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How to Manage an Outbreak: The Ebola Story

Last week, Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention (CDC), gave an update explaining how the current Ebola epidemic is being managed, avoiding an even more disastrous outbreak and avoiding many deaths worldwide.  Dr. Frieden spoke at a joint conference held by the Kaiser Family Foundation (KFF) and the Center for Strategic and International Studies (CSIS).

Ebola is one of the most deadly infectious diseases, causing death in at least 50% of those who become infected.  This is much higher than almost every other known infectious disease.

Dr. Thomas Frieden, Director, CDC

Dr. Thomas Frieden, Director, CDC

The fatality rate for influenza, by comparison is 1%, although far more people die from influenza because it’s more common.

There’s no preventative vaccine, treatment, or cure for Ebola.

The current outbreak, according to the Kaiser Family Foundation, stands at 23,132, with 42% of patients in Sierra Leone, 35% in Liberia, and 12% in Guinea.  All prior outbreaks of Ebola combined totaled about 10% of the current number of infected people.

The United States is by far the largest donor nation to the effort, having donated more than $2.4 billion, and the CDC plays a leading role, complete with boots on the ground, developing “best practices” to contain the virus.

The presentation revealed new U.S. public opinion data from KFF indicating that in 2014, Ebola was the most closely followed story, more than Ferguson, more than the missing Malaysian Air flight, and more than ISIS and terrorism.  The poll also indicated that as of December 2014, four in 10 believe Ebola is now under control.  In October 2014, that number was just one in 10.  In many ways, the public opinion is correct. New cases are dropping rapidly, though we are not yet out of the woods.  So what interventions by CDC and others helped make this turnaround happen?

“This is the most intensive response globally in CDC history,” said Dr. Frieden.  “We knew that for every one month of delay, the size of the epidemic would triple.  If we reached a tipping point where the majority [of Ebola patients] were safely identified and buried it would break.”

First, the CDC helped to diagnose the disease earlier in its staging by educating more health care workers on what symptoms to look for.  By knowing who is or may be infected sooner, the sick can be removed from locations where they might infect others.  The CDC’s efforts extend through providing, maintaining, and driving a fleet of 4 wheel drive vehicles throughout the effected regions to reach remote populations before the virus does and educating the population and health care workers about safety precautions. The CDC has worked quickly to change the culture around burials without compromising rituals and customs, by dressing the deceased in the clothes desired by the family while fully protected and behind glass so that the families can watch and approve.

How was the CDC able to move so quickly?  “There is no pro-Ebola lobby,” quipped Dr. Frieden.  “And this is a national security issue, which had strong support on both sides of the aisle. Health and health protection is an area where there’s common ground.  Public health systems remain a ‘best buy.’ It can have a major payoff not just in terms of lives saved, but social and economic stability too.”

“We’ve made tremendous progress,” said Dr. Frieden.  “The difference is night to day. Centers that used to be full of Ebola patients no longer are.  But there still are some centers where there used to be no cases but there now are.  We’re moving from a ‘build and bury’ stage – building treatment centers and burying the dead, to treatment phase.”

What’s next?  According to Dr. Frieden, an early detection diagnostic will be available soon.  That’s a good way to see that future outbreaks will be managed more expeditiously, resulting in fewer transmissions.

What do you think of the CDC’s ability to help contain Ebola?  While the U.S. is the largest donor, many nations donated as well.  Do you think we should lead the world in funding the effort to manage the Ebola outbreak?

Cultural Competency Key to Positive Health Outcomes

Early in my pharmacy career, a hospital social worker referred to me a deaf patient. He had a reputation for being rude and belligerent to providers. After our first encounter, I was no exception. However, after looking at health care from his perspective – slow communication, unthinking providers, long waits in the clinic – I had an idea.

Joel Zive

Joel Zive

Instead of counseling him with a pad and pencil, I counseled him in front of a computer screen. I made the font larger, and we communicated in this fashion. He was ecstatic! I learned that many deaf people communicate with a device called a Telecommunications Device for the Deaf (TDD), with which they can type responses and often learn to do so rapidly. Because I accounted for his unique point of view and modified my interactions with him accordingly, our relationship changed for the better.

For a provider, cultural competency involves understanding patients’ perceptions of their role in health care. When a provider or prescriber has that insight, significant improvements can occur in therapeutic outcomes. For example, cultural competency can aid providers in preventing drug interactions by determining which complementary and alternative medicines their patients use, as well as help improve patient adherence to prescribed therapies. This is especially important in minority communities, in which the devastating effects of diabetes, hypertension, and other diseases take a disproportionate toll.

Establishing this insight takes time that busy practitioners don’t always have. Fortunately, providers increasingly rely on capable, cost-effective partners: community health workers (CHWs). CHWs work in a variety of settings, including community-based organizations, AIDS service organizations, hospitals, and clinics. They are often of the same ethnicity as many patients and live in the neighborhood; in many cases, CHWs have already developed trusting relationships with patients and may have a better understanding of the nuances of how they expect or want to be treated. CHWs are also in a position to uncover problems that patients are unwilling to share with their physicians and other health care providers.

The positive effects of CHW involvement as provider extenders are well documented. For example, at the Gateway Community Health Center in Texas, CHWs played a valuable role in improving outcomes among people with hypertension and diabetes.

A critical area that can be enhanced by community health workers is complementary medicine. St. John’s Wort is one example of an herbal folk remedy that is sometimes used and endorsed by generations of family members for the treatment of depression, but that many patients may not report to their health care providers. This is significant because St. John’s Wort should not be taken with antiretrovirals. CHWs may be more effective than those ‘wearing white coats’ in learning about use of complementary and alternative medications and, when needed, explaining the dangers of drug interactions with sensitivity and compassion.

Research continues into the benefits of employing CHWs in pharmacies. Four pharmacy school professors at the University of Florida – Folakemi Odedina, Ph.D.; Richard Segal, Ph.D.; David Angaran, MS, FCCP, FASHP and Shannon Pressey – did a pilot project to see whether a CHW paired with a single community pharmacy could uncover medication-related problems that were missed by the pharmacist alone and improve outcomes in hypertension (view this short video for more information). In an interview with Real World Health Care, Dr. Segal said they teamed a CHW with a pharmacist to work cooperatively for 11 months to enroll 30 patients with poorly controlled hypertension (>140/90 mm Hg). The CHW was able to gather information about which patients were using complementary medicines as well as the barriers people were experiencing that affected their adherence to prescribed medicines. Together, the CHW and pharmacist developed a medication action plan that was informed by the added information the CHW was able to collect from patients. While four patients were lost to follow up, the 26 remaining patients showed a significant reduction in systolic blood pressure. The pilot program is being scaled up to involve 30 CHWs with funding from the Department of Health and the CDC. Segal concluded that clinical collaboration between pharmacists and CHWs should also be used for other disease areas.

What other ways can community health workers benefit patients in addition to increasing treatment adherence and decreasing the risk of drug interactions? Share your thoughts in the comments section.

What’s Getting Lost in the Health Care Debate?

Health care has never been more highly politicized than today.

Last year, it was central to the third longest government shutdown in U.S. history. This week, it consumed a large chunk of President Obama’s State of the Union address. Every day, we are inundated by news of health exchange website defects, insurance policy cancellations, coverage that forces people to switch doctors, and a laundry list of other problems attributed to the Affordable Care Act. On the flip side, advocates complain of the problems that make the U.S. rank among the lowest in health system efficiency among advanced economies and hail the health care law as a ray of hope.

Jamie Elizabeth Rosen

Meanwhile, a new study from the U.S. Centers for Disease Control and Prevention (CDC) revealed that one in four American families struggled to pay medical bills in 2012. Pretty dismal.

But there’s something missing from this barrage of coverage. Incredible advances are being made in health care every day, providing Americans with innovative ways to stay healthy, treat illnesses when they arise, and save money on medical problems. Just this month, a new program was launched to help people on Medicare living with multiple sclerosis afford copays for treatment; the FDA for the first time approved a postnatal test that can help parents identify possible causes of their child’s developmental delay or intellectual disability; and a study published in the Lancet showed that it is possible to train children’s immune systems to become less sensitive to peanuts.

At Real World Health Care, we focus on what is working.

That’s why I am proud to take over this week as editor of Real World Health Care. While much of my professional focus has been on health internationally – advocating for the development of vaccines to prevent tuberculosis, policies that save mothers and infants from dying during childbirth, and the formation of emergency medical systems in places where people have nowhere to turn – I am compelled by the notion that more attention must be focused on solutions that are improving U.S. patient care today. By serving as a central clearinghouse for information about improvements to segments of the U.S. health care system, we hope that our readers and those journalists who get ideas from our blog will be inspired to expand innovations that are working in health care today.

Real World Health Care – only entering its 11th month – already has a reputation for covering solutions to enhance nutrition, prevent diseases, reform medical education, improve hospitals, support patients, fund research, increase treatment adherence, and reduce costs. The blog serves as a resource for policy makers, health systems, research universities, non-profit health organizations, leading biopharmaceutical companies, government agencies, and the nation’s leading health journalists among thousands of others interested in practical and well-researched health care success stories.

We need your help to continue to grow our success. Have an idea for a story or a guest blog? Email me at jrosen@WHITECOATstrategies.com. Want to take part in advancing solutions in health care? Sign up for updates and share stories that inspire you via Twitter at https://twitter.com/RWHCblog. Do you believe in our mission to expedite improvements to our health care system? Consider co-sponsoring the blog while gaining visibility for your organization. We are now followed by over 300 health industry leaders each week, and journalists turn to us for story ideas about the good news on what’s working in our health care system. For more information, email dsheon@WHITECOATstrategies.com.

I look forward to continuing to cut through the political vitriol around health care with inspiring stories of what is keeping Americans healthy and saving lives. Thank you for giving meaning to our work by using this blog as a resource for yours.

Categories: General

Are You Ready to Help Stop Cervical Cancer?

National patient advocacy organizations and allies are urging American women to start the year off right by learning more about cervical cancer and prevention during Cervical Health Awareness Month this January.  Here’s what you need to know.

Paul DeMiglio

Paul DeMiglio

Although enormous strides have been made in the prevention of cervical cancer – which has gone from being the number-one cause of cancer death among American women in the 1950s to now ranking 14th for all cancers impacting U.S. women – much work remains in the fight to end this disease. Cervical cancer is still a major health concern, with approximately 12,000 women diagnosed each year in the United States and more than 4,000 women who die from the disease annually.

Cervical cancer is primarily caused by the human papillomavirus (HPV), the most common sexually transmitted virus in the U.S. impacting 79 million Americans. While HPV is most often the cause, other identified risk factors can include:

  • Smoking;
  • Having HIV or other conditions that weaken the immune system;
  • Prolonged (five or more years) use of birth control;
  • Three or more full-term pregnancies; and
  • Having several or more sexual partners.

While many of these factors don’t always lead to cervical cancer, it’s been shown that the risk of acquiring the disease can be decreased through frequent screening. Once women began regularly getting Pap tests and HPV vaccinations, for example, deaths resulting from cervical cancer decreased by nearly 70 percent in the United States from 1955-1992.

Cervical cancer is preventable because of the availability of a vaccine for HPV and effective screening tests, according to an announcement from the Centers for Disease Control and Prevention (CDC) of Cervical Cancer Awareness Month last year. Although highly treatable, the CDC shows that half of all cervical cancer cases occur in women who rarely or never were screened for cancer. In another 10-20 percent of cases, patients were screened but did not receive adequate follow-up care. The CDC has also issued information regarding the availability and importance of preventative HPV vaccines.

The National Cervical Cancer Coalition (NCCC) and the American Sexual Health Association (ASHA) also advocate for increased awareness of the disease. In its promotion of the event the NCCC provides numerous suggestions on how to spread the word, including:

  • Enlist radio stations to issue PSAs;
  • Share tweets and Facebook posts to educate their networks;
  • Distribute ASHA/NCCC’s news release to local media, with a guide on how to reach out to media networks; and
  • Write to their mayors or local legislative offices to recognize Cervical Health Awareness Month.

It’s also important for providers to know how to most effectively engage families with girls, according to ASHA/NCCC President and CEO Lynn B. Barclay.

“Only about 35 percent of girls and young women who are eligible for these vaccines have completed the three-dose series,” Barclay says. “Parents are strongly influenced by the recommendations of the family doctor or nurse, so we’ll continue developing cervical cancer information and counseling tools designed specifically for health professionals.“

Now we want to hear from you. How can you increase awareness about cervical cancer in your communities? What can organizations, places of employment and other stakeholders do to help heighten visibility around cervical cancer prevention strategies?

Editorial Note: At press time, information regarding expected estimates of cervical cancer rates in the U.S. for 2014 had not been released. Please note that we will include the latest statistics as soon as data becomes available.

Get Your Flu Shot Now to Stay Healthier Later

So you think you’re too busy to get your flu shot? It’s easy to put off, but taking the time to do it sooner rather than later could prevent you from getting sick while helping to protect those you care about – during the holidays and beyond. That’s why the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), state and local health departments as well as other health agencies are raising visibility around National Influenza Vaccination Week (NIVW), from Dec. 8-14.

Paul DeMiglio

Paul DeMiglio

With the flu season beginning in the fall and not peaking until January-February, it’s certainly not too late to get your influenza shot. In fact, the CDC’s Advisory Committee on Immunization Practices recommends that everyone 6 months of age or older receive it, including:

  • Children
  • Seniors 65 and older
  • Pregnant women
  • American Indians and Alaska Natives
  • Those with underlying health conditions like asthma
  • Those living with conditions including chronic lung disease, heart disease, HIV/AIDS, cancer and diabetes

Although the effectiveness of flu vaccination varies each year, the CDC reports that recent studies demonstrate the evidence-based public health benefits. The Mayo Clinic agrees, calling flu shots your best defense against the flu, enabling “your body to develop the antibodies necessary to ward off influenza viruses.”

“The single best way to protect against the flu is to get vaccinated each year,” said CDC’s Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Diseases. “Today, flu vaccines are available in more convenient locations than ever. The few minutes it takes to get a flu vaccine can save you from experiencing several unproductive days due to influenza. The most common side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.  Flu vaccine cannot cause flu illness.”

Despite evidence that the influenza vaccine is an effective tool, some still fear that getting their shot might put them at risk for experiencing severe side effects. No more than one or two cases per million people vaccinated acquire Guillain-Barré syndrome, an outcome much lower than the risk of developing severe complications from influenza. From 1976-2006, in fact, estimates show that far more people died from flu-associated deaths in the U.S. (3,000-49,000) than from negative reactions to the vaccines that protect against influenza.

To build awareness and support of NIVW and encourage people to get their shots, the CDC is making a rich variety of online tools and resources available to a wide spectrum of patients, educators and providers, such as:

Partnering with Reckitt Benckiser, Inc., the makers of LYSOL® Brand Products, the CDC is also spotlighting the Ounce of Prevention Campaign, which seeks to empower consumers and professionals with practical tips and information around effective hand hygiene and cleaning habits to prevent infectious diseases like the flu.

Click here to see if the vaccine is available in your area. To find a nearby location to get the vaccine, check out HHS’s “Flu Vaccine Finder” on Flu.gov, enter your ZIP code and share the widget to let your family members, colleagues and friends know where they can go too. HHS also provides a series of informative YouTube videos that cover prevention strategies, share tips for identifying symptoms and provide recommended treatment practices.

You can also make a powerful statement by taking the pledge to get vaccinated for the 2013-14 season, commit to taking a friend with you and in the process spread the word by clicking here. To get the latest updates on flu vaccination efforts, follow the CDC on Twitter (@CDCFlu and @CDCgov) and “like” them on Facebook.

Now tell us if you’ve gotten your flu shot. Where did you go? How long did it take? What ways could providers and health care stakeholders more effectively remind patients to get vaccinated?

Advocates Unite to Prevent Type 2 Diabetes During National Diabetes Awareness Month

One in three. That’s the number of people in the United States who will have diabetes by 2050 if current trends continue. Twenty-six million Americans – seven million of which are undiagnosed – now live with diabetes and another 79 million have pre-diabetes. To raise awareness and spotlight effective prevention strategies, patient advocates are mobilizing to promote National Diabetes Awareness Month and American Diabetes Month® this November.

Paul DeMiglio

Paul DeMiglio

As a disease that constitutes one of the leading causes of death and disability in the United States, diabetes is a disease in which glucose blood levels are elevated above their normal range. Those living with diabetes are also at higher risk of heart disease and stroke. According to the Centers for Disease Control and Prevention (CDC), the risk factors for type 2 diabetes include:

  • Being 45 years of age or older
  • Being overweight
  • Having a family history of Type 2 Diabetes
  • Engaging in physical activity fewer than three times per week
  • Giving birth to a baby that weighed more than 9 pounds
  • Having gestational diabetes (diabetes during pregnancy)

Although type 1 diabetes cannot be prevented because people are born with it, individuals can lower their risk of developing type 2 diabetes through a variety of practical strategies. The CDC’s National Diabetes Prevention Program is an evidence-based program for preventing type 2 diabetes. A public-private partnership of community organizations, private insurers, employers, health care organizations and government agencies, it teaches participants how they can incorporate physical activity into daily life and eat more healthfully, helping them to:

  • Cut their risk of developing type 2 diabetes in half
  • Lose 5-7 percent of body weight through modest changes in behavior
  • Reduce the risk of diabetes in people with pre-diabetes by 5 percent

The program pairs people with a lifestyle coach, in a group setting, to receive 16 core sessions and six post-core sessions over the course of a year. These lifestyle coaches work with the participants to identify emotions and situations that can sabotage their success. The group process encourages participants to share approaches for dealing with challenging situations.

Along with their National Diabetes Prevention program, the CDC also provides a Registry of Recognized Programs that lists contact information for community resources offering type 2 diabetes prevention programs. The registry was created to help health care providers more effectively refer their patients to the services they need, while also empowering patients to find and choose the programs that are right for them. For more information about diabetes and other diseases from CDC, you can sign up for e-mail updates here.

The National Diabetes Education Program (NDEP) is also committed to raising awareness and providing resources around issues such as diabetes risk, family support, and community support. The goal of their campaign – Control Your Diabetes. For Life is to increase awareness about the benefits of diabetes control through education materials, fact sheets, sample articles and PSAs for radio, print and television. A major part of their focus is also placed upon bringing diabetes information to community settings such as schools, worksites, senior centers and places of worship.

“Although the prevalence of diabetes has continued to rise due to the obesity epidemic, the aging of the U.S. population, and increasing numbers of people at high risk for diabetes, there are strong, encouraging indicators of progress in preventing and treating diabetes,” said Joanne Gallivan, M.S., R.D., Director of NDEP. “Today, there is much greater awareness that diabetes is a serious disease, a critical first step in changing outcomes. In 1997, only 8 percent of Americans believed diabetes was serious. In 2011, 84 percent of Americans understood that it is a serious disease.”

The American Diabetes Association (ADA), which works to “raise awareness of this ever growing disease,” leverages American Diabetes Month® to illustrate how diabetes impacts Americans. By asking people to submit photos that show “A Day in the Life of Diabetes,” the ADA plans to create a large mosaic that demonstrates how diabetes affects patients, families and communities nationwide from personal perspectives.

“Participating in ‘A Day in the Life of Diabetes’ for individuals living with diabetes lets them know that the American Diabetes Association is the one leading organization that continues to do research to ‘STOP Diabetes,’ advocate and promote ‘Healthy Lifestyle Management’ to avoid many of the health issues that people with diabetes die from, such as heart disease or stroke, kidney failure, blindness, and amputations,” said Lurelean B. Gaines, RN, MSN, President of Health Care and Education of the Association. “The campaign has grown this year and will continue to grow because every 17 seconds someone is diagnosed with diabetes.”

To learn more visit ADA’s website at www.diabetes.org and click on Diabetes Basics, Living With Diabetes, Food Fitness, Advocate, In My Community, or News & Research.  Information is available in English and Spanish. You can also “like” ADA on Facebook, follow them on Twitter (@AMDiabetesAssn) or call them at 1-800-Diabetes.

How can your community more effectively collaborate with stakeholders like ADA, CDC and NDEP to prevent diabetes and help those living with the disease?

August Health Awareness Days Provide Opportunities to Take Action

As young people across the country go back to school, patient advocates and government stakeholders are leveraging awareness days to help communities learn about health issues impacting children, prevention strategies and efforts to improve care. Here are some examples:

Children’s Eye Health and Safety Month
Each August organizations including the Envision Foundation underscore the need for screenings and examinations to promote early detection, intervention and prevention of vision problems in children.

Paul DeMiglio

Paul DeMiglio

Vision disorders in children cost Americans more than $5.7 billion in direct and indirect expenses each year, while the overall cost of vision problems nationwide soars to an estimated $139 billion (includes long-term care, productivity loss and medical bills), according to Prevent Blindness America. Treating eye disorders and vision loss early in life helps protect children from developing chronic, lifelong conditions that become more expensive to treat because of long-term, indirect costs that increase as populations age.

“The beginning of a new school year is an exciting time in a child’s life,” Hugh R. Parry, President and CEO of Prevent Blindness America, said in a statement.  “By working together with parents and educators, we hope to give all our kids a bright and healthy start!”

National Immunization Awareness Month
According to the Centers for Disease Control and Prevention (CDC), the National Public Health Information Coalition (NPHIC) highlights the need to improve national immunization coverage levels throughout August. To communicate the importance of immunizations now and throughout the year, NPHIC also developed a toolkit tailored to various populations including babies and pregnant women, pre-teens and teens, young adults, and adults. The toolkit seeks to:

  • Encourage parents of young children to get recommended immunizations by age 2.
  • Help parents ensure older children, preteens and teens have received all recommended vaccines by the time they return to school.
  • Remind college students to catch up on immunizations before they move into dormitories.
  • Educate adults, including health care workers, about vaccines and boosters they may need.
  • Urge pregnant women to get vaccinated to protect newborns from diseases like whooping cough.
  • Raise awareness that the next flu season is only a few months away.

The CDC also makes a wide array of resources available for those who want to learn more about the importance of immunizations or spread the word.

Neurosurgery Outreach Awareness Month
The American Association of Neurological Surgeons (AANS) is among the organizations that underscores why the beginning of the school year is a great time to educate communities about strategies to prevent sports-related head and neck injuries like concussions. AANS provides tools to help others more effectively identify symptoms of potentially serious head/neck injuries and take preventive steps to ensure safety, also offering the following tips:

  • Buy and use helmets or protective headgear approved by the American Society for Testing Materials for sports 100 percent of the time.
  • Remain abreast of the latest guidelines and rules governing sports with a high prevalence of head injuries including cheerleading, volleyball, and soccer.

“Concussion awareness, understanding the symptoms of a potential concussion or other traumatic brain injury, is critically important in all sports,” AANS Public Relations Committee chair Kevin Lillehei, MD, FAANS, said in a statement. “Educating the public is one of the best weapons we have when it comes to combating these types of injuries. That is why it’s so important to raise awareness in the community and explain just what some of the effects are that these injuries have.”

Psoriasis Awareness Month
Sponsored by The National Psoriasis Foundation each year, Psoriasis Awareness Month is dedicated to “raise awareness, encourage research and advocate for better care for people with psoriasis.”

The most common autoimmune disease in the US affecting 7.5 million Americans, Psoriasis occurs when the immune system sends out faulty signals that speed up the growth of skin cells and produce red, scaly patches that itch and bleed. About 20,000 children under 10 are also diagnosed, often experiencing symptoms that include pitting and discoloration of the nails, severe scalp scaling, diaper dermatitis or plaques.

As part of Psoriasis Awareness Month, NPF is creating a community of “Pscientists” to “answer real‑world questions about psoriasis and psoriatic arthritis.”

Spinal Muscular Atrophy Awareness Month
Although it’s considered a “rare disorder” with approximately 1 in 6000 babies born affected by it, Spinal Muscular Atrophy (SMA) is a motor neuron disease that causes voluntary muscles to weaken and in some cases can lead to death, according to the National Institutes of Health’s (NIH) National Institute of Neurological Disorders and Stroke (NINDS). Types I, II and III belong to a group of hereditary diseases that weaken the voluntary muscles in the arms and legs of infants and children, contributing to breathing issues, difficulty eating and drinking, impaired mobility and orthopedic complications.

Families of SMA, which has coordinated activities around SMA Awareness Month since 1996, and the Muscular Dystrophy Association (MDA), are two national organizations that support those living with SMA. Click here to learn about events this month, community networks and research projects for treatment and therapies.

What activities are taking place in your community to support one or more of these awareness days? What could the institutions in your neighborhood, workplace or at your school be doing year-round to more effectively engage populations about critical health issues?

Categories: Access to Care

World Hepatitis Day Spotlights Importance of Early Detection to Improve Prevention and Treatment Strategies

This Sunday, July 28, is World Hepatitis Day, an observance that reminds us that hepatitis (inflammation of the liver) remains largely unknown as a major health threat. Approximately half a billion people worldwide and 4.4 million people in the U.S. live with chronic viral hepatitis, with one million deaths resulting from the disease each year.

Linda Barlow

Linda Barlow

The goal of World Hepatitis Day is to move from awareness to action to address the “silent epidemic” of viral hepatitis – so named because most people don’t experience symptoms when they first become infected, often not until they develop chronic liver disease many years later.

Stakeholders in government and private industry are stepping up to answer the call, supporting early detection and medical intervention as key starting points to effectively address the epidemic.

Earlier this month, Quest Diagnostics announced a partnership with the CDC to improve public health analysis of hepatitis C screening, diagnosis and treatment for the 3.2 million Americans living with it. Under the collaboration, anonymous patient data will be evaluated to identify and track epidemiological trends in hepatitis C virus infection, testing and treatment and determine how those trends differ based on gender, age, geography and clinical management.

“Our collaboration with the CDC underscores the importance of using diagnostic information to derive useful insights enabling effective prevention, detection and management programs for diseases with significant impact on public health,” Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics, said in a statement.

Early detection was also the focus of a 2012 National Institutes of Health (NIH) study published in Proceedings of the National Academy of Sciences. In the study, researchers concluded that elevated blood levels of a specific enzyme and a specific protein early on in the course of hepatitis C infection were much more likely to develop into advanced fibrosis or cirrhosis. The study found:

  • The long-term course of chronic hepatitis C is determined early in infection.
  • Rapidly progressive disease correlated with persistent and significant elevations of alanine aminotransferase (ALT), an enzyme released when the liver is damaged or diseased.
  • Rapidly progressive disease correlated with persistent and significant elevations of the protein MCP-1 (CCL-2), a chemokine that is critical to the induction of progressive fibrogenesis and ultimately cirrhosis.

Armed with this information, clinicians are expected to make a fairly accurate assessment of which patients are likely to develop advanced disease rapidly. Instead of waiting for a new class of drugs to be approved, these patients are likely to be pressed to start treatment right away – with the goal of treating the virus before it causes cirrhosis of the liver.

Because hepatitis does not result in symptoms until serious liver damage occurs, getting tested is also crucial. In fact, the CDC recommends that everyone born from 1945-65 get a one-time test for hepatitis C because they are five times more likely than American adults in other age categories to be infected and face an increased risk of dying from hepatitis C-related illnesses.

The first FDA-approved hepatitis C genotype test is now available in the U.S. From Abbott, the fully automated Realtime HCV Genotype II test determines the specific type or strain of the HVC virus present in the blood of an HCV-infected individual.

To locate organizations where you can access services including Hepatitis testing, vaccines and treatment, click here. You can also take this 5-minute Hepatitis Risk Assessment to obtain a personalized report from the CDC.

Early awareness and prevention-based practices are crucial to avoiding hepatitis. But what else can be done to ensure access to and availability of reliable and cost-effective screening and diagnostics, in addition to safe and simple treatment regimens for people with the disease?

We hope this post serves as a resource for journalists covering or interested in writing stories about World Hepatitis Day and related issues. Also stay tuned for our follow-up post next week that will address the cost-savings implications of vaccination and early treatment of hepatitis.

HPV Vaccine Reduces Infection Rates in Teen Girls

Since the human papillomavirus (HPV) vaccine was introduced in 2006, vaccine-type HPV prevalence has decreased by 56 percent among females 14-19 years old, according to a new study published in The Journal of Infectious Diseases.

Linda Barlow

Linda Barlow

HPV is the most common sexually transmitted virus in the United States. Although the vast majority of HPV infections do not cause serious harm, some will persist and can lead to cervical cancer. Each year in the U.S., about 19,000 cancers caused by HPV occur in women.

“Unfortunately, only one-third of girls aged 13-17 have been fully vaccinated with HPV vaccine,” says CDC Director Tom Frieden, M.D., M.P.H. “Our low vaccination rates represent 50,000 preventable tragedies, which means 50,000 girls alive today will develop cervical cancer over their lifetime. This would be prevented if we reach 80 percent vaccination rates. For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes.”

Study author Markowitz notes that the decline in vaccine type prevalence could be due to factors such as “Herd” Immunity (also called “community immunity”), which occurs when most members of a community are protected against a contagious disease because a critical portion of the population has been immunized and the opportunities for an outbreak are reduced. “Herd” Immunity has been shown to control a variety of contagious diseases, including measles, mumps, rotavirus (MMR), influenza and pneumococcal disease.

Public health experts recommend routine HPV vaccination at ages 11-12 for both boys and girls. A series of three shots is recommended over six months. HPV vaccination is also recommended for older teens and young adults who were not vaccinated when younger.

The HPV vaccine is not without its critics, and health care providers are not consistently giving strong recommendations for the vaccine, particularly for younger teens, according to the CDC.

“One of the most common criticisms from parents – that their teen is not sexually active yet – misses the point,” suggests Frieden, who says that vaccines should be administered well before people are exposed to an infection.

Frieden also points out that, with the Vaccines for Children Program and the Affordable Care Act, vaccination is easy and cost should not be a barrier because many insurers are required to cover the vaccine at no cost to either female or male patients.

The power of an effective and widespread vaccination program should not be ignored. Smallpox, for example – a serious and sometimes fatal infectious disease – has no specific treatment and is only prevented by a vaccine. Although outbreaks of the disease have occurred from time to time over thousands of years, it is now eradicated worldwide because of a successful and comprehensive vaccination campaign.

A similar initiative is underway to eradicate polio worldwide. The development of effective vaccines to prevent paralytic polio was one of the major medical breakthroughs of the 20th century. Supported by the Bill & Melinda Gates Foundation, the Global Polio Eradication Initiative (GPEI) has helped to reduce the incidence of polio by more than 99 percent.

As with smallpox, if enough people in a community are immunized, the virus will be deprived of susceptible hosts and will die out. But high levels of vaccination coverage must be maintained to stop transmission and prevent outbreaks.

Will HPV go the way of smallpox and polio thanks to “Herd” Immunity? Do you agree with the CDC that it’s time to ramp up efforts to protect the next generation with the HPV vaccine? Or do you share the critics’ concerns?

Real-Time Health Alerts Join Twitter to Expand Access to Public Health Information

Is Twitter now monitoring your allergies or sleeping patterns?

Linda Barlow

Linda Barlow

In today’s era of real-time information, Twitter has emerged as a leading go-to source for the latest in news, entertainment and more. Now, Twitter is joining Everyday Health, Inc. to create HealthBeat, the first global real-time health alert and news offering. The partnership seeks to provide relevant health information and breaking news to the Twitter community in real time, offering promoted Tweets linking to Everyday Health’s news, expert advice, videos and tools that users can put into action.

HealthBeat will scour the 2 million daily health-related tweets in the U.S. to identify impending outbreaks and other health crises.

“We’ll be looking at the key health terms flaring up every day, and when something is indexing in an abnormal way, we’ll let Twitter know and we’ll supply content about what to do,” said Everyday Health President Michael Keriakos, in an interview published in Ad Age.

For example, Keriakos noted that HealthBeat could have been used to provide vaccination information to residents affected by a whooping cough outbreak in South Central Los Angeles two years ago.

Not only will the partnership provide important information relating to public health, it will also serve as a targeting mechanism for advertisers who are being sought by HealthBeat to promote content around broad health topics like allergies, flu season and insomnia.

While HealthBeat touts itself as the “first global real-time health alert” service, there are other online services – like Google’s flu tracker — that provide similar information on a regional or national level:

  • Launched in 2010, Health & Safety Watch is a Canadian-based web portal and iPhone app that lets users customize the type of alerts they want to see. It also indicates when an advisory or warning is over, for example, when a local water quality issue has been resolved.
  • In the U.S., the Centers for Disease Control and Prevention (CDC) provides alerts about health issues travelers may face when going abroad as well as alerts about disease outbreaks at home.
  • Also in the U.S., a service called HealthMap, developed out of Boston Children’s Hospital, offers an online portal called The Disease Daily, and a mobile app called Outbreaks Near Me.

“The sooner we get a signal of an infectious disease outbreak, the sooner we can devise an appropriate response, and hopefully, the negative impacts can be mitigated,” explained Anna Tomasulo, MA, MPH, HealthMap Program Coordinator, Boston Children’s Hospital.

According to Tomasulo, HealthMap has other tools that help prevent health problems.

“Our Vaccine Finder takes a person’s zip code and provides information on where they can access vaccines nearby,” she says, noting that the project started with flu vaccines but has since been expanded to other vaccines including human papillomavirus (HPV), measles, mumps and rubella (MMR), Varicella and more. “A questionnaire helps users determine what vaccine is most appropriate and provides a list of participating pharmacies within a given radius that provides the vaccine the user needs. Such vaccines help prevent costs associated with illness and potential hospital stays.”

So are HealthBeat, HealthMap and other real-time alert programs providing an important public health service? Are these alerts helpful or will they cause undue concern?

Categories: Access to Care