Posts Tagged ‘measles’

Dodging the Measles Bullet?

May 1st, 2014

10707_loresYou might remember from a few weeks ago that a single patient exposed over 1,000 Arizonans to measles.  Because measles is highly infectious and 90% of unvaccinated contacts become infected, Public Health worked overtime to identify and interview suspected cases.   Health care facilities were placed on heightened alert.  The State Laboratory rushed testing of suspicious measles cases.  Media interviews alerted the public of concerning symptoms.

This time, at least, it looks like we’ve dodged a bullet from this case.  We haven’t found any secondary cases yet, which means Arizona may have come out of this without an outbreak.  While we can breathe a lucky sigh of relief, efforts now redouble to ensure that 95% of the population is vaccinated against measles (making it harder for future measles cases to spread), that we maintain vaccination records for Arizonans, and that we’re prepared to control the next infectious disease that flies into AZ.

More Arizona Parents Choosing Not to Vaccinate their Kids

April 11th, 2014

Vac2_031.jpgAs I mentioned in a blog post last year, more AZ parents are choosing not to vaccinate their kids- using “personal exemptions” when they enroll their kids in school.  This has jeopardized our immunization rates enough that this week’s measles case in Maricopa County could spread.  We’ll know in a couple of weeks.

Vaccinating yourself and your kids is more about community protection than personal protection.  We need just about everybody to participate and get vaccinated in order to get the herd immunity we all need to prevent the spread of diseases like measles.   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.

Last year we asked the UA’s Mel and Enid Zuckerman’s College of Public Health to conduct a Study Summary and provide Recommendations to overcome the trend toward increased vaccine exemptions.  Using the study results, we developed and implemented an Action Plan to Address Vaccine Exemptions last year.  Here’s a link to our Action Plan Summary with the details of the key interventions we’ve conducted over the last year.

Detecting Scary Diseases

February 25th, 2014

Disease outbreaks can come from anywhere. In Arizona we’ve had illness from contaminated pomegranate seeds from the Middle East, measles from Switzerlandsalmonellosis from African dwarf frogs and cholera from Peru. More recently a Canadian traveler died of H5N1 after she returned home from a long trip to China. An exotic disease from another country is only hours away. West Nile virus likely came from Israel on a plane ride to New York in 1999 and now we see it every year here in Arizona. 

Right now, world health officials are keeping an eye on dozens of potentially dangerous new pathogens, from H7N9 bird flu in China, to the MERS virus in the Middle East, drug resistant bacteriaH5N1 bird flu in Southeast Asia, to Bas-Congo virus in the Congo. The Bas-Congo virus is a two-headed monster that causes bleeding like Ebola and invading the nerves like rabies. 

Effective disease surveillance in other countries helps to protect both their population and the US, since infectious diseases are only a plane ride away. Working with local governments and health officials, CDC recently set up two demonstration projects in Uganda and Vietnam to see if it would be possible to quickly scale up an effective surveillance and response. 

The project focuses on: 1) strengthening the public health laboratory system; 2) enhancing the existing communications and an online information system, and 3) developing a public health emergency operations center. In just six months, the CDC pilot program in Uganda found cases of West Nile virus, Zika virus, Crimean-Congo Hemorrhagic Fever virus, hepatitis E virus, and a bacteria that causes dangerous meningitis. 

We don’t know which disease will come next, but I’m confident the public health surveillance and laboratory system will detect it.

 

Sochi Public Health Tips

January 13th, 2014

I know that some of you out there are going to attend  the Winter Olympics – so I put together the blog post below over the weekend for folks that might be going.  Here goes in case you’re interested: Let’s start with the good news first- then the health tips… 

Sochi Games to be Smoke Free-

Russians are 4th in the world in cigarette consumption at about 2,800 cigarettes/person/year (the U.S. is 34th at about 1,000 cigarettes/person/year)… so it’s great that the Russian Federation has made the commitment to make the games smoke-free.  BTW: here’s a country by country listing of cigarette consumption per capita

Smoking will be prohibited in all the Olympic and Paralympic venues, including all bars and restaurants in the  Olympic park. No tobacco will be sold in any of the venues and the anti-smoking policy will be broadcast during all events on the scoreboards.   

Get Vaccinated-

Make sure you’re up to date up-to-date on all your routine vaccines- especially this year’s influenza vaccine.  Many adults haven’t had their Hepatitis A and B vaccine- both of which will come in handy- especially the Hep A vaccine.   There’ll be folks from all over the world there, bringing all sorts of viruses with them in a cold climate- so make a sure you don’t leave any protective vaccines on the table.  

Measles is still fairly common in that part of the world, so everyone under 55 years old should make sure they’re fully vaccinated for the measles.  People over 55 years old probably had the measles as a kid, so they’re at low risk.  More information on recommended vaccines is on CDC’s Russia destination page.   Also, DTaP or TDaP (depending on your age) is a good idea since diphtheria is still circulating in the region. 

Pack Smart-

Be sure to pack a travel health kit, including all your medications.  Pack them in your carry-on luggage and take extra in case of travel delays.  Be sure to pack plenty of warm clothes and sensible shoes with traction so you avoid falls.  The climate in Sochi is about like Prescott in February… but the competitions held uphill on snow and ice and any competition at night will be downright cold.  The right waterproof and windproof clothing will help too because it can rain there in February. 

Stay Hydrated-

It’s a lot easier than you think to get dehydrated in cold weather because cold air holds so little moisture.  Make sure you drink at least a couple of liters of water every day- more is better.   From what I’ve read, the water that leaves the Sochi treatment plant is OK to drink- but some of the underground pipes pre-date the revolution and the water can get contaminated on the way to the tap- so it’s best to seek bottled water or bring your own micro-filter. 

Traffic & Crowds-

Traffic will probably be heavy- so be careful when you’re a pedestrian.  Russian drivers don’t necessarily yield to pedestrians- and cars almost always have the right-of-way there.  Keep your thinking cap on while you’re walking around- not just looking out for cars but watching the ground for ice and stuff.  You don’t want to end up in a Russian hospital instead of enjoying the games!

Spectator crowds are sometimes tricky. Choose a place to meet if you get separated from your group (you probably won’t have your cell service to find each other), and pay attention to where emergency exits are when indoors at large events.  Above all- stay clear headed and don’t over-indulge on alcohol when in crowds or where the footing is slippery. 

Check Your Health Insurance-

Russia requires you to show proof that you have health insurance that’s valid in the Russian Federation in order to get a visa ($50).  Many domestic insurance plans won’t cover you if you need medical care overseas, so check with your insurance provider to find out the extent of your coverage outside the US.  You might want to buy supplemental travel health insurance that will cover any unexpected emergencies while you’re in Russia. 

Safety and Security-For more information about safety and security travel you can check out the State Department’s guidance for travel to the Sochi 2014 Olympic Games.

Measles & International Travel

April 30th, 2013

Guest Blog from Ken Komatsu, State Epidemiologist

With over 1 billion people crossing international borders each year, vaccine preventable diseases not usually found in Arizona, can arrive at any time.  Earlier this month a young child from Pima County became ill with a rash illness while visiting Asia.  This region of the world has had over a thousand cases of measles reported in the last six months as shown on this world map of measles.  Also, there was a community outbreak of measles in the town the child was visiting at the time.  While her older siblings were already immunized, the child did not receive measles vaccine prior to travel because of age.  The child was diagnosed with measles while in Asia, but continued traveling to London, New York and finally to Phoenix.

 

The child’s diagnosis was confirmed by our state public health laboratory after arrival, our epidemiologists followed up with the Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine.  CDC worked with the airlines to get names of all the passengers exposed on the two flights to the state health departments where each lives.  Health departments followed up on 53 passengers with possible exposure across the country:  5 from Arizona, 3 from Florida, 1 from Maryland, 1 from Massachusetts, 1 from Michigan, 12 from New Jersey, 24 from New York and 1 from North Carolina.

 

Luckily, no new measles cases among the exposed have been reported and the child was probably less infectious since he/she had already been ill for a few days during travel.  While our routine vaccination schedule does not recommend measles vaccination until 12 months of age, infants as young as 6 months should receive measles vaccine prior to international travel.  This child’s illness and all the hours of follow up by our epidemiologists, CDC, and seven other states, could have been prevented with one shot.  Another great reason for immunizing our children and adolescents since these diseases are still only a plane ride away.  For more information on health issues during international travel, please see the CDC Yellow Book.

 

19 Kids to Miss a Month of School

February 15th, 2012

A 4th grader in Gilbert was diagnosed with the mumps last week. Had all the staff and faculty in the school been previously vaccinated for the mumps at the school- it really would’ve been no big deal. But, it turns out that 19 kids at the school hadn’t been vaccinated for the mumps (mainly because their parents chose to sign exemptions from our vaccination requirements).

As a result, the 19 previously unvaccinated kids can’t go to class for about a month. Of course- the public health system doesn’t want to exclude the unvaccinated kids from school, but there’s really no other choice at this point- because it’s the only tool left to stop a potential cascade of new cases. Mumps can be pretty serious and spreads easily. It’s a virus that causes swelling in the salivary glands, high fever, loss of appetite and fatigue. There can be a lot of serious complications including meningitis, spontaneous abortions in pregnant women, and sterility in males. It’s spread by sneezing, coughing, contact with mucus membrane secretions, etc. My mom says it almost killed me in 1962.

Our official rules for this kind of situation say: “When a mumps case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative shall: a) Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and b) Comply with the local health agency’s recommendations for exclusion.” The 26 day exclusion period ordered by Maricopa County represents a full “incubation period” after exposure- the minimum needed to ensure that mumps won’t spread to additional people in the school.

Dr. Bob England from Maricopa County Public Health said it best in the paper this week; “It matters whether people around you have been vaccinated. It matters at least as much as it matters whether you’ve been vaccinated. No vaccine is perfect. Even people who have been vaccinated can contract diseases if they’re exposed to them. The key is to never be exposed. That’s how we’ve made all those previously common childhood diseases so rare. It’s not that the vaccine is so perfect. It’s that you get enough people vaccinated that when one person comes in with a disease that germ has a hard time finding another person to jump to. It’s called the herd effect.

Overall, 95% of Maricopa County elementary school kids are up to speed on the mumps vaccine, but it’s not evenly distributed. Some schools are at 100%, but one Maricopa County school is only at about 50%! Our team does a detailed annual analysis of immunization rates by school and gives that info to each of the county health departments every year- so they can do some intervention work.

Maricopa County Measles Case

February 15th, 2011

Maricopa County Department of Public Health (and our Lab) confirmed a case of measles in an Arizona resident this week.  Measles is one of the most communicable diseases there is (next to chicken pox).  It’s a viral disease of the upper respiratory system that’s spread in the air via droplets.  Measles starts with a fever and cough, eye irritation and a unique rash.  The MMR vaccine introduced in the 1960s pretty much wiped out measles in the US.  Around WW II the US had about 900,000 cases annually, but these days its usually less than 100 or so cases per year in the US.

When cases do show up, it’s usually among people that live overseas (in endemic areas) and visit the US or among US residents that travel overseas to areas with endemic measles (about 20 million people get measles globally every year).

The primary public health interventions are to identify contacts of cases and make sure that healthcare providers know exactly what to do when a patient presents with what could be measles, like implementing standard precautions and placing suspect cases in airborne precautions as soon as possible. If a patient calls a doctor and says that they’re sick and may have been exposed to measles we encourage the doctor to make sure that patients in the waiting room won’t be exposed and that all your staff are adequately vaccinated.  Of course, the best intervention of all is to keep our vaccination rates up.

Lancet Withdraws 12 Year Old Flawed Autism Article

February 3rd, 2010

An article published in the journal Lancet nearly 12 years ago set the public health world on fire.  The article published by Wakefield and 12 other authors suggested that they had found a link between the MMR (measles mumps rubella) vaccine and autism and bowel disease.  Since that time, a great deal of research has been conducted and numerous articles have been written, but none found a link.  Nevertheless, the rumor has persisted in some circles that there is some kind of association- usually citing the 1998 Lancet article.

On Tuesday this week, the authors of The Lancet finally retracted the article that they published in 1998 from the public record, stating that should never have published the research because the study was seriously flawed.  In fact, 10 of Wakefield’s 13 co-authors renounced the study’s conclusions several years ago.  In addition, Britain’s General Medical Council ruled that the authors of the study had shown a “callous disregard” for the children used in his study and had even acted unethically.

Here’s the full retraction statement from The Lancet:

“Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation.  In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”

You need to register to get access to the site, but the introduction is posted at: http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)60175-7/fulltext#bib1.  Registration is free.