Posts Tagged ‘outbreak’

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SARS… A 10-Year Retrospective

May 10th, 2013

This Spring marks 10 years since Severe Acute Respiratory Syndrome (SARS) arrived on the global public health scene.  It started as a mystery illness in SE Asia- without name, origin, or cure in February of 2003.  The CDC immediately began working with the World Health Organization to investigate the outbreak.  Public health scientists across the globe scrambled to understand and contain this health threat… which ultimately infected more than 8,000 people- killing about 10% of them. 

By March of 2003, the CDC had confirmed that the disease wasn’t caused by an influenza virus, but they didn’t know the culprit…  so they named it after the symptoms (Severe Acute Respiratory Syndrome) rather than the causative agent (it turned out to be a new Coronavirus).  March of ’03 also marked the time when the CDC figured out that the virus was spread via face-to-face human contact.  That’s also when the CDC and WHO recommended strict infection control measures including hand washing, gloves, avoiding sharing household items, and limiting interaction between ill patients and others. 

Exactly 10 years ago today CDC figured out that there were some “super-spreaders” that were a particular problem with the growing epidemic.  May ’03 also marked the month in which the investigation and public health and clinical interventions matured- bringing the full weight of the global public health and clinical management system to bear on the virus.  Interventions like concise case definitions and reporting standards, laboratory diagnostic tests, travel restrictions, and clear clinical management and infection control guidelines all worked together to eradicate the virus by the Summer of 2003. 

The forensic investigation continued for a few months after the virus was eradicated.  The investigation kept pointing toward an animal called a Civet as the source of the new Coronavirus.  A SARS-like virus had been isolated from civets captured in areas of China where the SARS outbreak originated and sold in live animal markets.  It’s a mammal with a catlike body, long legs, a long tail, and a masked face resembling a raccoon or weasel.  By January of ’04 it was pretty clear that a Civet was the probable source, and the CDC issued a  “Notice of Embargo of Civets”, which banned the importation of civets into the US. The ban is currently still in effect.  China also implemented some control measures on them. 

Interested in the whole story?  Check out “Remembering SARS: 10 Years Later” on the CDC’s website.

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Whooping Cough Booster & Pregnancy

April 4th, 2013

Whooping cough (pertussis) is a growing problem in the US and Arizona.  There were 41,880 cases and 14 infant deaths from pertussis in the US last year…  which is the largest number of cases since the vaccine became available in the 50s.  In Arizona there were 988 cases in 2012 and there’s a pretty substantial outbreak going on right now in Colorado City.  Anyone can get infected with whooping cough, but infants are most likely to die from it and family member – especially the infant’s mother – are the most likely to give it to infants. 

New data shows that a mother’s antibodies against pertussis are short-lived.  Therefore, giving pregnant women a booster shot in one pregnancy might not provide protection for the next.  In fact, new recommendations from the CDC’s Advisory Committee on Immunization Practices say that every pregnant woman should get a pertussis booster during every pregnancy.  Places to find vaccines can be found at The Arizona Partnership for Immunization (TAPI) website.

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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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Strategic National Stockpile Readiness

February 27th, 2013

The CDC’s “Strategic National Stockpile” is a large quantity of medicine and medical supplies that are available to states in case there’s a public health emergency (flu outbreak, asteroid, etc.) severe enough to cause local health supplies to run out.  Once federal and local authorities agree that the stockpile is needed, meds and supplies are delivered to any state in time for them to be effective. Each state is responsible for receiving and distributing the stockpile assets to local communities fast. 

Our Public Health Emergency Preparedness shop is responsible for the overall planning and execution in AZ.  The Plan (which isn’t posted on-line for security reasons) provides a step by step approach to accessing and distributing pharmaceuticals, vaccines and other medical equipment and products stored by the Feds.  Our Plan is evaluated yearly by the CDC.  The review covers every aspect of our plan… including how we communicate with the public, work with our healthcare and Agency partners as well as how we plan to work with vulnerable populations should SNS assets be needed. 

This year we got a score of 93% from the CDC…  and our partner counties (Pinal and Maricopa) received similar scores- demonstrating that the plans work together effectively to serve the public when they need to be activated.  We’ll be testing these plans during a full-scale exercise this week.  Congratulations to our preparedness rock-stars Teresa Ehnert, Marcus Castle, Stacey Cain and the whole emergency preparedness team! 

By the way…  we received and executed stockpile assets (antiviral medications and other healthcare supplies) during the 2009 H1N1 Influenza pandemic.  Our turnaround time from the minute we received the first shipment until everything was at its local destination was less than 36 hours- an impressive testament to our ability to plan and execute during a public health emergency. 

 

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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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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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H7N3

June 29th, 2012

Remember the 2009 H1N1 influenza pandemic?  That brand new virus that caused the pandemic was a combination of RNA from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe.  The natural laboratories for new influenza viruses that end up causing pandemics (like the ’09 pandemic) are birds and pigs- so it’s important to pay attention to new viruses that emerge in these species so interventions can be implemented to manage outbreaks and potentially prevent human outbreaks or even pandemics. 

Last week Mexican veterinary authorities found a new strain of influenza virus called H7N3 that has been infecting and killing large numbers of poultry at several large commercial farms.  This is the first major outbreak in Mexican flocks since the country battled H5N2 influenza virus in the mid 1990s.  Luckily, there are no human cases and no suggestion yet that it is a kind of virus that can infect humans- but it’s still important to follow up on  Follow-up report No. 1 (25/06/2012). 

By the way- the Influenza virus strains get their names from compounds called hemagglutinin and neuraminidase.  The H in the name refers to the kind Hemagglutinin on the virus and the N stands for the strain of Neuraminidase on the virus.

 

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AZ Smallpox Outbreak

February 6th, 2012

Smallpox broke out in southeast Arizona almost exactly 100 years ago last week (co-incident with the Statehood activities).  The first cases were in Tucson and Douglas with a few dozen cases and several deaths… and there were a few additional cases in Nogales and Globe.  Of course, all the cases were among folks that hadn’t been vaccinated.  The public health interventions of the time were much like what we would do today- case contact follow up with targeted vaccinations of folks that had contact with cases. 

For example, Dr. Chenoweth (Santa Cruz County Superintendent of Health) implemented an aggressive targeted vaccination effort following the Nogales case.  From the 1912 records, we know that Dr. Chenoweth immediately began a “house-to-house vaccination campaign, vaccinating every person within a radius of six or seven miles of the case under quarantine, except one person who secreted herself and escaped vaccination, but developed smallpox instead.”  These two cases were the only ones reported from Santa Cruz County. 

As the outbreak progressed in the following months, the State Board of Health weighed in on the public health response that had been undertaken in the various counties.  The 1912 State Board of Health minutes stated that: “In our opinion this (contact and ring vaccination campaigns) is not sufficient, as there is no one to keep check on the patient or guardian to see that vaccination is done.  Our public health law should be amended to read:  In addition to the above stated section, no principal, teacher or superintendent shall permit any person to attend school, unless they have been vaccinated.  A large per cent of the children of Arizona have not been vaccinated and will not as long as they are allowed to attend school without first having been vaccinated. 

So, the February 1912 Smallpox outbreak in SE AZ was that spark that triggered the debate about whether and how to require vaccination as a prerequisite for attending school.  You can check out our pre-school and school resource page to find out more about today’s school vaccination requirements.

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Arizona’s Food Safety Network

October 11th, 2011

The Listeria monocytogenes outbreak has captured the public’s attention these days- so I thought I’d do a piece on Arizona’s food safety network. Let’s start at the farm & ranch.  The Arizona Department of Agriculture is responsible for ensuring that the base of the food safety pyramid is solid in Arizona.  They have several divisions that are responsible for everything from Arizona farm-grown fruits and vegetables to livestock and poultry.  They also work with the USDA & the FDA to ensure that imported foods are safe and from an approved source.  So, basically, the AZ Dept. of Agriculture is responsible for food safety from the farm or ranch until the food hits the wholesaler or “jobber’s” warehouse. 

Once foods hit the middleman- it’s our job to ensure that food is safely handled until it makes it to your plate at a restaurant or leaves the grocery store in your cart. While our environmental health shop has the overall responsibility for ensuring that your food is safe from the warehouse to you- it’s our partnerships with the local health departments and departments of environmental services that make the system work.  We use the framework outlined in state law and our food safety rules to help guide the counties to make effective decisions in the field.  You can see a more detailed summary of the statewide activities in our latest annual food safety report (the new report is due out in a month or so). 

We delegate our food safety authority to the local health departments who use our authority do the actual inspections for restaurants and food retailers.  But, some of the counties actually act on their own- using authority granted from their board of supervisors.  For example, Maricopa County Environmental Services acts under their county authority rather than using our statewide authority.  All the inspections are done by people called Registered Sanitarians, who are required to have at least 30 hours of college credits in the natural sciences and pass a registration test. 

Of course, no food safety network would be complete without a robust foodborne illness surveillance system including the laboratory capacity to identify and track foodborne illnesses.  This part of the network also includes collaboration with the local health departments.  Physicians and private labs that identify or diagnose foodborne illness infections report that info to their local health department.  By pulling together the statewide data- we’re able to identify trends and sources- and along with the CDC’s resources, the public health system provides the feedback loop to the food safety network- allowing the system to track down and stop sources.

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