prevention announced that childhood immunization rates for vaccines routinely recommended for children are at near-record or record highs. But CDC experts say that without ongoing efforts to maintain immunization programs in the US – and to strengthen them worldwide -- vaccine-preventable diseases remain a threat to children. In 2010, for example, an outbreak of pertussis (whooping cough) killed ten infants in California.

CDC and the CDC Foundation are recognizing innovative child immunization efforts this year with the CDC Childhood Immunization Champion Awards, a new annual award to recognize individuals who make significant contributions toward improving public health through their work in childhood immunization.

Innovations recognized this year include:

• A contest to help increase the number of people vaccinated against season flu.
• A link between a hospital’s electronic medical records and the state immunization registry which lets pediatrics practices upload vaccine information directly into the registry and gives providers easy access to registry data about their patients.
• Vaccine mobiles, providing free vaccines regardless of insurance coverage, parked at public spaces and linked to a state registry system.

Read about the champions in all fifty states.

Weigh In: What innovative approaches have increased infant immunization rates in your community?

2011 Worst Year for Measles in 15 Years

A new Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention finds that there were 222 cases and 17 outbreaks of measles in the United States last year—more than four times the usual annual rate, and the highest number of reported cases of measles in the nation in the last fifteen years. In the ten years between 2001 and 2011, an average of 60 cases and four outbreaks were reported each year.

Most of the Measles cases in 2011 were in people who had traveled abroad, half to Europe where there have been significant measles outbreaks in the last few years. A significant number of those who developed measles last year were between the ages of 16 months and 19 years and eligible to be vaccinated against measles, but had not been vaccinated because of philosophical, religious or personal exemptions. Read the latest infectious disease news.

New Diabetes Guidelines Released

New guidelines for managing elevated blood glucose levels in people with type 2 diabetes have been released by the American Diabetes Association and the European Association for the Study of Diabetes.

The new guidelines call for a more patient-centered approach that allows for individual patient needs, preferences and tolerances, and takes into account differences in age and disease progression. The guidelines also call for providing all patients with diabetes education, in an individual or group setting, focusing on diet, increased physical activity and weight management. The organizations behind the guidelines encourage health care professionals to develop individualized treatment plans based on a patient’s specific symptoms; co-morbidities; age; weight; racial, ethnic, and gender differences; and lifestyles. Read more on diabetes.

VA to Add Mental Health Workers to Aid Returning Veterans

The Department of Veterans Affairs (VA) has announced that it will add about 1,600 mental health clinicians, including nurses, psychiatrists, psychologists, and social workers, as well as nearly 300 support staff to the existing workforce of 20,590 mental health staff, as part of an ongoing review of mental health operations.

Off to its latest start in 29 years, according to Joseph Breese, MD, chief of the Epidemiology Prevention Branch at the Centers for Disease Control and Prevention (CDC), the flu season has finally begun. November vaccination rates for 2011 were higher than for the year before, so that may be one reason for the milder season so far, says Dr. Breese. But the late start doesn’t indicate how severe the flu season will be, so the CDC is still recommending that anyone six months or older who hasn’t had a flu shot, make sure they get one. The American Lung Association’s Vaccine Finder still shows supplies throughout the country, but it's helpful to call clinics first to make sure they have vaccine on hand.

But should that flu shot recommendation be a little more forceful for some groups in order to protect patients, some of whom may be vulnerable to severe flu-related health outcomes because of weakened immune systems? An increasing number of hospitals around the country now require workers to get a flu shot. Professional associations including the American Academy of Pediatrics and the American College of Physicians recommend that hospital workers get flu shots. The National Business Group on Health, which advises large employers on health benefits and policies, issued a “strong recommendation” last month urging hospitals and health care facilities to require flu vaccines for all of their employees.

“Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue,” says Helen Darling, president and CEO of the Business Group. “Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs.”