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Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013

August 3, 2014 Comments off

Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

On August 30, 2013, the Florida Department of Health in Columbia County was notified of a Bordetella pertussis laboratory-positive unimmunized child attending a local charter school (316 students from pre-K through 8th grade) in a large religious community averse to health care and vaccinations. Kindergarten immunization records showed that only five (15%) of 34 students were fully immunized with pertussis-antigen–containing vaccines. In seventh grade, only one (5%) of 22 students was fully immunized with pertussis-antigen–containing vaccines. Of the children who were not fully immunized in these two grades, 84% had religious exemptions (1).

Interviews confirmed that a sibling of the patient had symptoms consistent with pertussis. By September 3, two additional children from the same school were confirmed by polymerase chain reaction to have pertussis. On September 12, the Florida Department of Health in Columbia County declared a communicable disease emergency; children with cough illness were excluded from school, and reentry required an evaluation by a health care provider. After this declaration, 38 additional students were excluded. Prophylaxis or treatment with antibiotics following current guidelines were provided to patients and household contacts (2). The local health department offered to provide these services free of charge to persons without health care coverage. Pertussis vaccine administered at the health department was available; however, fewer than five persons from the community used this opportunity for vaccination.

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

July 14, 2014 Comments off

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis
Source: Environmental Health Perspectives

Background:
Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM2.5 and PM10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence.

Objective:
To provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer.

Methods:
We conducted meta-analyses of studies examining the relationship of exposure to PM2.5 and PM10 with lung cancer incidence and mortality. In total, 18 studies met inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m3 increase in exposure to PM. We used random effects analyses to allow between study variability to contribute to meta-estimates.

Results:
The meta-relative risk (95% CI) for lung cancer associated with PM2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as sub-analyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM2.5 was greatest for former smokers, 1.44 (95% CI: 1.04, 1.22) followed by never smokers, 1.18 (95% CI: 1.00, 1.39), and then current smokers, 1.06 (95% CI: 0.97, 1.15). In addition, meta-estimates for adenocarcinoma associated with PM2.5 and PM10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively.

Conclusion:
The results of these analyses, and the decision of the IARC working group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources.

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits

June 28, 2014 Comments off

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits
Source: Preventing Chronic Disease (CDC)

Introduction
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.

Methods
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.

Results
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.

Conclusions
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.

CDC Travel Notice — MERS in the Arabian Peninsula

May 30, 2014 Comments off

MERS in the Arabian Peninsula
Source: Centers for Disease Control and Prevention

Cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula. There have also been cases in several other countries in travelers who have been to the Arabian Peninsula and, in some instances, their close contacts. Two cases have been confirmed in two health care workers living in Saudi Arabia who were visiting the United States.

CDC does not recommend that travelers change their plans because of MERS. Most instances of person-to-person spread have occurred in health care workers and other close contacts (such as family members and caregivers) of people sick with MERS. If you are concerned about MERS, you should discuss your travel plans with your doctor.

Reducing black carbon emissions from diesel vehicles : impacts, control strategies, and cost-benefit analysis

May 23, 2014 Comments off

Reducing black carbon emissions from diesel vehicles : impacts, control strategies, and cost-benefit analysis
Source: World Bank

A 2013 scientific assessment of black carbon emissions and impacts found that black carbon is second to carbon dioxide in terms of its climate forcing. High concentrations of black carbon in the atmosphere can change precipitation patterns and reduce the amount of radiation that reaches the Earth’s surface, which affects local agriculture. Acute and chronic exposures to particulate matter are associated with a range of diseases, including chronic bronchitis and asthma, as well as premature deaths from cardiopulmonary disease, lung cancer, and acute lower respiratory infections. The transportation sector accounted for approximately 19 percent of global black carbon emissions in the year 2000. This report aims to inform efforts to control black carbon emissions from diesel-based transportation in developing countries. It presents a summary of emissions control approaches from developed countries, while recognizing that developing countries face a number of on-the-ground implementation challenges. This study applies a new cost-benefit analysis methodology to four simulated diesel black carbon emissions control projects – diesel retrofit in Istanbul, green freight (plus retrofit) in Sao Paulo, fuel and vehicle standards in Jakarta, and compressed natural gas (CNG) buses in Cebu taking into account the additional climate benefits of black carbon reductions. While this report focuses on quantifying just the health and climate benefits of transport interventions, it also serves to highlight the challenges that can be faced when undertaking more comprehensive evaluation of transport projects. A cost-benefit framework for economic analysis of diesel black carbon emissions control transport projects is also presented that factors in both climate and health benefits. Historically, technical interventions to control diesel black carbon emissions in developed countries have successfully relied on fuel quality improvements and vehicle emissions standards.

The Cost of Air Pollution: Health Impacts of Road Transport

May 22, 2014 Comments off

The Cost of Air Pollution: Health Impacts of Road Transport
Source: Organisation for Economic Co-operation and Development

Outdoor air pollution kills more than 3 million people across the world every year, and causes health problems from asthma to heart disease for many more. This is costing societies very large amounts in terms of the value of lives lost and ill health. Based on extensive new epidemiological evidence since the 2010 Global Burden of Disease study, and OECD estimates of the Value of Statistical Life, this report provides evidence on the health impacts from air pollution and the related economic costs.

CDC — Middle East Respiratory Syndrome (MERS)

May 12, 2014 Comments off

Middle East Respiratory Syndrome (MERS)
Source: Centers for Disease Control and Prevention

Middle East Respiratory Syndrome (MERS) is viral respiratory illness first reported in Saudi Arabia in 2012. It is caused by a coronavirus called MERS-CoV. Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness. They had fever, cough, and shortness of breath. More than 30% of these people died.

So far, all the cases have been linked to countries in the Arabian Peninsula. This virus has spread from ill people to others through close contact, such as caring for or living with an infected person. However, there is no evidence of sustained spreading in community settings.

On May 2, 2014, the first U.S. case of MERS was confirmed in a traveler from Saudi Arabia to the U.S. The traveler is considered to be fully recovered and has been released from the hospital. Public health officials have contacted healthcare workers, family members, and travelers who had close contact with the patient. At this time, none of these contacts has had evidence of being infected with MERS-CoV.

On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came to the U.S. from Saudi Arabia. This patient is currently hospitalized and doing well. People who had close contact with this patient are being contacted. The two U.S. cases are not linked.

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