CDC Publication on Vulnerable Populations

by Michael Sheyahshe

During any significant event - catastrophic or otherwise - first responders, community groups, and many other public health individuals will most likely encounter individuals from vulnerable populations; populations that exhibit specific needs based on "age, class, race, poverty, language, and a host of other social, cultural, economic, and psychological factors." Such encounters are especially pertinent here in Oklahoma, considering our Native American community makes up almost 8% of the state's total population (see image below for more detail).

To assist in preparing the public health community, the Center for Disease Control and Preventions (CDC) has published the "2006-2007 ASPH/CDC Vulnerable Populations Collaboration Group Preparedness Resource Kit," available online at:

http://preparedness.asph.org/documents/VulnerablePopulations.pdf

After being appointed to one of the CDC's Collaboration Group that focused on Vulnerable Populations, I was fortunate enough co-author this important document along with many other Public Health leaders from academic institutions around the nation. I chaired the committee on Ethnic and Cultural Minority Populations, which produced that section within the publication.

Individuals within the Public Health field and especially those first responders that will most likely encounter such populations are urged to review this Resource Kit to foster learning and enable improved effective response for such groups in future events.

Source: US Census FactFinder for Oklahoma

OVERVIEW: Effectively Using Virtual Simulations

Government Technology reports about the emerging use of virtual simulations (read that: "video games") for effective training in the Public Health arena.

The article ("Virtual Worlds Help Public Safety Officials Practice for Real-Life Threats") outlines simulation use by California Department of Health Services, in conjunction with the University of California-Davis Health System; U.S. Department of Defense; Telemedicine and Advanced Technology Research Center; Duke University School of Medicine; the Emergency Management Training, Analysis and Simulation Center (EMTASC); and Virginia Emergency Response Team Exercise.

In short, the article outlines how more and more institutions are implementing virtual 3D simulations to help facilitate and supplement effective training and education with Public Health in mind.

See the article at: http://www.govtech.com/gt/261426?topic=117677.

FEMA Plans Trailer Exodus Over Chemical

By MICHAEL KUNZELMAN (AP)

NEW ORLEANS (AP) - After downplaying the risks for months, the Federal Emergency Management Agency said Thursday it will rush to move Gulf Coast hurricane victims out of roughly 35,000 government-issued trailers because tests found dangerous levels of formaldehyde fumes.
FEMA Administrator R. David Paulison said the agency hopes to get everyone out and into hotels, motels, apartments and other temporary housing by the summer, when the heat and stuffy air could worsen the problem inside the trailers.
"The real issue is not what it will cost but how fast we can move people out," he said.
The Centers for Disease Control and Prevention said fumes from 519 tested trailers and mobile homes in Louisiana and Mississippi were, on average, about five times what people are exposed to in most modern homes. Formaldehyde, a preservative commonly used in construction materials, can lead to breathing problems and is also believed to cause cancer.
The findings stirred worry and anger across the Gulf Coast, where FEMA is already a dirty word and housing has been scarce since Hurricanes Katrina and Rita struck in 2005.
"Am I angry at FEMA? Of course I am. They should have started moving people out of these trailers once they first started finding problems," said Lynette Hooks, 48. She said that since she began living in her trailer outside her damaged New Orleans home in October 2006, she has suffered headaches and sinus problems, in addition to the asthma she had before.
The CDC findings could also have disturbing implications for the safety of other trailers and mobile homes across the country, Homeland Security Secretary Michael Chertoff said on Capitol Hill on Thursday. But the CDC study did not look beyond the FEMA housing.
Paulison vowed that the agency will never again use the flimsy, cramped travel trailers to shelter victims of disasters. Mobile homes are generally roomier than trailers and considered less susceptible to buildups of fumes.
FEMA will press ahead with plans to supply leftover, never-used mobile homes from the twin disasters to victims of last week's tornadoes in the South, Paulison said. But the mobile homes will be opened up, aired out and tested first, he said.
The formaldehyde levels in some trailers were found to be high enough to cause breathing problems in children, the elderly or people who already have respiratory trouble, CDC Director Dr. Julie Gerberding said. About 5 percent had levels high enough to cause breathing problems even in people who do not ordinarily have respiratory trouble, she said.
Gerberding said the tests could not draw a direct link between formaldehyde levels and the wide range of ailments reported by trailer occupants. But the CDC urged people to move out as quickly as possible.
As early as 2006, trailer occupants began reporting headaches, nosebleeds and difficulty breathing.
But as recently as last spring, a FEMA spokesman said the agency said no reason to question the safety of its trailers. Just last month, congressional investigators accused FEMA of suppressing and manipulating scientific research to play down the danger - an accusation the agency denied.
"I don't understand why FEMA bought trailers in the first place that were dangerous," said Henry Alexander, 60, who has been living in a trailer since February 2006. "You would hope they would test them for formaldehyde before." He said he was "very angry" that another agency had to step forward and say they were a health risk.
(AP) In a file photo FEMA trailers that are being used for housing for University of New Orleans...Full Image Chertoff said at a Senate committee hearing that the government has trying since last summer to prod people to move out of the trailers, but it has been difficult to get them to do so because the housing shortage means they might have to move far away, and because they are being allowed to live in the trailers rent-free.
Louisiana has 25,162 occupied FEMA trailers and mobile homes, while Mississippi has 10,362, according to FEMA. Other states also have hundreds of trailers. At one point, FEMA had placed victims of the 2005 hurricanes in more than 144,000 trailers and mobile homes.
Paulison had no estimate of how much it would cost to put people in hotels, apartments and other housing.
Formaldehyde has been classified as a carcinogen by the International Agency for Research on Cancer and a probable carcinogen by the U.S. Environmental Protection Agency. Fumes can cause burning of the eyes and nose, shortness of breath, wheezing, coughing and tightness in the chest.
The CDC examined only FEMA housing and cannot draw any conclusions about the safety of prefab homes elsewhere, Gerberding said. But "I think we're going to learn a lot more in the next year or two," she said after a news conference at FEMA offices in New Orleans.
"It seems like I have had more respiratory problems since I have been in the trailer," Roger Sheldon, 60, said in Pascagoula, Miss. But he was not ready to blame formaldehyde "You know you can walk into any new trailer, or house for that matter, and things like new carpet can cause irritation."
"To be honest, I'm thankful to the government," he added. "I don't like the trailer, but it beats the alternative for now."
With housing still in short supply - 80 percent of New Orleans was flooded, the pace of rebuilding has been slow, and rents are out of reach for many - Ernest Penns of the devastated Lower Ninth Ward said he, too, was grateful for his trailer: "I got nowhere else to go."
---
Associated Press writers John Moreno Gonzales in New Orleans, Kathy Hanrahan and Emily Wagster-Pettus in Jackson, Miss., Eileen Sullivan in Washington and Mike Stobbe in Atlanta contributed to this story.

See this story at http://apnews.excite.com/article/20080215/D8UQH9P80.html

CDC: Too Few Adults Get Their Vaccines

By LAURAN NEERGAARD
WASHINGTON (AP) - Vaccines aren't just for kids, but far too few grown-ups are rolling up their sleeves, disappointed federal health officials reported Wednesday.
The numbers of newly vaccinated are surprisingly low, considering how much public attention a trio of new shots - which protect against shingles, whooping cough and cervical cancer - received in recent years.
Yet many seem to have missed, or forgotten, the news: A survey by the National Foundation for Infectious Diseases found that aside from the flu, most adults have trouble even naming diseases that they could prevent with a simple inoculation.
"We really need to get beyond the mentality that vaccines are for kids. Vaccines are for everybody," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention, who called the new data sobering. "We obviously have a lot more work to do."
The new CDC report found:
Only about 2 percent of Americans ages 60 and older received a vaccine against shingles in its first year of sales.
There are more than 1 million new cases a year of shingles, an excruciating rite of aging that causes a blistering skin rash. Up to 200,000 of them develop a complication, severe nerve pain that can last for months or even years. Anyone who ever had chickenpox is at risk, especially once they hit their 60s, because the chickenpox virus hibernates for decades in nerve cells until erupting again.
"Many people describe the shingles pain as the worst pain they've ever endured," said Dr. Michael Oxman of the University of California, San Diego.
The shingles vaccine, Merck & Co. (MRK)'s Zostavax, isn't perfect, but it cuts in half the risk of shingles - and those who still get it have a much milder case.
About 2 percent of adults ages 18 to 64 got a booster shot against whooping cough in the two years since it hit the market.
The cough so strong it can break a rib is making a big comeback, because the vaccine given to babies and toddlers starts wearing off by adolescence. Older patients usually recover, but whooping cough can cause weeks of misery. Worse, those people can easily spread the illness to not-yet-vaccinated infants, who can die from the bacterial infection, also called pertussis.
The pertussis booster was added to another long-recommended shot, a booster against tetanus and diphtheria that adults should get every 10 years. The new triple combo is called "Tdap." Sanofi-Aventis's Adacel brand is for ages 11 to 64. There also is a version for 10- to 18-year-olds, GlaxoSmithKline's Boostrix.
About 10 percent of women ages 18 to 26 have received at least one dose of a three-shot series that protects against the human papillomavirus, or HPV, that causes cervical cancer.
There are more than 100 different types of HPV, the most prevalent sexually transmitted infection. Usually, the body gets rid of HPV without symptoms. But certain high-risk strains can persist and cause genital warts or cervical cancer.
The vaccine, Merck's Gardasil, protects against four of those high-risk types. That's not complete protection - so even the vaccinated still need regular Pap smears - but those strains are responsible for about 72 percent of cervical cancer and 90 percent of genital warts, said Dr. Stanley Gall of the American College of Obstetricians and Gynecologists.
Stay tuned: The government is considering whether even more women should get the vaccine - those up to age 45 who aren't yet infected, Gall said. And studies are under way to see if it works in men.
Price may play a role in these low vaccination rates. The shingles shot costs around $150, and the three-shot HPV vaccine about $300, and insurance coverage varies. There's no national program to guarantee access for adults who can't afford vaccines as there is for child vaccines.
But adults aren't taking full advantage of some cheap old standby vaccines, either. Among people 65 or older, a high-risk age, CDC found only 69 percent get an annual flu shot; just 66 percent have had a one-time pneumonia vaccine; and 44 percent had received a tetanus shot in the past 10 years.
It's not too late for a flu shot this year - and Oxman urged getting some of the other adult shots in the same doctor visit.
See the full story at: Excite News - CDC: Too Few Adults Get Their Vaccines

More Info on OK's Readiness

source: NewsOK.com

by Jeff Raymond, Staff Writer

Oklahoma has sustained disaster readiness but falls short in protecting healthcare providers from being sued and in the number of elderly who receive flu vaccines, according to a national report released Tuesday that measures states' public-health preparedness.

In its fifth-annual report, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism – 2007,” Washington-based Trust for America’s Health found states have made significant progress but gaps remain.

Click HERE for the full article.

Some States Not Planning for Flu Season

(source: Excite News)
By KEVIN FREKING, Assoc. Press

WASHINGTON (AP) - Seven states have yet to participate in a federal program to buy antivirals for a potential influenza pandemic. Thirteen states do not have adequate plans to distribute vaccines and medical supplies from the Strategic National Stockpile.

Those findings and others are part of a new report on how well states have prepared for public health emergencies. The report concluded that states have made significant progress since the terrorist and anthrax attacks in 2001. However, critical gaps remain.

Seven states performed adequately in each of the 10 categories that were measured, which earned them a score of 10 from the Trust for America's Health, a research group. The top scores went to Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee and Virginia.
The states that got the lowest score were Arkansas, Iowa, Mississippi, Nevada, Wisconsin and Wyoming. The federal government has had a difficult time measuring progress when it comes to the billions of dollars it has sent states over the past six years to improve preparedness. The money went to upgrade laboratories, buy medical supplies and conduct training exercises.

The Bush administration has encouraged states to stock up on antivirals in the event of an influenza pandemic. Under one program, the federal government will pay for a quarter of the cost of buying Tamiflu or Relenza, and states pay the remainder for a combined investment of about $680 million. Antivirals reduce the severity of influenza.

Seven states have so far declined to purchase any antivirals, according to the report: Colorado, Connecticut, Florida, Massachusetts, Mississippi, North Dakota and Rhode Island. Several more have bought only a fraction of what they're entitled to under the federal program.

"If a significant number of states don't pick up their share of responsibility, then the country as a whole is less protected," said Jeffrey Levi, executive director of Trust for America's Health.

A spokesman for the Department of Health and Human Services said that states have until June 2008 to get their orders in. All states, have told the federal government they plan on participating, he said. However, many have only ordered part of the medicine that's available to them.

"States that are not buying the full amount of antivirals we have allocated under this program are putting their own citizen at risk," said HHS Spokesman Bill Hall.

The report also highlighted the need for nearly half the states to update their "Good Samaritan" laws. Such laws create liability shields for those who come to the aid of another at the scene of an emergency. The trust said states need shield laws that can cover days or even weeks of voluntary work, such as a shield law tied to a declared emergency by a governor.

The report also warned that a decrease in federal funding could offset many of the improvements that states have made since 2001.

Among the other categories measured, the report said
- Flu vaccination rates for the elderly dropped in 11 states.
- Six states cut their public health department budgets last year.
- All 50 states and the District of Columbia held emergency drills with their health department and state National Guard.
- Twenty-one states do not have key liability protections for health care volunteers who respond to emergencies.

On the Net: Trust for America's Health: http://healthyamericans.org/

New MRSA Article in PHR

contributed by Paul Woodson, Ph.D.

January/February 2008 Issue of PHR Features Methicillin-resistant Staphylococcus aureus (MRSA) in Practice Article

"A Model for Surveillance of Methicillin-Resistant Staphylococcus Aureus," by authors Ms. Hannah Simons and Dr. Philip Alcabes appears in the "Practice Articles" section of the first 2008 issue of Public Health Reports. The article addresses methicillin-resistant Staphylococcus aureus (MRSA) as a community pathogen and attempts to distinguish the differences between community-associated and hospital-associated MRSA strains. Some of these differences include distinct methicillin resistance genes and genetic backgrounds and differing susceptibilities to antibiotics. The best methods for population-level detection and containment of these strains have not yet been established.

Find out more HERE.