Posts Tagged ‘disease’

Interested in Developing a “Family Health Portrait”?

December 11th, 2013

We’ve known for a long time that your family health history can have a profound impact on your risks for certain inheritable diseases and illnesses.  Until now, there hasn’t been an easy way to track your family health history. 

The Surgeon General’s Office has developed an internet-based tool called “My Family Health Portrait” which makes it easy for you to record your family health history.  I’ve been told that the tool is easy to access on the web and simple to fill out- although I haven’t done it myself.  It assembles your information and makes a “pedigree” family tree that you can download. It’s a “private” tool in the sense that it doesn’t store or keep the information that you input.  

Using My Family Portrait allows you to: 1) enter your family health history; 2) print your family health history to share with family or your health care provider; and 3) save your family health history so you can update it over time.   Here’s where to learn more about the new tool.

Schistosomiasis, a blood fluke

September 26th, 2013

You may remember that at the end of May, Maricopa County Department of Public Health warned us about avoiding swimmer’s itch by not wading along the shorelines of some of our lakes.  Swimmer’s itch or cercarial dermatitis, is a rash caused by a tiny parasitic flatworm of birds that can occur in lakes and ponds throughout Arizona.  Waterfowl are the host for the worms.  The worm lay eggs, the eggs of the worm get into the feces and drop into the water, hatch and then search for a snail to infect.  Once inside the snail, they reproduce and then leave the snail in search of a bird… or an unsuspecting swimmer. This itchy rash is caused by an allergic reaction to the tiny larval stage of the worm burrowing into your skin and then dying.  People can be exposed when swimming or wading in the shallow, marshy parts of the water where the snails are found.  The rash goes away without treatment and symptoms are most commonly treated with topical creams or lotions. 

In Africa, the Caribbean, the Middle East and Southeast Asia, a closely related flatworm or “blood fluke” causes schistosomiasis (also known as Bilharzia).  The same cycle between humans, water and snails, except with this blood fluke, the larval stage does not die, but continues to move through the body, and eventually mature into adult male and female worms  in the blood vessels near the intestines or kidneys.  The female produces eggs that are released in the person’s urine or feces.  If these eggs get into a river or lake, with the right snails, they can complete their cycle and eventually infect another person entering the water.  If the eggs don’t make it out of the body, the body’s reaction to these eggs causes the injury and damage characteristic of this disease.  Symptoms usually start one to two months after exposure and include: an itchy rash, bloody urine or diarrhea, stomach pain, or fever and chills.  Unfortunately, continual exposure to infected waters causes repeated infections.  More eggs trapped in the body leads to more symptoms and more severe disease. Untreated infections lead to enlarged liver, abdominal pain, anemia, blood in the urine or feces, trouble passing urine and an increased risk of bladder cancer.  

Schistosomiasis affects about 240 million people worldwide and is estimated to be responsible for over 200,000 deaths each year in sub-Sahara Africa.  700 million people live in areas where this disease is found.  The impact of this disease is second only to malaria as the most devastating parasitic disease. Treatment is available to eliminate the flat worm, but cannot undo the damage from the eggs.   Repeated mass treatment, providing potable water, sanitation, education on hygiene and snail control can help control and eventually eliminate this disease.

Valley Fever Monsoon Refresher

July 15th, 2013

We’re smack dab in the middle of monsoon now, which means it’s time to think about Valley Fever. It’s a lung infection caused by a fungus that lives in the soil in the desert (below 4,000 feet).   People get it by breathing in dust that contains fungal spores. Valley Fever causes cough, fever, headache, feeling tired, and shortness of breath. Other signs can include a rash, night sweats, and losing weight. Sometimes, the fungus causes serious disease.  You can’t get Valley Fever from another person. 

Serious (or disseminated) disease happens when the Valley Fever infection spreads to the skin, joints, bones, or brain. Disseminated disease, especially brain infections, can be deadly and may require treatment for life. Pregnant women, people with weak immune systems, and people of African-American or Asian (especially Filipino) descent are at a higher risk for developing serious disease. 

It’s hard to prevent Valley Fever infections. Avoiding activities associated with airborne dirt can be an option, but no guarantee against getting infected. Dust storms are common during monsoon so it’s important to stay inside when you see a lot of dust in the air outside. The best method of prevention is to educate yourself about Valley Fever. If you have any Valley Fever symptoms, ask your doctor to test you for Valley Fever

Over the last 10 years, we’ve seen a huge increase in the number of Valley Fever cases in Arizona . In 2012, there were about 13,000 cases. Our Office of Infectious Disease Services monitors rates of Valley Fever in Arizona, carries out investigations to better understand the disease, and educates healthcare providers and the public. If you want to learn more about Valley Fever, including information on educational materials, please visit:

Obesity Declared a Disease

June 21st, 2013

The American Medical Association voted to recognize obesity as a disease this week.  This is an important change… because the term “disease” in the managed care world means that that prevention and treatment is more medically necessary, justifying reimbursement for necessary interventions. 

If obesity isn’t a disease then I don’t know what is.  Obesity has gone from being a public health nuisance to a public health disaster in the last 20 years.  In Arizona, the percentage of obese adults has nearly doubled in the last 15 years- from about 13% in 1995 to more than 25% in 2010.  It’s overwhelming the country both in health care costs and productivity. We spend about $150B annually on health care costs related to obesity… and it increases the risk of heart disease and type 2 diabetes. Type 2 diabetes leads to devastating health problems including blindness, the loss of limbs and an early death. 

As a public health system, we’ve got to start pulling folks out at the top of the waterfall rather than fishing them out at the bottom. While the change by the AMA is a positive step forward, some doctors might need the nudge of calling this a disease so that they’ll actually put together a treatment and prevention management plan together for their patients. This is where our work becomes even more important.  

Reducing obesity is a Winnable Battle both nationally and in Arizona.  We have lots of resources to help you and your family eat healthier meals and become more active. Check out the Arizona Nutrition Network’s Champions for Change for simple ways to eat better. Find more ideas for healthy eating and active living at, where you can sign up for healthy recipes that are emailed every week.

New Research Reconfirms Vaccine Safety

April 8th, 2013

Fifteen years ago The Lancet published a case study that erroneously suggested that there could be a link between the MMR vaccine and autism.  That letter has long since been discredited, and back in 2010 The Lancet retracted the article.  Anti-vaccine advocates have been pointing to that long-since discredited 1998 case study to argue that there is some kind of link between vaccines and autism… even though numerous articles published in the last several years have all concluded that there is no such link.  

The Journal of Pediatrics just released another new study that again demonstrates that there’s no association between vaccines and autism development in children.  This new study looked at the number of antigens from vaccines that children receive (antigens are the things in vaccines that help our immune systems make the antibodies needed to fight disease).  This look at antigens was important because different shots have different amounts of antigens in them, so looking at the number of antigens kids received is more thorough than just looking at the total number of shots they got. 

This new study concluded that…  “These results indicate that parental concerns that their children are receiving too many vaccines in the first 2 years of life or too many vaccines at a single doctor visit are not supported in terms of an increased risk of autism.” 


Solve the Outbreak

March 4th, 2013

Check out CDC’s new iPad App, Solve the Outbreak, which lets you pretend you’re a disease outbreak investigator in the world-class Epidemic Intelligence Service by solving outbreaks based on real-life.  When new outbreaks happen, disease detectives are sent in to figure out how they started, before they can spread.  You get to investigate the outbreak and make decisions about confirming cases and implementing public health interventions like isolation and quarantine, social distancing, vaccine prioritization etc.  

The better your answers, the higher your score – and the more quickly you’ll save lives. You’ll start out as a Trainee and will earn badges by solving cases, with the goal of earning the top rank: Disease Detective.  Post your scores on Facebook or Twitter and challenge your friends to do better.  Download the free app today!  

BTW: Dr. Frieden (the CDC Director) paid us a visit during our monthly Local Health Officers meeting on Wednesday afternoon.  Check out the pictures on the Facebook.

‘Tis the Season to Be Vaccinated…

December 19th, 2012

The CDC’s Advisory Committee on Immunization Practices released issued new recommendations to encourage pregnant women to get the whooping cough (pertussis) vaccine (Tdap) during their pregnancy.  Since most kids get whooping cough from a close family member, vaccinating parents (and teens) is one of the best ways to prevent infants, especially those who are too young to be fully protected from this life threatening infection.  Whooping cough cases have been increasing in AZ again this year, with over 900 cases as of a couple of weeks ago…  103 more than during the same time last year and 4 times more than we have in a typical year. 

There are many things contributing to the high rate of whooping cough in AZ and nationally. Symptoms are non-specific during the first two weeks- usually just a cough that won’t go away. Providers might not identify the case until weeks later when cough intensifies and the more classic signs like “whoop” are noticed. Even then, doc’s may not be able to diagnose it if the sick person looks fine during the office visit (if they’re between coughing fits). Whether the doctor is able to diagnose the patient or not, the person may have already infected others and the disease continues to spread. 

This leads to school or community outbreaks, especially in areas with low vaccination rates. This year, one outbreak has been ongoing since May.  Routine vaccination – given as DTaP in children or Tdap in adults – is important for preventing future outbreaks from occurring.  Talk to your doctor about pertussis vaccine – particularly if you spend a lot of time with babies.  Remember, the best gift for your children this holiday is to get vaccinated!

Vaccines & the Social Contract

December 14th, 2012

At the core- vaccines are really about community protection.  Our public health system depends on a solid network of providers that are available to vaccinate kids for all of the nasty infectious diseases that have plagued humanity for millennium. It’s not just access to care and a solid network of providers that vaccinate that are important- we also need folks to fulfill their social contract. In other words, we need just about everybody to participate and get vaccinated in order to get the herd immunity we all need to eliminate the spread of infectious vaccine-preventable diseases.  Vaccinating yourself and your kids is more about community protection than personal protection.  It’s a social contract that we have with each other to keep all of us healthy- just like it’s everyone’s responsibility to be a Good Samaritan when you see a car crash. 

For decades vaccination rates in the US and AZ have been pretty good.  The problems we had were due to the lack of access to care.  Low vaccination rates were mainly in low income areas where folks weren’t able to get to the doctor on time to get their shots or didn’t have insurance.  Over the decades, the public health and healthcare systems have closed many of those gaps- and immunization rates responded.  But now we have a new problem- more and more parents are purposely deciding to not vaccinate their kids.  The trend is increasingly jeopardizing us all.  It’s called a “personal exemption”. 

In order to figure out what to do next, we began working with the UA College of Public Health to find out the who, what, when, where, and why of this group of parents that are increasingly deciding to not vaccinate their kids.   Today the UA investigators published a preliminary report in the Journal Vaccine that gives us some insight into this population. 

The research team used data about personal exemptions from our 2010- 2011 kindergarten Immunization Data Report and linked it to data about education statistics to determine if there are similarities between the areas where there are more exemptions.  They found that schools where mostly white students attended, those with fewer students who use free and reduced lunch, and charter schools were more likely to have high exemption rates.  There are geographic differences too – those in the northern part of the state were more likely to have personal exemptions than those in the south – and the number of exemptions increased from west to east. 

These geographic and demographic details are important in designing the right intervention to help bring up herd immunity in the state.  This information will help the AZ public health system to improve the vaccination uptake and pay close attention to those areas if there is a disease outbreak.  A follow-up study is on the way that’ll look in more depth into why parents are increasingly choosing “personal exemptions” over vaccination.  We hope to use the combined data to develop intervention strategies to improve immunization rates moving forward.

We Nailed Smallpox- Why Not Polio?

October 24th, 2012

Today is World Polio Day so I thought I’d throw together this post to give you an update on where we are in the global eradication effort.  2012 has been a good year so far- as the global public health system has made some real progress.  This year we’re down to only 3 countries with cases (Afghanistan, Nigeria and Pakistan) and only 200 cases.  We’re closer than ever to global eradication of this nasty disease.  The world was about this close to eliminating polio in the 2000′s, but political strife and other issues in West Africa turned the tide and set the eradication clock back.  

A couple billion kids around the world have been vaccinated against polio in the last decades - resulting in a 99% decrease in global polio cases.  The Bill and Melinda Gates Foundation has been adding support to the new push to eradicate by working with the Global Polio Eradication Initiative.  

You might wonder why public health was able to get rid of Smallpox but not Polio (yet).  It’s basically because Polio is spread through via the “fecal-oral” route.  That means that folks shed the virus in feces…  and other people catch the disease through contaminated water (or food).  That means that we need to use mass vaccination efforts to prevent more cases rather than the more cost effective and efficient “ring vaccination”  approach that we used to eradicate Smallpox.  With Smallpox…  we could track down cases quickly and vaccinate contacts and villages to prevent the spread- since it went person to person. 

Looking for a book to read about one of public health’s biggest achievements?  You’ll enjoy a new book written by Dr. Bill Foege called House on Fire: The Fight to Eradicate Smallpox.

2012 State by State Preparedness Report

October 2nd, 2012

Safeguarding the public’s health is more important than ever.  Whether the threat is a disease outbreak, environmental hazard or natural disaster, the public health system works 24 hours a day, 7 days a week to keep Arizonans safe.  Each year, the CDC evaluates state and local public health preparedness programs in a detailed report.  This year’s installment is entitled 2012 State-by-State Report on Laboratory, Emergency Operations Coordination, and Emergency Public Information and Warning Capabilities.  This document outlines each state’s ability to perform key laboratory functions, engage in emergency operations, and develop and distribute public health messages. 

Our Lab tests thousands of biological and chemical samples each year, and is a cornerstone of our public health system.  As a part of the Laboratory Response Network, we have consistently demonstrated its ability to detect high-threat biological agents like anthrax. Our lab team works long hours to test samples from suspicious packages and provide accurate results to our first responder community. As the report indicates, one area for improvement is our turn-around-times for pulsed-field gel electrophoresis testing- a technique used to identify organisms that commonly cause food borne illness.  We’re working to improve these turn-around-times by ensuring we have the right staffing and resources needed to meet these bench marks. 

Another capability addressed in this year’s report is Emergency Operations Coordination.  ADHS has participated in dozens of exercises and drills over the past several years to prepare our staff for public health emergencies.  For the third year in a row, our staff met the 60 minute target for Emergency Operations Center activation.  Similarly, our staff successfully demonstrated our ability to develop and distribute public health messages in a timely manner.  These examples illustrate our ability to manage public health emergencies and safeguard the public’s health during a disaster. 

For our employees that work in preparedness, the work is never done.  But I’m proud to say that we have achieved all of our emergency preparedness targets, and nearly all of the lab requirements for this year’s report.  Thanks to all of our preparedness staff for their hard work and dedication.