Mumps outbreaks in 2016 – highest number in over a decade

mumps outbreaks

Over the past few years, there have been outbreaks of diseases we all assumed had been eradicated – chicken pox, measles, and, more recently, mumps. According to a report from the Centers for Disease Control and Prevention (CDC), there were over 4,000 mumps cases in the USA in 2016. Mumps outbreaks may be the new normal thanks to clusters of unvaccinated kids.

The mumps vaccination program started in 1967 – before that there were about 186,000 cases reported each year (and that number might be low because of underreporting). Once mumps vaccinations were commonplace, the incidence of the disease fell by over 99%. For those who think that better sanitation or whatever caused decreases in diseases, I think that 1967 is fairly recent, and it’s clear that the vaccine itself started the precipitous drop in mumps outbreaks. Since the start of the vaccine era, annual mumps cases in the USA hovered below 1,000 during most years. But over the last 10 years, there has been a noticeable uptick in annual cases, with a high of over 6,000 cases in 2006.

Let’s examine the mumps outbreaks and see what may be the cause. Spoiler alert – expect Andrew Wakefield’s name to appear.

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CDC director Thomas Frieden resigns – time for a Trump appointment

CDC director Thomas Frieden

CDC director Thomas Frieden has announced his resignation from his position at the Centers for Disease Control and Prevention. The federal agency’s main goal is to protect public health and safety through the control and prevention of disease, injury, and disability across the world. And our favorite anti-science president-elect, Donald Trump, will appoint his successor.

The agency focuses its attention on infectious disease control partially through advocacy for vaccines. The staff of 15,000 scientists, researchers, physicians, and US Public Health Services commissioned officers, are dedicated to investigating infectious diseases, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and public health educational activities – all are designed to help improve the health of Americans and people across the world.

CDC officials are often the first responders to ground zero of dangerous infections. They are generally the first scientists who determine the proper course of treatment for novel diseases, while monitoring its spread across a geographic area. They are warriors in the fight against diseases across the world, including Zika virus and many others.

A significant part of the CDC’s mission involves attacking public health problems globally. In today’s interconnected world, a disease that shows it’s ugly head in an isolated village in the Amazon can be transported to a major city in another country in less than 36 hours. This take money. And this takes manpower.

Let’s take a look at the career of CDC director Thomas Frieden, and the potential consequences of a Donald Trump appointee to the position.  Continue reading “CDC director Thomas Frieden resigns – time for a Trump appointment”

HHS nominee Tom Price and a radical right-wing physician organization

Tom Price HHS nominee

Recently, president-elect Donald Trump nominated Georgia congressman Tom Price to be Secretary for Health and Human Services (HHS). Price is a medical doctor whose impact on politics has been almost exclusively based on his unwavering opposition to the Affordable Care Act, known as Obamacare.

Once Trump was elected, along with a Republican Senate and House, most of us in healthcare knew that Obamacare was probably doomed. I don’t think it will be easy for the Republicans, now that they’re in power, to actually dismantle Obamacare, especially some of the more popular provisions such as elimination of the pre-existing conditions as a disqualification for receiving health insurance.

Also, there are over 20 million Americans who have taken advantage of health insurance from Obamacare, and I think it would be almost impossible for the Republicans to cut them off. But I may be delusional about the limits of Republican dislike of poorer Americans.

Setting aside healthcare insurance, what else may be impacted by Tom Price? Well, the Department of Health and Human Services is responsible for many of the important health care institutions that matter to me and my readers. Some of the major institutions under the HHS umbrella are:

  • The National Institutes of Health (NIH) – the nucleus of biomedical and health-related research in the USA. Much of the research at NIH, which has an impressive world-wide reputation, serves as the foundation of much of what we know about human health and disease.
  • The Centers for Disease Control and Prevention (CDC) – if you are a reader of this website and blog for the past 5 years, you know I, and many others, have tremendous respect for the CDC. It functions as the frontline, first responders if you will, for any disease that appears in the world. It is made up of some of the leading scientists, public health specialists, and thought leaders in healthcare, who give their careers to help humanity. And, of course, they set vaccine policy for this country. The CDC has tremendous influence on public health across the globe.
  • The Food and Drug Administration (FDA) – the primary regulator of pharmaceuticals, medical devices, food, diagnostics, supplements, and many other areas, it is one of the most powerful agencies in the world for protecting the health of consumers.
  • The Centers for Medicare and Medicaid Services (CMS) – the federal agency that administers the Medicare program along with advising the states on Medicaid and other public health care programs.

Tom Price will have significant influence on much of the science of medicine, let alone the financing of health care in the USA. There is one thing in Price’s background that give us some significant insight as to how he’ll run his department – let’s just say, it’s not good. Yeah, none of us of would have predicted this.

Continue reading “HHS nominee Tom Price and a radical right-wing physician organization”

Prevent Zika virus with GMO mosquitoes – Frankensquito returns

Prevent Zika virus – female

Over the past few months, the Zika virus, a mosquito borne disease that is passed from the mother to the developing fetus, has become the focus of a lot of attention because of the danger it poses to the fetus. There are no vaccines or treatments for the virus, so the best we can do is stop the carrier, two species of the Aedes mosquito. Probably the best way to prevent Zika virus spread is with genetically modified mosquitoes, the Frankensquito.

Even though mosquitoes are the main way to be stricken with the Zika virus, it is even crazier than that. Men and women who contract the disease can then transmit it sexually to their partners. So even those who are nowhere near the Zika carrying mosquitoes may be at risk of getting the virus.

Recently, there have been numerous cases of Zika virus infection in  south Florida, and, because of the lack of effective preventative vaccines and treatments, public health officials have looked at other methods to prevent Zika virus. The most effective way is to eliminate the carriers of this virus, mosquitoes.

I have written several articles about these GMO mosquitoes, but that had been with regards to preventing Dengue fever, also a dangerous mosquito carried disease. But just like the “outcry” with the Frankensquito and Dengue fever, we’re hearing almost the same nonsense with respect to Zika virus. Let’s look at the scientific facts, with the hope that some will see the importance of prevention.

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Gun control regulations and firearms mortality

Gun control regulations and public health.

Firearms mortality, either murder, accidental or suicide, has always been a public health issue in the USA. There have been several good epidemiological studies that have examined whether gun control regulations and firearms mortality risk are related – and the results are surprisingly vigorous.

From recent epidemiological research, there is some convincing evidence that establishes a correlation between state-level gun control regulations and firearms mortality rates. However, the link is not as black and white as one might wish – the relationship between firearms regulations and mortality depends on the quality of the law.

The nation’s leading public health organization, the Centers for Disease Control and Prevention (CDC), is essentially prevented from analyzing and publishing any epidemiological research that would help us understand what, if any, links there are between gun control and firearms mortality. The Republican dominated congress have done everything they can to prevent the CDC from using any funds to study the issue.

Furthermore, because the CDC cannot (or will not) fund research into gun control, it has lead to a chilling effect on gun control research in academia. According to the Washington Post, “young academics were warned that joining the field was a good way to kill their careers. And the odd gun study that got published went through linguistic gymnastics to hide any connection to firearms.”

But maybe because this public health menace can no longer be ignored, a smattering of well done epidemiological research is being published in very high quality medical journals. Let’s look at one.

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Water fluoridation benefits and risks – a systematic review

Water fluoridation has become a fairly common public health practice, as communities across the world accepted the evidence that fluoridated water is relatively safe and reduces cavities (known properly as dental caries). Several decades ago, it became a part of the public health strategy in many communities.

However, as fluoride became more available, especially in the forms in toothpaste and various mouthwashes, it has become time to review water fluoridation benefits and risks – especially as it becomes one of those “things” that cause concerns with the public.

As I’ve mentioned literally a few hundred times in this blog, the very highest level of research is a meta (or systematic) review, which tries to identify, appraise, select and synthesize all high quality research evidence relevant to a particular question or hypothesis in medicine. Systematic reviews of high-quality randomized controlled trials are critical pieces of evidence that forms the basis of science-based healthcare.

Systematic reviews are best when they select hundreds or even thousands of research studies over decades of clinical studies, eliminating studies with bias (or pointing out the bias), and combining data from the best of the best. Now it’s time to look at one of the newer meta-reviews regarding water fluoridation benefits and risks from the Cochrane Collaboration, probably the premiere group that produce systematic reviews.

Using data from a wide variety of resources (from clinical trials to peer-reviewed studies to recommendations from public health organizations), the Cochrane Collaboration attempts to find the best and least biased data to answer a question. In case you’re wondering who is this “Cochrane,” they are either a group of brilliant scientists trying to provide better data for medicine or dentistry. Or they’re a cabal of evil wizards, hiding from the world in a dungeon in one of Big Pharma’s creepy castles in New Jersey. My guess it’s the former. Continue reading “Water fluoridation benefits and risks – a systematic review”

Vaccine Informed Consent, Mandates and Liability

I would need informed consent if my physician was trying to inject 25 cc of fluid through a huge needle. In other words, typical of stock photos, they get it all wrong.
I would need informed consent if my physician was trying to inject 25 cc of fluid through a huge needle. In other words, typical of stock photos, they get it all wrong.

Updated 27 February 2015.

This article was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law in San Francisco, CA. 

Dr. Reiss writes extensively in law journals about the social and legal policies of vaccination. She is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

Several people have asked me whether having school mandates is in tension with the idea of informed consent. The answer is no. While school mandates have some effect on parental autonomy, the doctrine of informed consent should not be conflated with autonomy.

For a somewhat different reason, imposing sanctions on those who do not vaccinate is also not a violation of informed consent. Continue reading “Vaccine Informed Consent, Mandates and Liability”

Poll–Mandatory vaccination and informed consent

kirk-and-spock-needs-quote

Professor Dorit Reiss has written another wonderful article here clarifying that there really is a lack of conflict between so-called “informed consent” and public health mandates to keep citizens (especially children) safe from infectious diseases. It could not be clearer (at least to me) that informed consent does not trump the needs of the greater good.

In the Star Trek Movie, the Wrath of Khan, Spock and Kirk had this conversation:

Spock: Do not grieve, Admiral. It is logical. The needs of the many, outweigh…
Kirk: The needs of the few.
Spock: Or the one.

So here’s a poll. Vote early. Vote often.


Mandatory flu vaccinations for health care workers

Nosocomial infections, or hospital acquired infections, are a significant issue in hospital environments and has become a serious public health issue. These infections include everything from drug resistant bacteria to several viruses, including the flu.  They have serious repercussions in a hospital environment–everything from employee absenteeism to higher mortality rates of patients.  For example, influenza, which has a reputation of being innocuous, can be dangerous to infants, the elderly and immune compromised patients.  Further, a flu outbreak can leave a hospital short-staffed with sick nurses, techs and physicians, making it more difficult to deal with the outbreak itself. Continue reading “Mandatory flu vaccinations for health care workers”

No whooping cough deaths in California in 2011

The California Department of Public Health announced this week that there were no whooping cough (pertussis) deaths in California for the first time in 20 years, although there were still over 3000 cases of the infection identified in the state.  As a comparison, there 9000 cases and 10 deaths in 2010 in California.  The state worked closely with hospitals, schools, doctors and clinics to get more people vaccinated against whooping cough, a bacterial infection that afflicts the respiratory system.  Despite the myths that whooping cough is harmless, pertussis can be dangerous to infants because they cannot be fully vaccinated until they are six months old.

Despite the protestations, denialism and disinformation from the anti-vaccination gang, this is evidence of how vaccinations can have a positive impact on the public.