Did you forget about Ebola?

Ebola Ebola was big news in 2014. But we seem to have lost interest in it, especially now that no one in the US is being treated for the virus. While the number of cases in African countries is dropping, the epidemic and its repercussions are far from over. In fact, there are still important developments happening every day.

A promising new treatment An experimental antiviral drug has shown potential for treating early cases of Ebola. Favipiravir, which has also shown to be effective against influenza, West Nile, and yellow fever as well as other viruses, seems to drastically reduce mortality in patients who are not yet seriously ill. It doesn’t seem to help patients with severe Ebola infection. One of the most important advantages of favipiravir is that it is a pill. Other potential therapies must be kept frozen and are administered through infusion, leaving the health care worker at risk for needle sticks.

Red Cross aid workers suffer from attacks in Guinea In Guinea, public misconceptions about the role of aid workers and the mode of Ebola transmission have led to attacks on Red Cross and other volunteers conducting safe burials of deceased Ebola patients. While many Guineans understand and accept the practices the Red Cross uses to disinfect homes and bury Ebola victims, some are concerned that the Red Cross is actually spreading the virus. This has resulted in an average of 10 attacks per month. The Red Cross is warning that the violence against its volunteers is hampering its ability to contain and quell the epidemic.

Maybe Ebola can be transmitted through aerosols, but probably not One of the best things about this 28 day writing challenge is that through my research I found Carl Zimmer. I aspire to his level of health writing clarity and scientific rigour. His piece “Is It Worth Imagining Airborne Ebola?” does an excellent job of outlining the concerns expressed by a few scientists while also offering the counterpoints that help give those concerns context. Before you get carried away with alarmist headlines, take a look at what he has to say.

From soap and water to soap opera Sierra Leone is starting to move from the traditional forms of public health communication to a more innovative medium. Celebrities are partnering with a major bank to create a soap opera designed to help prevent transmission, explain treatment and safe burial practices, and dispelling myths about Ebola. One of the twelve episodes focuses on quarantine by centering around a family who is under quarantine. Through this storyline, the actors explain what happens during a quarantine and why adherence to it is crucial. In the major city of Freetown, the soap opera is broadcast on television, while in more rural areas, it plays on the radio.

Right now, the Ebola epidemic seems to be waning. However, this epidemic will resonate throughout the region for decades. Even as new public health issues surface, we would be well-served to remember what has and is happening in this part of Africa.

Part III: The terrifying realities of antimicrobial resistance that will keep you up at night

As promised, today’s post will focus on the terrifying realities of antimicrobial resistance. I'm generally not an alarmist, but these two issues are Not Good. We are on our way to a post-antibiotic age of medicine.

The terrifying realities of antimicrobial resistance that will keep you up at night

CRE: Carbapenem resistant enterobacteriaceae This week, I saw headlines about a “nightmare bacteria” that killed two people and infected at least five more. Turns out the nightmare wasn’t such a surprise—the infections were caused by carbapenem-resistant enterobacteriaceae, or CRE.

Enterobacteriaceae are a family of bacteria that includes familiar disease-causing bugs including as Salmonella, E. coli, Enterobacter, and Shigella as well as other bacteria that don’t make us sick. In fact, some of the bacteria found in this family live benignly in the digestive tracts of humans and animals. Others, however, can cause serious illness or death.

What’s particularly frightening is that carbapenems, a particular class of antimicrobials, are usually used as the last-ditch effort to fight infection when other antimicrobials have failed. Bacterial infections treated with carbapenems are nearly always resistant to multiple other drugs. This means that if bacteria are resistant to carbapenems, they’re almost certainly resistant to all other antimicrobials. There are a few drugs that are used to treat CRE, though none of them are particularly effective. If those fail, you're in big trouble.

That’s right: CRE are resistant to basically every antimicrobial. If you get a CRE infection, your chances of survival are 50-50.

CRE are a serious threat to hospital patients. People are unlikely to come across CRE in their daily lives. However, people who are receiving hospital treatment are vulnerable to CRE infections.

I haven’t found any direct evidence linking CRE directly to animal agriculture. However, because carbapenem is only used when all other antimicrobials fail, if the bacteria weren’t already resistant, carbapenem wouldn’t have to be used in the first place! If you’d like to learn more, I recommend starting with Carl Zimmer’s piece “The ‘Nightmare Bacteria:’ An Explainer.”

Foodborne illness is a direct result of animal agriculture When you get food poisoning, it doesn’t matter whether the culprit is ground beef or cantaloupe: the microbes that traveled from your salad to your stomach came from the fecal matter of an animal. Maybe it was the cow you were eating, or one of its neighbors, or maybe it was an animal whose manure runoff contaminated the ground that the cantaloupe grew on. Either way, your gastrointestinal distress is tied directly to the bugs living in the digestive systems of agricultural animals.

CDC estimates that 48 million, or 1 in 6, Americans get a foodborne illness each year. Antimicrobial-resistant infections from food cause 430,000 illnesses each year in the US. Multi-drug resistant Salmonella causes 100,000 illnesses annually. Some strains of illness-causing microbes are becoming less resistant, while others are getting stronger.

A white paper from the Center for Science in the Public Interest shows a bleaker picture. It identifies 55 foodborne illness outbreaks from 1973 to 2011 that were associated with antimicrobial resistant microbes. Foods most likely to be implicated in these outbreaks were dairy, ground beef, and poultry. More than half of the outbreaks were due to multi-drug resistant microbes.

Maybe even more concerning is the fact that 58% of the outbreaks in that 38 year period occurred between 2000 and 2011. That’s right—more than half of foodborne illness outbreaks caused by drug resistant microbes since 1973 have occurred in the 21st century. The number of human illnesses caused by food contaminated by resistant microbes is on the rise.


This series has raised a lot of questions for me, and I plan to continue exploring this issue. Are there any related questions you’d be interested in having me research? I’ll totally do the work for you!


Special thank you to John Phillips for setting me straight on carbapenems. He's going to be a great pharmacist.

Part II: Evidence of the link between animal agriculture and antimicrobial resistance

Yesterday, I wrote about the basics of animal agriculture and antimicrobials. Today, I’ll dive deeper into the issues.

Part II: Evidence of the link between animal agriculture and antimicrobial resistance

What is antimicrobial resistance and why should I care about it? Antimicrobial resistance occurs when microbes have developed the ability to evade antimicrobials, survive antimicrobial treatment, multiply, and infect others. Microbes are able to survive partly because antimicrobial treatment may kill off the sensitive microbes and leave the more adapted ones to adapt to the antimicrobial and multiply.

Microbes can become resistant to multiple drugs. This makes the infection difficult or impossible to treat. By its very nature, an infection will spread to others, endangering more people with resistant infections.

The FDA has a pretty great video explaining the process of antimicrobial resistance.

Is there any evidence of association between antimicrobial use in animal agriculture and antimicrobial resistance in humans? Yes. Most of the evidence is based on studies of foodborne illness such as Salmonella and Campylobacter because the foodborne route is the most common way that resistant microbes are transferred from animals to humans.

Some resistant bacteria will themselves endanger human health. Others which cannot make humans ill will share their resistant genetic code with microbes that can make humans ill. These previously vulnerable, pathogenic microbes become resistant when they receive the resistant genes.

Using antimicrobials at sub-therapeutic levels to enhance growth means that all bacteria in an animal’s body is regularly exposed to low levels of antimicrobials. The most susceptible microbes will be killed or incapacitated, but the surviving ones will become increasingly resistant to the antimicrobial used.

How does using antimicrobials in animal agriculture contribute to human foodborne illness? The CDC report “Antibiotic resistance threats in the United States, 2013” outlines exactly how these two issues are related:

  1. Antimicrobial-resistant microbes may be formed through biological (e.g. selective pressure, mutations) or human (e.g. antimicrobial misuse, inadequate diagnostics) avenues.
  2. Antimicrobials used in animal agriculture kill off susceptible microorganisms while allowing resistant microbes to survive.
  3. Resistant microbes can be passed from animals to humans through fecal or other forms of contamination of food.
  4. When humans eat contaminated food, they develop infections (e.g. coli) that cannot be treated with antimicrobials. For generally healthy people, this may not be problematic, as their immune system will fight the infection itself. However, some people will need a boost from antimicrobials—antimicrobials that are now useless.

Beacause of this strong connection between animal antimicrobial use and human illness, CDC recommends that antimicrobials are used only to treat infections rather than to enhance growth. The CDC calls this antibiotic stewardship. 

What are some other ways animal agriculture-induced antimicrobial resistance affects human health?

  • Infections that would not have otherwise occurred
  • Treatment failures
  • Increased severity of infections (Source.)

Is animal agriculture the only cause of antimicrobial resistance? Definitely not. The other major contributor to antimicrobial resistance is improper human medical use. For example, when doctors prescribe antibiotics for a viral infection, the antibiotic will not treat the viral infection. However, the antibiotic may kill off a few bacteria from a minor bacterial infection, leaving only the remaining bacteria resistant to the drug.

 

Come back tomorrow for Part III: The Stuff That Will Keep You Up At Night

Part I: The basics of animal agriculture + antimicrobial resistance

Before antimicrobials, strep throat could be fatal. Nearly every child who had bacterial meningitis died. A small cut, once infected, could kill a person. In my mind, antimicrobials are neck-and-neck with vaccines and basic sanitation as the most important health and medical discoveries. And yet we are quickly losing our grasp on treating infections. Multi-drug resistant tuberculosis is on the rise, as is drug resistant gonorrhea, and MRSA strikes fear into anyone working or staying in a hospital.

Animal agriculture may have something to do with this. Antimicrobials are used extensively in the livestock and poultry industries. This piece is Part I of my exploration of the links between animal agriculture and the looming public health crisis of antimicrobial resistance.

The basics of animal agriculture and antimicrobial resistance

What is the difference between antibiotics and antimicrobials? Strictly speaking, an antibiotic is a substance produced by a microorganism that is used to kill or inhibit the growth of other microorganisms. Penicillin, grown from fungus, is an antibiotic.

An antimicrobial can be naturally-occurring, semi-synthetic, or entirely synthetic compound that it used to kill or inhibit the growth of other microorganisms. Antimicrobials include sulfonamides and amoxicillin. Antimicrobials can be used against bacteria, viruses, fungi, and protozoa such as malaria and toxoplasma gondii.

When discussing animal agriculture, the term antibiotic resistance is often used. However, because it doesn’t include synthetic or semi-synthetic antimicrobials, I’m going to follow the lead of the United Nations, the World Health Organization, and the World Organization for Animal Health and use antimicrobial resistance.

How are antimicrobials used in animal agriculture? Antimicrobials are primarily used as growth promoters and are given to livestock and poultry at sub-therapeutic levels, meaning that the levels at which the antimicrobials are administered are below the threshold that would fight off infection. Using antimicrobials as growth promoters is a direct result of the ever-increasing demand for meat and animal products.

Antimicrobials increase animal growth rate by 2-10% and feed conversion efficiency 3-9%. It’s unclear how or why this happens, but some researchers suggest that cytokines released when the immune system fights off infection may stimulate growth-inhibition hormones. Others suggest that antimicrobials keep animals’ gut bacteria in check, allowing the energy that would have been used to stave off infection to instead be used for growth.

Because nearly all animals raised for food are kept in cramped, stressful conditions, antimicrobials are also used for disease prevention and control (metaphylaxis). The animals live in such a way that makes infectious disease likely—packed in very closely, standing their own excrement—and rather than make changes to their living conditions, the various industries choose to feed the animals preventative antimicrobials.

Antimicrobials are also used when animals get sick, or after an injury or surgery. However, these uses make up just a small portion of the antimicrobials used.

Does animal agriculture really use 80% of the world’s antimicrobials? This statistic is often cited. However, there doesn’t seem to be much evidence to support it. However, this figure includes ionophores, which are not used in human medications but are used as growth promoters.

Which antimicrobials are used in animal agriculture? This table shows a selection of the antimicrobials identified as both critical to human medicine and regularly used in animal agriculture in the Congressional Research Service brief “Antibiotic use in agriculture: Background and legislation” by Geoffrey S. Becker. I added the columns “Common drugs in this class” and “Human infections treated by this class (selected).”

Antimicrobial class Common drugs in this class Human infections treated by this class (selected) Use in animal agriculture Level of importance for human medicine as defined by the FDA, based on level of difficulty of transmitting resistance across genera and species
Cephalosporin (3rd generation) Cedax, Fortaz, ceftriaxone Gonorrhea; urinary tract; respiratory; pelvic inflammatory disease; pneumonia Disease treatment in cattle and swine Critical
Fluoroquinolone Cipro, Floxin, Avelox Anthrax; hospital-acquired infections, especially pneumonia; urinary tract Disease treatment in cattle Critical
Penicillin penicillin, amoxicillin, flucoxacillin Meningitis; syphilis; Lyme disease; strep throat Disease treatment in cattle; growth and disease treatment in swine High
Macrolide Zithromax, erythromycin Legionnaire’s Disease; chlamydia Disease treatment and prevention in cattle; growth, disease treatment and prevention in swine Critical
Tetracycline doxycycline, tetracycline, Chlamydia; acne and rosacea; typus; plague Disease treatment and prevention in cattle; growth, disease treatment and prevention in swine High
Lincosamide clindamycin, lincomycin Toxic Shock Syndrome Disease treatment in swine High
Streptogramin pristinamycin, quinupristin Vancomycin-resistant Staphylococcus aureus (VRSA) and enterococcus (VRE) Growth, disease prevention in chickens High

How does antibiotic resistance happen? The National Institute of Allergy and Infectious Disease (NIAID) cites seven ways that microbes can become drug resistant:

Biological causes

  • Selective pressure: only the microbes with genes that make them resistant to antimicrobials are able to survive
  • Mutations: random changes in the genetic code protect some microbes from antimicrobials
  • Gene transfer: microbes can get genes from other, drug-resistant microbes

Human causes

  • Inappropriate use: prescribing antimicrobials for a disease that cannot be cured by them—for example, prescribing an antibiotic for a cold
  • Inadequate diagnostics: using a broad-spectrum antimicrobial when a specific one may be more effective, or being unsure of the underlying cause of illness and prescribing a drug “just in case”
  • Hospital use: hospital patients are susceptible to infections, but giving them high doses of antimicrobials puts them at risk for resistant infections
  • Agricultural use: NIAID states that agricultural use of antimicrobials is still debatable as a public health issue.

Now that we’ve covered the basics, check out Part II!

Measles 101

As of January 30, 2015, 91 cases of measles have been reported in California, and 59 of those are linked to the Disneyland measles outbreak. So much for being the place where dreams come true. Hipster Ariel says I wanna be where the people are, better get my MMR

While this current outbreak is upsetting, and another reason for anti-vaxxers to shut up already, measles is a much bigger problem globally than it is in the United States. As with most infectious diseases that aren’t common here, there’s a lot of misunderstanding about what measles is and how dangerous it can be. Here’s a little Measles 101, sourced from WHO, CDC, and reputable scientific journals.

How serious is measles? In 2013, WHO reported 145,700 measles deaths worldwide--that’s about 16 deaths per hour, every day. Prior to 1980, when vaccination became widespread, WHO estimates there were 2.6 million measles deaths per year.

But I thought it wasn’t much worse than chicken pox! Well, there’s a rash and fever. But the complications are what make measles so frightening. Blindness, encephalitis, and pneumonia are a few of the serious complications. Severe measles is more likely among populations who are under age five or over age 20, undernourished (particularly with a vitamin A deficiency), or who have weakened immune systems.

How is measles transmitted? The measles virus can stay alive, airborne or on a surface, for two hours. People who have been infected are contagious for four days prior to the emergence of a rash, and for four days after the rash appears. Historically, each person infected with measles will infect between 11 and 18 other people, though there is some evidence that measles is becoming slightly less contagious in recent years. (This is a really awesome explanation of R0, R, and eliminating infectious diseases. Public health nerds, unite!)

But I thought measles was eliminated from the United States. Technically, as of 2000, it is. All elimination means is that a virus no longer regularly circulates through the population--its theoretical incidence in a geographic area is 0. But that doesn’t mean that measles no longer exists on Earth, so it’s easy for measles to guest star in an outbreak here and there. In 1989-1991, there was a particularly nasty outbreak in the United States in which about 55,000 people were infected, resulting in 11,000 hospitalizations and 123 deaths.

How can I avoid getting measles? Get the MMR vaccine. It doesn’t cause autism, and a 95% of people who get a single dose are immune to measles, mumps, and rubella. A second dose closes the gap, and close to 100% of people who get two doses of the MMR vaccine are protected against all three viruses. Yeah science!

To learn more about measles, check out the Measles and Rubella Initiative. For a more humorous take, The Onion wrote up a great outline of the 2015 outbreak.

If you live in the US and are worried about getting Ebola, you’re self-absorbed.

My dear friend Lisa shared this with me on Facebook: More Americans have been married to Kim Kardashian than have died from Ebola.

 

I love a good Kim K jab, especially if it’s intended to calm down some of this Ebolanoia*. But I quickly realized that while it’s important to properly communicate how unlikely it is for someone in the US to be infected with Ebola, it is equally important not to downplay the seriousness of what’s happening in West Africa.

 

At this point, we’ve all talked with a person who’s terrified of contracting Ebola. Or maybe we’re that person ourselves. But honestly, the likelihood of someone in the US coming down with it is miniscule. There have been three confirmed cases and a total of 172 people are under surveillance due to their contact with the three cases. Sixty of those people have completed surveillance and are healthy. Ebola’s R0, the number of people one person with a disease is likely to infect unless precautions are taken, is between 1.5 and 2.

 

And precautions are being taken. We have been quarantining anyone who’s come into contact with the Ebola patients in the US. Ebola is only contagious once a person starts showing symptoms, so if someone in quarantine—the only people who had direct contact with the confirmed cases—shows symptoms, the newly-sick person will not be able to infect anyone else. This means that Ebola will almost certainly not be a problem in the US.

 

However, Ebola is a huge problem in West Africa. In the countries of Guinea, Liberia, and Sierra Leone, more than 9000 people have contracted the disease, and half of them have died. People living in these countries are the ones who are at risk, not those of us sitting comfortably on our couches reading (and/or writing) blog posts about Ebola.

 

So, those of us in the US shouldn’t be worried about catching Ebola. But that doesn’t mean we shouldn’t be worried. We just need to be worried about the right thing.

 

Although it’s killing West Africans almost exclusively, Ebola is a world-wide health concern. Not just in a don’t-want-to-spread-the-disease kind of way, but because every life matters. Each person infected with Ebola has a basic human right—the right to health—taken from them. This is an avoidable travesty. We know how to stop the epidemic, and yet we are not. The lives of the people of Guinea, Liberia, Sierra Leone, and other West African nations are meaningful.

 

If you’re one of the people who are convinced they’ll get Ebola sitting in a movie theater in New Jersey or on a plane to Kansas City, I urge you to channel that anxiety into something more constructive. Donations to organizations doing good work will likely be the best way to help. CNN has a good list. If financial support isn’t an option for you, become an educated megaphone for sane Ebola information. Learn what’s really going on and post about it on Facebook, talk to your coworkers, email your mom.

 

And if you make any more Kardashian+Ebola memes, send them my way.

 

 

*a portmanteau of Ebola and paranoia. I discovered and fell in love with this term via Maryn McKenna.

Friday Five: Salmonella, abortion, bubonic plague, rabies, Tom Hanks

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Government shutdown, Foster Farms, and drug-resistant Salmonella

Foster Farms—a chicken processor who was the source of a Salmonella outbreak earlier this year—has been implicated in selling meat that has sickened at least 278 people in 17 states. Although the processor insists the problem is due to consumers insufficiently cooking their chicken, they have decided to revamp their procedures rather than be shut down by the USDA. This particular outbreak consists of seven strains of Salmonella, four of which are drug resistant—and due to the government shutdown, the CDC cannot properly investigate the problem and may be missing information that could reduce illness or save lives. This is a perfect example of a useful government program that should be funded regardless of politics…salmonella doesn’t care if you vote red or blue.

 

Abortion news

There’s lots going on this week regarding abortion. A woman who will have to leave the country to terminate her pregnancy since she is carrying twins who have anencephaly is highlighting Northern Ireland’s total ban on abortion. Ohio passed a budget that included three abortion restrictions, and the ACLU is suing the state, claiming the rules have nothing to do with the budget and are unconstitutional. The Nebraska Supreme Court upheld a ruling stating a pregnant foster child was not mature enough to elect to have an abortion, so she must deliver the baby and place it for adoption. Arsonists have tried to attach the Planned Parenthood in Joplin, Missouri twice in one week. Finally, some good news: California expanded access for abortions by allowing nurse practitioners, physician’s assistants, and certified nurse-midwives to perform abortions.

 

Bubonic plague may be an issue for Madagascar

Unless Madagascar gets its rat population under control, it’s likely to face a bubonic plague epidemic starting this month. That’s right, the Black Death is endemic in the island nation. Rats abound in the main prison, and the concern is that if the bacteria is introduced to those rats, the fleas they carry will be able to spread bubonic plague to inmates, employees, and visitors. And you can’t just kill rats—you have to kill the fleas, too. No word on what’s being done to avert this potential disaster.

 

Rabies vaccines are way too pricey

Fewer than 10 people have been documented as surviving full-blown rabies, but if a person who has been bitten receives the rabies vaccine before serious symptoms develop, they are likely to survive. Rabies kills about 24,000 people, mostly children, annually across Africa (approximately 26,000 die in Asia). Rabies experts at a conference this week in Dakar, Senegal suggested the best preventive measure is to tie up dogs since the post-bite treatment is cost prohibitive to most people who are bitten in Africa. The treatment requires four or five injections that cost about $13 each. Seems to me that rabies vaccine manufacturers Sanofi Pasteur and Novartis should be striking a deal with someone to lower these costs and save a huge number of lives.

 

Tom Hanks has Type 2 diabetes

During an interview with Dave Letterman, America’s favorite actor Tom Hanks announced he has Type 2 diabetes due to years of uncontrolled high blood sugar. Hanks doesn’t blame his weight fluctuations for movie roles, but says, “I think it goes back to the lifestyle I’ve been leading since I was probably seven, not 36.”  He joins the ranks of Paula Deen, Randy Jackson, Billie Jean King, Patti LaBelle, Larry King, and 25.8 million Americans. Can you imagine if Paula Deen, Larry King, and Tom Hanks did a diabetes prevention campaign? That’d be TV ratings gold.

http://www.youtube.com/watch?v=wBhZoTN2bvM

 

Friday Five: Manning, Uganda, beer, Spanish screenings, wellness programs

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Chelsea Manning comes out

After being sentenced to 35 years in military prison for handing classified documents to be published on the infamous WikiLeaks, Bradley Manning came out as a transwoman (someone assigned “male” at birth but who identifies as “female”), asked to be called Chelsea and referred to as a woman. She will still be imprisoned at the all-male Ft. Leavenworth and the facility does not offer hormone treatment or sex reassignment surgery. Her incredibly high profile is sparking conversations about pronouns, Gender Dysphoria, and health care within the military. Furthermore, Manning’s announcement highlighted the fact that transgender people are not allowed to serve in the US military, despite the fact that transwomen join the military at twice the rate of the general population. Politics aside, Manning is about to embark on a difficult journey, and I hope the Army treats her with the human dignity to which she is entitled.

Confused about trans terminology? GLAAD has a great glossary here.

 

Hemorrhagic fever outbreak in Uganda

Late last week, Ugandan health officials announced an outbreak of Crimean Congo Hemorrhagic Fever (CCHF), which has killed at least one person. CCHF has no known cure or vaccine and an up to 40% case fatality rate, meaning that up to 40% of people who contract it will die. CCHF is zoonotic, which means that the virus lives in animals or insects and is somehow transferred to humans; CCHF is spread through tick bites or exposure to the blood or tissue of animals infected by tick bites. CCHF and other viral hemorrhagic fevers are characterized by bleeding under the skin, sudden high fevers, and kidney or liver damage, among other symptoms. Thankfully, hospitals have leftover protective equipment and disinfectants from 2010’s yellow fever outbreak, and Ugandan officials are watching the outbreak carefully.

 

Stay away from the Bud Ice (not just because it’s gross)

A few months after turning 21, I was headed to a friend’s house and didn’t want to arrive empty handed. Being new to the beer-purchasing demographic, I was overwhelmed and reached for the cheapest option, Steel Reserve…and it was one of the most repulsive beverages I’ve ever tried to consume. Little did I know that six years later, Steel Reserve would be tagged as a beverage highly likely to land drinkers in the ER, along with other gems like Bud, Bud Light, Bud Ice, and Colt 45. These five brands accounted for the majority of alcohol consumed among Baltimore ER patients. They’re cheap, potent, and highly popular: a dangerous mix that can quickly lead to unhealthy drinking behaviors. (PS: I’m no booze snob, but Steel Reserve is forever on my no-buy list.)

 

Autism screenings are rarely conducted in Spanish

The American Academy of Pediatrics recommends screening children for autism spectrum disorders (ASD) at 9, 18, and 24 or 30 months of age. However, a study released this week showed that only 29% of California primary care doctors surveyed provided these screenings in Spanish. Considering that as of 2010, 14 million Californians identified as Hispanic, this finding may illuminate another reason why Spanish-speaking children are diagnosed with ASD at lower rates and later ages than their white non-Hispanic peers. While it’s premature to assume the low rates of Spanish-language screening exist across the country, and to assume that all Hispanic people would require a screening in Spanish, the study does tell us about the cultural competence of these particular doctors. Systemic exclusion of these children from the recommended process puts them at a disadvantage—this is a health equity issue that needs to be quickly addressed.

 

Employers provide lots of wellness options for employees

Kaiser Family Foundation released a report this week about employer based health benefits, and the headlines strewn across news sites noted a 4% increase in family health insurance premiums, which is modest but higher than inflation and wage increases. When I read the report, I found something even more interesting: employers are providing an astonishing number of wellness programs. Nearly all large employers (200+ employees) provide at least one wellness program such as gym memberships, flu shots and vaccines, and smoking cessation counseling. Smaller employers are less likely to have these programs in place, but even so, 76% of them do. This is a win-win for employers and employees: keeping workers healthy cuts costs for employers not only on health insurance, but on lost work days and presenteeism.

 

 

Friday Five: National Immunization Awareness Month

national immun awareness monthThis week’s Friday Five focuses on five important or interesting facts about vaccines in honor of National Immunization Awareness Month. Most of the sections are adapted just slightly from other sources. You can find the original source material by clicking the link next to each subheading.  

How do vaccines work? (History of Vaccines)

Vaccines work to prime your immune system against future “attacks” by a particular disease. When a pathogen enters your body, your immune system generates antibodies to try to fight it off…Vaccines work because of this function of the immune system. They’re made from a killed, weakened, or partial version of a pathogen. When you get a vaccine, whatever version of the pathogen it contains isn’t strong or plentiful enough to make you sick, but it’s enough for your immune system to generate antibodies against it. As a result, you gain future immunity against the disease without having gotten sick: if you’re exposed to the pathogen again, your immune system will recognize it and be able to fight it off.

 

What is herd immunity? (Vaccines Today)

Herd immunity is a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. It arises when a high percentage of the population is protected through vaccination against a virus or bacteria, making it difficult for a disease to spread because there are so few susceptible people left to infect…These include children who are too young to be vaccinated, people with immune system problems, and those who are too ill to receive vaccines (such as some cancer patients)…The proportion of the population which must be immunized in order to achieve herd immunity varies for each disease but the underlying idea is simple: once enough people are protected, they help to protect vulnerable members of their communities by reducing the spread of the disease. However, when immunization rates fall, herd immunity can break down leading to an increase in the number of new cases.

 

Do children get too many shots? (from CHOP Vaccine Education Center)

Newborns commonly manage many challenges to their immune systems at the same time. Because some children could receive as many as 25 shots by the time they are 2 years old and as many as five shots in a single visit to the doctor, many parents wonder whether it is safe to give children so many vaccines…From the moment of birth, thousands of different bacteria start to live on the surface of the skin and intestines. By quickly making immune responses to these bacteria, babies keep them from invading the bloodstream and causing serious diseases. In fact, babies are capable of responding to millions of different viruses and bacteria because they have billions of immunologic cells circulating in the bodies. Therefore, vaccines given in the first two years of life are a raindrop in the ocean of what an infant’s immune system successfully encounters and manages every day.

 

What do vaccine preventable illnesses look like? (Immunization Action Coalition)

Most people in the US have never seen a case of polio or diphtheria. This photo gallery may help remind us why immunizing against these diseases is so important.

 

How can we lessen the pain of getting shots? (CHOP Vaccine Education Center)

(This is important for scaredy-cats like me.)

For most children, getting vaccines simply means the pain of getting a shot. Although pain is to some extent unavoidable, there are a few things worth trying in older children.

Blowing away the pain

One technique is called "blowing away the pain." Just before the shot, take out a feather, tell the child to take a deep breath, closing his eyes if he wants, and then to blow out...blow, and blow on the feather until you or the nurse tells them to stop. The distraction of blowing on the feather has been shown in one study to lessen the amount of pain perceived by the child.

Cold versus pain

Another idea is to swab a small amount of alcohol on the forearm of the opposite arm that will receive the vaccine. The child then blows on the alcohol before and during the shot. Our bodies don't feel cold and pain in the same place at the same time. Rather, when confronted with the choice of cold or pain, the body picks cold. So the feeling of pain from the shot will be reduced.

EMLA cream

For older children with severe phobias to needles, you might consider the use of an EMLA patch applied to the skin. The limitation of this technique is that the patch (which helps to numb the area) must be applied at least one hour before the injection. Also, EMLA cream works to decrease pain caused by injections under the skin (called subcutaneous injections), but doesn't lessen the pain of vaccines given in the muscles.

Friday Five: Chicago, ACA, firefighters, prescription drugs, vaccine recall

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Fourth of July shootings in Chicago

This Fourth of July weekend is proving to be deadly for Chicago. Yesterday, eight people were killed and more than 30 were hurt in shootings across the city. The youngest victim is just five years old, and was shot while attending a party in a park with his family. These shootings are a disgrace, as is the lack of national coverage of the violence permeating Chicago. Victims’ stories should be plastered across every news station and website, and the nation should be reviving the post-Sandy Hook gun conversation in light of this inexcusable violence.

 

Another ACA delay

The Obama administration added to the confusion surrounding the Affordable Care Act by pushing the employer mandate deadline back one year to January 1, 2015. Another instance of caving to private sector demands means increased misunderstanding for the public. The law was incredibly complicated as written, and the administrative tweaks, House repeals, and flat-out lies disseminated by the media ensure that nobody has any idea what’s going on. The ACA is the single most important change to health care the US has seen since 1965, and its frustrating to watch it falter. Hopefully, the exchanges will still open as scheduled on October 1.

 

Firefighters killed in Arizona fires

Nineteen elite firefighters were killed on Sunday battling a blaze that is still only 45% contained. Their deaths have reminded us that the people suffering from these fires are not only those who lose their homes, but the people who are willing run into the flames to try to protect those homes. We’re learning about the hotshot teams specially trained to fight wildfires, an aspect of firefighting that was unknown to many people. I’ve been trying to imagine what it’s like to do what these teams do: go out to the fire, live near it for days, battling it while awake and smelling it while you sleep. I am in awe and very grateful.

 

More ‘scripts, more problems

This was a big week for news about prescription drugs. A brief rundown:

  • 70% of Americans take at least one prescription a day, mostly antibiotics, antidepressants, or painkillers
  • The number of fatal overdoses in women quadrupled between 1999 and 2010, and approximately 42 women die daily from overdoses
  • The FDA busted 1600 illegal online pharmacies

 

Hepatitis B Vaccine recall

Merck issued a recall this week for one lot of the Hepatitis B vaccine Recombivax. The issue is not with the vaccine itself, but with the glass vials that may easily crack. Merck is concerned about the sterility of the vaccine, and the FDA assures consumers there’s no need to be revaccinated if a doctor administered one of the recalled lot. The anti-vaccine websites I visited seem to have not picked this up yet, so maybe this vaccine news won’t be misconstrued. We can only hope.

In honor of yesterday's Fourth of July holiday, here's a little Katy Perry to get you dancing:

http://www.youtube.com/watch?v=QGJuMBdaqIw