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Video of Stanford Ebola panel now available

Video of Stanford Ebola panel now available

Last week, a group of Stanford and CDC experts came together to address the health, governance, security and ethical dimensions of Ebola, the virus that is spreading rapidly in West Africa. Video of the lengthy and timely talk, courtesy of the Freeman Spogli Institute, is now available.

Previously: Ebola panel says 1.4 million cases possible, building trust key to containmentInterdisciplinary campus panel to examine Ebola outbreak from all angles, Expert panel discusses challenges of controlling Ebola in West Africa, Should we worry? Stanford’s global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications

CDC, In the News, Infectious Disease, Pediatrics, Public Health

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

SONY DSCToday’s New York Times features a story on the accelerating spread of enterovirus-D68, a virus that is causing severe respiratory illness in children across the country. As the Times reports, some emergency departments in the Midwest have been so swamped with cases that they’ve had to divert ambulances to other hospitals. Although California is still only lightly affected, the state’s first four cases were confirmed by the California Department of Public Health late last week, with more expected to surface.

To help parents who may be wondering how to prevent, spot and care for EV-D68 infection, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answered some common questions about the virus:

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Have any patients at Lucile Packard Children’s Hospital Stanford been affected with EV-D68?

As of today (Sept. 26), we have not yet had a documented case at our hospital. However, there have been a total of 226 confirmed cases in 38 states across the country. Some children who have this virus are probably not being tested, so the real number of cases nationwide is likely to be higher.

If your child has respiratory symptoms and you suspect EV-D68, what should you do?

The virus causes symptoms such as coughing, sneezing and runny nose. In some cases but not all, kids also have a fever. If your child has respiratory symptoms with or without a fever, especially if he or she also has a history of asthma, monitor your child at home. If you feel that he or she has been sick for a long period, is getting worse or is experiencing worsening of asthma or difficulty breathing, go see your pediatrician.

Which groups are most at risk?

Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get sicker with these viral infections.

How can the illness be prevented?

This virus is spread by contact with secretions such as saliva. If your children are sick, they should stay home from school to avoid spreading the illness to others. To avoid getting sick, stay at least three feet from people with symptoms such as coughing and runny nose, wash your hands frequently, and make sure your kids wash their hands often, too.

What is the treatment for EV-D68?

There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

Previously: Tips from a child on managing asthma
Photo by Michelle Brandt

CDC, Events, Global Health, In the News, Infectious Disease

Ebola panel says 1.4 million cases possible, building trust key to containment

Ebola panel says 1.4 million cases possible, building trust key to containment

ebola workers2The Ebola epidemic is spreading rapidly – leaving a wake of suffering – in large part because West Africa has shockingly few medical facilities or trained personnel. But it’s exploding exponentially because of mistrust, a panel of experts told a packed crowd on the Stanford campus last evening.

The numbers, as described by Ruthann Richter in a just-published story, are sobering:

Officially, more than 5,800 Ebola cases and 2,800 deaths from the disease have been reported in four countries: Liberia, Guinea, Sierra Leone and Nigeria. But panelists said those figures were vastly underestimated. At the current rate of spread, in which the number of new infections is doubling every three weeks, the U.S. Centers for Disease Control and Prevention estimates that 1.4 million people could be infected by the end of January 2015 in the absence of dramatic interventions, said Douglas Owens, MD, a professor of medicine and director of the Center for Health Policy at Freeman Spogli Institute of International Studies.

But even with “very aggressive” intervention, Owens said, it’s estimated there would be at least 25,000 cases by late December. If intervention is delayed by just one month, there will be 3,000 new cases every day; if it’s delayed by two months, there will be 10,000 new cases daily, he said. “It gives you a sense of the extraordinary urgency in terms of time,” Owens told the audience.

During the talk Stanford health-policy expert Paul Wise, MD, screened a CNN video that depicts a man escaping from a treatment facility in Liberia. “You have to create treatment centers that are of the highest quality and that treat people with dignity — so people will want to go there, rather than escape,” he said.

Building trust starts local, Tara Perti, MD, told the audience. She works as a CDC epidemic intelligence service officer and spent time in both Guinea and Sierra Leone this summer:

In Guinea, she traveled to a village north of the capital city of Conakry, where she met two young men who had recovered from the disease, which has a fatality rate as high as 70 percent. One of the men had lost five members of his family, but he had become a community advocate. He traveled with Perti to a neighboring village, where they met a woman who was sick and whose son had died of the disease. “She was very fearful of going to the treatment center… but she was ultimately convinced to seek treatment. She recovered and was able to return home,” Perti said.

“The patient who survived was tremendously helpful because he could speak from experience and be credible. There needs to be more of these. In the forested region of Guinea, there are a lot of superstitions and different beliefs besides germ theory, and so it’s very challenging to go into those areas and help people understand that Ebola is a virus, it’s real and we do have ways to help patients.”

The world’s disjointed response to the epidemic points points to the need for global-health reforms, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, concluded.

Becky Bach is a former park ranger and newspaper reporter who now writes about science as an intern at the Office of Communications and Public Affairs. 

Previously: Interdisciplinary campus panel to examine Ebola outbreak from all angles, Expert panel discusses challenges of controlling Ebola in West Africa, Should we worry? Stanford’s global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications
Photo, of health workers at an Ebola treatment unit in Liberia, by USAID/Morgana Wingard

CDC, Nutrition, Pediatrics, Public Safety, Research, Stanford News

“Happy Meal ban”: Where are we now?

"Happy Meal ban": Where are we now?

MuppetBabiesA newly released Centers for Disease Control report of a study conducted at Stanford has examined the effects of San Francisco’s 2010 “Happy Meal ban.” The ban prohibited the free distribution of toys with unhealthy meals; the fast-food restaurants McDonald’s and Burger King instead sold the toys for 10 cents. Though neither restaurant complied with the ordinance’s specific calls for changes in nutritional content, improvements have been made.

As reported by SFGate.com:

…over the study’s two-year period, McDonald’s in particular made big changes to its Happy Meals, said [Jennifer Otten, MD,] of the University of Washington School of Public Health — first in California, then nationally.

The fast food giant cut the amount of French fries it serves in Happy Meals in half, replacing them with apples; stopped serving caramel sauce with apples; and began offering nonfat chocolate milk to customers. Otten said those substitutions were “pretty dramatic,” — they reduced the calories in a Happy Meal by 110, and cut the sodium and fat content of the meal as well.

Otten and her colleagues, including senior author Abby King, PhD, concluded in the study, “Although the changes…  did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results… suggest that public policies may contribute to positive restaurant changes.”

Previously: How fast-food restaurants respond to limits on free toys with kids’ meals, Toying with Happy Meals, How food advertising and parents’ influence affect children’s nutritional choices and Living near fast food restaurants influences California teens’ eating habits
Photo by Ursala Urdbeer

CDC, In the News, Pediatrics, Public Health

Teens these days: smoking less, but engaging in other risky behaviors

Teens these days: smoking less, but engaging in other risky behaviors

teen musicalMr. Camel, tear up those cigarettes. Statistics from the latest Youth Risk Behavior Surveillance System survey, released today by the U.S. Centers for Disease Control and Prevention, show that 2013 marked the lowest incidence (15.7 percent) of teen smoking reported since 1991.

In other news, texting while driving, drinking soda and having unprotected sex are among the behaviors the report notes are worthy of concern. From the report:

During the 30 days before the survey, 41.4% of high school students nationwide among the 64.7% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 34.9% had drunk alcohol, and 23.4% had used marijuana. During the 12 months before the survey, 14.8% had been electronically bullied, 19.6% had been bullied on school property, and 8.0% had attempted suicide.

During the 7 days before the survey, 5.0% of high school students had not eaten fruit or drunk 100% fruit juices and 6.6% had not eaten vegetables. More than one-third (41.3%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day.

Previously: Adolescent Health Van wins community award for aiming to “help kids turn their lives around”A reminder that texting and driving don’t mix, To reduce use, educate teens on the risks of marijuana and prescription drugs and National Cancer Institute introduces free text message cessation service for teens
Via The Checkup
Photo by Daniel Oines

CDC, Global Health, Infectious Disease, Pediatrics, Research

Measles is disappearing from the Western hemisphere

Measles is disappearing from the Western hemisphere

Decades of measles and rubella vaccinations for U.S. children are paying off. A new Centers for Disease Control report published today in JAMA Pediatrics confirms that the United States has eliminated endemic transmission of three potentially devastating diseases: measles, rubella (also known as German measles) and congenital rubella syndrome, which causes serious birth defects.

The report is part of a larger effort by the World Health Organization to certify the entire Western hemisphere free of endemic measles and rubella, which are chains of transmitted cases that continue for 12 months or more. Today, the large majority of measles cases seen in the U.S. are clearly linked to international travel or contact with travelers, and genetic evidence suggests that uniquely American strains of the measles and rubella viruses no longer exist. All other countries in the Americas are also reporting elimination of endemic transmission of these diseases.

The findings confirm the value of high rates of measles and rubella vaccination. Nearly 95 percent of U.S. children have had the two vaccine doses needed to confer lasting immunity by the time they enter kindergarten. Because measles is still endemic in other parts of the world, it’s important not to let up on vaccination here, the report notes. In spite of the good news about the elimination of endemic infections, 2013 has been a relatively bad year for imported infections, as CNN reported today.

An editorial accompanying the JAMA Pediatrics report offers interesting perspective on the need to continue with vaccinations:

Prior to 1990, Mexico was the leading source of measles importations into the United States, but this year, half of all importations into the United States were from Europe. Since 2008, there has been a resurgence of measles cases in Western European countries. The majority of these outbreaks have been in unimmunized populations in countries where national immunization programs are being challenged by a combination of public and political complacency regarding the value of immunization and by the rising influence of antivaccination groups. After 500 years, we have now returned to a situation where the Americas are free from indigenous measles and rubella with Europe once again a source of importations.

The elimination of endemic measles from the Western hemisphere raises hope that global eradication of measles is on the horizon, an important public health goal since measles is most likely to kill impoverished children in developing countries. Already, the increase in vaccination in African countries has led to a 91 percent decrease in measles deaths there, with 550,000 fewer annual deaths than a decade ago.

Previously: Measles are on the rise; now’s the time to vaccinate, says infectious-disease expert, Tips for parents on back-to-school vaccinationsA look at the causes and potential cost of the U.S. measles outbreaks and Unvaccinated children may pose a public health risk

CDC, Infectious Disease, Medical Education, Patient Care, Public Health, Science, Stanford News

Free online course aims to educate about “pressing public health threat” of antibiotic resistance

Free online course aims to educate about "pressing public health threat" of antibiotic resistance

antibioticsAre you smart about antibiotics? That’s the question the CDC is asking as part of its week-long effort to educate people about antibiotic resistance – something the organization calls “one of today’s most pressing public health threats.” Its Get Smart About Antibiotics website offers valuable tips and information on antibiotic use, and CDC Director Thomas Frieden, MD, MPH, will be answering questions on the topic during a live Twitter chat Friday morning. (Follow the hashtag #CDCchat at 10 AM Pacific time tomorrow to join the conversation.)

Stanford, meanwhile, is aiming to educate medical professionals by launching a free online course called “Antimicrobial Stewardship: Optimization of Antibiotic Practice.” The course, directed by Stan Deresinski, MD, head of Stanford’s Antimicrobial Stewardship Program, will “offer a practical approach to prescribing antibiotic therapy and development of antimicrobial stewardship across all specialties and settings.” As for the need for such a course, the website explains:

Antibiotics are among the most frequently prescribed classes of drugs and it is estimated that approximately 50% of antibiotic use, in both the outpatient and inpatient settings, is inappropriate.  At the same time, in contrast to any other class of drugs, every antibiotic use has a potential public health consequence – inappropriate use may not harm only the individual patient, but contributes to societal harm by exerting an unnecessary selective pressure that may lead to antibiotic resistance among bacteria.

The course is sponsored by the Division of Infectious Diseases and Geographic Medicine in the Department of Medicine. Participants have the option of taking the course for CME credit.

Previously: Side effects of long-term antibiotic use linked to oxidative stress, New method may speed identification of antibiotic targets, Harnessing evolutionary forces to develop more effective methods for treating superbugs and Norway’s strategy for fighting drug-resistant bacteria
Photo by Iqbal Osman1

CDC, Public Health, Research, Technology

CDC explores potential of using smartphones to collect public health data

CDC explores potential of using smartphones to collect public health data

Recognizing the value of mobile devices in conducting public health research, the Centers for Disease Control and Prevention has launched a project to examine the feasibility of collecting data using smartphone-based surveys and text messages. A recent post on Mobihealthnews offers more details:

The groups aim to first send the surveys to US residents aged 18 to 65 nationwide with questions related to smoking habits and alcohol consumption. Following the survey, the smartphone users will be asked to participate via text message in the feasibility study, which includes a survey immediately following the first and then another one a week later. The texts will include links to the survey on a mobile-friendly site.

Some of those who participate in the initial outreach that are non-smartphone users will be asked to participate in another study, the text message pilot, which will conduct the surveys one question at a time via text.

The study aims to evaluate, among other things, the response bias of data collected from the smartphone users on the mobile site to those responses collected via text.

Previously: Survey shows more than a quarter of American adults are mobile health users and CDC binge-drinking study demonstrates cell phones’ value in research
Photo by Jhaymesisviphotography

CDC, Global Health, In the News, Public Health

H7N9 got you aflutter? Wired offers help sorting fact from fiction

I admit to a certain sense of mounting dread about the news of the new H7N9 influenza virus arising in China. And the never-ending supply of Tweets (alarmist and otherwise) are not helping one little bit. That’s why I appreciated this article posted today by Wired reporter and author Maryn McKenna (she’s sometimes referred to as Scary Disease Girl, due to her focus on global health and infectious diseases).

McKenna breaks the current news down into a quick primer, based on her past experiences reporting on that ‘other bird flu’ H5 N1 (remember that one?) ten years ago. She follows with a caution to beware– or at least to be aware– of the sources of news of this quickly moving story, and an explanation of some peculiarities in Chinese media that may hamper or distort reporting. She also draws a parallel between what’s happening now with H7N9 and H5N1– pointing out that the latter never erupted in humans as it was first feared. Says McKenna:

And H7N9 might not, as well. It is far too soon to say, despite the rapidly escalating case count and the reports — which came in while I was writing this — of a possible animal reservoir in pigeons and a possible human-to-human case. I have been writing about flu and possible pandemics since 1997 — for what it’s worth, I wrote the first story in the US in 1997 about that first H5N1 case in Hong Kong — and so at this early point, what I most want to say is this: We all love scary diseases. (If you didn’t, you wouldn’t be reading this blog.) But there is a fog of war in disease emergencies, just as there is in military ones, and it is very easy to get lost in it.

It will take a while for this story to become more clear. Anticipating that, I want to suggest some things to think about as you follow the news.

She ends with this great advice:

[...] Don’t assume that everyone who is loading information onto their blogs or pushing it onto Twitter is doing it in a sharing spirit of helpfulness. There are people — you can see this already — who are opportunistically using this to feed their egos, angle for jobs, or generally to stir up trouble. More than ever, it’s important to be skeptical about the sources of the information you consume.

McKenna makes it easier for us to practice what she preaches by listing several reputable news sources–traditional, web-based and, even on, Twitter– that should be reliable sources of information. You can follow McKenna on Twitter at @marynmck.

Previously: “Superbug” author discusses dangers, history and treatment of MRSA and Image of the week: What H5N1 looks like

CDC, Infectious Disease, Public Health

CDC: More U.S. adults need to get recommended vaccinations

CDC: More U.S. adults need to get recommended vaccinations

Shortly before being discharged after giving birth to my second daughter, a hospital nurse glanced at my chart and asked if I was up to date on my vaccinations. I couldn’t remember having gotten a tetanus shot as an adult, I told her, so I probably did need one. (“Will it hurt?” I asked as she approached my arm with the needle, and she just laughed. Not compared to having a baby was her – totally accurate – answer.)

If it wasn’t for this attentive nurse, I probably wouldn’t be up to date on my DTaP - which is why I wasn’t at all surprised to hear of a new CDC report on non-influenza vaccination coverage among adults. According to the report, a large chunk of Americans fail to get recommended vaccines. In 2011, just over 64 percent of adults aged 19–49 years had received a tetanus vaccination in the last 10 years, for example. And only around 16 percent of adults over the age of 60 reported having gotten a herpes zoster vaccination to prevent shingles – something that is recommended for this group by the CDC.

Calling the vaccination coverage levels among adults “unacceptably low,” the report goes on to outline components of a successful vaccine program that could boost these rates.

Previously: Failure to vaccinate linked to pertussis deaths and The cost of forgoing routine vaccinations
Via @DrFriedenCDC
Photo by blakespot

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