Category Archives: Infectious diseases
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.
From antibiotic-resistant superbugs to the seasonal flu to Salmonella, infectious diseases are a serious health threat that also cost individuals and the health care industry billions. A new report from Trust for America’s Health and the Robert Wood Johnson Foundation, Outbreaks: Protecting Americans from Infectious Diseases, assesses gaps in our public health system that could severely limit our ability to effectively respond to an outbreak.
NewPublicHealth created an infographic that illustrates many of the key findings of the new report.
A new study published recently in the American Journal of Public Health finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease. The researchers reviewed relevant laws and regulations for each year between 2001 and 2008 and rated them on their restrictiveness in granting exemptions. The study was funded by a grant from the Public Health Law Research program, a national program of the Robert Wood Johnson Foundation.
According to the study, state laws that make it difficult for children to be exempted from vaccines on religious or philosophical grounds could reduce the number of whooping cough cases, but did not have an impact on cases of measles, mumps, haemophilus influenza type B (Hib) or Hepatitis B.
“Our research shows that during the study period, if all states increased the restrictiveness of their non-medical exemption laws by one level, the number of U.S. whooping cough cases would decline by 1.14 percent, resulting in 171 fewer cases per year,” according to study author Y. Tony Yang, ScD, MPH, associate professor at the College of Health and Human Services at George Mason University.
The study found that the impact on whooping cough may be greater than for the other diseases studied simply because whooping cough affects more people. Researchers call this a “threshold effect,” which means laws may not have a significant impact unless they works to prevent a disease that affects a critical mass of people. During the study period, whooping cough was much more prevalent than the four other diseases studied—the average incidence rate for whooping cough was 18 per 100,000 individuals from 2001 to 2008. For Hib, Hepatitis B, measles, and mumps, the mean incidence rates were less than 1 per 100,000.
A new report from Trust for America’s Health finds that despite recommendations by medical experts about the effectiveness and safety of vaccines, an estimated 45,000 adults and 1,000 children die from vaccine-preventable diseases each year in the United States.
NewPublicHealth spoke with Litjen (L.J) Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition, to ask about ongoing efforts to improve immunization rates among all age groups across the nation. The Coalition works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public and facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies. The Coalition is supported by the U.S. Department of Health and Human Services.
NewPublicHealth: What are the critical gaps in immunization in the United States—for children and adults?
Litjen Tan: Immunization rates are really high in our childhood population, but generally not at all high in the adult population, though for some vaccines the rates are improving. We are also not doing very well for adolescents. On the broader level I think what the immunization rates reflect is the state of preventive care in the United States when you come out of childhood, which is why I think the Affordable Care Act really is a great boon. We’ve got this wonderful preventive care model for our kids; we take our kids in, we get them their shots, they get protected and we’ve got high coverage rates generally over 90 percent for all major vaccines. We have almost no vaccine-preventable disease in the United States except for instances linked to pockets of populations that haven’t been vaccinated—as we’ve seen recently with measles.
But then we get to adolescence we have this breakdown. Rates for HPV vaccination are not so good. Our meningococcal vaccination rates are not where they should be and neither are the tetanus, diphtheria and pertussis booster rates in adolescents. What happens with the adolescents is parents don’t necessarily bring them in for prevention checkups anymore. We bring them in when there’s a problem or when they need a school sports visit, and so we plant in adolescents this idea that care is no longer about prevention but care is now about acute care, and that persists into adulthood. This is the thinking that stops us from saying, “hey, do I need my vaccines? When should I get them?”
We need to make sure that our adolescents get the idea that vaccines prevent disease and that they actually do have vaccines that are recommended for them and then I think we’ll begin to see an appreciation of immunizations for adults as well.
NPH: Do we need to target both parents and the adolescents themselves?
Tan: Absolutely, but there’s a lot of discussion about how we do that. It gets a little tricky because we push autonomy of the adolescent, and we have a precedent in public health—discussions between providers and adolescents about sexually transmitted infections—but there are a lot of legislative and regulatory barriers against directly talking to an adolescent in the absence of a parent.
“Outbreak” is a relative word. A modern outbreak could be a virus that kills a couple hundred thousand (such as the recent swine flu), or simply an infected shipment of food that left dozens sick. However, a look back through history reveals outbreaks so expansive—so deadly—that they essentially changed the course of history. Below are the five deadliest outbreaks and pandemics in history.
Ask yourself—are we prepared as a nation for the next big outbreak?
(Image source: WikiCommons)
A plague so devastating that simply saying “The Plague” will immediately pull it to the front of your mind, in the middle of the 14th century—from 1347 to 1351—the Black Death remade the landscape of Europe and the world. In a time when the global population was an estimated 450 million, at least 75 million are believed to have perished throughout the pandemic, with some estimates as high as 200 million. As much as half of Europe may have died in a span of only four years. The plague’s name comes from the black skin spots on the sailors who travelled the Silk Road and docked in a Sicilian port, bringing with them from their Asian voyage the devastating disease, now known to be bubonic plague.
Outbreaks can advance quickly and through a wide variety of vectors. We all know to be wary of mosquitos and ticks, but there are plenty of other ways diseases can spread that may not be top of mind for most. This is where food safety and other precautions around wild animals can help. But never fear. We have compiled a list of the top five strangest things that can spread disease so you can be prepared.
(Image source: WikiCommons)
While their mythical status as vampires in another form might be what scares some people about bats, what’s even scarier is their potential to spread disease. A species of bats in China are believed to have helped spread SARS (severe acute respiratory syndrome), which killed more than 750 people worldwide between 2002 and 2003. Researchers found two SARS-like viruses in horseshoe bats found in China, suggesting that they could have been the origin of the human pandemic.
Add flu surveillance to the list of casualties of the current government shutdown.
Every flu season, states collect data on flu cases — including case reports and viral specimens — and send those to the Centers for Disease Control and Prevention (CDC) in Atlanta for recording and tracking. That tracking is critical in order to:
- provide information on how well-matched the seasonal flu vaccine is to the flu viruses found in the community;
- identify severe outbreaks that require increased supplies of antiviral medicines for people who contract the flu; and
- identify emerging strains that might require a new vaccine to be developed this season, which is what happened several years ago when CDC identified the H1N1 influenza virus toward the end of the flu season, and quickly ramped up for a new vaccine.
Flu season generally runs October through April, with the peak from about January to March. If the shutdown continues then, “as the flu season goes on, our knowledge of what’s happening will be impaired,” says William Schaffner, MD, Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine, and the immediate past president of the National Foundation for Infectious Diseases.
CDC director Thomas Frieden, MD, MPH, underscored his concern in a tweet on the first day of the government shutdown: “CDC had to furlough 8,754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.”
Recent debate about the federal government shutdown that started two days ago for federal employees has included a wide range of concerns and viewpoints from different sides of the spectrum. But Forbes Magazine has a new article that points out that the shutdown means something else entirely for some often overlooked, but very influential, bodies outside the federal government: microbes.
According to the piece in Forbes, the shutdown has the potential:
to pose a threat to public health because [it will] allow microbes to gain footholds as our defenses against them falter.
The article reported that several federal agencies will reduce such critical work as research funding, food inspections and surveillance for the flu and other infectious diseases including the emerging MERS virus, which has caused dozens of deaths overseas. A recent post from The Atlantic also pointed out a related piece of reporting from The Wall Street Journal: "about 200 patients who otherwise would be admitted to the NIH Clinical Center into clinical trials each week will be turned away. This includes about 30 children, most of them cancer patients...."
>>Read more on how researchers are studying microbes in buildings to health create healthier spaces.
Ahead of the annual pilgrimage of Muslims to Mecca and Medina in Saudi Arabia this October, the Saudi health ministry is limiting the number of foreign and local pilgrims in order to lower the risk of the spread of H7N9, a new form of avian flu identified several months ago in China, and MERS, or Middle East respiratory syndrome corona virus (MERS/MERS-CoV), a potentially fatal virus that emerged last year. The largest numbers of cases of the virus—and deaths—have been in Saudi Arabia. According to a recent post on the Network for Public Health Law’s (NPHL) blog by Daniel G. Orenstein, JD, deputy director of NPHL’s Western Region, so far neither the U.S. Centers for Disease Control and Prevention nor the World Health Organization have issued travel restrictions about the Hajj.
However, the post does note that the emergence of the two viruses has prompted the U.S. Food and Drug Administration (FDA) to take action under its legal authority to increase U.S. readiness to treat potential outbreaks of H7N9 and MERS. Under the Pandemic and All Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), the FDA recently issued Emergency Use Authorizations (EUAs) for diagnostic tests for both viruses. EUAs enable the FDA to temporarily allow use of unapproved medical products such as antibiotics, vaccines and diagnostic tests needed during emergencies.
Orenstein says that “issuing the EUAs illustrates the flexibility and adaptability of FDA authority as clarified under PAHPRA. As epidemiologic research develops further on these viruses, FDA will be able to respond quickly, hopefully mitigating the impact on population health.”
>>Read more: Read the full post on the Network for Public Health Law’s blog.
Following several outbreaks of mumps cases on college and university campuses this past spring, the American College Health Association (ACHA) recently issued an alert urging institutes of higher education to keep mumps on their radar and require proof of complete mumps vaccination coverage for all students, which means having received two doses of MMR (measles, mumps and rubella) usually between 12 to 15 months and then again between the ages of 4 and 6.
According to the Centers for Disease Control and Prevention (CDC), up to half of people who contract mumps show very mild to no symptoms. However, the most common symptoms of mumps that may appear after 12 to 18 days of incubation include:
- Muscle aches
- Loss of appetite
- Swollen and tender salivary glands under the ears
While mumps is usually a mild disease in children, contracting mumps after puberty can have adverse effects on both the male and female reproductive systems and in some cases can affect the central nervous system.
According to the chair of ACHA’s Vaccine Preventable Diseases Committee, Susan Even, MD, most colleges and universities already require two doses of the MMR vaccine for enrolled students. Even is also the executive director of the student health center at the University of Missouri, where she says the health center participates in new student orientation. Incoming students who are behind on immunizations including the full course of MMR are directed to come in to the health center and receive the appropriate boosters, which they can charge to their campus account.