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Oct 30 2014
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Public Health News Roundup: October 30

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EBOLA UPDATE: WHO Officials See ‘Glimmers of Hope’ in Liberia as New Case Rate Declines
(NewPublicHealth is monitoring the public health crisis in West Africa.)
There are “glimmers of hope” in Liberia as officials from the World Health Organization (WHO) say the rate of new Ebola cases appears to be declining for the first time since the outbreak began. Still, an official with the global health agency said they are still very much concerned and on guard. “It’s like saying your pet tiger is under control,” said Bruce Aylward, the WHO’s assistant director-general in charge of the operational response, according to The Washington Post. “This is a very, very dangerous disease” and “the danger now is that instead of a steady downward trend we end up with an oscillating trend where the virus goes up and down” because areas become reinfected. Read more on Ebola.

Study: Infant’s Birthweight Tied to Disease Risk Later in Life
An infant’s size at birth may help predict their health later in life, with babies who are heavier have less of a risk for future disease, according to a new study in The FASEB Journal. Researchers based their findings on an analysis of cord blood of newborn babies from mothers with raised glucose levels during late pregnancy and blood taken later. "These findings support the hypothesis that common long-term variation in the activity of genes established in the womb may underpin links between size at birth and risk for adult disease," said Claire R. Quilter, Ph.D., study author from the Mammalian Molecular Genetics Group, Department of Pathology at the University of Cambridge in the United Kingdom. "If confirmed these could be important markers of optimal fetal growth and may be the first step along a path to very early disease prevention in the womb." Read more on maternal and infant health.

FDA Approves New Meningitis Vaccines
The U.S. Food and Drug Administration (FDA) has approved the first vaccine approved to prevent invasive meningococcal disease in the United States. The drug is to prevent  Neisseria meningitidis serogroup B is approved for individuals ages 10 to 25 years. Approximately 500 total cases of meningococcal disease were reported in the United States in 2012, with 160 having been causes by serogroup B. “Recent outbreaks of serogroup B Meningococcal disease on a few college campuses have heightened concerns for this potentially deadly disease,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, in a release. “The FDA’s approval of Trumenba provides a safe and effective way to help prevent this disease in the United States.” Read more on vaccines.

Oct 21 2014
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The Progress on Ebola: Q&A with Tarik Jasarevic, the World Health Organization

Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.

NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa? 

Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa. 
 
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed? 

Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
 
NPH: What is the current fatality rate?

Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia. 

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Oct 16 2014
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Faces of Public Health: Jim Blumenstock, ASTHO

People tuning into news coverage of the Dallas Ebola cases have come to recognize David Lakey, the Texas state health officer. Every state has a similar position and those officials are charged with improving population health—from holding immunization clinics to responding to potentially fatal illnesses. The Association of State and Territorial Health Officers (ASTHO) is the professional association of the 50 state health officers. Jim Blumenstock is the chief program officer of ASTHO’s public health practice division. NewPublicHealth spoke to Blumenstock this week about state and federal coordination on Ebola detection and case treatment.

NewPublicHealth: What is ASTHO’s role in dealing with preparedness for Ebola in the United States and with the current cases?

Jim Blumenstock: In a crisis or a public health emergency like we’re experiencing with Ebola, ASTHO’s role principally is to do two things. Number one is to sort of be the glue or the hub that helps pull together the 50 states, the nine territories and the District of Columbia as an integrated, harmonious component of our public health infrastructure. The second feature is to provide a solid interface between federal efforts and state efforts. So, that’s our role with any significant public health issue.

During the H1N1 outbreak several years ago, both ASTHO and the National Association of County and City Health Officials (NACCHO) had key staff embedded in the U.S. Centers for Disease Control and Prevention’s (CDC) Emergency Operation Center because it was recognized that the value of the insight of a national organization that represents all the states and locals was so critical to the federal planning and response process. That was the first time it was done.

We’re on standby to do it and we’re sort of functioning in that capacity right now, but sort of in a virtual or remote area. For example, I’m not today embedded in CDC’s Emergency Operation Center. However, I would say I’m on the phone with them at least six to eight times a day—including last evening—and have had email exchanges already this morning, not only to get information, but also to be part of some planning and problem solving efforts they’ve requested our help on, or a request for our help on state consensus around a strategy or a tactic or an approach on a particular matter.

And our other critical roles are to help our members; to talk to federal public health officials; and to educate and inform the public. 

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Oct 13 2014
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PBS Series ‘Frontline’ Examines Antibiotic Resistance

In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.

According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.

NewPublicHealth recently spoke with Hoffman about the project.

NewPublicHealth: What made you interested in the topic of antibiotic resistance?

David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.

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Oct 13 2014
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Public Health News Roundup: October 13

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CDC Confirms Texas Hospital Nurse Who Cared for Infected Patient Has Ebola
On Sunday, the U.S. Centers for Disease Control and Prevention (CDC) confirmed test results that found that a healthcare worker at Texas Presbyterian Hospital in Dallas is positive for Ebola. The health care worker provided care for a Dallas patient who contracted Ebola in Liberia and died last week. The nurse is being cared for in an isolation unit.  In a statement released on Sunday, the CDC said “this development is understandably disturbing news for the patient, the patient’s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures, including ongoing contact tracing, health monitoring among those known to have been in contact with the index [first]patient, and immediate isolations if symptoms develop.” Read more on Ebola.

Medicare Part B Premiums and Deductibles Will Remain the Same for 2015 as Rates of the Past Two Years
The U.S. Department of Health and Human Services has announced that the standard Medicare Part B monthly premium and deductible for 2015 will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.  About 50 million Americans are enrolled in Medicare Part B and their monthly premiums and annual deductibles will be $104.90 and $147, respectively. Read more on Access to Health Care.

Monitoring Illness at Preschools Could Offer Early Avert for Some Disease Outbreaks
A web-based system that allows preschools and child care centers to report illnesses to local public health departments could improve the detection of community disease outbreaks and allow resources to be mobilized faster according to a study presented at the American Academy of Pediatrics meeting in San Diego. The researchers created a computerized system and tested it at four early learning centers in Michigan. Staff was trained to use the system daily and send illness updates to local health department weekly, or more frequently if spikes in illnesses were seen. Among their findings: the four preschools reported a gastroenteritis outbreak three weeks earlier than other area schools. Read more on infectious disease.

Oct 8 2014
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Public Health News Roundup: October 8

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EBOLA UPDATE: Kaiser Infographic Lays Out the Key Statistics
(NewPublicHealth is monitoring the public health crisis in West Africa.)
A new infographic on the current Ebola outbreak produced by the Kaiser Family Foundation and published in the Journal of the American Medical Association breaks down the crisis into key elements, including the disease count so far, the rate of response and the key U.S. government agencies charged with addressing the outbreak. Key numbers include:

  • Fatality rate — 53 percent which is lower than in previous outbreaks
  • Outbreak geography — In the current outbreak, five West African countries that have never had Ebola cases are now battling the disease including Guinea, Liberia, Nigeria, Senegal and Sierra Leone
  • U.S. agencies responding — Department of Defense, Department of States, U.S. Agency for International Development, Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health

The World Health Organization also maintains a dedicated Ebola information website that is updated frequently and includes case counts, studies, policy announcements and feature stories about aid in West Africa. Read more on Ebola.

CDC: 2.5M Emergency Department Visits for Vehicle Crashes in 2012
Motor vehicle crashes sent more than 2.5 million people to emergency departments (EDs) and led to more than 200,000 people being hospitalized in 2012, according to a new report from the U.S Centers for Disease Control and Prevention (CDC). All told, the lifetime medical costs for these crash injuries will be $18 billion and the lifetime work lost will be an estimated $33 billion. “In 2012, nearly 7,000 people went to the emergency department every day due to car crash injuries,” said CDC Principal Deputy Director Ileana Arias, PhD, in a release. “Motor vehicle crash injuries occur all too frequently and have health and economic costs for individuals, the health care system, and society.  We need to do more to keep people safe and reduce crash injuries and medical costs.” Read more on injury prevention.

Task Force Recommends Diabetes Screening for All Americans Over Age 45
Everyone over the age of 45 should be screening annually for type 2 diabetes and prediabetes, according to new recommendations from the U.S. Preventive Services Task Force. "For people with abnormal blood sugar, changes in their lifestyle, such as eating healthier and exercising more often, can help prevent or delay the onset of type 2 diabetes,” said Michael Pignone, MD, a task force member, in a release. “The best way to do that is to participate in a program that supports these behaviors. That's why we're recommending that people who are at increased risk be screened." According to the U.S. Centers for Disease Control and Prevention, approximately 29.1 million Americans have diabetes, although 8.1 million of those cases are undiagnosed. Read more on prevention.

Sep 29 2014
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Ebola Outbreak Prompts Concern for Impact of Other Infectious Diseases

As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.

Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”

Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.

This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.

A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments. 

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Sep 25 2014
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Preparing for Ebola in the U.S. Makes Good Public Health Sense

U.S. public health officials have continually said that it is highly unlikely that the Ebola virus will spread in the United States, even if infected travelers land here. Officials at the U.S. Centers for Disease Control and Prevention (CDC) say that the disease is most contagious when people come into contact with the bodily fluids of someone who is ill—and someone that ill would be very likely be identified by border and airline personnel quickly. If hospital admission became necessary, U.S. infection control procedures could stem an outbreak, according to Tom Frieden, MD, the CDC’s director and the point person for the U.S. government on the current Ebola outbreak. Frieden has discussed the issue repeatedly during several news conferences in the last few weeks.

Of course, that changes if the virus becomes transmissible through the air, rather than just via bodily fluids, as Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, suggested in the New York Times last week. While Osterholm often addresses the direst potential outcomes of infectious disease outbreaks, it’s prudent to at least know what to do, which is why agencies such as the CDC and the Network for Public Health Law say what’s needed is information and procedures...but not panic.

Last month, the Network held an online webinar on preparedness measures and Ebola which was watched by more than 1,200 public health officials. Following the webinar, Network experts posted answers to follow-up questions, including one about the right of public health or hospital workers to refuse to care for/help with someone suspected of having Ebola.

The Network also recently created an online primer on preparedness and legal issues surrounding the Ebola outbreak, both for public health officials engaged in the response overseas and for those with current or future responsibility for handling Ebola-related issues in the United States.

>>Bonus Link: Richard Besser, MD, now the chief health editor for ABC News, was formerly the CDC’s head of disaster response and led the early response to the H1N1 outbreak in the United States several years ago. In a recent opinion piece for the Washington Post, Besser laid out what’s being accomplished and what still needs to be done to stem the Ebola outbreak in West Africa.

Sep 25 2014
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Public Health News Roundup: September 25

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EBOLA UPDATE: Public Health Experts Worried About a ‘New Normal’ For Ebola
(NewPublicHealth is monitoring the public health crisis in West Africa.)
With the World Health Organization announcing that the death toll from the Ebola outbreak in West Africa has now surpassed 2,900 people, public health experts are increasingly resigning themselves to the very real possibility that the outbreak will go on for a very long time. Previous human outbreaks were either stopped quickly or in no more than a few months. However, this outbreak is taking hold in urban areas—previous outbreaks were found in rural areas with smaller, more spread out populations—making it unlike any of the others. “What’s always worked before—contact tracing, isolation and quarantine—is not going to work, and it’s not working now,” said Daniel Lucey, a professor of Microbiology and Immunology at Georgetown University Medical Center, according to The Washington Post. Read more on Ebola.

Common Painkillers Linked to Increased Risk of Blood Clots
Common painkillers including aspirin, naproxen and ibuprofen may be linked to an increased risk of developing dangerous blog clots known as venous thromboembolisms (VTE), according to a new study in the journal Rheumatology. The painkillers are all types of non-steroidal anti-inflammatory drugs (NSAIDs). Researchers analyzed the results of six studies that included 21,401 VTE events, finding that patients who used NSAIDs were almost twice as likely to develop the clots. "Our results show a statistically significant increased VTE risk among NSAIDs users. Why NSAIDs may increase the risk of VTE is unclear,” said study lead author Patompong Ungprasert, in a release. “It is possibly related to COX-2 inhibition leading to thromboxane-prostacyclin imbalance. Physicians should be aware of this association and NSAIDs should be prescribed with caution, especially in patients already at a higher risk of VTE." Read more on heart and vascular health.

U.S. Lags Behind Much of Europe in Infant Mortality Rates
The United States continues to lag behind much of Europe and several other developed nations when it comes to infant mortality rates, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). Approximately 6.1 U.S. infants died per every 1,000 live births in 2010. While that was down from the rate of 6.87 in 2005, it was still double the rates of Finland, Japan, Portugal, Sweden, the Czech Republic and Norway. "I think we've known for a long time that the U.S. has a higher preterm birth rate, but this higher infant mortality rate for full-term, big babies who should have really good survival prospects is not what we expected," said lead author Marian MacDorman, a senior statistician and researcher in the CDC's National Center for Health Statistics, according to HealthDay. Reasons for the United States’ high rate include prenatal care that leads to the birth of more at-risk preemies, as well as disparities in prenatal care. Read more on maternal and infant health.

Sep 22 2014
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Following the Announcement of New Antibiotic Resistance Initiative, Advocates Call for Increased Emphasis on Prevention in Livestock

Despite growing awareness of the dangers, antibiotic resistance continues to sicken two million Americans and kill 23,000 each year, according to a 2013 report from the U.S. Centers for Disease Control and Prevention. Late last week the Obama administration announced a series of efforts targeting the public health issue. Among them:

  • A Cabinet-level task force to create a national action plan on  antibiotic resistance
  • Improved federal oversight of antibiotic use in the United States, including better tracking of outbreaks
  • Incentives for developing new generations of antibiotics aimed at treating currently resistant microbes
  • A $20-million prize for the development of a rapid diagnostic laboratory test that doctors can use to identify highly resistant bacterial infections

Many in the public health field are quick to note that more should be done to address a key source of antibiotic resistance—widespread use of antibiotics to prevent infection and promote growth in livestock. There have been concerns that, in addition to over-prescription by physicians overuse, of the antibiotics in farm animals has also contributed to the growing trend of antibiotic resistance. A recent study found that livestock workers can harbor resistant bacteria acquired on the job and introduce it into the community.

Ed Silverman, who writes the Pharmalot blog for the Wall Street Journal, said that an administration report calls for the U.S. Food and Drug Administration (FDA), the U.S. Department of Agriculture, the National Science Foundation and the U.S. Department of Homeland Security to work together to develop an analytic model to assess the relationship between antibiotic use in livestock and the development of antibiotic resistance. The FDA currently has voluntary guidelines for livestock producers on limiting antibiotic use that go into effect in 2016, but advocates had hoped for an actual ban.

APIC ABCs of Infections

>>Bonus Link: The Association for Professionals in Infection Control and Epidemiology (APIC) has released a useful infographic for public health professionals and physicians to share with consumers about their roles in preventing antibiotic resistance.