Posts Tagged ‘disease’

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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.” 

 

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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.

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‘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!

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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.

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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.

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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.

 

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ADHS’ Disease Detectives

July 25th, 2012

Awhile back, our epidemiology and licensing team of disease detectives including Jason Lempp, Cara Christ, Vinita Oberoi, Jessica Rigler, Ken Komatsu, Kathy McCanna, Connie Belden, Ken Komatsu, and Shoana Anderson learned of a severe case of a Methicillin-resistant Staphylococcus aureus  (MRSA) through our 24-hour disease reporting system.  Our team quickly contacted the county public health department which immediately began an investigation into the cause.  

Their investigation quickly uncovered more people with the infection who had been seen the same day.  The detectives also found that a single-dose vial of solution used for pain meds was diluted and used for more than one patient.  Medication shortages often push health-care providers to search for solutions to provide comparable care using limited supplies- which is what looks like happened in this case.  

Our work with the county led to an improvement in the clinic’s practices through discontinued use of mixed products; appropriate use of single dose vials; using personal protective equipment, such as face masks, during medication preparation and injections procedures; education of all staff on infection control practices; and the development of a plan to report further suspected infections.  This Arizona investigation was written up in this week’s CDC Feature Article and has added to the national picture on injection safety best practices. 

Note: Health-care-associated infections (HAI) affect nearly 100,000 people every year and result in over $30B in unnecessary health-care costs (HHS).  Our HAI Program works with partners across the state to rapidly identify and help prevent these infections. Traditionally, the focus of preventing HAIs has been in hospital settings, but more and more people are being identified outside of hospital settings.  They can happen at any health-care facility, but simple steps can help protect patients.

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Valley Fever Week

November 4th, 2011

This is Valley Fever Awareness Week- an annual event to provide awareness  of coccidioidomycosis (also known as Valley Fever)- the second most commonly reported infectious disease in Arizona.  Events for the general public include a “Learn about Valley Fever – Ask the Doctor Your Questions” held in Tucson on Sunday, Nov. 6 and the Walk for Valley Fever in Sun City West on Sunday, Nov. 6.  Healthcare providers can receive continuing medical education in Tucson on Saturday, Nov. 5:  “Coccidioidomycosis for the PCP” and “Advanced Clinical Aspects of Coccidioidomycosis”.  To find out more about valley fever awareness week events visit: http://www.vfce.arizona.edu/

Our epidemiology staff work closely with the Valley Fever Center for Excellence to promote education and awareness.  The Center is based at the U of A and will be opening a center in Phoenix in January.  Check out our home-grown video that’s designed help people understand the disease and how to talk to their doctors about it. To read more about valley fever and what has been done during past valley fever awareness weeks, please visit my blog.  I also wrote a piece about the effects that the large dust storms may have on valley fever, which by the way, we’re still investigating…

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AZ Data to Drive Public Health Interventions

October 24th, 2011

Making good decisions about prioritizing which public health issues to tackle and how to target our interventions rests on our ability to collect and analyze public health data.  For infectious disease surveillance that means have a base of solid reporting and surveillance so we can analyze infectious disease trends.  For chronic diseases, we need to know the behavioral trends and the demographic background so that we can target our resources effectively.  That’s where our annual Behavioral Risk Factor Survey plays a role… our brand new 2010 Report provides key data that can be used to monitor and plan health promotion and help our public health system to better target our intervention strategies for chronic disease prevention in Arizona. 

The (federally funded) Behavioral Risk Factor Survey is conducted throughout the year and examines the self-reported habits of 4,700 Arizonans.  The report contains key data on lifestyle risk factors contributing to the leading causes of death and chronic diseases- and measures the public health system’s progress on smoking, overweight, high blood pressure, exercise, flu/pneumonia vaccination, cholesterol, seat belt use, fruit/vegetable consumption and other risk factors.  These data give us some of the tools we need to set priorities and craft intervention strategies.  Judy Bass was the point person for this year’s report.  Well done Judy!

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Strategic Planning and Public Health Accreditation News

October 6th, 2011

As a follow up to my email earlier this month introducing you to the agency-wide efforts around accreditation and presentations of the draft strategic map, I’m happy to formally announce our new mission and vision: To improve the health and wellness of people and communities in Arizona (our Mission) and Health and Wellness for all Arizonans (our Vision).  These two small sentences say so much about who we are & where we’re going.  

During our presentation to the Division of Licensing Services last week, a great question was asked about the difference between the words health and wellness.  I addressed the group but wanted to share with the entire agency how I view the two and the distinction between them.  Health is the measure of optimal physical, mental and social conditions, with particular emphasis on the absence or successful management of disease and pain.  Wellness means the overall well-being of a person that includes the active process of becoming aware of and making choices toward greater satisfaction of one’s life in the areas of physical, emotional, social and spiritual life. 

So health is an outcome that can be fixed and measurable (e.g. blood pressure, cholesterol levels, etc.), and wellness incorporates mind, body and spirit, and relies more on self-assessment and self-report.  For instance, many people with chronic conditions such as diabetes, hypertension, asthma, etc. report high levels of well-being, while others who are in “good health” may report low levels of well-being.  If you get questions from stakeholders I am hoping this helps explain the difference.  I also want us to remember, that when we are talking about public health we are talking about all areas of our agency – prevention, preparedness, behavioral health, licensing, operations and the state hospital. 

As an update on the strategic map presentations, we completed our third strategic map presentation and have four more.  Next up is Public Health Prevention on October 17th.  If you have any questions please contact Managing for Excellence Program.

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