Category Archives: Infectious disease

Oct 24 2014
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Faces of Public Health: Daniel Barnett, MD

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News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.

NewPublicHealth recently spoke with Barnett.

NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?

Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.

That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.

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Oct 24 2014
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Two Important Ebola Conferences Coming Up

Just about every think tank, school of public health and infectious disease association has held a conference on Ebola in the last few weeks, but two coming up are still absolutely worth tracking.

Now that New York City has seen is first diagnosis of Ebola, an already scheduled conference next week at Columbia University’s Mailman School of Public Health has taken on added importance. Presenters include ABC News Chief Health and Medical editor and former acting U.S. Centers for Disease Control and Prevention director Richard Besser, MD, as well as Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. While the conversation surrounding the Ebola cases in Dallas focused on the need for health care workers to receive better guidance and training, hours into the first case in New York City the focus is on the challenge of containing the disease in a huge urban setting—a topic the presenters will discuss at length.

And on November 7, the White House Office of Science and Technology Policy will host a simulcast workshop together with Texas A&M, the Worcester Polytechnic Institute and the University of California, Berkeley to discuss proposals to dispatch robots to aid in the care of Ebola patients and people who have succumbed to the disease. The idea is to augment — and not replace — health workers. Robots could spray disinfectant, respond to commands given by health workers in a remote location and even help bury the dead.

The conference will include not just engineers, but also public health officials and health care personnel who can speak to the human needs that need to be considered when design the robots. For example, Texas A&M engineering students are working on a robotic attachment that would pick up a dead body in movements that mimic compassion, rather than in another way that may be efficient but does not show sensitivity for the dead and their families.

>>Bonus Link: Read an interview with the conference conveners.

Oct 23 2014
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New Kaiser Infographics Compares Key Ebola Factors with Other Infectious Diseases

In the wake of the Ebola outbreak in West Africa and cases diagnosed in the United States, NewPublicHealth has been looking at the toll of other infectious diseases in need of new prevention and treatment efforts. Earlier this week, the Kaiser Family Foundation released a series of infographics that compare Ebola to twelve other infectious diseases, including SARS, malaria and HIV, which are all current public health challenges.

The infographics are an important teaching tool for explaining how Ebola is spread and for reminding public health professionals about the need for vigilance when it comes to other diseases. 

The series of infographics touch on topics including:

  • Transmission routes
  • Vaccines, treatments and cures
  • Fatality rates
  • Key characteristics such as immunity after infection and number of cases worldwide each year

Below is one of the Kaiser Family Foundation’s infographics. Click through to view the additional educational tools. 

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Oct 13 2014
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PBS Series ‘Frontline’ Examines Antibiotic Resistance

In light of the ongoing Ebola outbreak, NewPublicHealth recently launched an in-depth look at the current state of several infectious diseases and efforts to stem Ebola and other outbreaks. Tomorrow night the PBS documentary series Frontline will air “The Trouble with Antibiotics” (10 p.m. EST), taking a look at antibiotic use on American farms and the death of a patient being treated at the National Institutes of Health (NIH) three years ago who succumbed to a superbug the NIH was unable to treat.

According to the program’s correspondent, David Hoffman, a former journalist with the Washington Post, 70 percent of U.S. antibiotics are used on farms and are linked to at least some of the two million people who become ill and the more than twenty thousand people who die of antibiotic resistance each year.

NewPublicHealth recently spoke with Hoffman about the project.

NewPublicHealth: What made you interested in the topic of antibiotic resistance?

David Hoffman: In 2012, the Clinical Center at the National Institutes of Health disclosed the details of an outbreak of resistant bacteria in the hospital during 2011. It was a remarkable story in which advanced genomics from an NIH institute were used to unravel the mystery of how the organism had spread, and the hospital took extraordinary measures to combat it. This led to a 2013 Frontline film about the growing problem of resistance in human health, “Hunting the Nightmare Bacteria.” While working on “Hunting.”’ we heard a lot about antibiotics in animal agriculture. But the issues were complex and needed time for serious examination. We decided to devote our next film to answering some of the questions and that process took about a year.

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Oct 13 2014
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Public Health News Roundup: October 13

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CDC Confirms Texas Hospital Nurse Who Cared for Infected Patient Has Ebola
On Sunday, the U.S. Centers for Disease Control and Prevention (CDC) confirmed test results that found that a healthcare worker at Texas Presbyterian Hospital in Dallas is positive for Ebola. The health care worker provided care for a Dallas patient who contracted Ebola in Liberia and died last week. The nurse is being cared for in an isolation unit.  In a statement released on Sunday, the CDC said “this development is understandably disturbing news for the patient, the patient’s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures, including ongoing contact tracing, health monitoring among those known to have been in contact with the index [first]patient, and immediate isolations if symptoms develop.” Read more on Ebola.

Medicare Part B Premiums and Deductibles Will Remain the Same for 2015 as Rates of the Past Two Years
The U.S. Department of Health and Human Services has announced that the standard Medicare Part B monthly premium and deductible for 2015 will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.  About 50 million Americans are enrolled in Medicare Part B and their monthly premiums and annual deductibles will be $104.90 and $147, respectively. Read more on Access to Health Care.

Monitoring Illness at Preschools Could Offer Early Avert for Some Disease Outbreaks
A web-based system that allows preschools and child care centers to report illnesses to local public health departments could improve the detection of community disease outbreaks and allow resources to be mobilized faster according to a study presented at the American Academy of Pediatrics meeting in San Diego. The researchers created a computerized system and tested it at four early learning centers in Michigan. Staff was trained to use the system daily and send illness updates to local health department weekly, or more frequently if spikes in illnesses were seen. Among their findings: the four preschools reported a gastroenteritis outbreak three weeks earlier than other area schools. Read more on infectious disease.

Oct 9 2014
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TEDMED Great Challenges: Public Health’s Work on Infectious Diseases

Infectious diseases—and the treatment of infectious diseases—has been a common theme in the news recently, with almost 4,000 people now dead from an Ebola outbreak in West Africa. It was only yesterday that Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, died in a Dallas, Texas, hospital.

Earlier this week, some of the leading experts in infectious disease came together in the Google Hangout “TEDMED Great Challenges: Track, Treat, Prevent—A Better Battle Against Communicable Diseases.” They discussed the risk of communication, treatment, drug resistance, disease tracking innovation and related ethical issues. The event was moderated by Helen Branswell of the Canadian Press.

The panelists—across the board—agreed that the recent Ebola resurgence has served to highlight the importance of public health. Not just what it brings to the table during such emergencies, but the need for it to focus even more on prevention efforts and ensuring public health is fully funded and supported.

“Public health funding is one of those things people only really notice when something goes wrong,” said Dara Lieberman, a Senior Government Relations Manager at Trust for America's Health.

Amy L. Fairchild, PhD, MPH, Professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health, believes that “in many ways, we’ve really lost our way in public health.”

“There was a period at the end of the 19th/beginning of the 20th century in which the field made these enormous strides in combatting infectious diseases and combatting communicable disease,” Fairchild said. “And then, with the rise of chronic diseases, we began to forget some of those...lessons learned about the need to focus on broad, sweeping environmental changes.”

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Oct 2 2014
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Public Health News Roundup: October 2

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EBOLA UPDATE: Texas Ebola Patient Came into Contact with at Least 80 People; Second Man Being Monitored
The known number of people who came into contact with the Ebola patient being treated in Texas—now identified as Thomas Eric Duncan of Liberia—has climbed from 18 to at least 80, according to Dallas Health Director Zack Thompson. Duncan, who is in isolation at Texas Health Presbyterian Hospital Dallas, is the first person to be diagnosed with the disease in the United States. Several members of his family are under a “control order” to stay inside their homes. Texas health authorities are also monitoring a second potential Ebola patient. Read more on Ebola.

HHS: Two Contracts to Improve Earlier, More Accurate Flu Diagnosis
The U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued two contracts to help improve doctors’ abilities to diagnose influenza cases sooner and more accurately. One contract is for 3.5 years and worth $12.9 million, while the other is a two-year, $7.9 million contract that could expand to a $14.7-million contract over four years. “Administering fast and inexpensive tests at the point of care has tangible benefits to personal and public health, particularly in helping doctors prescribe the right therapy immediately,” said Robin Robinson, PhD, director of ASPR’s Biomedical Advanced Research and Development Authority, in a release. “Prescribing medication or other therapies in a more targeted way is good stewardship and will be critical to reducing the risk of antimicrobial resistance.” Read more on influenza.

Health Officials: 500 Confirmed Cases of Enterovirus D68 in 42 States and the District of Columbia
There have now been more than 500 confirmed cases of Enterovirus D68 in forty-two states and the District of Columbia since the severe respiratory illness first began infecting children during the summer. While four patients have died in the past several weeks, health officials are still unsure whether the virus is linked to the deaths. They are also working to determine whether 10 cases of children with muscle weakness and even paralysis are due to the virus. Read more on infectious disease.

Sep 25 2014
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Preparing for Ebola in the U.S. Makes Good Public Health Sense

U.S. public health officials have continually said that it is highly unlikely that the Ebola virus will spread in the United States, even if infected travelers land here. Officials at the U.S. Centers for Disease Control and Prevention (CDC) say that the disease is most contagious when people come into contact with the bodily fluids of someone who is ill—and someone that ill would be very likely be identified by border and airline personnel quickly. If hospital admission became necessary, U.S. infection control procedures could stem an outbreak, according to Tom Frieden, MD, the CDC’s director and the point person for the U.S. government on the current Ebola outbreak. Frieden has discussed the issue repeatedly during several news conferences in the last few weeks.

Of course, that changes if the virus becomes transmissible through the air, rather than just via bodily fluids, as Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, suggested in the New York Times last week. While Osterholm often addresses the direst potential outcomes of infectious disease outbreaks, it’s prudent to at least know what to do, which is why agencies such as the CDC and the Network for Public Health Law say what’s needed is information and procedures...but not panic.

Last month, the Network held an online webinar on preparedness measures and Ebola which was watched by more than 1,200 public health officials. Following the webinar, Network experts posted answers to follow-up questions, including one about the right of public health or hospital workers to refuse to care for/help with someone suspected of having Ebola.

The Network also recently created an online primer on preparedness and legal issues surrounding the Ebola outbreak, both for public health officials engaged in the response overseas and for those with current or future responsibility for handling Ebola-related issues in the United States.

>>Bonus Link: Richard Besser, MD, now the chief health editor for ABC News, was formerly the CDC’s head of disaster response and led the early response to the H1N1 outbreak in the United States several years ago. In a recent opinion piece for the Washington Post, Besser laid out what’s being accomplished and what still needs to be done to stem the Ebola outbreak in West Africa.

Sep 8 2014
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Public Health News Roundup: September 8

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Mandatory Policies Increase Flu Shot Rates for Health Care Workers
Hospitals can improve their flu vaccination rate among health care workers by using a mandatory employee vaccination policy, according to a study by researchers at the Henry Ford Health System in Detroit. At Henry Ford, getting the flu shot is a condition of employment and the health system now has a 99 percent compliance rate. Nationally, only 63 percent of health care workers were immunized against the flu in the past two years, according to the Centers for Disease Control and Prevention, which poses a risk to patients. The study was presented this weekend at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington D.C.

Before making flu vaccination mandatory, the vaccination rate at Henry Ford was between 41 percent and 55 percent. An increasing number of health systems are making flu shots mandatory for employees. At Henry Ford, employees can opt out for religious or medical reasons so long as they have documentation from clergy or a physician and then must take other precautions against the flu, such as wearing a mask when caring for patients.

Many doctors’ offices, pharmacies and clinics already have the flu shot on hand for the upcoming flu season. The HealthMap flu shot locator has been updated for the 2014-2015 flu season.

Read more on the flu.

Study: Alcohol Ad Reminders to “Drink Responsibly” Promote Drinking
A new study by researchers at the Johns Hopkins School of Public Health finds that magazine ads from the alcohol industry that advise readers to “drink responsibly” or “enjoy in moderation” fail to convey important information about dangers associated with alcohol consumption.

The study, published in Drug and Alcohol Dependence, analyzed all alcohol ads that appeared in U.S. magazines from 2008 to 2010 to determine whether messages about responsibility define responsible drinking or provide clear warnings about the risks associated with alcohol consumption.

According to the study, 87 percent of the ads analyzed included a responsibility message, but none actually defined responsible drinking or promoted abstinence at particular times or in certain situations. When responsibility messages were accompanied by a product tagline or slogan, the messages were displayed in smaller font than the company’s tagline or slogan 95 percent of the time.

Responsibility statements are voluntary and are also frequently included in ads appearing in other media including radio and online ads. The researchers say more effective ads would have prominently placed tested warning messages that directly address behaviors and that do not reinforce marketing messages. “We know from experience with tobacco that warning messages on product containers and in advertising can affect consumption of potentially dangerous products,” say Katherine Clegg Smith, a professor at the Johns Hopkins Bloomberg School of Public Health and a lead author of the study. “We should apply that [tobacco ad] knowledge to alcohol ads and provide real warnings about the negative effects of excessive alcohol use.”

Read more on alcohol.

NYC Health Department Investigating Meningitis Outbreak among HIV Positive Men
The New York City Health Department is currently investigating a cluster of meningitis cases among HIV-positive men who have sex with men. Three cases of meningitis have occurred in Brooklyn and Queens since August 24, with the last two cases reported since early September.

Meningitis is a severe bacterial infection that has a high fatality rate. A previous outbreak of the disease among men who have sex with men ended in February 2013 after 22 cases were reported, including seven fatal cases.

The Health Department recommends meningitis vaccination for all HIV-positive men who have sex with men. Meningitis vaccinations are also recommended for men, regardless of HIV status, who regularly have intimate contact with other men met through a website, digital application (“app”), or at a bar or party.

People living with HIV are at a greater risk than the general population of acquiring meningitis and, if infected, dying from infection. This disease is spread by prolonged close contact with nose or throat discharges from an infected person.

Read more on sexual health.

 

 

Sep 3 2014
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Recommended Reading: Ebola Is Also an International Security Threat

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In the last few days, the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the medical aid group Doctors Without Borders have sounded alarms on the growing needs of several countries in West Africa fighting the Ebola outbreak. The groups have called for increased funding, equipment and expert health personnel to help stem the rapidly increasing numbers of infections.

As of last week, there have been more than 3,000 cases and more than 1,500 deaths, making it by far the largest outbreak since Ebola was discovered during the 1970s, according to the WHO. CDC Director Tom Frieden, MD, MPH, who last week visited the main West African countries dealing with the Ebola outbreak, said the number of cases could spike to 20,000 if more isn’t done to stem spread of the disease in those countries.

In addition, a recent post on ForeignPolicy.com said that the epidemic must be controlled before it also poses a security threat. Liberia, which has seen the highest number of Ebola cases and deaths in the region so far, has been under the watch of an international United Nations (U.N.) peacekeeping force since a civil war ended in 2003. While the U.N. had planned to begin drawing down the force next year, U.N. Secretary General Ban Ki-moon said he’d like to delay any drawdown for at least three months because of the virus outbreak, which has needed troops to help secure order.

However, several countries want to pull out troops now in order to reduce the risk to their personnel and to citizens at home who they worry could be infected by returning soldiers. Ban has said that the nature of the illness poses little risk to the troops, who are unlikely to have contact with the bodily fluids of people who are ill—which is the way the virus spreads—and some of the countries involved are considering sending their own experts to assess the risks.

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