How the CDC counts H1N1 cases

Thought you (you one person reading this, you) might be interested in this Wall Street Journal blog post about how CDC counts H1N1 cases.

The accompanying print article discusses how H1N1 information is based on flawed data. Carl Bialik writes that CDC relies on "the nation's patchy surveillance system" for its data - Well, Carl, if the U.S. were to fully fund states to perform adequate surveillance, maybe we'd be able to provide better data for you! (Are you listening, Congress?)

WHO to stop tracking H1N1 cases

Wow, it's been awhile! I've been out of the country (Africa!) and we've been busy here at the office. I will post a public-health-related posting about Africa, which was fascinating, but for now, here is a little H1N1 update.

Apparently, WHO says it will stop tracking H1N1 cases. Very interesting. It said in a "briefing note" posted on the website late Thursday that tracking would cease. One of the reasons indicated is that poorer countries are having a hard time keeping up with the load on their epidemiologists and laboratories. The website says that "there is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases." New countries with H1N1, however, will still be reported on the WHO website.

It is unclear what the agency will track exactly now. Dr. Michael Osterholm, quoted in the NY Times article, says that "bad measures can be worse than no measure at all" and that he hopes this "will force the public health community to come up with better [measures]."

Very interesting. We'll have to keep an eye on this.

New links

Here are 2 new links for the day. The first is about a new electronic reporting system by Orion Health Inc. The second discusses lessons from the H1N1 outbreak. It is by my favorite writer! (Ok, it's my dad. But he is qualified to write such an article as a practicing pediatrician who is involved with the American Academy of Pediatrics and the public health community.)

Some headlines ... briefly

See below for more details, but this blog will be light this week due to our Annual Conference. But here are a few headlines to peruse:

Tom Frieden to take over CDC Monday
State public health laboratories in the spotlight
This article highlights how much states and counties are hurting.
A general public health opinion/human interest piece.
Is FDA regulation of tobacco a good idea or a bad idea? Hard to say, there are lots of arguments (which I cannot get into now with my current time contraints) but this article has quite an opinion!
I told you - H1N1 has not gone away. Click here.

Food safety; Twitter for epis?

Is it safe to eat? This article outlines foodborne disease outbreaks and their prevalence in modern times. The author notes that food today is much safer with milk pasteurization, refrigeration, and other technologies. "Part of the explanation, public health experts say, is that the technology for identifying multistate outbreaks has improved greatly. Decades ago, the burden of illness was probably higher, but foods were not recalled as often, simply because investigators could not implicate them in a given outbreak. Now, modern genetic techniques can often link cases of food-borne illness, even in different parts of the country, allowing investigators to pinpoint the tainted food." Take a look at the rest of the article, it's interesting.

Twitter helping to identify epidemics? This visualization uses Twitter to track people's comings & goings around the globe. If not completely accurate or helpful to epidemiology, it's interesting. Take a look here.

"When public health is successful, nothing happens."

This is a great article about the "invisible hand" of public health.

"When public health is successful, nothing happens, and therefore there is no news to report. You will never see a headline citing how many people dined in a clean restaurant, avoided an injury or did not contract a sexually transmitted disease. However, when an outbreak such as listeriosis or the H1N1 flu virus occurs, there is panic."

So true! Public health officials deal all the time with the question of how to communicate this message. And it matters for funding, too. How does one communicate that ample funds are needed to prevent something from happening... to make sure that there is no news? In the example of H1N1, this article underscores that the country is prepared. Now, they're talking about Canada, but the same goes for the U.S. Pandemic plans are in place.

The author notes, "in fact, they will continue to promote the best science on how to enhance the health of Canadians, whether with respect to infectious diseases, chronic diseases, injury prevention or environmental health (topics that are not as sexy as pandemics)." Excellent point, Vivek Goel! There are many aspects of public health that are not nearly as exciting as infectious disease and pandemics, but they are hugely important public health issues.

Interesting article about epidemics

Check out this interesting article about the history of epidemics. The graphic shows epidemics from the 1892 cholera outbreak to the 2003 SARS outbreak and details symptoms, modes of transmission, public health strategies, etc - including scapegoats.

Scapegoats have been common in epidemics, notably Eastern European Jewish immigrants in 1892, Chinese immigrants in 1900, and gay men in the HIV/AIDS epidemic. The author also notes that scapegoats are frequently caused by widespread misinformation... although he equates this to the current epidemic by saying the pork farmers are upset by the rumor eating pork causes H1N1 transmission. Hardly a scapegoat situation.

"Confusion and blame games aside, we can take heart that our public health professionals are working around the clock to prevent this crisis from getting out of control. One thing the history of epidemics teaches us is that given our remarkable arsenal of treatments, public health measures and rapid surveillance and communications ability, there’s never been a better time to have a pandemic than today — except, that is, tomorrow."

Links for the week

The Kaiser Family Foundation reports results from a survey that show Americans find the HIV epidemic less urgent, even after the latest incidence estimate showed that more people than previously thought are contracting the virus each year. Interesting results - one would think public pressure to do something about the HIV epidemic would be even higher, but it's not.

Generally, public health is important! If you're reading this, the concept is nothing new - I'm preaching to the proverbial choir. This article brings home the point once again. Epidemiology and surveillance, clean water, disease treatment and prevention, food safety, and more. The author, Valerie Bassett, puts this very eloquently: "Who needs public health? We all do. Every resident of the Commonwealth - whether aware of it or not - relies on a strong, functioning public health system - a system that is greatly endangered. Without public health, there is no way for the Commonwealth to succeed in education, economic growth, environmental innovation, or civic engagement."

Take a look at this article about doctor shortages. While not directly public health, it certainly has an impact on public health.

In case you haven't heard, red meat isn't good for you.

See my next post for updates on swine flu!

A couple more links

This senior in high school won an award for an epidemiology paper she wrote. Great job, Marilyn! Go epidemiology! Now go to college, get your MPH in epi, and work to improve capacity at the state level!

French kissing can give you infectious diseases. Apparently (duh) saliva transmits some infectious diseases. Is it worth the risk? That's not for me to say...

Counterintuitive: This article reports on a study that says the addition of healthy menu choices can lead to unhealthier decisions. Huh? Apparently when a side salad was an option, consumers were more likely to choose french fries. Why would that be? Maybe I shouldn't comment since I love french fries, but it doesn't seem to make sense to me.

Colon cancer prevention: According to this article, colon cancer prevention in Utah is about to get a big boost. Generally chronic disease and cancer are getting a lot of attention these days, as Obama has highlighted it. Rightly so - both are huge public health issues, and it's about time they get addressed as a national priority!

Links for the week

Story of the week: Possible swine flu outbreak. Read more about swine flu here. Be assured that we'll post more if we get more news about this!

"Ill from food? Investigations vary by state" - New York Times article about how varied states are in their foodborne illness surveillance and the importance of epidemiology in foodborne illness outbreaks. Go epi!

HHS updates guidelines for health information security

Go public health! An article about what it is that one local public health department does.

Public health goes 21st century. This article briefly touches on public health's use of social networking sites to affect the spread of STDs. This link to CDC's social media page has all sorts of ways that CDC uses blogs, email, Twitter, and other modern communication tools.

Health surveillance & the internet

This article discusses detecting disease outbreaks through the internet. Wow.. whoever thought! Shoe leather epidemiology goes high tech. There are several sites that do this already, and they are growing in popularity and are quite intriguing. (Click here. Or here.) But it does indeed seem to hold up, at least to some extent - tracking disease through internet searches does seem to correlate with disease trends. The article uses a Canadian listeriosis outbreak as an example and has a nifty graph.
Screen shot of Google Flu (the Georgia trends, of course!)

Epi studies.. what do they mean?!

Commentary on:

“Get smart about science: Conflicting studies about health risks and benefits can drive you crazy. Here’s how to sort through the science”

By Trine Tsoudero, Chicago Tribune, February 16, 2009

The news abounds with stories such as “drinking coffee causes cancer”, “drinking coffee prevents cavities”, and even drinking coffee does not cause cancer or prevent cavities. What?! How can you sift through all of this? More importantly, why do the media report this stuff with such frequency and confidence?

This article brings to light an important fact about these epidemiologic studies: “sometimes findings that sound spectacular may be completely useless to you – though important to other scientists working on the bigger picture.” In other words, epidemiologic studies such as studying the link between drinking wine and heart disease are important to the larger body of science on the issue, but each individual study does not bring definitive answers.

One study this article examines involves investigating coffee drinkers versus non-coffee drinkers and their development of oral, pharyngeal, or esophageal cancers. Although coffee drinkers developed these cancers half as often as non-coffee drinkers, this finding delivers only the relative risk. Looking at the bigger picture, only a few people developed cancer out of this study, so drinking coffee may cut your risk from small to very small.

Second, researchers don’t always take into account other risk factors that may contribute to the finding. Coffee drinkers may have some other characteristic that decreases their risk. Perhaps coffee drinkers are those who can afford to buy coffee at a retail establishment and are therefore higher income level. Or perhaps non-coffee drinkers are more likely to sleep more and be more sedentary.

The bottom line is: realize that epidemiologic studies that you see reported frequently in the media are more likely to be contributing to larger unresolved questions in the scientific world than determining definitive answers for your health. Do more research before diving into that giant full-fat cappuccino every day.