Dogs & River Blindness

October 1st, 2013 by Will Humble No comments »

Last year a young child came down with onchocerciasis in northern Arizona.  Onchocerciasis, is caused by a filarial worm similar to dog heartworm and the roundworm that causes elephantiasis.  This child had a dog-related species (Onchocerca lupi) of the roundworm in her neck next to her spinal cord and was the first documented case in the US. A few other cases of this species has been found in dogs and cats in the US and about four other human cases in other parts of the world but where they got the infection and how they were infected is still unknown. 

Onchocerciasis, is also the second leading infectious cause of blindness in the world and can cause debilitating and disfiguring skin disease.  The human species of this parasitic worm (Onchocerca volvulus), is spread by the bite of an infected blackfly. It got the name “River Blindness” because the fly that transmits infection breeds in rapidly flowing streams and the resulting infection can cause blindness. Persons with heavy infections will often have a skin rash (usually itchy), eye disease, or nodules under the skin. The World Health Organization’s estimates that at least 25 million people are infected and 123 million people live in areas that put them at risk of infection. About 300,000 people are blind because of the parasite and another 800,000 have visual impairment. Nearly all of the infected persons live in Africa; with about 1% in Yemen and six countries in the Americas. 

The infection is transmitted in remote rural areas and, unlike malaria, an infection often requires more than one infectious bite. So the risk of infection is higher in adventure travelers, missionaries, and Peace Corps volunteers and other long-term volunteers who are likely to have repeated exposures to blackfly bites. There is a lower chance of transmission in the Americas, even for those with longer stays. 

The disease spreads from person to person by the bite of a blackfly, but the larva must undergo a change in the fly. When a blackfly bites a person who has onchocerciasis, tiny worm-like larva (called microfilaria) in the infected person’s skin enter and infect the blackfly.  After about 2 weeks, the larvae develop into a stage that is infectious to humans and make their way to the mouth of the fly.  Like mosquitoes, female blackflies feed on animal blood to make eggs.   An infectious blackfly will deposit larvae on the skin when biting a person. The larvae then penetrate the skin to infect the person.  The number of worms in a person is related to the number of infectious blackfly bites.  

It can take up to one year for the tiny larva (microfilaria) to develop into an adult worm and between 10 and 20 months before larvae can be found in the skin.  A nodule begins to form around the adult worms protecting it from the immune response.  Each adult female worm can live from 10-15 years, and produce thousands of larvae a day and millions of larvae during her lifetime.  It’s the dead and dying larvae that cause most of the symptoms of this disease, and most people feel well until the adults start producing large numbers of larvae.  The damage caused by larvae that die in the eye results in damage of the optic nerve or lesions on the cornea that without treatment, clouds the cornea resulting in blindness.  Blindness usually occurs with a heavier worm burden (an intense infection).

Influenza Vaccine Season Blows In

September 30th, 2013 by Will Humble No comments »

It’s almost that time of year… flu season.  Flu shots have arrived and are already in many pharmacies and doctor’s offices, meaning you can already get vaccinated before the flu hits this season.  There’s a wide array of influenza vaccine choices these days – more than ever.  

The nasal spray is approved for healthy, non-pregnant people between the ages of 2 and 49 years old. The shot is approved for most people 6 months and older. There’s also a special high-dose shot for folks 65+ that gives better protection by improving immune response.  This year there are even 2 types of flu vaccines aren’t grown in chicken eggs- allowing even people with egg allergies to be vaccinated this year. 

In past years, flu vaccines have always provided protection against 3 flu strains, 2 influenza A strains and one influenza B strain.  For the first time this year, 4 of the licensed flu vaccines will protect against 4 different flu strains-  two “A” strains and 2 “B” strains.  This year’s (three-strain) vaccines will contain the pandemic and H3N2 strains as well as a brand-new B strain. 

The flu season in the Southern Hemisphere peaked in mid-July and is winding down. Central America, the Caribbean, South America and South Africa and Australia and New Zealand have all been seeing influenza strains that are included in this year’s US vaccines- meaning that this year’s vaccines will likely be a good match for what starts going around when flu season gets going. 

The flu spreads from person to person through droplets made when people sick with flu cough, sneeze or talk. It can give you a fever, cough, sore throat, muscle aches, and make you really tired among other things. That’s why it’s so important to get vaccinated every year to protect yourself and those around you from this bad bug.

50 Years of Newborn Screening

September 29th, 2013 by Will Humble 1 comment »

The first newborn screening test was developed in 1963 by Dr. Robert Guthrie to test for phenylketonuria, commonly known as PKU. Since then, scientists have developed more tests to screen newborns for a variety of severe conditions.  This year, the nation celebrates 50 Years of Newborn Screening. The State of Arizona currently screens for 29 disorders, including hearing loss.

The Office of Newborn Screening launched a new webpage at the beginning of the year dedicated to celebrating this important milestone, as well as raising awareness of newborn screening by sharing information and family stories. Each month, a different disorder or aspect of newborn screening has been featured on the page. You can learn about Sean, who was born with Glutaric Acidemia Type 1 (a metabolic disorder which can cause brain defects if left untreated), or 9-year-old Kaidan with hearing loss due to Waardenberg Syndrome. The page also has great resources about many of the diseases we screen for in Arizona, including Cystic Fibrosis and Congenital Hypothyroidism.

Adding to the celebration, September is Newborn Screening Awareness Month, and the Office of Newborn Screening has teamed up with Baby’s First Test to participate in their “Be Bold, Wear Gold” campaign by wearing gold pins. By sharing newborn screening information through ADHS’ Twitter, including participating in and retweeting important messages from the national chat with Dr. Richard Besser about newborn screening, the Office of Newborn Screening continues to push their message and share the importance of screening for all babies.

E-cigarettes and Teens

September 27th, 2013 by Will Humble 1 comment »

E-cigarettes have been a huge topic of discussion in the tobacco control industry and in public health over the past few years. While containing no actual tobacco, they do contain nicotine, are flavored and require the user to emulate the act of smoking.   The CDC recently released a study showing that e-cigarette use has doubled among middle and high school students across the country over the past two years.  Up until last week it was legal for minors to buy an e-cigarette in Arizona….  but new legislation went into effect last week making it illegal for anyone under the age of 18 to purchase e-cigarettes. 

Our Bureau of Tobacco and Chronic Disease partners with the Attorney General’s Office on a program called Counter Strike. The Counter Strike program recruits youth ages 15 to 17 that have a valid ID to attempt undercover buys of tobacco products. The teens are accompanied by an undercover agent from the Attorney General’s office.  If they successfully buy tobacco products the store and clerk receive a citation. We’re also working with our partners at county health departments to make sure that local school districts have this new statutory language in their school policy to reprimand students for using e-cigarettes on campus in the same manner it would for regular tobacco users.

ADHS Web Resource Showcases General Plans Around AZ

September 26th, 2013 by Will Humble No comments »

Where you live impacts your health. General and Comprehensive Plans guide the big picture vision for how the community should take shape for the future. We know that to achieve the goals we’ve set out in our Strategic Map, planning must include community health. Working collaboratively with others, we’re finding ways to support healthy behavior, such as biking, walking, and having access to affordable healthy foods in our communities.  

Our new AZ Healthy Communities webpage supports Arizona communities that are using, or are interested in using, collaborative approaches to healthy community planning and the promotion of healthy lifestyles. An exciting addition to the website is a comprehensive listing of General Plans from around the state. Click the Arizona General Plan Resources link to find this list and read how other Arizona communities are planning for the future.  

Another tool available for communities to support their work in making the healthy choices is the Healthy Community Design Toolkit. The Toolkit is a guide for local residents who wish to participate in the process. The Toolkit will support Arizona communities in using collaborative approaches to healthy community planning and the promotion of healthy lifestyles.  Arizona was selected as one of seven states to receive a grant from the Health Impact Project to help bring health considerations into public policy decisions. Find out more about Health in Policy and Practice Arizona and the work partners can accomplish when they work together.

Schistosomiasis, a blood fluke

September 26th, 2013 by Will Humble No comments »

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.

High Five for Hand Washing

September 25th, 2013 by Will Humble 1 comment »

We know washing our hands is the best way to prevent spreading germs, but a new study shows that one in ten people don’t wash their hands at all after using the bathroom. Only 5% do it right. It’s a big deal when you consider that half of the foodborne illness outbreaks happen because people either don’t wash hands or don’t do it right. 

Chaparral High School students recently worked on a health project to promote the importance of hand washing by creating posters and health messaging for their classroom. The students worked with our staff and wrote the script, worked in front of and behind the camera, and on the audio recording and basic lighting to create the “High Five for Hand Washing” video. Special thanks to Marta Urbina, Chief for the Office for Children with Special Health Care Needs in the Bureau of Women’s and Children’s Health and Dallas Teat, Video Production Specialist, for hard work on this project.

CDC’s Smoking Cessation Campaign

September 24th, 2013 by Will Humble No comments »

The CDC just released a report for their national smoking cessation campaign launched in March 2012 called “Tips from former smokers.” Nationally, the ‘Tips’ campaign led to an estimated 1.6 million smokers attempting to quit with 100,000 likely quitting for good.  The campaign directed callers to 1-800-QUIT-NOW. If you call from an Arizona zip code you are routed to the Arizona Smokers’ Helpline (ASHLine). 

Locally the ‘Tips’ campaign increased calls to the ASHLine by 15%.  The additional attention the national campaign brings to quitting highlights the successfulness of the ASHLine. The CDC estimates that the ‘Tips’ campaign spent approximately $200 on each quitter and had a quit rate of approximately six percent. Compare that to the ASHLine where approximately $100 per quitter is spent resulting in a more than 30% quit rate. It’s estimated that every person who quits saves the public about $136,000 over the rest of his lifetime – that’s counting healthcare costs and lost productivity caused by illness and disease. 

We continue to help people in Arizona quit using tobacco by using innovative campaigns like Project Quit, and launching new resources like The CIGnal, which is a quitline designed for teen and young adult tobacco users.

Bad Bugs, No Drugs?

September 23rd, 2013 by admin No comments »

CDC released a report this week about antibiotic resistance. They found that more than 2 million people in the US get sick every year from germs that are resistant to antibiotics and at least 23,000 people die from these infections. The report also found that up to half of antibiotic use in people is unnecessary or inappropriate. Check out CDC’s website to understand how antibiotic resistance happens and how antibiotic resistance can spread. The report also gives easy-to-understand information on some important antibiotic resistant or antibiotic related germs like Clostridium difficile and Carbapenem-resistant Enterobacteriaceae (or CRE).

Our Healthcare-Associated Infections Program facilitates an Advisory Committee and Subcommittee on Antimicrobial Stewardship that champion work on these issues for Arizona.

2013 State Health Officer’s Meeting

September 21st, 2013 by Will Humble No comments »

This has been an excellent week to learn what others in my position are doing across the country.  All the state health directors met in Florida this week to look ahead and strategize about the coming year’s goals.  I’m always proud when our award-winning programs are highlighted, but it’s a great opportunity to talk to others about best practices in their states and bring them back to Arizona.  The “New Public Health” blog has some interesting moments from the conference and is a good resource for new ideas.