Can Saudi Arabia prevent an H1N1 outbreak at the hajj?

A very interesting story in yesterday's New York Times. (I know, another NYT article, but that's my newspaper of choice and I'm sticking to it.)

"Saudis Try to Head Off Swine Flu Fears Before Hajj"

So: will they be able to? They are recommending that those who are young, pregnant or elderly, and even those with certain chronic conditions, stay home this year. The hajj is a central ritual of Islam, and I am very skeptical that Saudi Arabia will be able to convince countries to not let or strongly discourage people from participating in this important tenet. In 2008, 3 million participated in this annual pilgrimage, this year taking place November 25-29.

Saudi Arabia, the host country of the hajj, has contacted public health experts from America medical schools and the U.S. Navy's medical laboratory in Cairo for help with any assistance they may need. (And they will need assistance!) In 2008, a flu outbreak occurred at the Catholic World Youth Day in Sydney, at which a Tamiflu-resistant strain emerged.

Officials recognize that it will be impossible to keep H1N1 away from the event and even to slow its spread. So they are encouraging those most vulnerable to stay home. Will this work, though? It is such an important part of Islam - the fifth of the five pillars of Islam. Will those who are coming be able to access the H1N1 vaccine? That is doubtful too, although China says it will vaccinate all of its pilgrims attending the hajj.

It will be very interesting to monitor this story in the next few weeks and see what happens - we'll keep you updated at the Epi Cafe!

Mr. T - and more!

Who can resist all of the H1N1 public service announcements going around? First was the video featuring Elmo, then the Atlanta Falcons, and now... you guessed it... Mr. T. He was quoted as saying “I’m the baddest in the world, and the flu gonna be all washed up when I’m through with it,” Mr. T said. “No, I don’t hate the virus. I pity the flu.” Perhaps not hard-hitting news, but still newsworthy, I'd argue!
(And by the way, this is from The Rebel Yell. Not a real news story!)


CDC has published new guidelines about infection control for H1N1 in hospitals. Because of the shortage of recommended N95 respirators, other measures must be taken to reduce risk of infection. Click here to view the guidance and here to read the RWJF Public Health Digest article about this issue.

This article also discusses infection control, in a larger sense. It mentions 10 ways hospitals can reduce infections, from hand washing to reporting laws to computer surveillance.

By now, of course, you've heard about Obama declaring H1N1 a national emergency. If not, read it here! This doesn't have anything to do with prevalence or severity. Rather, it opens up resources and allows hospitals and health departments to do more to cope with the pandemic.

This article has nothing to do with anything, but I didn't know the field of psychiatric epidemiology existed. So that was interesting to learn.

According to a recently published study, Holocaust survivors are more likely to get cancer later in life, perhaps due to the extraordinary physical and mental stress they underwent in the 1930s and 40s. This AJC article explains more.

Finally, CBS News reported that H1N1 is not as prevalent as thought, according to a 'study' they conducted. Effect Measure, a great epidemiology/public health blog (besides this one of course), examined this article and took issue with it.

2 H1N1 Links

First, the Obama girls have gotten their H1N1 vaccinations. Good for you, girls, and good for you, parents, for setting the example that the vaccine is acceptable. And, in case you were wondering, the vaccine is readily available in the DC area, and the White House doctor applied to receive 2 doses of vaccine just like every other site would apply.

Second, an article sure to spark controversy. This article asks the question, "Who should get a chance to survive when the number of severely ill people far exceeds the resources needed to treat them all?" It is an interesting issue, one that will surely bring debate to your dinner table.

The coolest video

This video is so neat! It explains how a virus, specifically influenza, invades one's body. This is from NPR. Click here for the web link.

Mental Health on Campus

Mental health is a growing issue in the U.S. I've blogged about mental health issues before (suicide prevention, financial stressors, and mental health in the armed services.)

This time, I'm writing about mental health on college campuses. Due to the growing number of children and teens taking medication for mental health issues, mental health has become a major concern among college administrators. They are seeing more and more freshman students arrive with not only extra-long twin sheets but also anti-depressants, anti-anxiety, and anti-psychotic medications.

Crises such as the Virginia Tech tragedy emphasizes the need that exists for mental health services on college campuses and for more outreach and education to students.

NPR had an interesting story this morning about mental health on campuses. Financial constraints have made it difficult for colleges to pay for counselors, even though the International Association of Counseling Services recommends having one counselor for every 1,000 students.

The bottom line, for any friends or family, is to keep an eye out for unusual or uncharacteristic behaviors, as these may be warning signs of mental illness. Communicate with them, find out what's going on, and help them to get the professional assistance they need.

Infection control, influenza, and more!

Infection control:
TheraDoc has come out with a new patient surveillance tool to monitor multi-drug resistant organisms such as MRSA. These patient surveillance systems are interesting - they don't play into public health surveillance systems, however, so it will be interesting to see how things like this affect the healthcare-associated infections surveillance that public health departments do. The American Recovery and Reinvestment Act (ARRA) included a lot of funding for the surveillance and prevention of healthcare-associated infections.

Influenza:

1. First, Minnesota has confirmed one case of the H1N1 virus in a pig. This may be the first indication that it is present in some swine in the U.S., according to this CNN article. The USDA assured the public that pork is still safe to eat.
   
   
2. This tool created by the Georgia Division of Public Health shows Georgia residents where they can find the H1N1 vaccine. The division has a lot of information on their H1N1 home page. They also have a PSA featuring Ovie Mughelli of the Atlanta Falcons.
   
   
   
   
3. This story on NPR conveys how skeptical people are of the H1N1 vaccine. My anecdotal experience is mixed - I've heard skeptics as well as those eager to get themselves or their children vaccinated. Some "public figures" like Glenn Beck are opposing vaccination. "Beck told his viewers on Fox News that he would do 'the exact opposite' of whatever the government recommends." Now, I would do the exact opposite of anything that Glenn Beck says, but that's my own personal opinion.
   
   An interesting point is that "public opinion surveys show that doctors and nurses are seen as the most credible sources of information on these kinds of medical decisions, but there has also been a flurry of media reports about some health professionals resisting mandatory vaccination campaigns at certain hospitals." So patients are getting a mixed message from doctors and nurses, even, which doesn't help the situation.
   
   This article released on Tuesday reemphasizes the safety of vaccines and how vaccines are a huge public health success story.
   
   Another article in the New York Times discusses how the H1N1 vaccine has "revitalized" the debate over vaccines. "Anti-vaccinators, as they are often referred to by scientists and doctors, have toiled for years on the margins of medicine. But an assemblage of factors around the swine flue vaccine — including confusion over how it was made, widespread speculation about whether it might be more dangerous than the virus itself, and complaints among some health care workers in New York about a requirement that they be vaccinated — is giving the anti-vaccine movement a fresh airing, according to health experts."
   
   
4. This article discusses preparing one's business in case an outbreak of H1N1 hits the office. It's a valid concern; absenteeism can be a huge source of lost productivity, especially during a pandemic.

Chronic disease:
I know what you're thinking: Finally, some focus on something else besides influenza.

1. A recent article in Health Affairs suggests that convenience stores and fast food chains are largely responsible for the obesity epidemic in South Los Angeles. Based on this study, lawmakers are considering limiting the density of such stores unless they sell fruits and vegetables, according to the LA Times. Last year, the district banned the establishment of new convenience stores for one year. The Health Affairs article suggests this one-year ban was not the best approach, because the density of convenience stores isn't high enough to be of concern compared to the rest of L.A. The article suggests that menu labeling and restricting excess calorie consumption would be much more effective.
   
   The article states: "Although the actual policy was based on questionable premises, this represents an important conceptual step forward. Research has made it clear that frequency and saliency of food cues in the environment, the types of food available, and the portion sizes served are key issues that effective policies need to address."
   
   
2. Although Health Affairs suggested menu labeling as a possible intervention in Los Angeles, a study of the New York City labeling law has produced results that suggest otherwise. New York City found several obstacles that need to be overcome: a.) voluntary posting of nutritional information is unlikely to succeed due to the overwhelming resistance of the restaurant industry, b.) many public health disciplines (environmental health, chronic disease, public health law, communications, and more) need to collaborate effectively, and c. ) additional steps beyond the posting of nutritional information are needed to reduce overeating.
   
   Another study in Health Affairs indicated that menu labeling was noticed by consumers, and it may have influenced their choices, but overall calorie consumption was not affected.
   

Serious H1N1 Clip

... And here's a more serious clip, this one from 60 Minutes about H1N1 and CDC's response.\


Watch CBS News Videos Online

Click here for more information and an article relating to this clip.

Funny H1N1 Clip

This clip is funny - I had to share it. Take a look (and if you're not feeling funny today, chill out, it's just a comedy sketch.)

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Doubt Break '09
www.thedailyshow.com
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Cancer screenings - new research

Check out this article in today's New York Times. It questions the benefit of prostate and breast cancer screening. Anything else I might say would just be reiterating the article, so I'll refer you directly to it.

Cost effectiveness of Gardasil for boys

This article discusses the (non) cost-effectiveness of the Gardasil vaccine among boys. It's an interesting read. A previous post discusses cost-effectiveness, that post specifically about cancer screening. What do you think?

H1N1 self-assessment tool

There is a new self-assessment tools for H1N1 that seem quite interesting.

Emory University and Microsoft have come out with one self-evaluation tool. This tool assesses whether the user has H1N1 or another virus. The user is asked, at the end of the assessment, if he or she would like to submit the data to Emory for research purposes. It will be interesting to follow-up and see how the data are used. Here is the privacy statement that talks about how the data are used if submitted. Once symptom and basic demographic info is entered, the assessment is given.

When I entered my fake data, the tool told me "you probably don't have the flu, but you may be sick from something else" and told me to go to my physician if I am worried about my health. It then gave me resources to find more information.

Flu.gov also houses this self-evaluation tool.

Today's links

First, the EPA set out new standards that airlines have to test and disinfect water on planes. Ew, you mean they weren't doing this before? Read here for the article, and read here for more from the EPA.

Second, and a biggie. The first doses of H1N1 vaccine are just now becoming available, and there is much excitement over it. According to this article, several states were offering the nasal spray to children, with shots beginning next week. Public health officials are battling myths and opposition to the vaccine, posing public relations troubles for CDC and state health departments.

Here is an article about immunizations and opposition to them.

Finally, a tongue-in-cheek article from the Huffington Post about Big Pharma and H1N1.

Enjoy!

H1N1 vaccine: "Don't blame flu shots for all ills"

The NYTimes published a great article about the forthcoming H1N1 vaccine. The article states that when the public starts receiving the H1N1 vaccine, there will be deaths and other health issues such as heart attacks, strokes, and miscarriages. However, these illnesses are not necessarily caused by the vaccine. Basically, federal officials are in a public relations nightmare. How can they explain to the public (and in a tiny sound clip, no less) this non-causal relationship?

There are thousands of people who have, say, seizures every day. If the proportion of those who have recently received the vaccine and have a seizure is statistically significantly higher than those who have not received the vaccine, there may be a causal relationship. If, however, the rate of seizures among vaccinated and unvaccinated people is similar, a relationship is unlikely.

The article says:

"To defend itself, Dr. Butler [chief of the swine flu vaccine task force at CDC] said, the C.D.C, has compiled data on how many problems like heart attacks, strokes, miscarriages, seizures and sudden infant deaths normally occur. And it has broken those figures down for various high-priority vaccine groups, like pregnant women or children with asthma. When vaccinations begin, it plans to gather reports from vaccine providers, hospitals and doctors, looking for signs of adverse events, so it can detect problems before rumors grow."

The emphasis on this point stems from several sources. First, the 1976 vaccination program against swine flu had horrendous problems with Guillain-Barré syndrome as well as deaths that were attributed to the vaccine. Second, anti-vaccine groups are much more prominent and vocal now than they have ever been, and these groups may pose threats to the credible information being put out from sources such as CDC. Third, it's just plain confusing. It's hard to understand, especially for a public getting information from multiple and possibly conflicting sources.

So all those who are reading this (which isn't many), spread the word! There will be illnesses and health events that happen after people get the H1N1 vaccine. But most of these events are likely to have occurred anyway. CDC will be closely monitoring health events to determine whether they are caused by the vaccine or not, rest assured.

Here's another article in the Washington Post about the same issue.

Sneezing 101

This video is just too adorably cute not to post. We all know to Cover our Cough, but this presents it in the cutest of ways! It is a PSA from the Virginia Department of Health.