Most everyone is familiar with the term ‘meningitis.’ We know it refers to an infection in the fluid and linings surrounding the brain and we know it can be deadly. We also know meningitis is potentially contagious. Beyond that, our understanding of meningitis is cloudy. And we generally tend to fear things we don’t understand, especially those things that are contagious and deadly, right? So let’s explore the mystery that is meningitis with the expectation we can turn fear into understanding.
Meningitis does indeed describe an infection of the fluid surrounding the brain and the spinal cord. Many types of bacteria, viruses, and fungi can be responsible for the infection. They all seem to cause a fever with severe headache and stiff neck. Fungal infections are rare and occur most commonly in people with impaired immune systems. Viral infections, while uncomfortable, tend to resolve on their own and without specific treatment. Bacterial causes of meningitis, on the other hand, are a big worry as they can cause major disability and death.
There are three main causes of bacterial meningitis and each will be explained below.
Pneumococcal meningitis is caused by the bacterium Streptococcus pneumoniae, also called ‘The Pneumococcus’. It is the most common cause of meningitis in newborns and in infants. Cases of meningitis due to pneumococcus, at one time quite common, have been drastically reduced through the use of a vaccine called Prevnar given to infants at 2, 4 and 6 months of age. Meningitis caused by S. pneumoniae is rarely contagious.
Hemophilus meningitis is caused by the bacterium Haemophilus infuenzae type b, also known as ‘Hib.’ Prior to the widespread use of Hib vaccine, H. influenzae was the most common cause of meningitis in children up to 5 years of age and used to be the most frequent cause of acquired deafness in children. Although extremely rare now, Hemophilus meningitis is contagious and is a significant risk to un-immunized children.
Meningococcal meningitis is caused by the bacterium Neisseria meningitidis, also referred to as the ‘The Meningococcus’ bacteria. N. meningitidis is a frequent cause of meningitis in infants and the main cause of meningitis in older children and young adults. It is often associated with outbreaks or clusters of meningitis illness in schools, camps, and large gatherings of people. Although meningococcal meningitis is quite rare, occurring at a rate of less than one case per 100,000 people per year, it causes severe disability and often death. The low rate of illness due to meningococcus is surprising, especially considering the fact that at any given time, 5 to 10 percent of the population may carry meningococcus in their nose and throat. Meningococcus is contagious, being spread from person to person by the exchange of saliva.
A vaccine is available for the prevention of disease due to most strains of N. meningitidis. It is routinely recommended for children in the 11-12 year old age range and for entering college students who have not previously been vaccinated. The vaccine is relatively ineffective for children under 2 years of age. The duration of immunity from the meningococcal vaccine, perhaps lasting only 3-5 years, is also fairly low compared to other vaccines.
Meningitis, from any cause, is rare in Whitman County. Unfortunately, in the last four months there have been two cases of illness due to N. meningitidis. Both cases occurred in first year Washington State University students and both were the same Type Y strain. It is unusual to have two cases of meningococcal disease in a year, let alone two cases of the same type over a 4 month period. But even more mysterious is that both students were vaccinated against meningococcal meningitis only three years ago.
The threshold for declaring an outbreak or epidemic of meningococcal illness is three cases occurring in three months in a well defined population like a school or a university. Two cases in four months falls short of meeting this definition, but it is cause for concern nonetheless.
In response to the recent cases of meningococcal disease, WSU has initiated a campaign to make students more aware of the signs and symptoms of meningitis. Students are asked to take steps to limit the transmission of bacteria from person to person through frequent hand washing and avoidance of sharing items like cups, water bottles, eating utensils and smoking materials. WSU officials, in concert with the Whitman County Health Department, are also encouraging students to consider vaccination as an additional measure to reduce the chance of infection. See the WSU Health and Wellness page for more information (http://hws.wsu.ed/default.asp?PageID=4927).
Meningitis may still be a mystery in some respects, but we can protect ourselves by getting the appropriate vaccination at the right time, knowing the signs and symptoms of meningitis, and adopting simple hygienic measures. For more information on meningitis, contact the Whitman County Health Department or visit these excellent web resources:
http://www.cdc.gov/meningitis/index.html
http://www.doh.wa.gov/cfh/immunize/diseases/meningitis/default.htm
http://www.meningitisfoundationofamerica.org/templates/
Thursday, January 20, 2011
Tuesday, November 2, 2010
No Ordinary Cough
Pertussis, or Whooping Cough, is making a comeback. All states on the West Coast have seen record setting numbers of cases this past year, with over a dozen deaths occurring in California just this past summer. Whitman County has recorded several cases this year, and counties around Whitman have also seen increased numbers of pertussis.
Pertussis is a bacterial disease that causes severe inflammation and narrowing in the respiratory passages. It usually begins with a runny nose and a mild cough, but after a week or two of fairly mild illness, symptoms get much worse. The cough becomes severe, often occurring in prolonged fits or spasms that make it hard to breathe. A characteristic inspiratory “whoop” may be heard after these coughing spells. The bronchial narrowing and inflammation caused by pertussis may be life threatening in children with small airways, especially those under one year of age.
Pertussis is spread easily between people as it is carried on respiratory droplets created during coughing or sneezing. At the beginning of last century, pertussis was a common illness that caused untold amounts of suffering and death. With the advent of a safe and effective vaccine, pertussis was nearly eliminated as a threat to health.
Infants are immunized for pertussis at two, four, and six months of age as part of the Diphtheria, Tetanus and acellular Pertussis vaccine (DTaP). Even with three shots, immunity is only partial and two more shots are given before school entry to ensure complete coverage. Immunity from DTaP wears off with time however, and a booster shot (Tetanus, diphtheria and acellular pertussis or ‘Tdap’) is needed by age 11 to keep pertussis at bay.
All adults age 18 and over should also get a pertussis booster (Tdap) one time in place of a regular tetanus booster (‘Td’), especially if they work or live with children or infants. That’s because adults can harbor pertussis bacteria in their throat and transmit it to susceptible persons. It doesn’t matter when your last tetanus booster was given; you can receive Tdap now. Ask your doctor or public health office if you are unsure of your immunization status or the immunization status of your family members.
Pregnant women should get a Tdap booster immediately after delivery in order to protect their baby prior to the initiation of the DTaP series. Adult family members of pregnant women should get a Tdap now. Adults over the age of 65 who take care of small children should talk to their medical provider about receiving a Tdap booster too (currently, the Tdap is only FDA licensed for persons under age 65).
For further information on pertussis vaccine, check the CDC website at: http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm
As always, we welcome your comments or questions.
Pertussis is a bacterial disease that causes severe inflammation and narrowing in the respiratory passages. It usually begins with a runny nose and a mild cough, but after a week or two of fairly mild illness, symptoms get much worse. The cough becomes severe, often occurring in prolonged fits or spasms that make it hard to breathe. A characteristic inspiratory “whoop” may be heard after these coughing spells. The bronchial narrowing and inflammation caused by pertussis may be life threatening in children with small airways, especially those under one year of age.
Pertussis is spread easily between people as it is carried on respiratory droplets created during coughing or sneezing. At the beginning of last century, pertussis was a common illness that caused untold amounts of suffering and death. With the advent of a safe and effective vaccine, pertussis was nearly eliminated as a threat to health.
Infants are immunized for pertussis at two, four, and six months of age as part of the Diphtheria, Tetanus and acellular Pertussis vaccine (DTaP). Even with three shots, immunity is only partial and two more shots are given before school entry to ensure complete coverage. Immunity from DTaP wears off with time however, and a booster shot (Tetanus, diphtheria and acellular pertussis or ‘Tdap’) is needed by age 11 to keep pertussis at bay.
All adults age 18 and over should also get a pertussis booster (Tdap) one time in place of a regular tetanus booster (‘Td’), especially if they work or live with children or infants. That’s because adults can harbor pertussis bacteria in their throat and transmit it to susceptible persons. It doesn’t matter when your last tetanus booster was given; you can receive Tdap now. Ask your doctor or public health office if you are unsure of your immunization status or the immunization status of your family members.
Pregnant women should get a Tdap booster immediately after delivery in order to protect their baby prior to the initiation of the DTaP series. Adult family members of pregnant women should get a Tdap now. Adults over the age of 65 who take care of small children should talk to their medical provider about receiving a Tdap booster too (currently, the Tdap is only FDA licensed for persons under age 65).
For further information on pertussis vaccine, check the CDC website at: http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm
As always, we welcome your comments or questions.
Thursday, September 2, 2010
Happy Anniversary H1N1
One year ago this week, as we were welcoming students back to WSU and celebrating our local legume at the Lentil Festival in Pullman, H1N1 Influenza made a full frontal assault on the population of Whitman County. Besides sickening thousands of students in the first few weeks of school, then spreading to the community at large, H1N1 Influenza nearly brought local clinics, emergency rooms and the public health department to the breaking point. Health care providers resorted to using a triage system in an attempt to keep H1N1 infected patients away from well patients, and the health department scrambled to find ways to stop the spread of this new flu virus while the prospect of an effective vaccine was still several months away. The fear we had for the safety and well being of ourselves, our friends and our families was extreme and was real.
What a difference a year makes. Our encounter with H1N1 Influenza is now nothing more than a distant, bad memory. And with the exception of pockets of flu in New Zealand and India, the Great Influenza Pandemic of 2009 appears to be over.
Or is it? Plenty of folks were affected by H1N1 flu last year, but many were not. Those who were lucky enough to avoid the flu last Fall constitute a sizable reservoir for another wave of illness. No one knows if the H1N1 flu virus is capable of causing another epidemic surge this year and, frankly, we aren’t really eager to find out.
This Fall, though, we have a safe and reliable way to make sure H1N1 doesn’t come back. It’s called seasonal flu vaccine. That’s right; the same flu vaccine we use every Fall has been reformulated to provide protection against H1N1 Influenza, and it is recommended for everyone six months of age and older.
Actually, seasonal flu vaccine is reformulated nearly every year. It contains three strains of flu virus; two are Influenza A and one is Influenza B. Every Summer, scientists review the data available regarding the most common flu viruses circulating in the Southern Hemisphere and make recommendations regarding the strains to be included in this year’s seasonal flu vaccine. Because last year’s H1N1 flu virus has been the predominant Influenza A strain in circulation around the world, it was naturally selected to be a component for this year’s seasonal flu vaccine.
Studies have shown that both seasonal flu vaccine and the H1N1 flu vaccine developed last year are extraordinarily safe and effective. The seasonal flu vaccine available for use this year, with the H1N1 component included, is made with the same methods and at the same facilities in which seasonal vaccine is made every year. Some vaccine will be available in nasal spray form for use in healthy, non-pregnant individuals age 2 to age 50 while other, preservative-free, vaccine will be made available for pregnant women and young children. It is the same flu vaccine we are used to receiving every year, but this one protects against the pandemic causing H1N1 strain.
Seasonal flu vaccine is currently being shipped to clinics and pharmacies and should be available soon. The public health department will probably begin offering flu vaccine sometime in mid-September. While the Centers for Disease Control and Prevention recommends that everyone over 6 months of age be vaccinated, the groups that are especially urged to get the vaccine are young children, pregnant women, people over age 65, and individuals with chronic medical conditions because they are at greater risk for severe complications from the flu. Keep checking this blog or the website of the Whitman County Health Department for updates on vaccine availability.
We welcome your questions and wish you a Fall and Winter free of worries about Influenza.
What a difference a year makes. Our encounter with H1N1 Influenza is now nothing more than a distant, bad memory. And with the exception of pockets of flu in New Zealand and India, the Great Influenza Pandemic of 2009 appears to be over.
Or is it? Plenty of folks were affected by H1N1 flu last year, but many were not. Those who were lucky enough to avoid the flu last Fall constitute a sizable reservoir for another wave of illness. No one knows if the H1N1 flu virus is capable of causing another epidemic surge this year and, frankly, we aren’t really eager to find out.
This Fall, though, we have a safe and reliable way to make sure H1N1 doesn’t come back. It’s called seasonal flu vaccine. That’s right; the same flu vaccine we use every Fall has been reformulated to provide protection against H1N1 Influenza, and it is recommended for everyone six months of age and older.
Actually, seasonal flu vaccine is reformulated nearly every year. It contains three strains of flu virus; two are Influenza A and one is Influenza B. Every Summer, scientists review the data available regarding the most common flu viruses circulating in the Southern Hemisphere and make recommendations regarding the strains to be included in this year’s seasonal flu vaccine. Because last year’s H1N1 flu virus has been the predominant Influenza A strain in circulation around the world, it was naturally selected to be a component for this year’s seasonal flu vaccine.
Studies have shown that both seasonal flu vaccine and the H1N1 flu vaccine developed last year are extraordinarily safe and effective. The seasonal flu vaccine available for use this year, with the H1N1 component included, is made with the same methods and at the same facilities in which seasonal vaccine is made every year. Some vaccine will be available in nasal spray form for use in healthy, non-pregnant individuals age 2 to age 50 while other, preservative-free, vaccine will be made available for pregnant women and young children. It is the same flu vaccine we are used to receiving every year, but this one protects against the pandemic causing H1N1 strain.
Seasonal flu vaccine is currently being shipped to clinics and pharmacies and should be available soon. The public health department will probably begin offering flu vaccine sometime in mid-September. While the Centers for Disease Control and Prevention recommends that everyone over 6 months of age be vaccinated, the groups that are especially urged to get the vaccine are young children, pregnant women, people over age 65, and individuals with chronic medical conditions because they are at greater risk for severe complications from the flu. Keep checking this blog or the website of the Whitman County Health Department for updates on vaccine availability.
We welcome your questions and wish you a Fall and Winter free of worries about Influenza.
Friday, April 9, 2010
Public Health Week 2010
This week, April 5-8, 2010, is National Public Health Week. That probably doesn’t excite most of you and it is unlikely there will be any parades or celebrations in support of Public Health locally. However, in just the last week every Whitman County resident received in the mail a publication titled “County Health Rankings 2010.” It was a report produced by the Robert Wood Johnson Foundation in conjunction with the University of Wisconsin Population Health Institute*. In terms of premature death and disability, Whitman County was ranked the third healthiest county in the State of Washington. Now that is a big deal and it definitely deserves to be celebrated.
It also deserves to be explained. What makes Whitman County so special?
The factors leading to longevity and good health go well beyond how many health care providers and hospitals a county has (In fact, Whitman County ranks dead last in that category). Instead, good health is mostly a product of our education, our income, our behaviors, and our environment (natural and man-made). So much of our health destiny is related to where we live that epidemiologists can predict with a high degree of certainty the average life span of any person based on location of residence alone. That’s because our social environment is a huge determinant of our educational achievement, our choice of occupation, and our health behaviors.
There isn’t any reason to think our number three ranking in health outcomes is related to better water, safer food, or cleaner air here in Whitman County. We aren’t much different from our neighboring counties in those respects. After agriculture, Whitman County’s biggest industry is education and one of our biggest exports is educated individuals. That’s the real reason we are so healthy. Add in other attributes such as income, employment, social support, and community safety, and Whitman County ranks number one in the State in terms of social and economic factors related to good health.
So where does Public Health fit in? One hundred years ago, the leading causes of death in the US were all related to infectious disease. Typhoid, measles, dysentery, diphtheria, polio, whooping cough, pneumonia and tuberculosis were very common. We were lucky to live long enough to make it into adulthood. The primary reason we don’t worry about much about these illnesses any more is due to the advancements in Public Health science and the diligence of public health workers. Immunization has nearly eliminated 12 serious childhood diseases. Water treatment makes drinking from the tap a no-risk endeavor. Standards for food safety and air quality let us dine with gusto and breathe with ease.
Most of the threats to our health in this century are due to our individual lifestyle choices. We choose whether or not to eat right, to engage in physical exercise, to smoke cigarettes, and on and on. Public policies, like requirements for immunization, seat-belt use, or sewage disposal, have an enormous impact on our collective and individual health. Most of these regulations are well supported, both by science and the public. And we could probably make laws regulating every health choice one has, but then we would end up with what has been aptly named the “Nanny State.” No one wants that kind of control.
Whitman County is a prime example of how to create healthy communities the right way. Education is the answer. The better informed we are, the more likely we are to make choices that enhance our own health and well being as well as the health and well being of our children. Healthy communities, after all, begin with healthy individuals.
The Whitman County Health Department is here to inform you about the cause, nature and prevention of disease and disability, and to preserve, promote and protect the health of all county residents. Let us know if we can help you. And celebrate with us the good health we all enjoy in Whitman County during National Public Health Week 2010.
* http://www.countyhealthrankings.org/sites/default/files/states/CHR2010_WA.pdf
It also deserves to be explained. What makes Whitman County so special?
The factors leading to longevity and good health go well beyond how many health care providers and hospitals a county has (In fact, Whitman County ranks dead last in that category). Instead, good health is mostly a product of our education, our income, our behaviors, and our environment (natural and man-made). So much of our health destiny is related to where we live that epidemiologists can predict with a high degree of certainty the average life span of any person based on location of residence alone. That’s because our social environment is a huge determinant of our educational achievement, our choice of occupation, and our health behaviors.
There isn’t any reason to think our number three ranking in health outcomes is related to better water, safer food, or cleaner air here in Whitman County. We aren’t much different from our neighboring counties in those respects. After agriculture, Whitman County’s biggest industry is education and one of our biggest exports is educated individuals. That’s the real reason we are so healthy. Add in other attributes such as income, employment, social support, and community safety, and Whitman County ranks number one in the State in terms of social and economic factors related to good health.
So where does Public Health fit in? One hundred years ago, the leading causes of death in the US were all related to infectious disease. Typhoid, measles, dysentery, diphtheria, polio, whooping cough, pneumonia and tuberculosis were very common. We were lucky to live long enough to make it into adulthood. The primary reason we don’t worry about much about these illnesses any more is due to the advancements in Public Health science and the diligence of public health workers. Immunization has nearly eliminated 12 serious childhood diseases. Water treatment makes drinking from the tap a no-risk endeavor. Standards for food safety and air quality let us dine with gusto and breathe with ease.
Most of the threats to our health in this century are due to our individual lifestyle choices. We choose whether or not to eat right, to engage in physical exercise, to smoke cigarettes, and on and on. Public policies, like requirements for immunization, seat-belt use, or sewage disposal, have an enormous impact on our collective and individual health. Most of these regulations are well supported, both by science and the public. And we could probably make laws regulating every health choice one has, but then we would end up with what has been aptly named the “Nanny State.” No one wants that kind of control.
Whitman County is a prime example of how to create healthy communities the right way. Education is the answer. The better informed we are, the more likely we are to make choices that enhance our own health and well being as well as the health and well being of our children. Healthy communities, after all, begin with healthy individuals.
The Whitman County Health Department is here to inform you about the cause, nature and prevention of disease and disability, and to preserve, promote and protect the health of all county residents. Let us know if we can help you. And celebrate with us the good health we all enjoy in Whitman County during National Public Health Week 2010.
* http://www.countyhealthrankings.org/sites/default/files/states/CHR2010_WA.pdf
Wednesday, January 20, 2010
Active Living by Design
Twin epidemics of obesity and type 2 diabetes continue unabated in the US, while we search for causes and solutions. The abundance of low cost, high calorie, low nutrient food has certainly been a contributor. But so too has been our lack of physical activity. Our automobile-centric society has all but done away with an activity that only one century ago we did without a second thought: walking.
Dependence and preference for personal vehicle transportation co-evolved with the way we design our cities and towns. A priority consideration behind most housing and commercial developments is car accessibility. Typically, all other modes of transport and movement are clearly subordinate. Or they are completely ignored. Getting a new street put in for driving convenience is relatively easy. A pedestrian or bicycle path takes years of effort and countless fund raisers on the part of motivated citizens.
Automobile usage also tends to be self reinforcing. Take the relatively recent phenomenon of most children being driven to school by their parents. For a number of arguable reasons, parents perceive an increased safety hazard for their children as they walk to school. School buses, once the preferred conveyance for children, are now considered by many parents to be less than what their child deserves socially and some erroneously think buses are risky transportation. So more kids than ever get a ride to school.
The result is more traffic, more congestion, and increased risk to walking children. In some cities, studies show that 20 percent or more of the morning rush hour traffic is due to parents driving children to school.
It doesn’t need to be this way. What if we considered making community development “health promoting,” instead of “car convenient?” Many U.S cities have demonstrated that active living principals can be easily incorporated in community planning and design. Examples include Portland, Omaha, Buffalo and Orlando, to name just a few. They have implemented programs that provide safe routes for children to walk to school, paths for pedestrians and bicyclists to commute to work, and easily accessible parks. Additionally, they have created comprehensive plans that emphasize the importance of active living design in future development so that physical activity can become a part of our everyday routine, not just an add-on bit of exercise.
In the last 20 years, Pullman has come a long way toward creating a more active living environment. The Pullman trail system, the Chipman Trail, and the continuing work of the Pullman Civic Trust are a testament to that. But much more needs to be done to make Pullman a place where the environment actually encourages human powered transportation and makes physical activity more convenient than car use.
The current development on Bishop Boulevard demonstrates how little we currently plan for pedestrian or bicycle access in Pullman. There is not a single pedestrian crosswalk or stoplight on Bishop between south Grand Avenue and the bridge near the Professional Mall, even though multiple businesses are located on both sides of the street. There are no real bike lanes. And folks in the Bishop Place area need to take a car to reach the Pullman Care Community, which is directly across the street! This situation will only get worse with the arrival of further commercial development along Bishop Blvd.
To be fair, the Pullman’s Comprehensive Plan recognizes the importance of pedestrian and bicycle paths, but only in the context of alternate transportation: not in promoting health or livability. This should change. The livability of our community will only be enhanced by planning for, and designing in, those features that make an active lifestyle possible and even convenient. In fact, Pullman should and can become a model city for these values. Such a choice is marketable to more like-minded citizens settling here and could be a model for small town sustainable planning.
Dependence and preference for personal vehicle transportation co-evolved with the way we design our cities and towns. A priority consideration behind most housing and commercial developments is car accessibility. Typically, all other modes of transport and movement are clearly subordinate. Or they are completely ignored. Getting a new street put in for driving convenience is relatively easy. A pedestrian or bicycle path takes years of effort and countless fund raisers on the part of motivated citizens.
Automobile usage also tends to be self reinforcing. Take the relatively recent phenomenon of most children being driven to school by their parents. For a number of arguable reasons, parents perceive an increased safety hazard for their children as they walk to school. School buses, once the preferred conveyance for children, are now considered by many parents to be less than what their child deserves socially and some erroneously think buses are risky transportation. So more kids than ever get a ride to school.
The result is more traffic, more congestion, and increased risk to walking children. In some cities, studies show that 20 percent or more of the morning rush hour traffic is due to parents driving children to school.
It doesn’t need to be this way. What if we considered making community development “health promoting,” instead of “car convenient?” Many U.S cities have demonstrated that active living principals can be easily incorporated in community planning and design. Examples include Portland, Omaha, Buffalo and Orlando, to name just a few. They have implemented programs that provide safe routes for children to walk to school, paths for pedestrians and bicyclists to commute to work, and easily accessible parks. Additionally, they have created comprehensive plans that emphasize the importance of active living design in future development so that physical activity can become a part of our everyday routine, not just an add-on bit of exercise.
In the last 20 years, Pullman has come a long way toward creating a more active living environment. The Pullman trail system, the Chipman Trail, and the continuing work of the Pullman Civic Trust are a testament to that. But much more needs to be done to make Pullman a place where the environment actually encourages human powered transportation and makes physical activity more convenient than car use.
The current development on Bishop Boulevard demonstrates how little we currently plan for pedestrian or bicycle access in Pullman. There is not a single pedestrian crosswalk or stoplight on Bishop between south Grand Avenue and the bridge near the Professional Mall, even though multiple businesses are located on both sides of the street. There are no real bike lanes. And folks in the Bishop Place area need to take a car to reach the Pullman Care Community, which is directly across the street! This situation will only get worse with the arrival of further commercial development along Bishop Blvd.
To be fair, the Pullman’s Comprehensive Plan recognizes the importance of pedestrian and bicycle paths, but only in the context of alternate transportation: not in promoting health or livability. This should change. The livability of our community will only be enhanced by planning for, and designing in, those features that make an active lifestyle possible and even convenient. In fact, Pullman should and can become a model city for these values. Such a choice is marketable to more like-minded citizens settling here and could be a model for small town sustainable planning.
Tuesday, January 5, 2010
H1N1: A Pandemic in Review
Some folks say the recent pandemic of H1N1 (“Swine Flu”) influenza was no big deal; just a product of media hype and overzealous public health officials. Others think we dodged a bullet because the H1N1 pandemic was not as bad as it could have been. And others say the H1N1 pandemic was an unmitigated disaster due to pointless school closings, poor governmental communication, overstressed medical care facilities, inexplicable delays in vaccine production and delivery, and many lives lost.
Actually, everybody’s right.
H1N1 arrived in the US in April amidst considerable alarm and panic. A new influenza virus prompted swift action by public health and governmental officials. Schools were closed, travel warnings were issued and flu-fighting medicines were shipped from the federal stockpile to the nation’s public health departments. In Mexico, initial mortality rates from this new flu looked high. Worldwide media went into overdrive covering every flu-related topic they could find.
The pork industry lost hundreds of millions of dollars because the new flu was thoughtlessly called the “Swine Flu.” Personal and business travel to Mexico was eliminated or put on hold. Surgical masks were sold out. Calls were made for quarantines and fever scanners at airports. After a month or so, coinciding with the public school summer recess, the first wave of H1N1 flu ended.
But H1N1 did not go away. It continued along during the summer months at a slow rate, giving CDC epidemiologists time to produce a vaccine and refine H1N1 prevention and treatment guidelines. Review of the first several thousand cases of H1N1 showed it to be no more life-threatening than regular seasonal flu. This was good news. H1N1 was not the “killer” pandemic many scientists had been expecting. But in contrast to seasonal flu, which causes the highest mortality in people over 65, H1N1 was disproportionately affecting children, pregnant women, and adults under 60 with chronic diseases.
Knowing H1N1 flu activity would increase again later in the fall, officials from public health, public schools and hospitals got busy making preparations for flu prevention and treatment, as well as planning for an H1N1 vaccine arriving by mid-October.
What we overlooked is pathogens like H1N1 are on their own time schedule and don’t wait for a vaccine. Universities with late August starts found that school convened with an unwelcome visitor.
Washington State University was one of the hardest hit by H1N1 with the first case identified three days before classes started. By the end of the second week of classes, more than 2000 students had flu-like symptoms.
Thankfully, most people infected with H1N1 had a fairly mild disease. Nevertheless, health care providers were inundated with flu sufferers. Hospitals resorted to triaging patients with mild illness and no risk factors away from their Emergency Rooms so staff could cope, resources could be reserved for those who really needed them, and the spread of infection reduced. Many clinics and urgent care facilities were seriously stressed for several weeks. One wonders what would have happened had H1N1 been a more severe illness.
The speed at which H1N1 spread was truly impressive. WSU's experience demonstrated how explosive a new flu could be in a population where 100 percent were susceptible. Many public schools were caught off guard as H1N1 caused absenteeism rates up to 40 percent, canceling classes as well as athletic contests. In Whitman County, Washington, even rural school districts were impacted following a “Teen Mixer” dance at the County Fair.
By the end of September and into early October, the H1N1 epidemic was on the wane locally. The rest of the state was at least a month behind as H1N1 reached a peak toward the end of October, gradually subsiding to rates similar to what was seen over the summer by the end of November. Since September, 1357 hospitalizations and 71 deaths attributed to H1N1 have been reported in Washington. The hospitalization rate was highest among children 0-4 years of age while the death rate was highest among adults 50-64 years old.
By the time vaccine arrived in any useful quantity, the second wave of H1N1 was nearly over. The delay caused extreme frustration to providers and patients alike. Despite this fact, nearly a million doses of vaccine were distributed statewide. In Whitman County, about 1,000 doses were given at the Public Health Department while an additional 6,000 doses were distributed to hospitals, clinics and pharmacies. Further public interest in receiving the vaccine has essentially evaporated even though we are unsure if H1N1 has a third act waiting for us later this winter.
In retrospect, we were very fortunate. Believe it or not, H1N1 spread much faster and with greater fury than the 1918 influenza pandemic. But H1N1 influenza was a much milder disease than the flu in 1918, at least to those of us who survived it. As such, it served well as a sort of “training pandemic” for public health and other governmental officials. We now know what parts of our influenza pandemic plan work well, which don’t, and what needs improvement. We found out that, even under ideal circumstances (instant recognition, immediate vaccine production, and ideal distribution), we lack the technology to crank out vaccine soon enough and in sufficient quantities to avert a disaster if we truly face a deadly flu.
Beefing up our response plans for the next influenza pandemic is reasonable. However, it is foolish to assume we can prepare for a flu pandemic like the historic 1918 outbreak. Our health care system was taken to the breaking point with H1N1; a relatively mild flu . We don’t have enough beds, enough ventilators, enough anti-viral medicines, or enough doctors and nurses to handle anything like the Great Influenza of 1918. More importantly our society can’t afford to have massive surpluses of highly trained people and materiel on hand “just in case.”
The only way to rationally respond to the next “killer” flu pandemic is to prevent it entirely. Current flu vaccines are produced with the new flu virus strain after it has been identified. We then grow the virus in chicken eggs for vaccine production. As H1N1 showed us, the 1950s era technology is ineffective. Our strain specific vaccines also become less effective if the virus mutates much. Constant genetic changes are the reason we need to get a seasonal flu shot annually to maintain effective immunity.
What if we could develop an effective vaccine that acted on the parts of the flu virus that don’t change or mutate? This could result in a “universal” flu vaccine that prevents illness from strains of influenza circulating now, and new ones that may emerge in the future; even “killer” strains.
The idea of a universal flu vaccine is doable. Some researchers are already testing candidate vaccines and other diseases are being eliminated using the same strategies. Influenza vaccine researchers should be supported, encouraged, and most of all funded with the lion’s share of influenza pandemic planning resources. We can prepare for managing and surviving the next flu pandemic all we want. But a much better strategy is to prevent it from happening so that, in the future, we will ask, what was the flu like back when you were young and we still got it?
Actually, everybody’s right.
H1N1 arrived in the US in April amidst considerable alarm and panic. A new influenza virus prompted swift action by public health and governmental officials. Schools were closed, travel warnings were issued and flu-fighting medicines were shipped from the federal stockpile to the nation’s public health departments. In Mexico, initial mortality rates from this new flu looked high. Worldwide media went into overdrive covering every flu-related topic they could find.
The pork industry lost hundreds of millions of dollars because the new flu was thoughtlessly called the “Swine Flu.” Personal and business travel to Mexico was eliminated or put on hold. Surgical masks were sold out. Calls were made for quarantines and fever scanners at airports. After a month or so, coinciding with the public school summer recess, the first wave of H1N1 flu ended.
But H1N1 did not go away. It continued along during the summer months at a slow rate, giving CDC epidemiologists time to produce a vaccine and refine H1N1 prevention and treatment guidelines. Review of the first several thousand cases of H1N1 showed it to be no more life-threatening than regular seasonal flu. This was good news. H1N1 was not the “killer” pandemic many scientists had been expecting. But in contrast to seasonal flu, which causes the highest mortality in people over 65, H1N1 was disproportionately affecting children, pregnant women, and adults under 60 with chronic diseases.
Knowing H1N1 flu activity would increase again later in the fall, officials from public health, public schools and hospitals got busy making preparations for flu prevention and treatment, as well as planning for an H1N1 vaccine arriving by mid-October.
What we overlooked is pathogens like H1N1 are on their own time schedule and don’t wait for a vaccine. Universities with late August starts found that school convened with an unwelcome visitor.
Washington State University was one of the hardest hit by H1N1 with the first case identified three days before classes started. By the end of the second week of classes, more than 2000 students had flu-like symptoms.
Thankfully, most people infected with H1N1 had a fairly mild disease. Nevertheless, health care providers were inundated with flu sufferers. Hospitals resorted to triaging patients with mild illness and no risk factors away from their Emergency Rooms so staff could cope, resources could be reserved for those who really needed them, and the spread of infection reduced. Many clinics and urgent care facilities were seriously stressed for several weeks. One wonders what would have happened had H1N1 been a more severe illness.
The speed at which H1N1 spread was truly impressive. WSU's experience demonstrated how explosive a new flu could be in a population where 100 percent were susceptible. Many public schools were caught off guard as H1N1 caused absenteeism rates up to 40 percent, canceling classes as well as athletic contests. In Whitman County, Washington, even rural school districts were impacted following a “Teen Mixer” dance at the County Fair.
By the end of September and into early October, the H1N1 epidemic was on the wane locally. The rest of the state was at least a month behind as H1N1 reached a peak toward the end of October, gradually subsiding to rates similar to what was seen over the summer by the end of November. Since September, 1357 hospitalizations and 71 deaths attributed to H1N1 have been reported in Washington. The hospitalization rate was highest among children 0-4 years of age while the death rate was highest among adults 50-64 years old.
By the time vaccine arrived in any useful quantity, the second wave of H1N1 was nearly over. The delay caused extreme frustration to providers and patients alike. Despite this fact, nearly a million doses of vaccine were distributed statewide. In Whitman County, about 1,000 doses were given at the Public Health Department while an additional 6,000 doses were distributed to hospitals, clinics and pharmacies. Further public interest in receiving the vaccine has essentially evaporated even though we are unsure if H1N1 has a third act waiting for us later this winter.
In retrospect, we were very fortunate. Believe it or not, H1N1 spread much faster and with greater fury than the 1918 influenza pandemic. But H1N1 influenza was a much milder disease than the flu in 1918, at least to those of us who survived it. As such, it served well as a sort of “training pandemic” for public health and other governmental officials. We now know what parts of our influenza pandemic plan work well, which don’t, and what needs improvement. We found out that, even under ideal circumstances (instant recognition, immediate vaccine production, and ideal distribution), we lack the technology to crank out vaccine soon enough and in sufficient quantities to avert a disaster if we truly face a deadly flu.
Beefing up our response plans for the next influenza pandemic is reasonable. However, it is foolish to assume we can prepare for a flu pandemic like the historic 1918 outbreak. Our health care system was taken to the breaking point with H1N1; a relatively mild flu . We don’t have enough beds, enough ventilators, enough anti-viral medicines, or enough doctors and nurses to handle anything like the Great Influenza of 1918. More importantly our society can’t afford to have massive surpluses of highly trained people and materiel on hand “just in case.”
The only way to rationally respond to the next “killer” flu pandemic is to prevent it entirely. Current flu vaccines are produced with the new flu virus strain after it has been identified. We then grow the virus in chicken eggs for vaccine production. As H1N1 showed us, the 1950s era technology is ineffective. Our strain specific vaccines also become less effective if the virus mutates much. Constant genetic changes are the reason we need to get a seasonal flu shot annually to maintain effective immunity.
What if we could develop an effective vaccine that acted on the parts of the flu virus that don’t change or mutate? This could result in a “universal” flu vaccine that prevents illness from strains of influenza circulating now, and new ones that may emerge in the future; even “killer” strains.
The idea of a universal flu vaccine is doable. Some researchers are already testing candidate vaccines and other diseases are being eliminated using the same strategies. Influenza vaccine researchers should be supported, encouraged, and most of all funded with the lion’s share of influenza pandemic planning resources. We can prepare for managing and surviving the next flu pandemic all we want. But a much better strategy is to prevent it from happening so that, in the future, we will ask, what was the flu like back when you were young and we still got it?
Monday, December 14, 2009
The Wait is Over
As of Monday, December 14, the Whitman County Health Department now has enough H1N1 vaccine to lift any restrictions on who may receive it. Most other health departments in our area have also lifted restrictions now that vaccine supplies are adequate.
In Whitman County, we will be distributing vaccine to physician offices and pharmacies that are interested in giving the vaccine. Special clinics will be conducted at the offices of the Health Department, and, for WSU faculty and staff, immunization clinics will be held at the WSU Health and Wellness Service clinic on Wednesday, Thursday and Friday from 1-5 pm.
H1N1 vaccine is now available to anyone over the age of 6 months. Vaccination is especially encouraged for anyone with a chronic medical condition, pregnant women, children 6 months to 2 years of age, everyone 65 years of age or older, and parents/care givers of children under 6 months of age.
H1N1 vaccine is available in several formulations. Preservative free injectable vaccine is reserved for young children and pregnant women. The nasal spray formulation is for healthy people age 2 to 49. Injectable vaccine with preservative is best for anyone with chronic health problems and folks age 50 and up.
The safety of the H1N1 vaccine has been excellent, with a rate of reactions/complications less than what we typically see with seasonal influenza vaccine. The most common reaction is soreness at the injection site.
If you are interested in getting the vaccine, this would be a good time to receive it. It takes about 10 days after immunization for immunity to build up. People who are traveling over the holidays should get the vaccine now to ensure protection.
Although it appears we are well past the peak of the H1N1 influenza epidemic around the country, there is a possibility of a resurgence or 'third wave' later in the winter. It is impossible to predict. Get the vaccine now and you won't need to worry about it.
Stay tuned for a more complete review of the H1N1 outbreak in a coming blog post.
Call the Whitman County Health Department (Colfax 509-397-6280, Pullman 509-332-6752, or the Flu Line 877-783-0039) or visit our website (www.WhitmanCounty.org/PublicHealth) for more information.
In Whitman County, we will be distributing vaccine to physician offices and pharmacies that are interested in giving the vaccine. Special clinics will be conducted at the offices of the Health Department, and, for WSU faculty and staff, immunization clinics will be held at the WSU Health and Wellness Service clinic on Wednesday, Thursday and Friday from 1-5 pm.
H1N1 vaccine is now available to anyone over the age of 6 months. Vaccination is especially encouraged for anyone with a chronic medical condition, pregnant women, children 6 months to 2 years of age, everyone 65 years of age or older, and parents/care givers of children under 6 months of age.
H1N1 vaccine is available in several formulations. Preservative free injectable vaccine is reserved for young children and pregnant women. The nasal spray formulation is for healthy people age 2 to 49. Injectable vaccine with preservative is best for anyone with chronic health problems and folks age 50 and up.
The safety of the H1N1 vaccine has been excellent, with a rate of reactions/complications less than what we typically see with seasonal influenza vaccine. The most common reaction is soreness at the injection site.
If you are interested in getting the vaccine, this would be a good time to receive it. It takes about 10 days after immunization for immunity to build up. People who are traveling over the holidays should get the vaccine now to ensure protection.
Although it appears we are well past the peak of the H1N1 influenza epidemic around the country, there is a possibility of a resurgence or 'third wave' later in the winter. It is impossible to predict. Get the vaccine now and you won't need to worry about it.
Stay tuned for a more complete review of the H1N1 outbreak in a coming blog post.
Call the Whitman County Health Department (Colfax 509-397-6280, Pullman 509-332-6752, or the Flu Line 877-783-0039) or visit our website (www.WhitmanCounty.org/PublicHealth) for more information.
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