Category Archives: Infectious disease

Dec 19 2013
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Public Health News Roundup: December 19

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Severe Flu-Like Illness Under Investigation in Texas
Health officials in Montgomery County, Texas, are investigating an outbreak of an influenza-like illness that has so far resulted in eight hospitalizations, with four of those patients having since died. Recent tests on the other four show that one seems to have the 2009 H1N1 influenza virus, two were negative for all flu viruses and results are so far unknown on the fourth patient. Close to 2,000 cases of the illness have been reported. So far the investigation suggests that none of the patients who died had been vaccinated against flu, and county residents who have not yet had the flu shot are being urged to get one. According to the county’s health director, the hospitalized patients range in age from 41 to 65, which is not typical; severe flu symptoms more likely occur in very young or very old patients. The U.S. Centers for Disease Control and Prevention (CDC) is assisting the health department in investigating the outbreak, and the county has established a telephone hotline and Facebook page to respond to questions from the public. According to news reports, the current outbreak resembles a cluster of severe respiratory infections in Dothan, Ala., in May; however tests showed that those hospitalized patients had a variety of common respiratory viruses and bacteria, with no unusual pathogens. Read more on flu.

CDC Issues Travel Advisory in Caribbean
The U.S. Centers for Disease Control and Prevention (CDC) has issued a travel health notice because of recent cases of chikungunya on the Caribbean island of St. Martin, which have been confirmed by the World Health Organization. According to the CDC, chikungunya is a very serious illness caused by a virus that spreads through mosquito bites. The most common symptoms are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. The mosquito that carries chikungunya virus can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas. There is currently no vaccine or medicine to prevent chikungunya. Travelers can protect themselves by following CDC recommendations on preventing mosquito bites. "Microbes know no boundaries, and the appearance of chikungunya virus in the Western hemisphere represents another threat to health security," said CDC Director Tom Frieden, MD, MPH, in the release. "CDC experts have predicted and prepared for its arrival for several years and there are surveillance systems in place to help us track it." Read more on infectious disease.

Life Expectancy Increases among Treated HIV-Positive People in North America
A new study in the journal PLOS ONE finds that a 20-year-old HIV-positive adult on antiretroviral therapy (ART) in the U.S. or Canada may be expected to live into their early 70's, a life expectancy approaching that of the general population. Researchers calculated the life expectancies of nearly 23,000 individuals on ART based on mortality rates in the early to mid-2000s. Changes in life expectancy from 2000-2007 among HIV-positive individuals were then evaluated using sociodemographic and clinical characteristics, such as drug use history and immune cell counts. The researchers found that life expectancy at age 20 increased from 36.1 to 51.4 years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007). Life expectancy was lower for individuals with a history of injection drug use, those who were non-white, and those who initiated ART with low CD4 count (a count of cells that activate the immune response) compared to those who started at a higher count. Read more on HIV.

Dec 18 2013
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Outbreaks on the Big Screen

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When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.

Well, maybe not all of them...

As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)

Contagion
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.

World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.

28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...

12 Monkeys
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.

The Crazies
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.

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

(Image source: WikiCommons, Sailko)

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

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While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.

Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.

>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."

NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.

NPH: How are you able to detect polio outbreaks?

Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.

NPH: Why is there insufficient vaccination in those countries?

Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.

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Dec 18 2013
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Public Health News Roundup: December 18

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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.

Dec 17 2013
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INFOGRAPHIC: A Close Look at How Prepared We Are for the Next Outbreak

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.

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

Dec 17 2013
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Recommended Reading: State Vaccine Exemptions’ Significant Impact on Vaccine Rates

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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.

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Dec 17 2013
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NewPublicHealth Q&A: Litjen Tan, Immunization Action Coalition

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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.

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Dec 17 2013
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Public Health News Roundup: December 17

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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.

Dec 16 2013
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The Five Deadliest Outbreaks and Pandemics in History

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“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?

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(Image source: WikiCommons)

1. The Black Death

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.

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Dec 16 2013
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Top 5 Things You Didn’t Know Could Spread Disease

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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.

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(Image source: WikiCommons)

5. Bats

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.

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