Browsing Tag

Public Health

Failure to Plan Parenthood in Texas

By March 1, 2016 2 Comments
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 The other day, I had a craving for coconut ice cream.

Stick with me here (and no, I’m not pregnant–this was just a garden variety gluttony)

I was dying for it, and in a stroke of luck I didn’t have to rush home to my kids that day, I had the chance to fully indulge myself. Of course, now that I had the opportunity to indulge, I went to four different stores looking for some and then I finally gave up. I had the motivation to drive all over creation to find it, the time and the ability to seek it out, and the money to pay for it once I found it but I STILL couldn’t get what I wanted when I wanted it.

That’s just life sometimes, and as a mother I’ve realized that’s life more often than not. But my great unfulfilled quest to find coconut ice cream made me think of a study I’d just read in the New England Journal of Medicine. Yes, I know. When you work in public health your brain never shuts off about this stuff.

Heading home without my ice cream was no big deal, but what if I’d been looking for something else instead. The only impact of me not getting my ice cream was that I was disappointed and Haagen-Dazs lost a sale. But what if I’d been looking for something of life-changing importance and I wasn’t able to get it? Let’s imagine we’re talking about birth control.

I know this seems like a stretch, but like I said, stick with me here.

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Categories: Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning

Americans, Public Health Rules are Different in Other Countries. Adjust!

By June 30, 2015 1 Comment
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American families traveling outside of the country this summer for a vacation, heads up, you might want to see your doctor before your trip. Whether you’re driving an hour to Canada or Mexico or flying across an ocean, there are two key things you want to consider, even if you’ve done your particular journey many times before:

  1. What vaccinations are recommended for the areas that you’re traveling to?
  2. What extra medications might you need to bring with you in the event that you or your children do get sick, and can’t quickly access familiar healthcare options (pharmacies, drugstores, physicians)?

I’m going to focus on travelers’ vaccines in this post, because it’s not the first thing that parents typically think about when going abroad.  To be clear there’s no law or mandate requiring you to get certain vaccines in order to travel abroad, in fact it’s just the opposite.  The State Department and CDC make recommendations, but it’s up to each individual and each parent to make those decisions for themselves based on the risk they perceive.

We all judge risk differently, and depending on the disease, the risk of contracting it may seem small enough to skip the recommended vaccines. But many of the worst infectious diseases you’d contract both here and abroad are actively avoidable, and the so-called “best case” scenarios of catching and recovering from those diseases with little impact are rare, exceptional, and statistically unlikely. After all, deadly infectious diseases, as they’re named, can kill you. They can permanently harm you. And they can leave you and your kids incredibly ill, suffering, and in quarantine, much like the recent case of the 6-year-old boy in Spain whose parents refused to vaccinate for diphtheria. After being in treatment for weeks with that deadly illness, that boy recently died.

Staying unvaccinated in the face of risk is a gamble with what is most precious – our lives.  I don’t feel comfortable taking that gamble because I’ve seen the statistics and science, and they’re stacked against any other decision. This issue came up recently as my soon-to-be stepsons are heading off to Mexico on vacation in a few weeks, a place that they frequent with their other half of the family since it’s literally an hour south of our collective homes in San Diego, California.

My fiance ran across the CDC traveler’s vaccine recommendations for Mexico via the State Department’s website as he was renewing his Passport two weeks ago, and found a recommendation for travelers to get both the Typhoid Fever and Hepatitis A vaccines for trips to Mexico, in addition the standard vaccines that most of us already have. When he spoke to the boys’ pediatrician about it, the physician seconded that recommendation. Though they hadn’t had the shots before, to be fair, travel to Mexico isn’t really a huge deal here. It’s a pretty acceptable and normalized option for many people for their day trips, family visits, and cross-border commutes to work. But during an informal poll of mine, I found that there seems to be a misconception that going to Mexico is really not like visiting a typical “foreign country,” and there are no needed travelers’ vaccines. That’s actually incorrect.

The oral Typhoid Fever vaccine - taken as 4 pills over 1 week

The oral Typhoid Fever vaccine – taken as 4 pills over 1 week

Despite its familiarity and its proximity, Mexico resides outside of the bounds of the U.S. public health bubble. That means that nation’s population doesn’t have the same vaccination requirements, statistical herd immunity, or public health rules and regulations for food handling, hospitals, etc. Many locals here might be surprised to learn that despite its proximity to San Diego, Mexico is actually considered a “developing” country, which is a fancy-shmancy term that captures a wide range of development, economic, and human factors. The designation also means that you as a traveler need to be cognizant of where corners may be cut in public funding (specifically for the purposes of this post, healthcare, and cheap/free vaccination availability), and take the appropriate precautions to safeguard your health. For my fiance, that meant he realized the boys needed to get their Typhoid vaccinations ASAP if they hadn’t already.

One of the many things the boys are excited about for this trip is that they’re staying at a resort location; but it’s also a reason given for why they might not need these vaccines, after all, it’s in a well-developed part of the country.  But just because they’re staying at a high-end resort, doesn’t mean they’re any safer from these diseases. I’m here to tell you that you don’t need to roll around in garbage and poop (yes, I said poop) in the jungle with no doctors for miles to get sick from something abroad. Sometimes it’s as easy as touching our faces after touching something contaminated that we were completely unaware of. Otherwise, we wouldn’t be taught to wash our hands the way that we do after we go to the restroom – after all, germs are invisible.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Typhoid Fever is definitely something along those lines, something that spreads largely through poor hygiene practices, since it comes from Salmonella Typhi, a bacteria that only lives in humans’ bloodstreams and intestinal tract, and gets transmitted easily, typically through contaminated food or drink (contaminated by, you guessed it, fecal matter). It’s not common in the U.S. with an estimated 6,000 cases per year, with 75% of those coming from international travelers. In developing countries, it affects a staggering 21. 5 million people a year – and it killed an estimated 161,000 people worldwide in 2013. Per the reports (and the one man I know who has had it, and got it from a 5-star resort abroad!), it takes 1-2 weeks to fully show up in an infected individual, it lasts around a month with treatment, and it’s awful: high fevers of up to 104 degrees Fahrenheit, a rash, exhaustion, delirium, swollen organs, and in worst case scenarios, internal bleeding and death.

So this was an issue easily remedied. Fortunately, these days, 4 simple pills taken over the course of a week can prevent all of that. A small copay, a series of pills, and the boys are now ready to go, teenage hygiene and poop threats be darned! Even better, they’ll be protected against the majority of cases for the next 5 years.

As Americans (and I’m talking generalities, of course), we tend to have an oblivious attitude toward how different things can be in other cultures and countries. And things are not always what we assume they are (read: the same as we are accustomed to), no matter how similar they may look. When confronted with this reality, we can fight it, avoid it, or we can just get over it, already, and adjust our behaviors in a way that best serves us and our children. So, adjust, protect, and avoid the awful things you can. There’s plenty of time to catch Monteczuma’s revenge in the meantime, if you really want to get sick while you’re abroad. Just remember to get a prescription of traveler’s antibiotics and some Pepto before you go.


Resources:

Centers For Disease Control Travel Center Accessed: 06/29/15

 US Passports and International Travel Country Information State Department. Accessed:  06/29/15

 Boy Dies Diphtheria Spain, Parents Rejected Vaccine ABC News/AP News. 06/27/15. Accessed: 06/29/15

 Country and Lending Groups .World Bank Data. Accessed: 06/29/15

 Community Immunity. Vaccines.gov. Accessed: 06/29/15

Germs. Communicable Disease Control and Prevention. San Francisco Department of Public Health  Accessed: 06/29/15

Typhoid Fever National Center for Emerging and Zoonotic Infectious Diseases. CDC.Gov. Accessed: 06/29/15

GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117–171. doi:10.1016/S0140-6736(14)61682-2

The New York Times Health Guide: Typhoid Fever. Accessed: 06/29/15

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Celebrity Moms Who Side With Science

By April 15, 2015 1 Comment
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Who has two thumbs and sides with science?

 

As a mom, vaccines are always on my mind. Just this morning, I found myself touring a prospective school for my toddler and asking about the vaccination rates of his potential classmates.

While the anti-vaccine celebrities get (too much) press, I’d like to give a shout out to the celebrity moms who side with science and passionately advocate for vaccination. I first wrote about this topic in 2013 when I was pleasantly surprised to see the TDAP vaccine being promoted on an episode of “Keeping Up With The Kardashians”.

With celebrity moms having such a public platform, I became curious about how closely their messages align with the barriers that we know stand between children and their vaccinations. In a nice review of patient barriers to immunizations, Hendriksz et al describe three types: (1) miseducation and misconceptions of patients, (2) fear and anxiety of immunization pain, and (3) lack of access (perceived and real) to immunizations.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

The Measles Drives Immunization Rates Up, but Whooping Cough Doesn’t Have the Same Effect in Washington State

By April 2, 2015 1 Comment
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On March 31, a prisoner escaped from a hospital about two miles from our house. He fired off a shot at police while he made his escape, and carjacked two individuals causing one car crash. The words, “armed and dangerous” and “area lock down” are not words that generally make the public feel safe, even after evidence suggested the prisoner had moved out of our immediate area.

It was this threat that made me realize how generally lax I am about safety in my own home. I had to confirm that the doors and windows were locked and as usual, I would have been lucky to find my phone to call 911 if I needed to. Theft and dangerous offenders aren’t something I worry about in our area because the crime rate is so low. It took an emergency for me to realize, “it might be a good idea if I knew how to lock our windows.”

Humans are terrible at judging risk. We’re categorically awful at it, and we don’t tend to act on slow-moving risks until the crisis is upon us. Reactively, rather than proactively. It looks like the same pattern is playing out in Washington State, where immunization

Image c/o The Seattle Times. Original can be found: https://static.seattletimes.com/wp-content/uploads/2015/03/dfbde78e-d7fb-11e4-8dd6-4df606469ca8-300x730.jpg

Image c/o The Seattle Times. via: SeattleTimes.com

rates have surged 27% higher than this time last year in the wake of the Disney measles outbreak.

This is remarkable news as immunization rates in Washington State have lagged behind the national average and in the past Washingtonians haven’t always responded to the resurgence of a deadly early childhood disease with the same gusto. A 2011/2012 whooping cough epidemic caused no increase in immunization rates, despite sickening 2,520 residents.

So what’s changed this time?

There are a few potential hypotheses, which include:

  1. The perceived severity of the illnesses, with whooping cough being viewed, not necessarily accurately, as “less severe” than the measles;
  2. Media coverage of the outbreak has been extensive and may have had an educational and awareness impact on parents;
  3. Parents that vaccinate have become much more vocal since the Disneyland outbreak, which may have helped change social norms in certain areas;
  4. A bill was introduced to the Washington State House (and was defeated) that would have removed the personal belief exemptions many parents use to not vaccinate, and this may have prompted parents to vaccinate before its potential passage.

So the short answer is: we don’t know what changed this time. My guess is that it’s a combination of the factors above, and I can’t wait to read the studies once they’re published!

If you’d like to learn more about immunization rates in Washington State, you can read the article from the Seattle Times: Measles vaccinations jump after scare, public dialogue.


 

Resources:

Resources:

JoNel Aleccia. Measles vaccinations jump after scare, public dialogue. The Seattle Times. March 31, 2014. Retrieved 4.2.15.

Rachel La Corte. Lawmaker aims to limit reasons for vaccine exemptions. The Seattle Times. February 4, 2015. Retrieved 4.2.15

Washington State Department of Health. News Release: State vaccination rates for children lag behind national average. September 12, 2013. Retrieved 4.2.15.

Wolf, E., Opel, D., DeHart, M. et al. Impact of a Pertussis Epidemic on Infant Vaccination in Washington State. Pediatrics. pp 456-464, September 2014. Retrieved 4.2.15

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

H7N9 Might Be The Next Pandemic, But It Might Not

By March 20, 2015 No Comments
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Remember that wordless scene at the end of Steven Soderbergh’s thriller, Contagion? The setting was a remote jungle, and the only actors on screen were two animals: a bat and a pig. In the chain of disease transmission, humans are only one or two links away from contracting seemingly distant zoonotic (from animals) viruses. Due to the growing incidence of droughts, wildfires, and deforestation, it’s quite easy for suburban residents to become neighbors with animals that carry diseases we don’t know much about, and certainly don’t want.

I spent a good portion of my career working in biosurveillence. One disease I especially loved chasing was H5N1 Avian Influenza (AI), aka “Bird Flu.”
AI has made its appearance in global news recently after scientists in China identified an influenza strain with “pandemic potential.” This should ring a bell since the disease of interest – H7N9 – caused panic back in February of 2013 after 133 people became severely ill with this particular strain. Well it’s reemerged and so far 571 confirmed cases have been reported with 212 related deaths. It is important to note that 99% of those cases occurred in China, Hong Kong, and Taiwan.

Nature published this study and stated that H7N9 should be considered a “major candidate to emerge as a pandemic strain in humans.” This conclusion sounds terrifying, but I would caution you not to think that the next Great Plague is upon us. The virus appears to be mutating frequently (not uncommon), and some genetic changes can increase a virus’ potential to reach pandemic proportions. However, it’s pretty premature to make that sort of conclusion about what’s happening with H7N9. To date, H7N9 only is spreading in live-poultry markets and slaughterhouses in East Asia.

Allow me to break this down a bit. H7N9 first emerged in birds before spreading to humans – much like H5N1 and the infamous 2009 H1N1 “swine” flu. As I mentioned above, we’re only 2 degrees of separation away from a number of animal-borne diseases. Influenza viruses are made up of two components: hemagglutinin (H) and neurominidase (N). Hemagglutinin allows the flu particles to attach to the cell membrane and neurominidase enzymes makes sure the virus doesn’t get stuck on its way out. There are 18 types of hemagglutinin and 11 types of neurominidase and ALL of them have been detected in birds. Through sequencing, the researchers were able to determine that today’s outbreak is linked to the 2013 virus – which means it’s growing in diversity.viral shift

The real concern will happen IF there is significant viral mutations causing the disease to skip a step on the disease chain and become spreadable from person-to-person. This has happened before (in 2009 with H1N1) but not always. Take for instance, H5N1. To date, infection has only occurred with direct contact with infected poultry.
All that to say, there’s a race in the infectious disease community and the finish line is identifying the next big pandemic. For decades, scientists have scoured books, medical journals, and remote corners of the world (and now the internet) for indicators and warnings of a newly emerging public health threat. I can promise you that I’m following this closely, and you readers will be the first to know should anything become a serious threat.

For now, just get your seasonal flu shots.


 

Resources:

Tsan-Yuk Lam, T. Zhou, B. Wang et al. Letter: Dissemination, divergence and establishment of H7N9 Influenza Viruses in China. Nature. Published online March 11, 2015. Retrieved March 22, 2015.

rld Health Organization. WHO Risk Assessment: Human Infections with Avian Influenza A(H7N9). Published February 28, 2014. Retrieved March 22, 2015.

World Health Organization. WHO Risk Assessment: Human Infections with Avian Influenza A(H7N9) virus. 23 February, 2015. March 22, 2015.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Hey Huffington Post! Tuberculosis is Serious, but it isn’t the Plague…

By March 19, 2015 No Comments
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There are very few things that set me ablaze quite like overly dramatic journalism or people chewing loudly with their mouths open. As a recovering journalist and longtime health policy and communications junkie, I shake my fist heavenward when I see articles with poorly chosen graphics like this recent Huffington Post piece on the Tuberculosis (TB) outbreak at a Kansas city-area high school.

I’m about to become a stepmother and after a few years working on maternal and perinatal health policy and implementation, I know the last thing a parent wants to see in relation to an infectious disease affecting children is an outbreak slideshow beginning with “The Bubonic Plague.” It’s essentially the fire-and-brimstone promise of certain death, and frankly, it sits in opposition to what is a managed and benign situation.

If you went to school in the 70s and 80s you likely remember getting TB “shots.” Yes I know, even in ye olden days, we cared/we were crazy enough about infectious disease and vaccinations enough to protect ourselves without protest (clutches pearls). But those TB shots weren’t vaccinations, they were actually harmless skin tests to see if we’d ever been exposed to Mycobacterium tuberculosis (the bacteria that causes TB) and were carrying it in a latent (read: dormant or inactive) form. These shots offered no protection, they were diagnostic, not protective.

After 72 hours, if a test was positive and it was determined that the patient hadn’t gotten a TB vaccine in another country that would cause a false positive, there was an intervention plan to stop it from progressing into a full-blown disease. Which is to say, most Americans like myself have been walking around blissfully unprotected from TB, and some may even carry it latently without knowing it. And frankly, that’s ok. Latency in this case means the body has isolated and cocooned the bacteria well enough via a healthy immune response that it hasn’t progressed into the actual disease, which is a slow-moving bacterial infection.

What spurred the recent testing in Olathe, Kansas was a singular student who presented with an active infection and actual symptoms – coughing, fever, and fatigue. In its earliest stages, TB isn’t always the movie-inspired hacking, choking, bleeding lungs disease we might imagine, so it’s no surprise that this student did not get in to a doctor sooner. While Tuberculosis is certainly a highly fatal disease when left both active and untreated, according to the CDC, a majority of people who have been exposed remain in the latent stage and never actually develop the disease as this student did.

This recent TB scare is a good reminder for why this shouldn’t trouble most parents. Tuberculosis is spread through the air via coughing, breathing, singing, etc., not by physical contact, and it typically takes extended exposure to a symptomatically infectious person to spread (unlike the measles). Of the nearly 350 individuals who had contact with the sick student, only 27 so far have tested positive for exposure, and many more have not been tested or alerted since the school’s currently out on spring break. Now nearly two weeks since the first sign of a TB case, and Johnson County officials, where Olathe is located, are now switching from mailed notices to phone calls to initiate preventative testing in the rest of that population. It says something about the urgency at which any of us should be considering this scenario.

Which is why the word “outbreak” is a bit of misnomer here. Only one person actually has Tuberculosis, and the 27 others have only tested positive for exposure to it. The student in question has already been isolated and will be cleared for contagiousness within a few weeks, and cured in the coming months. The rest are only positive for latent TB, but are not contagious, and do not feel sick. These individuals will take an up to 9-month course of antibiotics to insure that they’re never infectious, and that the dormant bacteria never develop into the full-blown disease.

If you are wondering why we don’t vaccinate for Tuberculosis, as other countries do with the BCG shot (bacille Calmette-Guerin) – to sum it up, it’s simply not the threat it once was, exposure is treatable, and the disease is curable. And of course, if you have concerns about your own child and a possible exposure, ask your pediatrician if the TB skin test is advisable.


 

Resources
KCTV 5 News. State: 27 at Olathe High School Tested Positive for Tuberculosis Infection. Updated March 18, 2015. Retrieved March 18, 2015.

Centers for Disease Control and Prevention. Tuberculosis (TB)9. Last updated December 16, 2014. Retrieved March 18, 2015.

Almendrala, Anna. Tuberculosis Outbreak at Kansas High School Infects 27. The Huffington Post. March 18, 2015. Retrieved March 18, 2015.

Johnson County, Kansas. Case of Active Tuberculosis Identified at Olathe Northwest High School. Released March 4, 2015. Retrieved March 18, 2015.

Olathe Public Schools. Tuberculosis Information. Retrieved March 18, 2015.

Centers for Disease Control and Prevention (CDC). Core curriculum on tuberculosis: what the clinician should know. Retrieved March 18, 2015.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

There’s Actually a Scientific Reason Behind Being #antivaxx

By February 24, 2015 No Comments
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In just under 10 minutes, Hank Green of YouTube’s famous SciShow gives the most scientific (while easily understandable) explanation of why people opt out of vaccines. His video follows the thinking of Nobel Prize winner Daniel Kahneman who claims that “[p]eople are much more afraid of their children dying from a vaccine than they are from a child dying of an illness that spreads naturally. If something would happen to their child after being vaccinated, their decision becomes a focus of enormous regret.”

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting