Category Archives: Infectious diseases
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.
MERS Unlikely to Cause Pandemic; Global Cooperation Still Needed
Middle East respiratory syndrome (MERS), which emerged last year in Saudi Arabia, was compared to severe acute respiratory syndrome (SARS) and found to be less infectious, in a new study published in The Lancet Infectious Diseases. The study examined the question of whether MERS has the potential to cause a pandemic, and how quickly. The study authors concluded that MERS does not yet have pandemic potential, and in fact appears to be less infectious than SARS. There have been 81 laboratory-confirmed cases of MERS infections, 45 of which were fatal. MERS is more likely to affect older men with chronic disease, and were most often transmitted in health care settings—but unlike SARS, the virus was less likely to also infect healthy health care workers. Researchers call for healthcare facilities to prepare to provide safe care for patients with acute respiratory infections, and take measures to help prevent the spread of the disease. Read more on infectious disease.
CDC: HPV Vaccination Rates for Adolescent Girls Remain Stagnant
Just over half (53.8%) of girls age 13-17 years old received the human papilloma virus (HPV) vaccine in 2012, with no increase over the rate in 2011. Since 2006, the Advisory Committee on Immunization Practices has recommended routine vaccination of adolescent girls at ages 11 or 12 years with 3 doses of HPV vaccine. HPV causes 70 percent of cervical cancers. If HPV vaccine had been offered during healthcare visits when girls were already in the office to get a different vaccine, HPV vaccination coverage could have reached 90 percent. Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million will become newly infected each year. Each year, 26,000 new cases of cancer are diagnosed that can be traced back to HPV infection. Read more on vaccines.
New Breathalyzer-like Device Tells You If Your Workout is Working
New technology being prototyped in Japan measures how well you're burning body fat and help you gauge the success of your diet and exercise program, using a smartphone and pocket-sized, bluetooth enabled device. The device measures exhaled breath for acetone, a metabolite produced from fat burning. The researchers tested the device in 17 healthy men and women, reporting their findings online July 25 in the Journal of Breath Research, and finding that the device was as effective as more established "gold standard" measures. Further research is needed on larger, more diverse populations, but if it pans out, "Enabling users to monitor the state of fat burning could play a pivotal role in daily diet management," Hiyama said in a journal news release. Read more on technology.
To what lengths will hospitals go to make sure their employees are washing their hands? The answer for North Shore University Hospital on Long Island, N.Y., is thousands of miles to India where far-flung employees check their monitors, trained on the hospital floors, to find workers who skip the sinks on their way to the hospital’s intensive care units. According to a recent article in the New York Times, that is just one of many ways hospitals are working to increase hand washing and stop the spread of germs that can kill hospitalized patients. Other methods include free pizza and coffee incentives for frequent hand-washers and embedded chips on hospital employees that emit an alarm when a doctor bypasses a sink outside a patient room.
A March report from the Centers for Disease Control and Prevention (CDC) easily explains the increasing emphasis on hospital hand washing. According to the report, a family of bacteria called Carbapenem-Resistant Enterobacteriaceae, which includes e.coli, have become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are developing incurable infections. CDC researchers found that during the first half of 2012, 4 percent of hospitals and 18 percent of long-term care facilities treated a patient with this type of infection.
Some hospitals have incentive ideas that employers and families can adopt including buttons that say, “Ask me if I’ve washed my hands?”
>>Read the article.
WHO Reports First Patient-to-Nurse Transmission of SARS-like Virus
The World Health Organization (WHO) is reporting that two health care workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients, which represents the first case of the virus spreading this way within a hospital. Novel coronavirus, or nCoV, is thought to be spread through close contact, but, "scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS -- a scenario that could trigger a pandemic," according to Reuters. Read more on infectious disease.
Repeated Head Injuries Raise Soldiers' Suicide Risk
Soldiers who sustain multiple traumatic brain injuries, even if they are mild, are at greater risk for suicide, according to a study published in the journal JAMA Psychiatry. Researchers found that the risk for suicidal thoughts or behaviors increased for soldiers with such injuries over the course of a lifetime -- not just in the short term after the injuries occur. Suicide is the second-leading cause of death among U.S. military personnel, and researchers say this study provides further guidance on assessing risks and supporting wounded soldiers. Read more on military health.
HHS Announces $1 Billion to Fuel Health Care Innovation
The U.S. Department of Health and Human Services (HHS) launched a nearly $1 billion initiative -- the Health Care Innovation Awards -- that will fund work to transform the health care system by demonstrating better care and lower costs. This is the second round of the award. In the first round, the Centers for Medicare & Medicaid Services awarded 107 Awards out of nearly 3,000 applications. Round one awardees included a medical home for people with disabilities that showed a 71 percent reduction in hospitalization rates. Read more on access to health care.
The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.
NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.
NewPublicHealth: What, if anything, is different about the flu this year?
Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.
During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.
The proportion of flu-related doctor visits has reached a nine-year high for this time of year, according to the Centers for Disease Control and Prevention, as reported by USA TODAY. Correct anyone who tells you it’s too late to get a flu shot, though. The Centers for Disease Control and Prevention intentionally schedules National Influenza Vaccination Week in December as a reminder to get the shot for the many millions of Americans who still haven’t.
“Flu season typically peaks in February and can last as late as May,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and Director of CDC’s National Center for Immunization and Respiratory Diseases. “We are encouraging people who have not yet been vaccinated to get vaccinated now.”
December holiday gatherings are optimal opportunities to spread the flu, and since it takes up to two weeks for full immunity to take effect, this week is a good time to roll up your sleeve if you’re still shot-less.
Flu shots come in several varieties. Children who never had a flu shot need two doses the first year they get the vaccine. There’s a nasal spray for adults 18-49 and a higher dose version for people 65 and older. Learn more from the CDC about different versions of the flu shot and what might be best for you and your family.
On World AIDS Day, Saturday, December 1, I’m Positive, a new documentary produced by the Kaiser Family Foundation and MTV, will introduce three young adults living with HIV. The documentary is part of a project called GYT: Get Yourself Tested, a campaign to encourage testing for STDs, including HIV. GYT is a sexual health public information partnership between the Kaiser Family Foundation and MTV.
NewPublicHealth spoke with cast member Otis Harris, who is an HIV/AIDS peer advocate who lives in Chicago.
NewPublicHealth: How old are you and how old were you when you found out that you were HIV positive?
Otis Harris Jr.: I am 25 years old and I was 22 [when I found out I was HIV positive].
NPH: What do you wish you had known then that you know now?
Otis Harris Jr.: I wish that I could have been a little more educated about the virus and what to look for and how to protect myself. And if I would have known what I know now then I probably wouldn’t have been infected.
NPH: People have been working on HIV/AIDS education efforts for so many years now, but clearly they weren’t getting through. What are the ways in which they didn’t communicate well and how can they communicate better?