Posts Tagged ‘outbreak’

Epidemiologists: Public Health’s Smoke-Jumpers

April 10th, 2014

MeaslesLike a hotshot team, a rapid response by public health is essential to stopping the spread of measles in unvaccinated persons… and disease detectives in Maricopa County are currently working to squash a measles outbreak right now.

Last week a person with measles visited a restaurant, church and airport in Arizona, exposing over a thousand people to measles.  Press releases and health alerts have gone out- and epidemiologists, public health nurses, and healthcare providers have been dispatched by Maricopa County Public Health to identify, isolate and control further cases.  Time will tell if their efforts pay off.  We should know in a couple of weeks (the incubation period for measles is 10 – 18 days).

Measles seeks out the unvaccinated like fire seeks a dry branch – the chance of an unvaccinated contact getting measles is 90% once exposed.   If you’re not vaccinated against measles, you can get it just by being in a room with someone who has measles.  A measles vaccine can prevent infection if given within 72 hours of exposure as an emergency control measure for unvaccinated folks…  but herd immunity is what keeps the community from getting burned.


March 31st, 2014

ebolaIf you’re like me, your introduction to Ebola virus came in the 1990s with the bestseller nonfiction thriller The Hot Zone and loosely-based film Outbreak.  The descriptions of a deadly hemorrhagic fever that quickly spread through the population were terrifying, as were the life-threatening dangers posed to the intervening infectious disease personnel.

The Guinea Ministry of Health has a total of 103 suspect and confirmed cases with 66 deaths.  They announced today that the disease has spread to the capital, Conakry.  Also, reports of suspected cases in neighboring countries are being investigated: Liberia reported to the WHO 8 suspected cases, including 6 deaths, in individuals with recent travel history to Guinea. Sierra Leone has reported 6 suspected cases, including 5 deaths.

Bats appear to be a reservoir and hosts for the ebolavirus. Initial infections in humans result from contact with an infected bat or other wild animal. Ebola spreads by contact with other patients’ infectious secretions and from consuming the meat of infected animals.  For Guinea’s particular strain, the fatality rate is nearly 90%, and is heralded by fevers and internal bleeding.   Doctors Without Borders and WHO both have teams in Guinea, working with the Health Ministry to contain the spread.

In countries with weak medical infrastructures, an outbreak like this can be devastating.  Historically, countries with poorer infrastructures and health status suffer far worse than more bolstered nations.  So while Arizona is under no threat from Ebola, maintenance of a strong public health and emergency preparedness program remains a top priority.

Send Your Teen to CDC’s Disease Detective Camp this Summer

March 21st, 2014

The CDC just began accepting applications for their annual summer Disease Detective Camp.  The Camp is open to motivated students who’ll be high-school juniors or seniors during the 2014-2015 school year.  Over the course of five days, campers  take on the role of disease detectives.   Campers can expect a variety of experiences including re-created outbreaks, mock press conferences, environmental and global health activities, a laboratory session, an introduction to chronic disease surveillance, public health law, and short lectures from world-renowned CDC scientists.  Here’s a sample schedule

Applicants need to be 16 years old by the first day of the camp in order to comply with CDC’s laboratory safety requirements.  Two sessions will be offered this summer:  June 23-27, and July 21-25.  Applicants are selected based on the Application Essay Questions submitted and the teacher/counselor Recommendation Form.  Applications need to be postmarked by April 11. 

The Camp is free, but campers are responsible for providing their own accommodations and transportation. Campers in past years have stayed with family friends or relatives in Atlanta.


September 10th, 2013

One tropical disease that you might have heard in the news lately is cyclosporiasis. This summer, cyclosporiasis was the cause of a multistate outbreak that hit Texas, Iowa and Nebraska the hardest. 

Cyclosporiasis is a diarrheal illness caused by the single-celled protozoan, Cyclospora cayetanensis. Like most protozoa, people can become infected with Cyclospora by consuming food or water contaminated with the parasite. However, Cyclospora differs from other protozoa of its kind (like Cryptosporidium) because after being passed in the feces, it takes days to weeks at the right temperature to transform and become infectious for another person. Therefore, direct person-to-person spread or transmission from ingesting newly contaminated food or water is unlikely to happen. 

Cyclosporiasis most commonly occurs in tropical and subtropical regions where outbreaks are frequently seasonal (such as summers and rainy season in Nepal). However, cyclosporiasis can occur in many countries. U.S. cases of infection also have been reported in persons who travel to these areas. Food-borne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, and in the most recent outbreak, salad mix. But the ultimate source is human, since man is the only known reservoir of this parasite.  Unfortunately, treatment of water or food with chlorine or iodine is unlikely to kill Cyclospora 

Some infected people will not show any symptoms of cyclosporiasis. Those who do experience symptoms will usually start to feel sick about a week after consuming the contaminated food or water. Symptoms of cyclosporiasis include watery diarrhea, cramping, and nausea. If not treated, the illness may last a few days to a month or longer, but usually resolves on its own. Symptoms may seem to go away and then return one or more times.  

As of August 29, 636 cases of cyclosporiasis were reported to the CDC from 23 states in June and July. Health officials suspect more than one source of contamination.  Although the investigation is ongoing, the recommendation stands that consumers should continue to enjoy the health benefits of eating fresh produce and to follow general fruit and vegetable safety recommendations.


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.

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.

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.

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. 


‘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.