CDC – Working 24/7

20 04 2013

Welcome to NIIW!

Every 20 seconds, a child dies from a disease that could be prevented with a safe and effective vaccine. Millions more children survive, but are left severely disabled. Vaccines have the power not only to save, but also transform lives by protecting against disease – giving children a chance to grow up healthy, go to school, and improve their lives.  Vaccination campaigns sometimes provide the only contact with health care services that children receive in their early years of life.

Immunization is one of the most successful and cost-effective health interventions—it currently averts an estimated 2 to 3 million deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles.

cdc blogImmunization is a global health priority at CDC focusing on polio eradication, reducing measles deaths, and strengthening immunization systems. CDC works closely with a wide variety of partners in more than 60 countries to vaccinate children and provide technical assistance to ministries of health to strengthen and expand countries’ abilities to create, carry out, and evaluate their national immunization programs.

Too few people realize that the health of Americans and the health of people around the world are inextricably linked. Viruses don’t respect borders, so they travel easily within countries and across continents. By helping to stop vaccine-preventable diseases (VPDs) globally, CDC is also helping to protect people in the United States against importations of VPDs from other countries.

For example, in 2011, there were 220 reported cases of measles in the United States—200 of the 220 cases were brought into the U.S. from other countries with measles outbreaks.

The most effective and least expensive way to protect Americans from diseases and other health threats that begin overseas is to stop them before they spread to our shores. CDC works 24/7 to protect the American people from disease both in the United States and overseas. CDC has dedicated and caring experts in over 60 countries. They detect and control outbreaks at their source, saving lives and reducing healthcare costs. In 2012, CDC responded to over 200 outbreaks around the world, preventing disease spread to the U.S.

CDC’s global health activities protect Americans at home and save lives abroad. They reduce the need for U.S. assistance and create goodwill and good relationships with global neighbors.

Thanks to the CDC for sharing this information.


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A Mother’s Legacy

25 06 2012

I would like to tell you about my mother and all mothers like her who suffered through the loss of a child from an infectious disease. Raising a family in the hills of Kentucky, where most people were too poor to pay for the little, if any, medical help available, my mother struggled to keep her family healthy.

When one of her babies became seriously ill, my mother and her parents did everything they could to try and help her. Despite their efforts, my mother watched her child, Patsy Lynn, die from whooping cough. While making arrangements for Patsy’s funeral my mother learned that another one of her children was gravely ill. Both children were buried on the same day, in the same casket, in the same grave next to my mother’s church.

After the death of two children, my family was able to relocate to the Cincinnati area where medical attention was more readily available. We all had our vaccines as my mother was determined not to lose another child to unseen viruses and she insisted on washing and boiling everything that we touched.

I lived through the effect the loss had upon my mother’s life. The fear of disease was so real then, but many of us today forget what it was like to live in a time when diseases like measles, polio and smallpox were so much more common and deadly.

I remember the time that I was not allowed to play with a friend because her mother had been sent to the “TB hospital” and I vividly remember the Sunday that we spent standing in the long lines to receive our sugar cubes laced with the polio vaccine.

During the early ’60s, I remember being put to bed in a dark room when it was thought I might have the measles. Most of all, I’ll never forget that several of my teachers wore braces because of the effects of polio.

My mother tried her best to prevent us from succumbing to any disease which may shorten our lives, so I’m thankful that when she died of cancer in 1982 she did not know that I had somehow contracted the hepatitis B virus.

In June 1995, I was diagnosed with hepatitis B about a week before my 25th wedding anniversary. A doctor told my husband that I had a sexually transmitted disease and that he should be tested and vaccinated. What the doctor failed to tell us at the time was that this hepatitis could be spread in many other ways. I had complete trust in my husband and, thank God he had faith and trust in me, so this suggestion of sexually promiscuity did not harm our marriage.

Within the week we were informed that my husband tested negative, as did my children, who have all been vaccinated.

I have tried for years to find out where I got the virus. Could it have been from my mother who died of liver cancer? Did I get it in grade school, or from dental work, surgeries? Did I get it in one of the hospitals or clinics where I have worked as an interpreter? Did I get it from a child who ran into me on the playground, or from the little girl who bit me while I was working in the Cincinnati Public Schools?

The only thing I can be sure of is that I did not get hepatitis B from sexual contact, drug use or tattoos. However, I have now arrived at a place of peace in my life by accepting the fact that I will never know the path of transmission—and I no longer search for that answer.

And this is my mother’s legacy to me: protect your children the best you can.

By Barbra Anne Malapelli Haun


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Ask Emily

24 05 2012

Will you explain the differences (and similarities) between endemic and epidemic diseases?

Yes, and I’ll throw in “outbreak” and “pandemic” for good measure.

First, anything that is endemic, whether a disease or an organism, occurs only in a specific group or area. “Endemic” implies “occurs only in.” So, the marine iguana, which occurs only on the Galapagos Islands, is an endemic species to those islands—it doesn’t live anywhere else. Substitute a disease for “marine iguana,” and you get the start of an idea of what an endemic disease is.

But there are a few extensions of that idea. First, an endemic disease can be one that occurs only in a certain area—and in this global society, that’s becoming increasingly rare. An example is Venezuelan equine encephalitis, which lurks in neotropical areas, usually in horses, but occasionally crops up among humans in these regions.

Endemic can also mean, however, that the disease has a constant presence in the population or area, perhaps at low levels, but always there—it never quite reaches zero in the defined population. Tuberculosis is an example of a disease that is endemic in many areas of the world, often carried around by people who don’t even know they’re infected.

Endemicity also comes in subtypes, depending on when infection occurs. If it occurs mostly in children in the population, the disease is holoendemic. Malaria is an example. A hyperendemic disease like influenza, on the other hand, is usually an equal-opportunity infector.

Is it possible for an endemic to become epidemic? Yes. If a disease that’s been lying low in a population suddenly shows sharp uptick in the population, that’s an outbreak. An epidemic is a burst of disease activity that spreads beyond the local population. So something that is endemic because it never quite hits zero cases—like measles—or something that’s endemic because it’s so localized, like Venezuelan equine encephalitis—could break out of its usual population bounds and spread across other populations.

Back to our endemic marine iguanas: If they suddenly kicked up their population levels on Galapagos alone but nowhere else, that would be an outbreak of iguanas. If they broke away from the Galapagos and established a claw-hold on the mainland, they’d be an epidemic of iguanas.

If the iguanas—or a disease—were to break the bounds of its immediate continental confines and spread to other continents or globally, that’s called a pandemic. A pandemic of iguanas is probably not a realistic concern, but the human population has already faced down a few pandemics in recent memory, including the Spanish flu, and still grapples with the pandemic of HIV/AIDS. While influenza remains the watchword for pandemic anxieties, no one can genuinely predict what the nature of the next pandemic will be.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of Wikimedia


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Adults Young and Old Need Vaccines

21 05 2012

 Adults know to wash hands and wear condoms to prevent infections. And we try to eat fruits and veggies to stay healthy. Some days, we even exercise.

One thing we don’t do enough of is get vaccinated.

Other than the flu vaccine in the autumn, I seldom think about vaccines for myself. I bet I’m not alone.

But, we should remember to vaccinate.

We make sure our kids wear seatbelts and helmets, cross the street at the light and keep a weather eye on the ocean for sneaker waves, and get all the vaccines they need.

For the most part, we follow the same safety rules, except for that one about vaccines.

I am determined to get myself fully vaccinated and to nag encourage friends to do the same. I don’t want to get sick and think “if only.”

If you’re like-minded, I’ve listed the diseases for which there are vaccines for adults 19 years of age and older. Not every adult will need every vaccine, so print out this post and take it to your provider, find out what vaccines you need, and realize that you may need more vaccines if you’re traveling outside the US:

  • Flu is a respiratory illness. It can cause fever, chills, sore throat, cough, muscle or body aches, headaches, tiredness, and a runny or stuffy nose. You get over it after several miserable days, unless you develop complications, some of which can be life-threatening.
  • Tetanus, diphtheria, and pertussis vaccines are combined for adults. Tetanus is caused by certain bacteria entering the body through a break in the skin. It’s the one that causes lockjaw, and can cause spasms and seizures. It has a surprisingly high death rate of 10 – 20% of cases. Diphtheria is caused by bacteria spread person-to-person and can damage the heart, kidneys and nerves. Pertussis, also called whooping cough, is a very contagious disease caused by bacteria. In some parts of the world, it’s called the 100-day cough. The “whoop” is most often heard from babies, for whom it can be a lethal infection.
  • Varicella, also called chickenpox, is a virus that spreads easily and causes a blistery rash, itching and fever. For some, it can cause severe complications including pneumonia or sepsis.
  • Human papillomavirus (HPV) is a sexually transmitted infection that is very common in the population. Most people get it and get over it, but some will develop genital warts or cervical or other types of cancers.
  • Zoster or shingles is caused by once having had chickenpox. The virus stays in the body after the chickenpox clears up and goes away, and years later can reactivate, causing pain and itching, followed by a rash.
  • Measles, mumps, rubella vaccines are also combined for adults. Measles is caused by a virus that makes you feel like you have a bad cold, along with a rash on the body and white spots in the mouth. It can develop into pneumonia or ear infections, sometimes requiring hospitalization. Rubella is also caused by a virus and brings with it a rash and fever. This infection can be devastating to the fetus if a woman is pregnant when infected. Mumps is caused by a virus with symptoms of fever, fatigue and muscle aches followed by the swelling of the salivary glands. Rarely it will cause fertility problems in men, meningitis or deafness.
  • Pneumococcal disease is caused by bacteria and can appear as pneumonia, meningitis, or a bloodstream infection, all of which can be dangerous.
  • Meningococcal disease is caused by various bacteria, and the available vaccines prevent many of these infections. The symptoms are varied and include nausea, vomiting, sensitivity to light and mental confusion. This disease can lead to brain damage, hearing loss, or learning disabilities.
  • Hepatitis A is caused by a virus. It’s generally a mild liver disease, but can rarely severely damage the liver.
  • Hepatitis B is also caused by a virus that damages the liver. Most adults are infected for a short time, but some become chronically infected. The infection can cause jaundice, cirrhosis or even liver cancer.

More information on these infections can be found on the CDC website.

Talk to your provider about these vaccines. Who can afford to get sick these days?

By Trish Parnell

Image courtesy of Lancaster Homes


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Why You Have to Vaccinate

7 05 2012

In 2000, public health workers slapped high fives and declared measles eliminated in the U.S. This meant that the disease wasn’t being passed person-to-person in this country.

In 2011, we had 222 cases of measles in the U.S.—a 15-year high.

Most of the 222 infected individuals were either unvaccinated or their vaccination status was unknown.

How did this happen? The answer is, almost all of the infections were imported. They came from U.S. residents returning from trips outside the country, or from visitors from foreign lands. The travelers carried the germ and, in some cases, infected others once they arrived.

Almost half of these cases came from countries with easy access to vaccines; the WHO European Region. The rub is, there are some Europeans who choose not to vaccinate themselves or their children, and the same is true in this country.

When a disease is floating around a community, it finds those who are unprotected and boom, we have disease outbreaks.

Most of the time, most of the diseases that are vaccine-preventable are not going to kill a child. They might not hospitalize him, or even make him feel really bad.

But, no one can say which disease will harm which child, and how much harm it will cause.

Kids do die from measles and chickenpox and other vaccine-preventable diseases. Or they don’t die and they only lose a limb, or their hearing, or they just need a liver transplant. Or any number of other health problems may occur that are still better than dying.

But like I said, no one can say how one child will be affected by one disease. So when I answer the phone here at PKIDs, and a parent on the other end asks if they really need to vaccinate their child against XYZ disease, I don’t have a problem telling them: you really do.

By Trish Parnell

Image courtesy of Vox efx


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Ask Emily

26 04 2012

What’s the deadliest infectious disease ever and what currently is the most deadly infectious disease?

The answer to this question is more complex than simply counting up numbers of people who die from infection. For example, diseases like measles and smallpox have proved to be far deadlier in some populations—such as Native Americans—than in others, because of population differences in disease resistance.

Another variable is intensity of the illness a pathogen causes. Influenza comes in many forms of virulence, and as the Spanish flu pandemic of the early 20th century made clear, even that virulence can vary depending on specific population features; the Spanish flu, which took an estimated 50 million lives, killed the young most relentlessly.

Even an individual disease vector can wax and wane in terms of how virulent it is or which tissues it invades. For example, Yersinia pestis, the bacterium responsible for the infamous Black Death that swept through Europe in the 14th century, may vary over time in its virulence and is far more deadly when transmitted as an aerosol to lung tissues than when it invades the lymph and causes the bubos that characterize it.

Another issue is, how do we calculate “deadliest?” Is it in terms of sheer overall numbers, or do we calculate it in terms of how many people it kills among the number infected? For the sake of addressing this question, let’s talk about both.

Historically, in terms of sheer numbers, the deadliest diseases were smallpox, measles, tuberculosis, plague (e.g., the Black Plague), and malaria. According to a handy Website, the Book of Odds, which calculates odds for us, measles has killed about 200 million people worldwide in the last 150 years and still kills hundreds of thousands in the developing world. Thanks to vaccines, the odds of contracting measles in the United States today are very low unless you are an unvaccinated person living in areas where vaccine uptake is low.

The story on smallpox is similar—it may have killed more people by percent or sheer numbers than any other infectious disease in history, including 300 million in the 20th century alone by some estimates. Yet smallpox as an infectious disease no longer exists thanks to its total elimination through vaccine campaigns.

Thus, along with the plague, smallpox and measles have, for millennia, been the historical killers of humans and would still be among the deadliest infectious diseases today were it not for vaccines. What we have left are some old killers on the list—tuberculosis and malaria—and a newer entity, HIV, the virus that causes AIDS.

We have yet to develop efficient vaccines against any of them. According to USAID, in terms of absolute numbers of deaths, AIDS kills the most people each year, with 2.8 million AIDS-related deaths in 2004, followed by tuberculosis and malaria.

Indeed, AIDS and tuberculosis are often co-conspirators in death, as infection with the HIV virus makes people 20 to 30 times more likely to develop active TB with TB infection. Research for vaccines against HIV and malaria has been feverish but as-yet incompletely successful, one reason these diseases remain the top global killers.

But what about the deadliest disease in terms of how many of infected people die? In the absence of effective treatment, HIV might be one candidate. But the ones that come first to mind are the viruses that cause fast-moving hemorrhagic fevers, such as the Marburg or Ebola viruses.

The Marburg virus, named for the location of the first outbreak and a virus that may reside without symptoms in fruit bats, has caused death rates as high as 90% in some areas, although the average is 23–25%. It is a filovirus, in the same viral family as the five Ebola viruses. One of the Ebola viruses, Ebola-Reston, is perhaps the most notorious of the hemorrhagic fever viruses, having led to death rates as high as 89% in outbreaks.

A near-100% mortality rate is about as deadly as an infectious agent can be if that’s the measure of “deadly” we’re using.

By Emily Willingham

Image courtesy of Wikimedia Commons


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Patsy Stinchfield Talks Measles

28 11 2011

Patsy Stinchfield, RN, MS, CPNP,  Director of Infectious Diseases at Children’s Hospitals and Clinics, talks measles.

Listen now!

Right-click here to download podcast


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All Hallows Eve

31 10 2011

Behold, it is a dark and thunderous night (but please, no rain, or the toilet paper will be impossible to lob over the tree limbs).

It is—BOM BOM BOM  . . . All Hallows Eve. The night that invites superstition, just as the dawn invites the dew.

What superstitions have we, this 31st of October? Let’s share—

Parents in remote villages in India believe a measles infection indicates a visit from God, and to vaccinate would deprive their child of that visit. They also believe the vaccine will cause the number “666” to appear on their child’s body.

Spitting three times, or saying “pooh, pooh, pooh” after the birth of a healthy baby will, according to some, ward off the evil eye and protect the babe from demons.

Should you want to get back at the kid who stole your cupcake, surreptitiously rubbing a toad on his skin will cause an outbreak of warts (bwahahahahah).

Hordes of healthcare workers believe a full moon brings chaos and disruptive patients to the Emergency Department and that Fridays, particularly Friday the 13th, bring excessive trauma cases and even more chaos. And, should anyone suggest a shift is “quiet,” all of hell will actually break loose.

In parts of Ukraine, mothers will not bathe children infected with chickenpox until all lesions are crusted over, believing it not safe for the child.

A few baseball players believe peeing on their hands will toughen them up (the hands, not the guys). At least one NHL player repeatedly dunked his hockey stick in the toilet to break scoring slumps and another talked to the net posts to make them his friends, believing they would cause opponents’ pucks to bounce off the posts during games.

In Louisiana, a few years back, some believed that a nosebleed could be stopped by putting cobwebs up the nose, yellow paper under the top lip, or by crisscrossing two match sticks in one’s hair and sprinkling salt in the hair. Teething woes were fixed by tying an animal bone or alligator tooth to a string and hanging it around the neck, although garlic in a pouch would do in a pinch.

One can dive deep to find superstitions, or it’s as easy as asking relatives. Superstitions abound, and the magical thinking is practiced by a surprising number of Americans.

Just what do you believe, on this All Hallows Eve? Will you step on a crack, and risk breaking your mother’s back?

By Trish Parnell

Image courtesy of Totally Severe


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Fifth Disease? What About Third or Fourth?

21 07 2011

Last summer, PKIDs’ advice nurse, Dr. Mary Beth, explained what fifth disease is: a viral rash that is tricky to contain because by the time you get the rash, you’re already through the contagious stage.

The rash itself is not painful and most children get through it without any problems, although adults may experience joint pain with this infection.

If a pregnant woman catches it, there is a small risk that the unborn baby will have severe anemia and the woman may have a miscarriage.

It’s also worse for people with sickle cell disease. Their red blood cells can get dangerously depleted during a bout with fifth disease.

Why is this condition known by a number instead of a real name? The vernacular term “slapped cheek syndrome” isn’t too endearing; neither is its scientific moniker, “erythema infectiosum,”  nor “parvovirus B19,” the name of the organism that causes it.

Even “variola” has a certain melodic ring to it, and that (smallpox) was the Chuck Norris of infectious disease.

It turns out that, by old tradition, several of the rashy illnesses of childhood were known by numbers:

  • First disease was measles
  • Second disease was scarlet fever, caused by the same bacterium that causes strep throat
  • Third disease was rubella
  • Fourth was Duke’s disease, which is not a defined disease today
  • Fifth, our friend erythema infectiosum
  • Sixth, roseola—which sounds a lot like rubella and rubeola—is actually caused by a couple of strains of herpes viruses

It seems that, just like squirrels are said to be rats with good PR, the names of the other diseases were relatively euphonious compared to “erythema infectiosum,” and so the rather anonymous “fifth disease” was the name that stuck.

Frankly, the whole rubella-rubeola-roseola conglomerate might be easier to keep straight if each of those diseases were still referred to by number. Maybe it’s time fifth disease got the charming name it’s never had. How about . . . slappacheeka? Rosella? Gwendolyn?

By Ms. Health Department

Image courtesy of http://healthpictures.in/


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Virus Slams Unvaccinated

7 07 2011

A deadly disease is marching its way across the United States and Canada. It’s a disease that infects about 20 million people every year and kills about 200,000. The United States once was a hotbed of infection, seeing almost 900,000 cases of this disease in 1941. But by the 1990s, that number had dropped to fewer than 150 cases annually. Why? Vaccinations.

The disease is measles. It sounds . . . childish, doesn’t it? And people often refer to it as a “childhood disease.” But make no mistake. It’s a virus, one that doesn’t care whom it infects or what tissues it targets, whether brain or lungs. A virus that has a 90% infection rate. A virus that kills children who seem perfectly healthy one day and are dead from lung complications or encephalitis the next. Roald Dahl’s daughter died of measles. Mark Twain almost did. Even though the descriptive “childhood” often accompanies it, there’s nothing remotely childish or casual about this virus. Hospitalization rates are high, and death is not uncommon. In 2005, for example, a total of 311,000 children worldwide died from measles.

And a couple of shots in the arm (or leg) can prevent all of it.

You might think that the outbreak in 2008 would’ve spurred some parents to ensure vaccinations for their children. After all, that year saw more measles cases in the United States than had happened in any year since 1997. Of the people infected, 90% had not been vaccinated or had an unknown vaccination status, according to the Centers for Disease Control and Prevention. Now, this year is well on its way to besting that record and then some.

Some notable facts about this year’s outbreak through May 20, 2011:

  • From 2001 to 2008, a median of 56 measles cases were reported annually to the CDC.
  • During the first 19 weeks of 2011, 118 were reported.
  • 89% of this year’s cases have been linked to import from other countries.
  • About 89% of those who have contracted measles so far have been unvaccinated.
  • 40% of those who have contracted measles in this outbreak have been hospitalized.
  • All but one of the hospitalized patients were unvaccinated (the one vaccinated patient was hospitalized for observation only).
  • Rates of hospitalization have been 52% for children under 5 years and 33% for children over age 5 and for adults.
  • Transmission has occurred in households, childcare centers, shelters, schools, emergency departments, and at a large community event.
  • One outbreak alone in Minnesota has encompassed 21 people so far, including seven infants too young to have been vaccinated.

This virus doesn’t care who you are, how old you are, how healthy you are, whether or not you were breastfed or organically fed or loved beyond all measure. It’s a virus. It kills, with pain and distress. And, it bears repeating, a couple of shots in the arm can stop it.

By Emily Willingham

Image courtesy Wellcome Library, London


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