Interesting links

Things are crazy here while we prepare for the CSTE Annual Conference, but here are a couple of links to satisfy your public health craving:

• Big Decline in Heart Attacks If All States Had Smoking Bans - an interesting article from Bloomberg saying that heart attacks would drop by 18,000 per year. Isn't that an incentive to implement smoking bans. 39 states currently have some sort of smoking ban.
• No Benefit in Delayed Immunization - That's right, folks, another immunization article asserting that vaccinating your kids against deadly and debilitating infectious diseases is a good thing! This one is from the Wall Street Journal.
• British Medical Council Bars Doctor Who Linked Vaccine With Autism - Dr. Andrew Wakefield has been banned from practicing medicine after his widely known Lancet journal article was retracted recently. This New York Times article discusses the recent news.
• In E. Coli Fight, Some Strains Are Largely Ignored - I will admit that I haven't finished reading this article, but it basically discusses how some strains of e. coli are tested for in labs and some are not, and the implications of this situation. Should be a good read.
  

Happy reading, readers!

Links and Lyme

First, some web links:

1. The Produce Safety Project is calling for food safety reform, says this article in Cattle Network (yes, Cattle Network). The report recommends improved data collection, creating a cabinet-level agency for food safety, and use best practices from Europe.
2. A little food safety reminder, speaking of reform: We can all reduce our risk of foodborne illness with a little supermarket safety, and this article from CBS News can tell you how.
   
3. This article raises the red flag that only 58% of Idaho's 2-year-olds are vaccinated to current recommendations. This situation is not exclusive to Idaho; other pockets of the U.S. have extremely low vaccination rates.
4. It's that time of year when the risk of contracting Lyme disease increases with our outdoor activities. Read some articles about Lyme disease and how to prevent contracting it: 1 from The Signal, 1 about a rally to promote Lyme disease awareness, a page from CDC, and the American Lyme Disease Foundation, an advocacy organization. The bottom line is cover up and use a bug spray with DEET to prevent tick bites.
5. And while we're at it, here's some info about West Nile Virus and CDC's "Fight the Bite!" campaign. Bug spray, guys! It's worth it!

Important news about vaccines

Everyone has heard the rumor that vaccines lead to autism. Well, here is breaking news: The Lancet, the journal that published Dr. Andrew Wakefield's 1998 groundbreaking study linking autism to vaccines, has formally retracted the article. This is hugely important news in the public health and vaccine world. According to this breaking CNN article, the author was found to be acting unethically in conducting his research.

Vaccines and herd immunity

Vaccines - ah, that long-controversial topic. Well, vaccines have resurfaced in the news this week. Some news about vaccines that might be of interest to you:

• A recent study from CDC shows that more U.S. kids are immunized and that disparities among socioeconomic groups are decreasing. "While these disparities persisted through the study period, they did get smaller, and racial and urban/suburban/rural disparities were no longer statistically significant by 2008." Of course, "additional work is needed to make sure that the underserved groups of children are vaccinated and protected against vaccine preventable diseases," says the author of the study.
• The American Academy of Pediatrics has released its 2010 immunization schedule for children. Changes include the addition of a recommendation to get the influenza A (H1N1) vaccine and revaccination for meningococcal disease.
• This article in USA Today explains the concept of herd immunity and its importance. It includes the standard USA Today human interest components (too much for my tastes), but it is a good snapshot of immunizations and their importance among the community. Nationally, 1.48% of children have exemptions from school immunization requirements, but this number is much higher in certain parts of the U.S. A recent study found that children who are unvaccinated are 9 times more likely to contract chicken pox and 23 times more likely to contract whooping cough.
  The article states, "before vaccines became available, hundreds of thousands of Americans — including thousands of children — routinely came down with dreaded infectious diseases each year. Although vaccines have nearly eliminated many of these diseases, doctors say outbreaks in unvaccinated communities put everyone at risk."
  

More links

1. Pneumococcal vaccine: Babies routinely get this vaccine, but older children, adults, and seniors need to keep it in mind too. This vaccine can protect those with underlying health conditions from getting pneumonia, a dangerous complication of influenza.
   

   "But because flu season lasts until May and more outbreaks are likely, some of those officials, including the top ranks at the CDC, have begun talking about the pneumonia vaccine, which they say could save thousands of lives a year and prevent debilitating effects of severe illness in many more."

2. Oh, that unhealthy Santa: Santa, the large jelly-bellied man who "visits" kids at Christmastime, sits around, gets pulled by reindeer, and eats cookies at every house he visits. What an unhealthy image for kids! This article suggests that Santa needs a carrot, not a cookie. And that's not even starting to talk about all the sick, snotty kids who sit on Santa's lap all day, every day this time of year. (Ew.)
   
   
3. Your tap water is legal, but is it healthy? This article discusses the outdated Safe Drinking Water Act, a 35-year-old law that covers a fraction of the thousands of potential chemicals and contaminants. And the effects of these contaminants may not be noticed until years after the exposure, making it difficult to pinpoint the source. The Environmental Protection Agency (E.P.A.) is looking into changing the standards:
   

   ".. Even the E.P.A., which has ultimate responsibility for the Safe Drinking Water Act, has concluded that millions of Americans have been exposed to drinking water that fails to meet a federal health benchmark.."

4. This very interesting blog post examines the latest health care reform proposal in the Senate for public health provisions. Examples include: focus on evidence-based medicine (we'll see how that goes over with the public - see the outcry about mammogram recommendations), emphasis on healthy communities and healthy lifestyles, authorizing the Epidemiology Laboratory Capacity program to increase surveillance capacity (yay!), addressing public health workforce shortages, and an emphasis on prevention.
   
   
5. Trust for America's Health has released a new report "which finds that the H1N1 flu outbreak has exposed serious underlying gaps in the nation's ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system." Surprise! The report scores states on their preparedness levels.
   
   
6. And finally, CSTE has released its 2009 Epidemiology Capacity Assessment report, which assesses states' capacity to perform essential public health services related to epidemiology and surveillance. Check it out!
   
   

Some recent links

1. This interesting article discuses evidence-based medicine and the recent mammogram recommendations (I know, they're still talking about it.) Take a look and see what you think.
2. As I've discussed before, climate change is expected to have a major impact on health and public health. This article is about its impact on mental health specifically. The point that makes the most sense is that climate change is expected to bring more natural disasters, bringing more life upheaval and therefore more stress and mental health issues.
3. Cancer death rates are declining, according to this article. Researchers who found this statistic examined colorectal cancer as an example, and found that the decline was mostly due to better screening. Here is the study from which the article draws, which is worth a read - interesting.
4. The CDC has reported that the death toll from H1N1 is at 10,000, but also suggests that the number of new cases could be trickling off. It says one in five Americans have had H1N1. Mike Osterholm says, in my opinion accurately, that this pandemic is not over:
   

   “So the C.D.C. says 50 million have been infected so far,” he said. “Another 50 million have been vaccinated. And maybe 20 million have got innate immunity because of their age. You do the math — that’s 120 million who are immune out of 320 million, so two-thirds of the population is still not immune. It’s amazing how many people are acting as if this is all wrapped up. The numbers could still go up dramatically.”

5. This article describes the dismal state of public health and its critical understaffed numbers. It's a great article.
   

   "If swine flu is a test of public health, we've already flunked. And we have only ourselves -- and the political leaders who have been disinvesting in public health since 1980 -- to blame."

6. Finally, a new report from the Institute of Medicine about the National Vaccine Plan seeks to elevate vaccines to a higher public health priority, increase funding, and other recommendations. This article explains the highlights of the report. The updated plan is expected to take effect in 2010. However, the development of this plan does not ensure its implementation:
   

   "Siegel has doubts that the proposed policy can be implemented and enforced. 'There are extremely difficult obstacles -- fear, noncompliance, media hype and poor government choices,' he said."

   
   

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

An interesting article about Paul Offit and vaccines.

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

Posted using ShareThis

Weekend links

1. There have been several teen suicides in California, prompting public outcry against suicide, which is the 3rd leading cause of death among teens, according to CDC. Actions are being taken to curb suicide in California, including counseling, suicide hotlines, and other measures. "These poor kids died from an untreated psychiatric illness, or undertreated. It's not as if it's a mysterious thing and it's not as if it's not preventable," says Madeline Gould, a psychiatrist. Once again, and I reference another suicide posting I've done, suicide is preventable, and it's important to treat mental illness and reach out to people.
   
   
2. Not surprisingly, H1N1 is hindering health departments' ability to conduct other activities. Dr. David Fleming, health officer in Seattle, says, "we're being held hostage by a national shortage of the vaccine."
   
   
3. The Infectious Diseases Society of America conference brought a lot of discussion of various infectious diseases this weekend. Antibiotic resistance is still a concern, according to this article in the Atlanta Journal-Constitution. There is also a virulent strain of MRSA going around, posing another infection-related problem in hospitals.
   
   
4. At the IDSA conference, Dr. Paul Offit, a frequent vaccine spokesperson, spoke out for the H1N1 vaccine. Another article about the speech can be found here.
   

   "... Now the seasonal flu vaccine and H1N1 flu vaccine are being skipped by millions of people who somehow distrust the science that went into making them, even though the illnesses they cause can be fatal.

   But hey, it’s a free country. Paul Offit just throws up his hands: “Is it your right to catch and transmit a potentially fatal infection? The answer is ‘yes,’” he says."

   The article continues:
   

   "So despite vaccines’ overwhelming safety profile when compared to the risks run by exposure to the diseases they prevent, and despite the exhortations of the CDC and World Health Organization, some people just gravitate toward other sources of information they deem more reliable."

5. In food safety news, the Produce Safety Project put out results of a survey showing that there are significant gaps in foodborne illness response. The survey asked about types of questionnaires administered, the time frame in which they were completed, types of questions asked, and how the data collected were used. They found that state health departments don't ask about fresh produce initially, use a mixed questionnaire with open- and closed-ended questions, and are more likely to interview an individual linked with an outbreak. This survey did not assess staffing or funding levels, which will be discussed in a forthcoming assessment by CSTE about foodborne illness epidemiology capacity. They did report, however, that "the decisions of the responding states appear to be driven by available resources." Very true.
   

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?

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.

Links

I know, you're saying "More links? Write a real article!" Well, there are just so many interesting links, I can't help myself.

• The Wall Street Journal reports that H1N1 (we are not calling it swine flu anymore, people!) may affect businesses and the workplace with people out sick. CSTE is heavily involved in putting together a Continuity of Operations plan so that we can carry on our work tasks while at home if needed. Talk to your employer about it!
  
• The 2009 Flu Vaccination Challenge - the beginning of flu season means the beginning of the flu challenge, a campaign to raise vaccination rates among health care workers. The podcast linked to on this page features Dr. William Schaffner, a great speaker!
• There is a new vaccine being developed for norovirus, very interesting. This vaccine stems from the tobacco plant; plant-based vaccines can be developed more quickly and therefore get to the public more quickly.
• A new study in Science (as reported here in the Atlanta Journal-Constitution) indicates that students and parents should get the H1N1 vaccine first, so that those most likely to get the virus are protected. The current guidance is for those who are most likely to be hit hard by the virus to be vaccinated first. An interesting debate.
• This article reports on a new finding that individuals enrolled in the food stamp program are more likely to gain weight. One of the recommendations of the study is that there be economic incentives for food stamp recipients to buy healthier foods.

Immunizations: Not just for kids!

Today's subject is adult immunizations. That's right, they're not just for kids! Adultvaccination.org says that "each year, about 50,000 adults die from diseases that can be prevented by vaccines."

Here is the adult immunization schedule from CDC. It includes Tdap, HPV, varicella, influenza, shingles, and more.

A recent National Foundation for Infectious Diseases survey found that people are most likely to listen to their doctor about getting immunized. The Foundation reports that "The vast majority of respondents (87 percent) said they are very or somewhat likely to get a vaccine if
their doctor recommends it." And as adult vaccination rates are low, physicians are being urged to talk to their patients about immunizations.

There is also a racial disparity in adult vaccination rates. For example, 67% of older adults received a flu vaccine, but only 50% of blacks and Hispanics. The disparity is even wider for pneumococcal vaccination.

Some of the issue is the lack of knowledge about the important role vaccines play. According to the AMA News, "only 30% of young adults know that flu kills more Americans than any other vaccine-preventable disease."

So get on it. Get vaccinated. It's pretty likely you've been meaning to get that tetanus shot that's out of date. Go ahead and update your other vaccines as long as you're at the doctor's office. It may just save your life.

H1N1 Vaccine News

CDC has released the latest H1N1 vaccine news and the priority populations for receiving the vaccine. The Advisory Committee on Immunization Practices (ACIP) met yesterday and determined recommendations. Priority populations include:

• pregnant women,
• infant caregivers,
  
• health care and emergency workers,
  
• those 6 months - 4 years old, and
  
• those 5 - 18 years old who have a complicating health condition such as a compromised immune system or chronic health disorder.

Before the vaccine is widely released, it will go through a series of clinical trials to test for safety. Officials are hoping the vaccine, made by 5 companies, will be available in October. It is important to note that there will be two influenza vaccines this fall: one for the H1N1 virus and one for the 'normal' seasonal virus. Each protects against a separate strain, and you will need to be vaccinated against both for full influenza protection.

Atlanta Journal-Constitution article
MMWR article about seasonal influenza vaccine

New links!

Lots going on this week, let's start right in:

First, H1N1 influenza. This situation has stretched local and state health departments even thinner than they already were. This is a major problem, as resources across the country are tight but expectations are high to handle the epidemic smoothly and without causing fear or panic. Speaking of panic, this article reveals some psychology about the fear and panic we humans tend towards. And this article examines the risk of new infectious diseases and people's reactions to that risk. Is there any way to reign this epidemic in? Find out here. And, finally, now that public concern is dying down (in conjunction with media attention waning, not coincidentally) will our focus on hand-washing die away too? Let's hope not.

On to other topics. As you may be aware, calorie counts on menus are popping up at fast food joints across the country, notably in New York City and in Chicago. This article examines the phenomenon and its impact, especially as federal legislation is pending.

The FDA is developing a new system to track and report adverse events of its products. We'll see how this story develops, but here is a summary article.

Finally, an article about parental refusal of the pertussis vaccine is in the latest issue of Pediatrics. The study found that children whose parents refuse the vaccine are at an increased risk of developing pertussis. The authors conclude that "these findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively."