Category Archives: Infectious diseases
Mandatory Policies Increase Flu Shot Rates for Health Care Workers
Hospitals can improve their flu vaccination rate among health care workers by using a mandatory employee vaccination policy, according to a study by researchers at the Henry Ford Health System in Detroit. At Henry Ford, getting the flu shot is a condition of employment and the health system now has a 99 percent compliance rate. Nationally, only 63 percent of health care workers were immunized against the flu in the past two years, according to the Centers for Disease Control and Prevention, which poses a risk to patients. The study was presented this weekend at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington D.C.
Before making flu vaccination mandatory, the vaccination rate at Henry Ford was between 41 percent and 55 percent. An increasing number of health systems are making flu shots mandatory for employees. At Henry Ford, employees can opt out for religious or medical reasons so long as they have documentation from clergy or a physician and then must take other precautions against the flu, such as wearing a mask when caring for patients.
Many doctors’ offices, pharmacies and clinics already have the flu shot on hand for the upcoming flu season. The HealthMap flu shot locator has been updated for the 2014-2015 flu season.
Read more on the flu.
Study: Alcohol Ad Reminders to “Drink Responsibly” Promote Drinking
A new study by researchers at the Johns Hopkins School of Public Health finds that magazine ads from the alcohol industry that advise readers to “drink responsibly” or “enjoy in moderation” fail to convey important information about dangers associated with alcohol consumption.
The study, published in Drug and Alcohol Dependence, analyzed all alcohol ads that appeared in U.S. magazines from 2008 to 2010 to determine whether messages about responsibility define responsible drinking or provide clear warnings about the risks associated with alcohol consumption.
According to the study, 87 percent of the ads analyzed included a responsibility message, but none actually defined responsible drinking or promoted abstinence at particular times or in certain situations. When responsibility messages were accompanied by a product tagline or slogan, the messages were displayed in smaller font than the company’s tagline or slogan 95 percent of the time.
Responsibility statements are voluntary and are also frequently included in ads appearing in other media including radio and online ads. The researchers say more effective ads would have prominently placed tested warning messages that directly address behaviors and that do not reinforce marketing messages. “We know from experience with tobacco that warning messages on product containers and in advertising can affect consumption of potentially dangerous products,” say Katherine Clegg Smith, a professor at the Johns Hopkins Bloomberg School of Public Health and a lead author of the study. “We should apply that [tobacco ad] knowledge to alcohol ads and provide real warnings about the negative effects of excessive alcohol use.”
Read more on alcohol.
NYC Health Department Investigating Meningitis Outbreak among HIV Positive Men
The New York City Health Department is currently investigating a cluster of meningitis cases among HIV-positive men who have sex with men. Three cases of meningitis have occurred in Brooklyn and Queens since August 24, with the last two cases reported since early September.
Meningitis is a severe bacterial infection that has a high fatality rate. A previous outbreak of the disease among men who have sex with men ended in February 2013 after 22 cases were reported, including seven fatal cases.
The Health Department recommends meningitis vaccination for all HIV-positive men who have sex with men. Meningitis vaccinations are also recommended for men, regardless of HIV status, who regularly have intimate contact with other men met through a website, digital application (“app”), or at a bar or party.
People living with HIV are at a greater risk than the general population of acquiring meningitis and, if infected, dying from infection. This disease is spread by prolonged close contact with nose or throat discharges from an infected person.
Read more on sexual health.
In the last few days, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the medical aid group Doctors Without Borders have sounded alarms on the growing needs of several countries in West Africa fighting the Ebola outbreak. The groups have called for increased funding, equipment and expert health personnel to help stem the rapidly increasing numbers of infections.
As of last week, there have been more than 3,000 cases and more than 1,500 deaths, making it by far the largest outbreak since Ebola was discovered during the 1970s, according to the WHO. CDC Director Tom Frieden, MD, MPH, who last week visited the main West African countries dealing with the Ebola outbreak, said the number of cases could spike to 20,000 if more isn’t done to stem spread of the disease in those countries.
In addition, a recent post on ForeignPolicy.com said that the epidemic must be controlled before it also poses a security threat. Liberia, which has seen the highest number of Ebola cases and deaths in the region so far, has been under the watch of an international United Nations (U.N.) peacekeeping force since a civil war ended in 2003. While the U.N. had planned to begin drawing down the force next year, U.N. Secretary General Ban Ki-moon said he’d like to delay any drawdown for at least three months because of the virus outbreak, which has needed troops to help secure order.
However, several countries want to pull out troops now in order to reduce the risk to their personnel and to citizens at home who they worry could be infected by returning soldiers. Ban has said that the nature of the illness poses little risk to the troops, who are unlikely to have contact with the bodily fluids of people who are ill—which is the way the virus spreads—and some of the countries involved are considering sending their own experts to assess the risks.
The National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health, is set to begin an early-stage clinical trial for a vaccine to protect against the Ebola virus. The trial should begin as early as September. The vaccine to be tested was developed by the NIAID’s Group Health Research Center in Seattle and does not contain infectious Ebola virus material. Instead, it’s what is known as an adenovirus vector vaccine containing an insert of two Ebola genes. The vaccine works by entering a cell and delivering the new genetic material, causing a protein expression that activates an immune response in the body. Researchers have seen success with studies in primates.
The vaccine being tested is not the experimental serum that was used on two Ebola-infected health workers recently evacuated from Liberia. In those cases, Samaritan’s Purse, the aid organization that sent the health workers to Africa, contacted officials from the U.S. Centers for Disease Control and Prevention (CDC) in Liberia to discuss the status of various experimental treatments they had identified through a medical literature search. CDC officials referred them to an NIH scientist in West Africa familiar with experimental treatment candidates who was then able to refer them to pharmaceutical companies working on experimental treatments. The serum being used is made by Mapp Biopharmaceutical of San Diego, Calif.
Read more on NIAID Ebola vaccine research.
>>Bonus Content: The CDC has released a new Ebola infographic.
Since March, several African countries have reported more than 1,000 cases of Ebola virus and more than 670 deaths. During a United Nations Foundation briefing in Washington, D.C., earlier this month, public health experts from the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization raised concerns about airline passengers from these countries spreading Ebola well beyond Africa. This week that fear became a reality when a U.S. citizen, Paul Sawyer, who had been in Liberia very recently as a consultant to the country’s finance ministry, fell ill on a flight from Liberia to Nigeria. Sawyer was hospitalized in Lagos, Nigeria, and died there of Ebola.
Several West African nations have responded by planning to set up monitoring stations at airports to identify people with fevers before they board planes. On a CDC conference call this week with reporters, Martin Cetron, MD, the CDC's director for Global Migration and Quarantine, said it makes more sense to put checkpoints in West African countries than to scan incoming passengers in the United States because there are few direct flights from West Africa, and fevers found among passengers entering the United States are unlikely to be Ebola.
“Ebola is contagious only when symptomatic, so someone unknowingly harboring the virus would not pass it on, “ said Stephan Monroe, deputy director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, during the conference call, also adding that even passengers showing symptoms are unlikely to pass the disease on to fellow travelers because blood and stool carry the most viruses. Cetron also said that those at highest risk for Ebola infection are family members who care for sick loved ones and health care workers who treat patients or accidentally stick themselves with infected needles.
"We do not anticipate [Ebola] will spread in the U.S. if an infected person is hospitalized here," CDC Director Tom Frieden told reporters. "We are taking action now by alerting health care workers in the U.S. and reminding them how to isolate and test suspected patients while following strict infection-control procedures."
The National Geographic recently took an in-depth look at the Ebola virus in Africa and the risk of it spreading to the United States. Read the full article.
Tomorrow, March 25, the day after World Tuberculosis Day, the Public Broadcasting Program Frontline will present TB Silent Killer a new documentary that looks at tuberculosis in Swaziland, the country with the highest incidence of the disease.
While many people, especially in the United States, think tuberculosis has long since been eradicated, there are in fact more than 8 million new infections every year, many of them virulent new drug-resistant strains that are passed—throughout the world—through a cough or a sneeze. According to the World Health Organization, tuberculosis has become the second-leading cause of death from an infectious disease on the planet.
Jezza Neumann, the filmmaker who created TB Silent Killer, tells the story of several people in Swaziland suffering daily from the disease, including ten-year-old Nokubegha, whose mother recently died of a multidrug resistant strain of tuberculosis and whose 17-year-old brother cares for her.
“In Swaziland, a quarter of all adults are HIV-positive, which means their immune systems are compromised and especially susceptible to TB infection,” said Neumann, “But globalization and international travel mean that these infections have the potential to spread all over the world.”
NewPublicHealth spoke by phone with Jezza Neumann a few days before the documentary was scheduled to air on Frontline (Check local PBS schedules here.)
NewPublicHealth: Why did you choose tuberculosis as your topic?
Jezza Neumann: The idea being to make films that make a difference and give voice to the voiceless. In doing so, we’ve made and kept relationships with nonprofits and NGOs and other organizations and look to find the issue that’s hidden in the background that no one is hearing about, that’s not getting the platform that it needs.
One of the organizations we’d worked a lot with is MSF, Medecins Sans Frontieres, or Doctors Without Borders as it’s known over here. The press officer at the U.K. office knew that Doctors Without Borders had been struggling to get the issue of tuberculosis out on the mainstream. People had done small reports but she knew there was a big impact possible with a documentary because the reality is if you combine the facts, stats and figures in documents with a film that has a human face and a human cost of those facts, stats and figures, it becomes something so much bigger. The documentary becomes a platform that has a life far further reaching than just the transmission.
For “Outbreak Week” we’ve already covered the deadliest pandemics in human history. But which outbreaks could be around the corner? Outbreaks: Protecting Americans from Infectious Diseases, 2013, the new report from Trust for America’s Health and the Robert Wood Johnson Foundation, lays out a few possibilities on which infectious diseases may pose the more serious threats in the future. Here are the greatest threats to the United States, according to Tom Inglesby, MD, Chief Executive Officer and Director of the UPMC Center for Health Security.
Middle East Respiratory Syndrome (MERS)
Spread across 12 countries, the virus has killed almost 40 percent of the people it’s infected. And while it may currently be confined to one region of the world, the high level of air travel between the Middle East and the United States increase the chance that it could find its way into the country, according to Inglesby, who said “we still don’t have a good handle on how it spreads, and there is no treatment for it or vaccine against it.”
Novel influenza virus
A new flu strain that, like the seasonal flu, is far reaching, but which would have a “far higher mortality rate.” Recent examples of major flu pandemics include the 2009 H1N1 outbreak; recent studies indicate the swine flu may have killed more than 200,000 people. The new H7N9 is also notable because of its high mortality rate.
Accident involving a lethal engineered virus
With scientists experimenting on viruses — enhancing their lethality or ability to spread — the risk grows of an accident releasing an engineered virus into the population.
It’s the most common infectious disease in the world and drug-resistant strains are only making the matter worse. “The level of drug resistance is growing and coping with this needs to be a real priority,” said Inglesby.
Not a pathogen, but a reason why pathogens could become even more dangerous. The U.S. Food and Drug Administration is taking steps to combat this growing issue, including new regulations on antimicrobial use in food animals and new restrictions on antibacterial soaps.
Deliberate biological threats
A biological attack, whether from another nation or as a terrorist act, could cause not only severe illness and death, but also communication problems that would hinder the ability of public health departments to respond.
Climate change is making this already existing problem even greater—with the regional climate shifts, places that haven’t had to deal with mosquito-based threats are now seeing them swarm in because of the warmer weather. Notable examples include the West Nile Virus and Dengue Fever. “We need to reinvigorate our strategy for mosquito control and the infectious diseases that come with mosquitoes.
How does public health take care of the communities it serves during a foodborne illness or infectious disease outbreak? Through a series of sophisticated steps, most choreographed long before an emergency occurs. Every minute of every day, U.S. and global health experts monitor reports that could indicate a disease or foodborne illness outbreak, as well as review samples of food, water, soil and other resources to detect outbreaks. Some of the steps are well laid out and public; others, such as those monitored by the Department of Homeland Security—watchful for terror attacks on food and water supplies—are hidden from view, but supremely vigilant.
Other examples of outbreak preparedness activities:
- Each year the American Public Health Association updates its Control of Communicable Diseases manual, and adds updates as needed to the manual’s mobile platforms.
- Outbreak guidance for new public health officers, as well as refreshers for veterans, are provided by public health official member associations such as the National Association of County and City Health Officials and the Association of State and Territorial Health Officials.
- New public health officers are also invited to the U.S. Centers for Disease Control and Prevention (CDC) for an orientation that includes outbreak guidance.
No, health officials can’t know whether an outbreak might occur next week or next month—or never—and whether it’s going to be a new strain of flu, or tainted ground beef sold at multiple food outlets. But by having a set of continually reviewed steps for alerting the public—and keeping them up to date with real-time guidance—targeted advice for any outbreak can be quickly assessed and disseminated.
Health agencies typically share information and best practices with local and state health departments through conference calls and alerts throughout a crisis. And, with the explosion of social media, just about all health departments continually add communications channels for the people they serve. For example, health officials in Montgomery County, Texas, this week are keeping the public informed about an illness outbreak that may turn out to be a severe form of flu, through dedicated channels that include a telephone hotline and its Facebook page. Read the wealth of posts on preparedness on NewPublicHealth to see the many avenues health departments take to keep residents continually informed when an outbreak occurs.
We've declared this week "Outbreak Week" on NewPublicHealth, and we're using it as an opportunity to crystallize discussion among the public health community and beyond about whether we're prepared as a nation to handle the next big outbreak. Spread the word, not the germs.
Here are the highlights of our coverage this week:
- Top 5 Things You Didn't Know Spread Disease: 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. Are you prepared?
- The 5 Deadliest Outbreaks and Pandemics in History: A modern outbreak could be a virus that kills a couple hundred thousand, 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.
- Outbreak Week Q&A on Vaccines with Litjen (L.J) Tan: 45,000 adults and 1,000 kids die each year from vaccine-preventable diseases. Where are the gaps and how can we close them?
- State Vaccine Exemptions' Impact on Vaccination Rates: A new study 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.
- 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.
- Outbreaks on the Big Screen: When outbreaks hit the big screen is it good for public health or does it make people panic?
- Where Polio Remains a Threat: Outbreak Week Q&A with Sona Bari: Bari of the World Health Organization discusses polio's resurgence as a critical global health issue and efforts to eradicate the disease globally.
- Throwback Thursday: Zombie Apocalypse: The CDC urged folks to prepare for the zombie apocalypse — with a goal of boosting overall preparedness for real health threats and disasters, back in 2011. Did it work?
- Outbreak Response Dream Team: Which pop culture characters would you want on your team with the diverse skills to respond to and cure a deadly, worldwide epidemic?
- Digital Outbreak Response: A roundup of how the digital world is working to improve emergency preparedness and outbreak response.
Outbreaks can spread faster than you think. But luckily the development of new digital tools and technologies to assist with documenting, tracking and alerting the public of the spread of infectious disease is progressing even more rapidly. There are new databases, maps and communications technologies that make tracking down an outbreak and getting it under control a much quicker and more efficient process. Digital developments focusing on emergency preparedness and response can help protect more of the population from the next pandemic.
We’ve brought together a few examples of how the digital world is working to improve emergency response:
- At the University of Pittsburgh School of Public Health, a new initiative called Project Tycho is working to convert 125 years worth of data from paper documents into an open-access database. Project Tycho will save researchers around the world the time of finding reliable historical data from different sources for infectious diseases, which is critical to understanding underlying epidemic dynamics, according to Dr. Willem van Panhuis, an assistant professor of epidemiology at University of Pittsburgh School of Public Health.
- The Advanced Molecular Detection Initiative proposed in the President’s 2014 Budget could help make huge strides in controlling infectious disease. The initiative would bring together experts in laboratory science, epidemiology and bioinformatics to join forces like never before. By using genetic sequencing to examine infectious pathogens, these technologies are on the verge of revolutionizing medical professionals’ abilities to diagnose infectious diseases; investigate and control outbreaks; understand transmission patterns; develop and target vaccines; and determine antimicrobial resistance—all with increased timeliness and accuracy and decreased costs.
- Social media and crowdsourcing technologies have helped medical professionals develop tools to track the spread of disease and where outbreaks are occurring and even make the data available to the general public. HealthMap is one of the original examples of using digital technologies to track outbreaks while keeping the public informed.
- In efforts to spread the skills needed to deal with public health issues such as outbreaks, the CDC has made learning more fun through games such and applications such as CDCology and Solve the Outbreak for the iPad. CDCology is a pilot program through the CDC and supported by HHSIgnite (beta). The pilot website uses CDC staff-created, student-solved, virtual microtasks to tackle public health challenges at CDC. As they complete the short microtasks, the students gain valuable educational experience, insight and exposure to the field of public health. Solve the Outbreak puts you in the shoes of a member of the Epidemic Intelligence Service. Playing the game presents the opportunities to use clues, analyze data, solve the scenario and save lives in this virtual world, but also helps teach the public more about the process behind handling a real outbreak.
Picture this: The world just ended. Well, not completely. But things aren’t looking up. An influenza strain has cut a deadly swath through nearly every continent. Or maybe the Black Death is making a special encore appearance. Or your now-undead neighbor—Phil, normally a great guy, invited you to a dinner party just last week—is shuffling around the front yard, trying to gnaw on your brains.
The point is it’s time for action. And since we’re talking theoretical, we might as well be talking fictional, too. Below is NewPublicHealth’s “Outbreak Dream Team”—pop culture characters with the diverse skills we’d need to respond to and cure a deadly epidemic. And maybe a dose of what’s really needed in the way of a public health workforce to keep us ready for whatever could happen next.
- In a nationwide (or global) public health emergency such as a pandemic, the President has to step up and provide leadership among different sectors and divisions of the government to coordinate a response and assure the nation of a secure path forward.
Laura Roslin, “Battlestar Galactica”
As a former Secretary of Education she has experience working with large groups with disparate goals. (Plus, she gets that education impacts health in so many ways). And as president of the roughly 50,000 humans left alive after a Cylon invasion wiped nearly everyone out, she’s adept at balancing public policy needs, working with everyone from public advocates to top military leaders. Some of her decisions are more-than-a-bit iffy, but you try pleasing everyone all the time when the last vestiges of humanity are spread across a fleet of ships drifting through space.
National Public Health Lead
- Equivalent to the Director of the U.S. Centers for Disease Control and Prevention (CDC). The CDC safeguards the nation’s health by preparing for, detecting, rapidly responding to and preventing health threats 24/7 to save lives and protect communities. The director’s job is to make sure that happens.
Ann Perkins, “Parks & Recreation”
As a practicing public health nurse and the PR Director of Pawnee's Health Department, Ann Perkins has dealt with infectious disease control from a hospital, a government and even a girlfriend perspective. Smart and determined, this go-getter can not only treat the symptoms of infectious diseases, she can detect and track them, coordinate response, and educate the community—all while maintaining a confident, calm and collected public face. While Leslie Knope leads the town through the city council, Ann has the potential to lead diverse teams and bridge health and health care to coordinate a swift and decisive response. If she can take on Pawnee's obesity epidemic one candy company at a time and teach sex ed to senior citizens, she can certainly handle a national outbreak or two. Plus, she gets bonus points for being (probably) the only true public health character on television.