Showing posts with label CDC. Show all posts
Showing posts with label CDC. Show all posts

Friday, May 11, 2018

MMWR: Access to Syringe Services Programs — Kentucky, North Carolina, and West Virginia, 2013–2017

Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report (MMWR)
Weekly / May 11, 2018 / 67(18);529–532

Access to Syringe Services Programs — Kentucky, North Carolina, and West Virginia, 2013–2017
Danae Bixler, MD1; Greg Corby-Lee2; Scott Proescholdbell, MPH3; Tina Ramirez4; Michael E. Kilkenny, MD5; Matt LaRocco6; Robert Childs, MPH7; Michael R. Brumage, MD4; Angela D. Settle, DNP8; Eyasu H. Teshale, MD1; Alice Asher, PhD


The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013-August 1, 2017. State-level data on the number of SSPs, client visits, and services offered were collected by each state through surveys of SSPs and aggregated in a standard format for this report. In 2013, one SSP operated in a free clinic in West Virginia, and SSPs were illegal in Kentucky and North Carolina; by August 2017, SSPs had been legalized in Kentucky and North Carolina, and 53 SSPs operated in the three states. In many cases, SSPs provide integrated services to address hepatitis and human immunodeficiency virus (HIV) infection, overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of IDU. Prioritizing development of SSPs with sufficient capacity, particularly in states with counties vulnerable to epidemics of hepatitis and HIV infection related to IDU, can expand access to care for populations at risk.

Discussion 
During 2013–2017, the number of operational SSPs increased from one to approximately 50 in Kentucky, North Carolina, and West Virginia. Visits to SSPs by clients who inject drugs also increased. In Kentucky and North Carolina, this increase followed changes in laws permitting access to sterile injecting supplies; in West Virginia, SSPs were never prohibited under state law. In North Carolina, any group can start an SSP after notifying the state health department; Kentucky requires a lengthy approval process for local health departments before offering syringe services. This paper demonstrates that increasing access to SSPs is possible with community support using a variety of models if SSPs are not prohibited by law.

The increase in client visits to SSPs by persons who inject drugs represents an unprecedented opportunity to improve access to care for this highly stigmatized population. In addition to increased access to sterile needles, syringes, and injection paraphernalia (5), comprehensive syringe services programs should also improve access to medication-assisted treatment, counseling, and social support to address substance use disorder (6); naloxone and lay naloxone training to prevent fatal overdose (7); the full range of contraceptives, including long acting reversible contraceptives to prevent unintended opioid-exposed pregnancy; prenatal care and medication-assisted treatment to reduce harm from substance use disorder in pregnant women and their infants (8); vaccination; and HCV, HIV, and hepatitis B virus (HBV) screening and treatment (5). State and local health departments that are actively addressing the health effects of the opioid crisis might consider a formal evaluation process to improve service quality and access for persons who inject drugs, including those attending SSPs. Process evaluation indicators for SSPs should include number of clients, number of syringes distributed, number of syringes returned, availability of services in hours per week, summary statistics on HIV, HBV, and HCV testing, and number and type of services (e.g., patient-centered family planning services and naloxone) and referrals provided (e.g., medication assisted treatment, prenatal care, HIV, and hepatitis treatment) (9). Evaluation should also include health indicators such as rates of hepatitis, HIV, fatal and nonfatal overdose, unintended pregnancy and neonatal abstinence syndrome, and initiation and retention in drug treatment. CDC has published a framework to guide evaluation of public health programs (10), which might be useful for evaluating access to essential services at the community level for persons who inject drugs.

The findings in this report are subject to at least six limitations. First, data were self-reported from SSPs and are therefore subject to bias. Second, because some programs do not collect identifying information, the total numbers of clients served is estimated. Third, at the time of this analysis, North Carolina was in its first year of implementation, and limited data are available. Fourth, no data were obtained for SSPs operating underground (i.e., outside the legal framework). Fifth, growth of SSPs and service integration in these states is rapid, and the most recent data on SSPs should be sought through the state or local health department or harm reduction coalition. Finally, these data cannot be used to evaluate quality of service delivery and whether service delivery is adequate to meet the needs of the population.

SSPs can be implemented through a variety of models and by a variety of agencies and organizations including those in rural areas. Demand for syringe services is growing rapidly in these three states with underserved populations of persons who inject drugs, representing an opportunity to implement, evaluate, and improve access to evidence-based services known to reduce the considerable morbidity and mortality associated with injection drug use.

Full report -  https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a5.htm?s_cid=mm6718a5_w

Friday, December 22, 2017

Opioid crisis trims U.S. life expectancy, boosts hepatitis C: CDC

CDC Reports - Mortality in the United States, 2016
This report presents final 2016 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns among U.S. residents by variables such as sex, race and ethnicity, and cause of death. Life expectancy estimates, age-specific death rates, age-adjusted death rates by race and ethnicity and sex, 10 leading causes of death, and 10 leading causes of infant death were analyzed by comparing 2016 and 2015 final data

In 2016, a total of 2,744,248 resident deaths were registered in the United States—31,618 more deaths than in 2015. From 2015 to 2016, the age-adjusted death rate for the total population decreased 0.6%, but life expectancy at birth decreased 0.1 year. Age-specific death rates between 2015 and 2016 increased for younger age groups and decreased for older age groups. The age-adjusted death rate decreased for non-Hispanic white females and increased for non-Hispanic black males.

The 10 leading causes of death in 2016 remained the same as in 2015, although two causes exchanged ranks. Unintentional injuries, the fourth leading cause in 2015, became the third leading cause in 2016, while chronic lower respiratory diseases, the third leading cause in 2015, became the fourth leading cause in 2016. Age-adjusted death rates decreased for seven leading causes and increased for three. Life expectancy at birth decreased 0.1 year from 78.7 years in 2015 to 78.6 in 2016, largely because of increases in mortality from unintentional injuries, suicide, and Alzheimer’s disease, with unintentional injuries making the largest contribution. This is the second year in a row life expectancy has declined (1). Changes in death rates at younger ages have a larger impact on life expectancy than changes at older ages. The increases in death rates at the younger ages from 2015 to 2016 resulted in the decrease in life expectancy observed during that period.

In 2016, a total of 23,161 deaths occurred in children under age 1 year, which was 294 fewer infant deaths than in 2015. The leading causes of infant death were the same in 2016 and 2015. The only significant change among the 10 leading causes of infant death was a 7.3% decrease in the IMR for maternal complications.

Key findings
Data from the National Vital Statistics System
- Life expectancy for the U.S. population in 2016 was 78.6 years, a decrease of 0.1 year from 2015.
- The age-adjusted death rate decreased by 0.6% from 733.1 deaths per 100,000 standard population in 2015 to 728.8 in 2016.
- Age-specific death rates between 2015 and 2016 increased for younger age groups and decreased for older age groups.
- The 10 leading causes of death in 2016 remained the same as in 2015, although unintentional injuries became the third leading cause, while chronic lower respiratory diseases became the fourth.
- The infant mortality rate of 587.0 infant deaths per 100,000 live births in 2016 was not significantly different from the 2015 rate.
- The 10 leading causes of infant death in 2016 remained the same as in 2015.
This report updates statistics on deaths from drug overdoses in the United States and includes information on trends since 1999 as well as key findings for 2016.

The rates of drug overdose deaths continued to increase. In 2016, the age-adjusted rate of drug overdose deaths (19.8 per 100,000) was more than three times the rate in 1999 (6.1). Rates increased for both males (from 8.2 in 1999 to 26.2 in 2016) and females (from 3.9 in 1999 to 13.4 in 2016). Rates also increased for all age groups studied. In 2016, among persons aged 15 and over, rates were highest for adults aged 25–34, 35–44, and 45–54, at about 35 per 100,000. From 2015 to 2016, drug overdose death rates increased 28% for persons aged 15–24, 29% for persons aged 25–34, 24% for persons aged 35–44, 15% for persons aged 45–54, 17% for persons aged 55–64, and 7% for persons aged 65 and over. In 2016, 22 states and the District of Columbia had age-adjusted drug overdose death rates that were statistically higher than the national rate; 5 states had rates that were comparable to the national rate; and 23 states had lower rates.

The pattern of drugs involved in drug overdose deaths has changed in recent years. The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled in a single year from 3.1 per 100,000 in 2015 to 6.2 in 2016. Rates of drug overdose deaths involving heroin increased from 4.1 in 2015 to 4.9 in 2016. Rates of drug overdose deaths involving natural and semisynthetic opioids increased from 3.9 in 2015 to 4.4 in 2016.

Key findings 
Data from the National Vital Statistics System, Mortality
- In 2016, there were more than 63,600 drug overdose deaths in the United States.
- The age-adjusted rate of drug overdose deaths in 2016 (19.8 per 100,000) was 21% higher than the rate in 2015 (16.3).
- Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had the highest rates of drug overdose deaths in 2016 at around 35 per 100,000.
- West Virginia (52.0 per 100,000), Ohio (39.1), New Hampshire (39.0), the District of Columbia (38.8), and Pennsylvania (37.9) had the highest observed age-adjusted drug overdose death rates in 2016.
- The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled between 2015 and 2016, from 3.1 to 6.2 per 100,000.
Read More

Media
Opioid crisis trims U.S. life expectancy, boosts hepatitis C: CDC
Julie Steenhuysen
CHICAGO (Reuters) - The opioid crisis is rippling through the U.S. healthcare system, causing a spike in rates of hepatitis C related to increased opioid injections and reducing overall life expectancy among Americans, which has fallen for the second year in a row, U.S. health officials said on Thursday. Researchers used a national database that tracks substance abuse admissions to treatment facilities in all 50 U.S. states. They found a 133 percent increase in acute hepatitis C cases that coincided with a 93 percent increase in admissions for opioid injection between 2004 to 2014.

By Nick Wing
A new report shows back-to-back years of declining life expectancy, and the CDC says a third straight year appears to be on the way.
The average American life expectancy ticked downward for the second straight year in 2016, on the back of surging drug overdose deaths, according to data released Thursday by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. And while the nation hasn’t experienced a back-to-back drop in life expectancy since the 1960s, the CDC says the opioid crisis is shaping up to extend this decline for a third consecutive year, a milestone that hasn’t been seen since the Spanish flu pandemic in 1918.

Thursday, October 5, 2017

October Audio and Teleconference Transcript: Obesity and Cancer

Recommended Reading
Editorial - Lancet
The US Centers for Disease Control and Prevention released a new report on cancer and obesity last week, highlighting that cancers associated with overweight and obesity, including thyroid, liver, kidney, and ovarian cancer, constitute 40% of cancers diagnosed in the USA, with over 630 000 diagnoses in 2014 alone.... 

Obesity, hepatitis C epidemics drive ‘alarming’ increase in liver cancer incidence, mortality
HemOnc Today, October 10, 2017
A SEER analysis published this summer revealed staggering statistics about liver cancer in the United States. Incidence has increased steadily since the mid-1970s, and…

Vital Signs - October Teleconference Transcript: Obesity and Cancer

Overweight and Obesity are Associated with Cancer




CDC Telebriefing: New Vital Signs Report – Why is the overall cancer rate declining, while cancer rates associated with overweight and obesity are on the rise?

Tuesday, October 3, 2017

Listen here
Audio recording

Press Briefing Transcript
Please Note: This transcript is not edited and may contain errors.

OPERATOR: Good afternoon and thank you for standing by. As a reminder, today’s conference call is being recorded. If you have any objections, please disconnect at this time. Your lines have been placed in listen only mode until the Q&A session of today’s conference. At that time, you may press star followed by the number one to ask a question. I would now like to turn the conference over to your moderator, Kathy Harben. Thank you, you may begin.

KATHY HARBEN: Thank you, Michelle. Thank you, everyone, for joining us today for the release of a new CDC Vital Signs. We are joined today by CDC’s deputy director, Dr. Anne Schuchat, as well as, Dr. Lisa Richardson, who is director of CDC’s Division of Cancer Prevention and Control.

ANNE SCHUCHAT: Good afternoon, everyone, and thanks for joining us today. CDC provides for the common defense of the country against health threats. Each month in our vital signs report, we focus on a disease from the front lines and give you information to help stop it. Today’s report contains new information about national cancer trends and focuses in on trends in those cancers associated with obesity and overweight. Let’s start with the good news. We have made great strides in overall cancer since the 1990s. As a nation, we’re now better at preventing and treating some cancers. Improvements in early detection through screening have helped drive down cancer rates. Between 2005 and 2014, the incidence of cancers not associated with overweight or obesity decreased 13%. But today’s report shows in some types of cancers, we are going in the wrong direction. As we’ve highlighted before, we are seeing the effects of obesity and overweight on many chronic conditions. Today’s vital signs report highlights how the growing prevalence of obesity and overweight is affecting cancers as well. This may be surprising to many Americans, since awareness of some cancers being associated with obesity and overweight is not yet widespread. Research shows that being overweight or having obesity is associated with at least 13 types of cancer. Today’s report looked carefully at trends in the rates of specific cancers, comparing the ones that are associated with obesity and overweight with the ones that are not, and looking closely at colorectal cancer, which is associated with obesity but also has a very effective screening intervention that can address precancers. Our study shows that cancers not associated with obesity and overweight are going down. Colorectal cancer is going down, but the rates of most of the cancers associated with obesity or overweight has increased over the past decades. They’re up 7%. We’ve noticed these cancers are increasing particularly among middle-aged adults, people between the ages of 50 and 74. These are important results, and may be harbingers of even greater challenges in the years to come. Tackling obesity is difficult. Many of us struggle with our weight. We’ve heard for a long time that people who are obese or overweight are more likely to suffer from heart disease, strokes, and diabetes. But more than half of Americans are not aware that excess weight can increase the risk of many cancers. And unfortunately, two out of three Americans are either overweight or obese. It’s easier to prevent overweight and obesity than it is to reverse it and the science is still catching up on whether and how much losing weight can lower a person’s risk of some cancers. We do know that even modest weight loss can help when it comes to lowering the risk of other chronic diseases like diabetes and heart disease. The trends we’re reporting today are concerning. The first step to addressing a risk is to be aware of it. There are many good reasons to strive for healthy weight. Now you can add reducing your risk for cancer to the list. The obesity epidemic is a complex and major public health challenge that requires comprehensive efforts. People can eat healthy, be physically active, and get recommended cancer screening. I’m going to turn things over now to Dr. Lisa Richardson, who will share the detailed findings from the report.

LISA RICHARDSON: Thank you, Dr. Schuchat. For this Vital Signs report, we analyzed data from the United States Cancer Statistics database to calculate cancer rates associated with being overweight and having obesity in 2014 and trends from 2005 to 2014. We looked at the 13 types of cancer classified by the International Agency for Research on Cancer as having enough evidence to support being associated with excess body fat. These include cancers of the thyroid, gallbladder, upper stomach, liver, pancreas, kidneys, ovaries, uterus, colon and rectum, breast in post-menopausal women, myeloma, a cancer of blood cells, meningioma, cancer in the brain and spinal cord, and a type of cancer of the esophagus. In 2014, 13 cancers associated with overweight and obesity made up 40% of all cancers diagnosed. Around 55% of cancers in men and 24% of — sorry, in more men, and 24% of cancers in men were associated with overweight and obesity. The fact that endometrial, ovarian, and post-menopausal breast cancers accounted for 42% new cases in 2014 reflects the fact that these cancers occur among females. However, among cancers that affect both males and females, incidence rates were higher among males. For the time period studied, new cancer rates for all cancers associated with overweight and obesity are down, but the decrease varied widely by age group. Colorectal cancer had the second largest decrease in rate of new cases during the study period. Increased colorectal cancer screening, which prevents colon cancer, most likely accounts for this decline. It’s important to note, though, that when we took colorectal cancer out of the equation, we found cancers associated with overweight and obesity went up in all age groups except people age 75 or older. These findings are concerning and it will take the cooperation and coordination of many more organizations to help more people nationwide get to or maintain a healthy weight. On a federal level, CDC supports comprehensive cancer control programs in all 50 states, the District of Columbia, 8 tribes and 7 territories. Our programs focus on cancer prevention, education, screening, quality of cancer care, and survivorship. Our programs work with partners in the community that are already doing some of the following activities. Schools are providing healthy food options and quality physical education. Health care providers can screen for and educate patients about the dangers of overweight and obesity. Workplaces are encouraging physical activity and offering healthy food options in vending machines. Planners are building parks, gardens, and roads that are safe for all types of transportation to share including walking. Planners are being — sorry, encouraging families to be physically active is part of the equation as well. Maintaining a healthy weight and reducing overweight and obesity in adults and children can help reduce the risk and burden of cancer. We’re still learning how losing weight can decrease the risk of some cancers in people who weigh more than recommended. Losing weight also lowers the risk for high blood pressure, diabetes, heart disease, stroke, and other chronic conditions. The bottom line is it will take everyone working together to reduce cancer associated with overweight and obesity. Thank you. I will now turn it back to the moderator.

KATHY HARBEN: Thank you, Dr. Richardson. Michelle, we’re now ready for questions.

OPERATOR: Thank you. At this time if you would like to ask a question, you may press star one. To withdraw your question, you may press star two. Again, star one if you do have any questions. Jessica Glenza, from The Guardian, you may go ahead.

JESSICA GLENZA: Hello. Thank you so much for holding this call. My question is whether rates of obesity linked cancer now rival that of tobacco linked cancer since the CDC has said that tobacco-linked cancers account for 40% of overall cancer diagnoses in the United States.

ANNE SCHUCHAT: Thank you for that question. We could actually get you more information subsequently, but one thing I would like to clarify, when we say obesity associated cancers, some of those cancers are also actually associated with tobacco. It’s different to say something is associated with obesity and overweight than to say that that is the cause. We know that there are different levels of causation, and of course, tobacco has been pretty clearly shown to be the cause of several types of cancer. So, I think the specific numbers involved of adding up all the tobacco-associated cancers and whether those tally greater numbers than all of the current obesity-associated cancers is something that folks can do after the call. I do want to caution that our finding is looking at the 13 types of cancers that are considered associated to obesity and overweight, not that are necessarily all causally related to obesity and overweight. Next question.

OPERATOR: Thank you. Our next question comes from Laurie McGinley from The Washington Post. You may go ahead.

LAURIE MCGINLEY: Yes, thanks very much for taking my question. I’m interested in what you think the mechanisms are of the link here, whether it has to do with inflammation or if there is some explanation or if people don’t really know what the explanation is. And also, you mentioned that not losing weight, it’s not clear whether it would reduce the risk. Why would that be, that not losing weight would not necessarily reduce your risk? Thank you.

ANNE SCHUCHAT: Let me start — this is Dr. Schuchat, then I’ll let Dr. Richardson fill in more details. There are multiple mechanisms considered to be likely biological underpinnings for a link between overweight and obesity and cancer, including the endocrine changes that occur, as well as inflammatory mechanisms that can sometimes be turned on by some of those endocrinological changes that occur with overweight and obesity. In terms of the reversal, we know that it’s possible for some things. You know if you quit smoking for several years, your risk can reduce. The question is really whether the mechanisms that are turned on in the presence of overweight and obesity can be reversed, or whether the cancer process is already far enough along. That’s the high level answer. But let me let Dr. Richardson go into more details about the specific mechanisms.

LISA RICHARDSON: This is Dr. Richardson. Dr. Schuchat is exactly right. For some cancers, the endocrine mechanism, especially estrogen, is very prominent for blood cancer and endometrial cancer. As you stated, inflammation is extremely important in causing carcinogenesis or generating cancer in the first place. Regarding losing weight, the current evidence is the biomarkers, the inflammatory marker that we look for, are decreased when we lose weight about the evidence is still not there about whether it would reduce the risk for developing cancer completely. There is promising research that was published this year in the Journal of Clinical Oncology from the women’s health initiative looking at intention weight loss. In that study, women who lost weight of ten pounds or more did lower their risk of developing endometrial cancer. The evidence is early but promising.

ANNE SCHUCHAT: Thanks. Next question, please.

OPERATOR: Thank you. Mike Stobbe, from the Associated Press. You may go ahead.

MIKE STOBBE: Thank you for taking my call. Just a variation of the earliest one. Could you say in the clearest possible way, does obesity cause cancer, yes or no? Or what’s the most plainspoken statement you can make to answer that question?

ANNE SCHUCHAT: Obesity and overweight are associated with a higher risk of many types of cancers. Our report found an increase in a number of types of cancers associated with obesity and overweight at a period where the prevalence of obesity and overweight has increased substantially in the middle ages. So our report has indirect evidence that this greater evidence of obesity is starting potentially to show up in our cancer statistics. The evidence for a link between obesity and overweight and cancer is considered strong by the international association of research on cancer. And that consortium group has essentially identified 13 types of cancers that are associated with overweight and obesity. So it’s not exactly the same as what we say about tobacco and cancer. But the mounting evidence points to this association and the trends that we’re seeing are an indirect emphasis that there are important general changes going on. Next question?

MIKE STOBBE: Thank you.

ANNE SCHUCHAT: I’m sorry, did you have a follow-up, mike?

MIKE STOBBE: I was just wondering, are there other possible explanations for some of the trends that were noted in some of these cancers besides the fact that these categories of cancer are associated with obesity?

ANNE SCHUCHAT: Yes, and in particular, I think one of the simplest ones to think about is the trend in liver cancer. We saw an important increase in liver cancer between 2005 and 2014. But we know of a number of factors that are associated with liver cancer besides obesity and overweight. Of course, we’re talking a lot about Hepatitis C here as something that’s become quite a bit more common. So I think with liver cancer, there are a number of factors. Hepatitis C and Hepatitis B are both associated with liver cancer, as is fatty liver, which can result from alcohol problems and can also result from overweight and obesity. So I think that gives you an example of the complexity of each of these cancer statistics. I think the importance of today’s report is when we step back and we lump together all of the types of cancers that are associated with overweight and obesity, we saw a direction upwards. And when we looked at all of the other cancers except for colorectal cancer, we saw a direction downwards. That’s not a smoking gun. But that is a note of caution for us. And that’s one of the reasons that we’re trying to bring broader attention to awareness that at this point, obesity and overweight have been associated with a number of types of cancers. Most of us hadn’t heard of that, and that’s one of the things we’re trying to alert the public about. Next question.

OPERATOR: Thank you. Leigh Ann Winick from CBS News. You may go ahead.

LEIGH ANN WINICK: Thank you. I’m wondering and you mentioned in your introduction that about half of Americans are not aware of this association. What does that point to as far as a directive to primary care physicians and other public health officials? What might you be suggesting?

ANNE SCHUCHAT: You know, awareness is the beginning. And certainly we know that people hearing from their doctors or nurses take information differently than when they hear it from the general public or the media. So we do think it’s important for us to get the word out and for clinicians to get the word out with their patients about the potential health effects of overweight and obesity. We know that there’s lots of challenges with maintaining a healthy weight, but that it’s an important thing each of us can do. We know that there can be challenges with having enough physical activity in our daily schedules. But it’s an important thing to do. We do urge clinicians to talk with their patients about how to maintain a healthy weight. And if they are overweight or obese, what kinds of steps they might take to work on that. Next question.

OPERATOR: Thank you. Once again, as a reminder, you may press star one if you would like to ask a question. Our next question comes from Tom Corwin with Augusta Chronicles. You may go ahead.

TOM CORWIN: Thanks for taking my question. I see you have the 13 cancers listed here. One that’s not on the list is prostate cancer. I’m curious whether that was looked at in this report or not.

ANNE SCHUCHAT: Dr. Richardson can answer that one.

LISA RICHARDSON: No, prostate cancer was not reviewed in the most recent report, no. The report, it was not looked at.

TOM CORWIN: Okay. Thank you.

ANNE SCHUCHAT: Okay. Next question.

OPERATOR: Our next question comes from Rachel Bergman with the American Public Health Association. You may go ahead.

RACHEL BERGMAN: Yes, hi, thanks.

ANNE SCHUCHAT: It’s hard for us to hear you, could you try to speak closer to the microphone, please.

RACHEL BERGMAN: Is this any better?

ANNE SCHUCHAT: Just a little bit.

RACHEL BERGMAN: I apologize. I’ll try to speak up. You spoke a little bit about the disparate incidence between males and females with these cancers. Can you talk about other disparities you saw in other population groups?

ANNE SCHUCHAT: Right. Thank you. We did see that the increases were more pronounced in the middle-aged adults than in adults over 75 — or 75 and over. So that was — the trends were, you know, increasing in that middle-aged population. That was an important factor. You know, in terms of the direction that things were going rather than the individual risk. When we look at age in general, of course, cancer rates are higher in the oldest of age groups. But when we looked at the trend in the obesity and overweight associated cancers, we saw it was increasing in those younger age groups and not in the group that was 75 and over. There of course have been some racial and ethnic differences in the incidence of cancers in general, and there are as well in the incidence of obesity and overweight-related cancers, some geographic differences. But I think the important — most important of the differences that we found was that this age group of middle-aged adults, who probably are the cohort that has really experienced this increase in the prevalence of obesity and overweight in America, that that’s the group where obesity and overweight-related cancers, associated cancers, have been increasing, rather than in the oldest age group.

ANNE SCHUCHAT: Next question.

OPERATOR: Once again, if you do have any questions or comments, you may press star one. Again, that is star one if you would like to ask a question.

KATHY HARBEN: Michelle, this is Kathy Harben, the operator. If anyone else has questions, they’re welcome to call us at 404-639-3286. Or they can e-mail us at media@cdc.gov. I would like to thank Dr.’s Schuchat and Richardson for joining us today. We will post a transcript of this call later. And again, if you have other questions, please contact us by phone or e-mail. Thank you very much.

OPERATOR: And thank you. This concludes today’s conference call. You may go ahead and disconnect at this time.

Thursday, July 6, 2017

Opioid Prescriptions Falling But Remain Too High, CDC Says

July 2017
CDC - Opioid Prescribing



Health News From NPR

Opioid Prescriptions Falling But Remain Too High, CDC Says
In a new report, the CDC says U.S. doctors are prescribing fewer opioids than they were in 2010, but that overall rates remain high.

The U.S. is in the midst of an opioid crisis. Millions of Americans are addicted to the powerful prescription painkillers, and tens of thousands are dying each year from overdoses.

A new report out Thursday offers a bit of hope: Doctors are prescribing opioids less often, and the average dose they're giving patients has dropped, according to the Centers for Disease Control and Prevention.

However, the number of patients getting opioids is still too high, and doctors are giving their patients prescriptions that last longer, according to the report in the CDC's Morbidity and Mortality Weekly Report.

Continue reading....

Wednesday, June 21, 2017

Hepatitis C - CDC New Surveillance for Viral Hepatitis

Of Interest
Medscape - New Video Series
About this Series
In the past few years, a new class of direct-acting antiviral agents has made the treatment of HCV easier and more effective than ever before, with cure rates nearing 100%, even among HIV-positive patients. But not all patients with HCV who are eligible for antiviral treatment are identified, and even fewer are being referred for care. Thus, HCV infection remains a significant risk for progression to cirrhosis, liver failure, and hepatocellular carcinoma. Liver specialists at two prestigious Chicago medical centers confront the key issues in the management of patients with chronic HCV infection.
View: Episode 1/ Strides and Obstacles



Surveillance for Viral Hepatitis – United States, 2015
The Centers for Disease Control and Prevention’s (CDC) National Notifiable Diseases Surveillance System (NNDSS) (1) receives viral hepatitis case reports electronically each week from state and territorial health departments in the United States (U.S.) via CDC’s National Electronic Telecommunications System for Surveillance (NETSS), a computerized public health surveillance system. The surveillance system accepts case reports of acute and chronic infections from all states and the District of Columbia, though not all jurisdictions report their data. In 2015, a total of 48 states submitted reports of acute hepatitis B virus (HBV) infection, 40 submitted reports of acute hepatitis C virus (HCV) infection, 40 submitted reports of chronic HBV infection, and 40 submitted reports of chronic HCV infection.

View Report Online - Commentary

Hepatitis C: 
Reported cases of acute HCV infection increased more than 2.9-fold from 2010 through 2015, rising annually throughout this period. Examining annual trends beginning in 2011, reported cases of acute HCV infection increased 44.3% from 2011 to 2012 (n=1,232 and 1,778 cases, respectively), increased 20.3% to 2,138 cases in 2013, increased 2.6% to 2,194 cases in 2014, and increased 11% to 2,436 cases in 2015. The increase in acute HCV case reports reflects new infections associated with rising rates of injection-drug use, and, to a much lesser extent, improved case detection (15). Several early investigations of newly acquired HCV infections reveal that most occur among young, white persons who live in non-urban areas (particularly in states within the Appalachian, Midwestern, and New England regions of the country) (16); trends in these states likely indicate an overall increase in HCV incidence throughout the country (15, 17). States with the highest rate of new HCV infections (e.g., West Virginia, Kentucky, and Tennessee) did not receive CDC support for case finding during these reporting years (2011-2015). After adjusting for under-ascertainment and under-reporting (2), an estimated 33,900 (95% CI=26,800–115,000) new HCV infections occurred in 2015.

Based on the data from national health surveys conducted in the 2003-2010 time period, approximately 3.5 million persons are currently infected with HCV (18). Mortality among HCV-infected persons—primarily adults aged 55–64 years—increased during 2006-2010 (19, 20). In 2013, HCV associated deaths exceeded the combined number of deaths with 60 other infectious diseases as underlying causes (21). CDC data indicate the number of HCV-associated deaths increased 10.9% from 2011 through 2014 and decreased 0.2% to 19,629 in 2015. Approximately one-half of all deaths in 2015 occurred among persons aged 55-64 years. However, deaths associated with HCV are largely underestimated; the only large U.S. study of deaths among persons with confirmed HCV infection indicated that only 19% had HCV listed anywhere on the death certificate despite 75% having evidence of substantial liver disease (20). To increase the proportion of persons with HCV who are tested and linked to recommended care including curative treatment for HCV (12, 13), CDC and USPSTF recommend one-time testing for HCV infection among all adults born during 1945–1965 and among others at increased risk for HCV infection (22).

Continue reading report @ https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm

Monday, May 15, 2017

New Hepatitis C Infections Hit 15-Year High: CDC

Heroin Epidemic Is Driving A Spike In Hepatitis C Cases, CDC Says
From 2010 to 2015, the number of new infections leaped nearly 300 percent, according to the Centers for Disease Control and Prevention. And researchers appear confident of the cause.(Image credit: Spencer Platt/Getty Images) (Source: NPR Health and Science)
Continue Reading...

New Hepatitis C Infections Hit 15-Year High: CDC
FRIDAY, May 12, 2017 -- Reports of new hepatitis C infections in the United States nearly tripled over five years, reaching a 15-year high, federal government data show.

The highest number of new infections were reported among 20- to 29-year-olds. Many stemmed from the growing use of injected drugs linked to the current opioid epidemic, officials said.

The number of reported cases rose from 850 in 2010 to 2,436 in 2015, according to the U.S. Centers for Disease Control and Prevention.

But nearly half of people who have the liver infection don't know it, so most new cases are never reported. The CDC estimated there were actually about 34,000 new hepatitis C infections nationwide in 2015.

"We must reach the hardest-hit communities with a range of prevention and treatment services that can diagnose people with hepatitis C and link them to treatment. This wide range of services can also prevent the misuse of prescription drugs and ultimately stop drug use -- which can also prevent others from getting hepatitis C in the first place," said Dr. Jonathan Mermin in a CDC news release.

He is director of the agency's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The virus can be spread by sharing drugs and needles, the stick of a contaminated needle, and through sex. A child can also catch it if born to an infected mother.

More Americans die from hepatitis C than any other infectious disease reported to the CDC. Nearly 20,000 Americans died from hepatitis C-related causes in 2015, and most were age 55 and older, according to the new report.

Three-quarters of the 3.5 million Americans infected with hepatitis C are baby boomers, born between 1945 and 1965. They are six times more likely to be infected than people in other age groups and have a much higher risk of death from the virus, the CDC said.

Recent CDC studies also show that hepatitis C infections are rising among women of childbearing age, putting a new generation at risk.

New medicines can cure hepatitis C in as little as two to three months, but many people who need treatment can't get it, according to the CDC.

"Stopping hepatitis C will eliminate an enormous disease and economic burden for all Americans," said Dr. John Ward, director of CDC's Division of Viral Hepatitis.

"We have a cure for this disease and the tools to prevent new infections. Now we need a substantial, focused and concerted national effort to implement the National Viral Hepatitis Action Plan and make effective prevention tools and curative treatment available to Americans in need," Ward said.

The federal action plan sets goals for improving prevention, care and treatment of viral hepatitis and eliminating new infections.

More information
The U.S. Centers for Disease Control and Prevention has more on hepatitis C.

Tuesday, March 28, 2017

New report lays plan to eliminate 90,000 hepatitis B and C deaths by 2030

New report lays plan to eliminate 90,000 hepatitis B and C deaths by 2030

US could be rid of hepatitis B and C as public health problems, preventing nearly 90,000 deaths by 2030, with better attention to prevention, screening, treatment, and creative financing for medicines

National Academies of Sciences, Engineering, and Medicine

WASHINGTON - Hepatitis B and C kill more than 20,000 people every year in the United States. A new report from the National Academies of Sciences, Engineering, and Medicine presents a strategy to eliminate these diseases as serious public health problems and prevent nearly 90,000 deaths by 2030.

A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report

Released:
Report at a Glance
  • Report Highlights (PDF)
  • Release Slides (PDF)
  • Report Recommendations (PDF)
  • Press Release (HTML)

Learn More

"Viral hepatitis is simply not a sufficient priority in the United States," said Brian Strom, chair of the committee that carried out the study and chancellor and university professor, Rutgers Biomedical and Sciences, Rutgers University, Newark, N.J. "Despite being the seventh leading cause of death in the world - and killing more people every year than HIV, road traffic accidents, or diabetes - viral hepatitis accounts for less than 1 percent of the National Institutes of Health research budget."

About 1.3 million people in the United States have chronic hepatitis B, and about 2.7 million have chronic hepatitis C. These infections also increase risk of liver cancer. Together, hepatitis B and C cause about 80 percent of the cases worldwide of liver cancer, which has been steadily increasing in both new cases and deaths in the United States since the early 2000s. The incidence of liver cancer in the United States increased 38 percent between 2003 and 2012, and liver cancer deaths increased 56 percent in the same time, primarily due to viral hepatitis.

The world has the tools to prevent these deaths. Hepatitis B is preventable with vaccination, and recent advances in treatment make hepatitis C curable with short and easily tolerable courses of medicines. The committee said the number of deaths from hepatitis B could be cut in half by 2030 by diagnosing 90 percent of the nation's chronic hepatitis B patients, bringing 90 percent of those to care, and treating 80 percent of those for whom treatment is warranted. These actions would avert more than 60,000 deaths and also reduce liver cancer and cirrhosis from hepatitis B infection by about 45 percent. Similarly, treating everyone with chronic hepatitis C would reduce new infections by 90 percent by 2030 and reduce hepatitis C deaths by 65 percent over the same time. These actions would avert 28,800 deaths by 2030 and depend on diagnosing 110,000 new cases a year between now and 2020, gradually dropping off to 70,000 a year by 2025.

The committee said eliminating hepatitis B and C as public health problems in the U.S. by 2030 will require a significant departure from the status quo - including aggressive testing, diagnosis, treatment, and prevention methods, such as needle exchange. It called for a coordinated federal effort to manage hepatitis elimination, and it recommended expanding syringe exchange for people who inject drugs, free hepatitis B vaccine in pharmacies and other easily accessible places, and unrestricted treatment for everyone with hepatitis C. Because the medicines that cure chronic hepatitis C are expensive, the committee gave considerable attention to novel ways to pay for them and recommended a voluntary licensing agreement between the federal government and a patent-holding pharmaceutical company as a way to make the drug more affordable for Medicaid beneficiaries and other underserved patient populations.

Prevention is the first step to eliminating the public health problems of hepatitis B and C, the committee said. About 90 percent of U.S. children were fully immunized against hepatitis B in 2013, but only about a quarter of adults over 19 were immunized. If states supported hepatitis B vaccination to the same level as the seasonal influenza vaccine, great improvements could be made. Offering vaccination in pharmacies is one way to reach a wider cross-section of society, but some states restrict the types of vaccines offered in pharmacies and the circumstances under which pharmacists may administer them. The committee recommended that states expand access to adult hepatitis B vaccination, removing barriers for free immunization in pharmacies and other easily accessible settings.

Hepatitis B virus can easily pass from mother to baby, and the committee was concerned with preventing such cases. Children born to women with chronic hepatitis B require immunization within 12 hours of birth, and other children should receive it within a day of birth. The committee recommended that the National Council on Quality Assurance monitor the delivery of the first dose of hepatitis B vaccine, thereby drawing attention to this essential service. There are also cases where preventive measures are not enough to stop the virus from passing from a mother to her child. Expectant mothers with hepatitis B should have testing early in pregnancy to measure viral DNA, the committee said. This would identify highly viremic women, allowing them and their doctors to weigh the pros and cons of additional medical intervention to prevent neonatal hepatitis B infection.

Until there is a vaccine for hepatitis C, prevention will be mostly a matter of limiting exposure to the virus. People who inject drugs account for 75 percent of the roughly 30,500 new hepatitis C infections every year in the United States, so ending transmission depends on reaching this population. The best strategies to prevent hepatitis C combine both safer injection and treatment for the underlying addiction. Opioid agonist therapy uses prescription medicines - one example is methadone - to relieve the symptoms of drug withdrawal. Such treatment can prevent drug overdose and transmission of blood-borne infections, but 30 million Americans live in places where no providers prescribe these medicines. Syringe exchange programs are also essential, but they currently do not have sufficient reach, even in cities. Rural and suburban areas are home to about half of the people who inject drugs in United States, but these areas have only 30 percent of the nation's syringe exchange programs and distribute 8 percent of the total syringes. Syringe exchange programs do not encourage new drug users or increase drug use among clients, but laws in some states impede their functioning. The committee recommended expanded access to syringe exchange and opioid agonist therapy in accessible venues. Pharmacies, for example, may be a promising setting for syringe exchange, as they are easy to reach in most of the country and reasonably well equipped to provide a confidential space for counseling. Exchanges operating from a van or bus could also reach people in remote areas and may face less community opposition than a fixed-site exchange.

The direct-acting antiviral drugs that cure hepatitis C make elimination feasible in the United States, but their cost is an obstacle to large-scale treatment, creating inequities. While these drugs are very expensive, they are also cost-effective, when compared to other health care interventions. A recent study found that almost half of Medicaid patients were refused hepatitis C treatment, compared to only 5 percent of Medicare patients and about 10 percent of patients with commercial insurance. Furthermore, less than 1 percent of prisoners with hepatitis C have been treated. Faced with the unenviable task of allocating scarce treatment, some payers give first priority to the sickest patients - those at immediate risk of cirrhosis or end-stage liver disease. But delaying treatment increases a patient's risk of cirrhosis, liver cancer, and death. It also hurts society, as the untreated patient can still transmit the virus. Treating everyone with chronic hepatitis C, regardless of disease stage, would avert considerable suffering in hepatitis C patients and would pay off in a reduction in new infections.

Unrestricted, mass treatment of hepatitis C is necessary to eliminate the disease as a public health problem by 2030, but no direct-acting agent will come off patent before 2029. Delaying mass treatment until generic medicines are available would result in tens of thousands of deaths and billions of dollars in wasted medical costs. At the same time, innovator drug companies have the right to compensation for the risk they took to bring a valuable product to market, and society benefits from the financial incentive for pharmaceutical breakthroughs that patent protection offers. In an effort to balance these competing needs, the committee recommended that the government purchase a license or assignment to the patent on a direct-acting antiviral drug, and use it only in those market segments where the government pays for treatment and access is now limited, such as Medicaid and prisons. The committee proposed a voluntary transaction where six innovator pharmaceutical companies bid to sell a license to the government for use in a narrow market that the companies would not otherwise reach. This limitation will also control costs, because the government should not have to pay as much as if it were compromising the lucrative private market. The voluntary nature of this process guarantees the drug company reasonable compensation, and the patent holder has the option to walk away if the price is too low.

The committee's calculations suggested a patent license should cost about $2 billion, after which states and the federal government would pay about $140 million to produce the medicines needed to treat about 700,000 neglected patients. For comparison, under the status quo, it would cost about $10 billion over the next 12 years to treat only 240,000 of the same people.

Another challenge of eliminating hepatitis B and C in the U.S. is that people who have or are at risk for contracting the diseases often are not engaged in care and can be difficult to reach, including people who are born abroad, are uninsured, have substance use problems, and are or have been imprisoned. The committee recommended that the U.S. Department of Health and Human Services work with states to build a comprehensive system of care and support for such patients on the scale of the Ryan White system, which brought HIV services to millions of poor HIV patients.

Working through primary care providers can also improve the reach of hepatitis services. There is precedent for managing hepatitis C in primary care, but treating viral hepatitis carries risks that providers in small practices may be reluctant to accept, causing a disparity where viral hepatitis care is out of reach for people in rural and underserved communities. The committee recommended that the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America partner with primary care providers and their professional organizations to build capacity to treat hepatitis B and C in primary care.

People in jails and prisons bear a particularly high burden of viral hepatitis. The committee found an opportunity in this problem because correctional facilities are an ideal place to test and vaccinate for hepatitis B and to cure hepatitis C. Directly observed therapy is the norm and the risk of drug diversion is low. The committee recommended that the criminal justice system screen, vaccinate, and treat hepatitis B and C in correctional facilities according to national clinical practice guidelines.

The study was sponsored by the Centers for Disease Control and Prevention Division of Viral Hepatitis and Division of Cancer Prevention and Control; U.S. Department of Health and Human Services Office of Minority Health; American Association for the Study of Liver Diseases; Infectious Diseases Society of America; and National Viral Hepatitis Roundtable. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. The National Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit http://national-academies.org. A roster follows.

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Resources:
http://www.nationalacademies.org/HepatitisElimination
Report Highlights
Report Recommendations

Friday, January 27, 2017

AtlasPlus Released: The latest CDC surveillance data on HIV, viral hepatitis, STDs, and TB

The CDC has released AtlasPlus, a tool that gives users the ability to create tables, maps, and charts using over 15 years of HIV, viral hepatitis, STD, and TB surveillance data. AtlasPlus offers significant upgrades from the original version of Atlas including:

Easy, quick access to the latest data by county, state, or U.S. total;
  • 2015 data for HIV, STDs, and TB; 2014 data for viral hepatitis;
  • An upgrade to the Tables function (Based on user feedback, we made it more intuitive to build tables based on the exact subset of the data you want to view.);
  • Improved chart capabilities such as line graphs by year, bar charts by states or counties, pie charts for sex, bar charts for age, race/ethnicity, transmission category (HIV), country of birth (TB);
  • New ability to create two side-by-side maps or charts, e.g., compare two diseases, two race/ethnicity groups, or two age groups; and
  • Mobile access.
    For more information, see our What’s New webpage and visit the new AtlasPlus application!

  • Tuesday, July 7, 2015

    CDC Underestimates Number of Acute HCV Infections

    CDC Underestimates Number of Acute HCV Infections
    Lara C. Pullen, PhD
    July 07, 2015

    Source - Medscape

    Formal surveillance by the Centers for Disease Control and Prevention (CDC) does a poor job of measuring the clinical diagnosis of acute hepatitis C virus (HCV) infection, according to a new report. Case ascertainment is negatively affected by incomplete clinician reporting, limitations of diagnostic testing, problematic case definitions, and imperfect data capture, and these problems persist despite automated electronic laboratory reporting.

    Shauna Onofrey, MPH, from the Massachusetts Department of Public Health in Jamaica Plain, and colleagues published the results of their case series and chart review online June 30 in the Annals of Internal Medicine. The investigators reviewed medical records from two hospitals as well as a state correctional healthcare system in an effort to validate estimates of the incidence of acute HCV infection in their state.

    Theirs was not a population-based survey of acute HCV infection, and thus they did not have an overall denominator with which to calculate incidence of disease.

    The investigators identified 183 patients who were clinically diagnosed with acute HCV infection from 2001 to 2011. The majority (81.4%) of these patients were reported to the Massachusetts Department of Public Health for surveillance classification.

    During that time, less than 1% of these cases were reported to the CDC, and the majority of the cases did not match the national case definition of acute infection. Reporting was also incomplete because of the requirements for negative hepatitis A and B laboratory results.

    The authors had some suggestions to improve surveillance: "we agree with the decision to add seroconversion to the CDC's surveillance case definition of acute HCV infection in late 2012 to account for incident cases without need for an illness compatible with HCV infection, a criterion that is often absent, and to remove the requirement for negative test results for hepatitis A and B virus. Successful application of seroconversion as a criterion requires regular interval testing of high-risk patients. More detailed risk behavior history about specific injection practices and history of onset was extremely useful in a systematic screening for HCV infection in the Massachusetts state prison system, tripling the rate of identification."

    In 2010, 850 acute HCV cases were reported to the CDC by local health authorities, and the CDC used this number to estimate a total of 17,000 cases annually. The current study suggests this is an underestimate.

    Moreover, the lack of reported surveillance cases in Massachusetts stands in stark contrast to a growing HCV infection epidemic among adolescents and young adults in the state.

    One coauthor reports receiving personal fees from AbbVie Pharmaceuticals outside the submitted work. Another coauthor reports receiving grants from the CDC during the conduct of the study. Dr. Kim reports receiving grants from the National Institutes of Health, personal fees from Bristol-Myers Squibb, and grants and personal fees from AbbVie Pharmaceuticals and Gilead Sciences during the conduct of the study. The other authors have disclosed no relevant financial relationships.

    Ann Intern Med. Published online June 30, 2015. Abstract

    Related-
    Hepatitis C - Rise in heroin use drives needle exchange programs


    Thursday, May 21, 2015

    CDC Hepatitis C section Under Fire - "Centers for Disease Control and Prevention: protecting the private good?"

    CDC Hepatitis C section Under Fire - "Centers for Disease Control and Prevention: protecting the private good?"
     
    BMJ 2015 (Published 15 May 2015)

    Download PDF @ NATAP
     
    Commentary:
    Executive Director: Jules Levin

    From Jules: lets be clear - who is really to blame - if the CDC itself, The White House, Congress would fund HCV adequately & appropriately then the CDC Foundation would not have to take any funds from industry. The CDC desperately wants to address the HCV epidemic & I do not see any evidence they are not acting appropriately; without CDC Foundation funding the CDC Hepatitis Section could do nothing because the CDC director & The White House & Congress give them next to nothing in funding for HCV. HCV is a public health epidemic & newly developed HCV drugs can cure HCV up to 100% with safe, tolerable, effective 12-week time-limited duration therapy, the 1st time in history that we can cure a virus with time-limted duration no less. SO, where is Tom Frieden, the CDC director, on this, why has HE not redirected funds from his budget to HCV? For years I have publicly stated the CDC has budget flexibility, they could move funds over to HCV but they refuse. Congress & The White House also refuse to fund HCV adequately, they provide a completely inadequate amount of $31 million to the CDC Viral Hepatitis section & recently The White House recommended an additional $31 mill which Congress is reviewing and this additional $31 mill White House recommendation is a joke - it should be just for starters $150 mill, that is what the CDC needs merely to launch a national screening project; because, it is estimated 75% of individuals with HCV are undiagnosed! so how can we cure anyone if they are undiagnosed.....

    Article
    Centers for Disease Control and Prevention: protecting the private good?
     
    BMJ 2015 (Published 15 May 2015)
     
    After revelations that the CDC is receiving some funding from industry, Jeanne Lenzer investigates how it might have affected the organisation's decisions The Centers for Disease Control and Prevention (CDC) includes the following disclaimer with its recommendations: "CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products . . . CDC does not accept commercial support."

    Continue reading @ NATAP

    Saturday, March 28, 2015

    CDC Hepatitis Updates - HCV Testing Makes Public Health Sense



    CDC Hepatitis Updates - HCV Testing Makes Public Health Sense
    Centers for Disease Control and Prevention (CDC) sent this bulletin at 03/27/2015 11:18 AM EDT

    Viral Hepatitis Updates from CDC

    HCV Testing Makes Public Health Sense
    In response to Is widespread screening for hepatitis C justified?, Drs. Jonathan Mermin and John W. Ward of CDC wanted to set the record straight on a number of key points including “the CDC and USPSTF recommendations for one-time testing of persons born during 1945-1965 are based on sound evidence that HCV testing linked to care is beneficial for patients, cost effective, and with the potential of averting over 120,000 deaths from HCV.”
    http://www.bmj.com/content/350/bmj.g7809/rr-11

    WHO issues its first hepatitis B treatment guidelines
    WHO issued its first-ever guidance for the treatment of chronic hepatitis B. Worldwide, some 240 million people have chronic hepatitis B virus with the highest rates of infection in Africa and Asia. People with chronic hepatitis B infection are at increased risk of dying from cirrhosis and liver cancer. Key recommendations include: the use of a few simple non-invasive tests to assess the stage of liver disease to help identify who needs treatment; prioritizing treatment for those with cirrhosis - the most advanced stage of liver disease; the use of two safe and highly effective medicines for the treatment of chronic hepatitis B; and regular monitoring using simple tests for early detection of liver cancer, to assess whether treatment is working, and if treatment can be stopped.
    http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1&ua=1

    New Hepatitis C & Injection Drug Use Fact Sheet
    CDC has developed a fact sheet on Hepatitis C and injection drug use. The fact sheet includes an overview of hepatitis C including symptoms, testing, transmission, prevention, treatment, and reinfection.
    http://www.cdc.gov/hepatitis/HCV/PDFs/FactSheet-PWID.pdf

    FDA Safety Alert
    Hepatitis C Treatments Containing Sofosbuvir in Combination With Another Direct Acting Antiviral Drug: Drug Safety Communication - Serious Slowing of Heart Rate When Used With Antiarrhythmic Drug Amiodarone
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/
    SafetyAlertsforHumanMedicalProducts/ucm439662.htm

    Monday, June 2, 2014

    Outbreaks highlight infection risks associated with drug diversion


    Outbreaks highlight infection risks associated with drug diversion

    June 2nd, 2014 10:24 am ET - CDC's Safe Healthcare Blog

    Author: Joseph Perz, DrPH, MA
    Quality Standards and Safety Team Leader for the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention 

    When prescription medicines are stolen or used illegally, it is called drug diversion.

    Prescription opioid addiction has reached epidemic proportions and is a major driver of drug diversion . One aspect of drug diversion that is not well recognized involves healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms.

    These include:
    Substandard care delivered by an impaired healthcare provider,
    Denial of essential pain medication or therapy, or
    Risks of infection (hepatitis C virus, hepatitis B virus, HIV, bacterial infection) if a provider tampers with injectable drugs.

    CDC and state and local health departments have helped investigate outbreaks that occurred when healthcare providers tampered with injectable drugs. Along with my CDC colleague Dr. Melissa Schaefer and I recently published a summary of six of these outbreaks, which were investigated over the last ten years.

    These outbreaks revealed gaps in prevention, detection, and response to drug diversion. To prevent diversion, healthcare facilities should enforce strong narcotics security measures and maintain active monitoring systems. Appropriate response when diversion is suspected or identified includes prompt reporting to enforcement agencies and assessment of harm to patients, including assessment of possible infection risks. 

    Drug Diversion in Healthcare Settings

    Medscape: Expert Video Commentary
    View video here, or read transcript below. 

    Read The Full Text Article; Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

    Hi. I'm Dr. Joe Perz, a healthcare epidemiologist at the Centers for Disease Control and Prevention (CDC). I'm pleased to be speaking with you today as part of the CDC Expert Video Commentary series on Medscape. I will be addressing the issue of drug diversion.

    Drug diversion can be defined as any act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient. Prescription opioid addiction, which has reached epidemic proportions in some areas of the United States, is a major driver of drug diversion

    This commentary will focus on diversion involving healthcare personnel who steal controlled substances for their personal use. Under these circumstances, patient harm can take many forms, including substandard care delivered by an impaired provider, denial of appropriate therapy or pain control, and even infection risks stemming from tampering with injectable drugs. Healthcare professionals who divert drugs risk losing their licenses, credentials, and employment; they even risk losing their lives if they overdose. Consequences may also include litigation or imprisonment.

    At CDC, I lead a group that monitors outbreaks of healthcare-associated infections. We recently published a manuscript in the journal Mayo Clinic Proceedings.[1]

    In that article, we describe 6 outbreak investigations over the past 10 years in which diversion -- specifically tampering with controlled substances -- resulted in the transmission of infections. Two outbreaks involved tampering with opioids administered by patient-controlled analgesia pumps, which introduced contaminants and resulted in gram-negative bacteremia in 34 patients. The remaining outbreaks involved personnel who tampered with syringes or vials containing fentanyl. This involved, for example, self-injecting fentanyl from a syringe, replacing the contents with a clear solution such as saline, and returning the syringe to the procedure area or anesthesia cart. In these 4 outbreaks, hepatitis C virus (HCV) infection was transmitted to at least 84 patients. In each of these 4 outbreaks, the implicated professional was HCV-infected and served as the source. Nearly 30,000 patients were potentially exposed to bloodborne pathogens and targeted for notification advising testing.

    Our review probably underestimates the burden of infections resulting from diversion. Making the connection between unexplained or difficult-to-detect infections on the one hand, and illicit, concealed drug diversion activities on the other hand, is extremely difficult. Our review also does not in any way adequately reflect the frequency of diversion by healthcare personnel in the United States. It has been reported that more than 100,000 US doctors, nurses, technicians, and other health professionals struggle with abuse or addiction.[2] Prescription drugs and controlled substances such as oxycodone and fentanyl are often involved. A manager of controlled substance surveillance at one hospital recently reported identifying at least 1 healthcare provider each month stealing medication from the facility.[3] What sets this institution apart from others? Perhaps nothing more than the fact that it has a program to actively monitor for diversion activity.

    Patient safety and professional safety all demand effective, reliable safeguards to maintain the integrity of prescription drugs and controlled substances. Here are 3 things that you can do, whether your role is that of a manager or healthcare professional: Prevent, detect, and respond.

    Prevent.
    Prevention always comes first. Healthcare facilities are required to have systems in place to guard against theft and diversion of controlled substances. It is important that all staff understand and comply with these protocols, acting in ways to minimize unauthorized access or opportunities for tampering and misuse.

    Detect.
    Even with such prevention safeguards, healthcare facilities must have systems to facilitate early detection. These systems can include active monitoring of pharmacy and dispensing record data, as well as having staff who are aware of and alert for behaviors and other signs of potential diversion activity.

    Respond.
    This leads to the third action: response. For staff, this can be summarized as "see something, say something." Appropriate response at the institutional level includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.

    In closing, consider the ubiquitous nature of controlled substances in many healthcare environments -- settings where you provide care or help to manage. Access to these drugs must be tightly managed and monitored for the good of your fellow staff and your patients. Maintaining the security of controlled substances is a shared responsibility. Working together, we can raise awareness and strengthen protections in this area.

    Web Resources

    CDC: Injection Safety
    CDC: Risks of Healthcare-Associated Infections From Drug Diversion
    CDC: One and Only Campaign
    CDC: Impacts Related to Unsafe Injection Practices
    Minnesota Hospital Association Drug Diversion Prevention Toolkit
    Premier Drug Diversion

    Dr. Joseph Perz is the Ambulatory and Long Term Care Team Leader for the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. Dr. Perz entered the field of public health after training as an engineer and environmental scientist. After receiving a doctorate in public health from Columbia University, he served as an epidemic intelligence service officer with the Tennessee Department of Health. During his 15 years with the CDC, Dr. Perz has guided dozens of outbreak investigations and special studies, drawing attention to the need for injection safety and other basic infection control. He has authored or coauthored over 50 peer-reviewed journal articles, Morbidity and Mortality Weekly Report articles, and book chapters. His team's activities are currently focused on interagency collaboration, support to health departments, and partnership efforts to expand prevention activities to ambulatory and long-term care settings.

    Thursday, February 20, 2014

    Flu Hitting Younger Adults Hard: More deaths than usual among younger and middle-aged adults

    THURSDAY Feb. 20, 2014, 2014 -- (HealthDay News)

    The flu is hitting younger and middle-aged adults unusually hard this season, but getting vaccinated reduces the need for a doctor's care, U.S. health officials said Thursday.

    People aged 18 to 64 represent 61 percent of all flu hospitalizations this flu season, according to the U.S. Centers for Disease Control and Prevention. This age group accounted for only about 35 percent of flu-related hospitalizations the last three seasons, officials said at a CDC news conference.

    "We think one of the reasons flu is hitting younger adults hard is that such a low proportion get a flu shot, even those with underlying conditions like asthma, COPD, and diabetes," said CDC Director Dr. Tom Frieden at the news conference.

    "The bottom line is, influenza can make anyone very sick, very fast and it can kill. Vaccination every season is the single most important thing you can do to protect yourself," he added.

    More deaths than usual have occurred among younger and middle-aged adults this season, too. People 25 to 64 years old have accounted for about 60 percent of flu deaths -- triple the rate for that age group three seasons ago, the CDC said.

    Flu activity will likely keep up for several more weeks, especially in places where flu surfaced later in the season, the CDC officials noted. Southern states, especially Alabama, Louisiana, Mississippi and Texas, saw an early spike in flu activity this season. During January, flu activity decreased in the Southeast and South Central states but picked up in the West and Northeast, health officials said.

    The currently circulating H1N1 virus, which is striking younger adults, emerged in 2009 and triggered a pandemic. H1N1 viruses have continued to circulate since the 2009 pandemic, but this is the first season since then that they have predominated in the United States, according to the CDC officials.

    While flu hospitalizations are still highest among the elderly, adults aged 50 to 64 now have the second-highest hospitalization rate followed by children up to 4 years old. During the 2009 pandemic, people 50 to 64 years also had the second-highest hospitalization rate, the CDC said.

    "Younger people may feel that influenza is not a threat to them, but this season underscores that flu can be a serious disease for anyone," said Frieden.

    He stressed the value of vaccination. The current flu vaccine has cut the risk of needing medical care for flu-related problems by about 60 percent across all ages, he said, noting that's "encouraging."

    However, by November, only one-third of 18- to 64-year-olds had been vaccinated. "That's why we're seeing more hospitalizations and deaths" in that age group, he noted.

    Frieden said it's important to remember that some people who get vaccinated may still get sick. "People at high risk of complications should seek treatment if they get a flu-like illness. Their doctors may prescribe antiviral drugs if it looks like they have influenza," he explained.

    Dr. Len Horovitz, an internist and pulmonary specialist at Lenox Hill Hospital in New York City, said six of his patients in the last three weeks -- mostly young adults -- who were vaccinated still had symptoms and tested positive for influenza after a nasal swab test.

    He urged people who think they have the flu to see their doctors sooner rather than later if flu symptoms arise. "It's important to see a physician if it's in the first 24 to 48 hours because you can treat with [the antiviral drug] Tamiflu, even in people who have been vaccinated," said Horovitz.

    People at high risk for flu complications include pregnant women, people with asthma, diabetes or heart disease, the morbidly obese and people older than 65 or younger than 5 years, but especially those younger than 2 years.

    The CDC recommends that everyone 6 months and older get an annual flu vaccine. "This season vaccinated people were substantially better off than people who did not get vaccinated," Frieden said.

    Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, stressed it's not too late to get a flu shot.

    "I want to remind you that the season is not over and things could change," she said at the press conference.

    Horovitz said to prevent flu infection, practice good hand washing and avoid touching your face. Also, avoid kissing on the face when someone is sick, and steer clear of people who are coughing.

    "If you're walking behind someone coughing who has flu, even outdoors, droplets are more sustained in cold air than warm air, so cover your face," Horovitz added.

    Sourc - HealthDay

    More information
    For more on this year's flu, follow @CDCFlu on Twitter, or visit the U.S. Centers for Disease Control and Prevention.

    CDC -Editorial Note

    Update: Influenza Activity — United States, September 29, 2013-February 8, 2014

    Influenza activity in the United States began to increase in mid-November and remained elevated and widespread as of February 8, 2014. During September 29, 2013-February 8, 2014, pH1N1 accounted for the majority of circulating influenza viruses, but influenza A (H3N2) and influenza B viruses also were identified. This season, influenza activity first increased in the southern states. By the end of December 2013, high influenza activity was seen throughout the United States. During the first 4 weeks of 2014, influenza activity decreased in the southeast and south central areas of the United States but began increasing in the west and northeast areas. Elevated influenza activity in parts of the United States is expected for several more weeks.

    Surveillance data from previous influenza seasons have shown that the epidemiology of influenza is related to the circulating subtype, which can vary by season. This is the first season that pH1N1 has been the predominant influenza virus circulating in the United States since this subtype emerged in 2009. Although illness was seen in all age groups during the 2009 pandemic, persons aged 50-64 years had the highest influenza-associated death rate and second highest influenza-associated hospitalization rate among all age groups (2).

    Preliminary surveillance data for the 2013-14 influenza season suggest that although overall disease prevalence is lower than during the 2009 pandemic, persons aged 18-64 years are again at relatively high risk for severe illness from influenza this season.

    As of February 8, 2014, persons aged 18-64 years represented 4,077 (61%) of influenza-associated hospitalizations reported by FluSurv-NET. In contrast, during the past three seasons in which H3N2 or B influenza viruses predominated, persons aged 18-64 years accounted for only 35% (2012-13), 40% (2011-12), and 43% (2010-11) of all influenza-associated hospitalizations reported by

    FluSurv-NET (Figure 4). For the 2013-14 season, cumulative influenza-associated hospitalization rates for persons aged 18-49 years (16.8 per 100,000) and 50-64 years (38.7 per 100,000) in FluSurv-NET have already surpassed the end-of-season rates from three of the previous four seasons (3).



    During the three previous influenza seasons, the total number of P&I deaths reported through the 122 Cities Mortality Reporting System ranged from 37,444 to 41,708, of which <1% to 2% were deaths for which influenza was listed on the death certificate as an underlying or contributing cause of death. Although the age distribution of pneumonia deaths this season is similar to previous seasons, the age distribution of influenza deaths has changed. The number of influenza deaths during the current season (through February 8, 2014) among persons aged 25-64 years (352) exceeds the 138 deaths reported for that age group for the entire 2012-13 influenza surveillance season (September 30, 2012-September 28, 2013). This age group has accounted for approximately 62% of all influenza-associated deaths already this season, compared with 47% in 2010-11, 30% in 2011-12, and 18% in 2012-13 (Figure 4).

    The more severe impact of pH1N1 on adults aged 18-64 years seen this season and during the pandemic is thought to result from at least two factors. First, persons in this age group likely lack the cross-protective immunity to pH1N1 seen in adults aged ≥65 years, which was likely acquired from past infection with antigenically related viruses (4). Second, preliminary vaccination coverage estimates for this season indicate that by early November 2013, adults aged 18-64 years had been vaccinated against influenza at a rate substantially lower (33.9%; 95% confidence interval [CI] = 31.9%-35.9%) than those aged 6 months-17 years (41.1%; 95% CI = 38.8%-43.4%) and ≥65 years (61.8%; 95% CI = 57.9%-65.7%) (5). In previous years, adults aged 18-64 years also have been less likely to receive influenza vaccine, compared with persons in other age groups (5). Although some persons infected with pH1N1 during the 2009 pandemic might retain some residual immunity, this protection has likely declined over time. Furthermore, seroprevalence studies showed that only a minority (approximately 35% of all ages combined) were seropositive for pH1N1 after the 2009 pandemic, with even smaller percentages (26%) among those aged 25-64 years (6).

    Surveillance data available from the 2013-14 season are a reminder that, although some age groups are at increased risk of influenza complications every year (e.g., adults aged ≥65 years), influenza can cause severe illness in persons of any age, even in adults aged 18-64 years. Vaccination is the primary means to prevent influenza and its complications and is recommended annually for all persons aged ≥6 months. Data from the current and two previous influenza seasons suggest that vaccination reduced the risk for medical visits associated with influenza by 47%-61% (7,8). Health-care providers should continue to recommend and offer influenza vaccine for the remainder of the season to all unvaccinated persons aged ≥6 months.

    Early and aggressive treatment of influenza with neuraminidase inhibitor antiviral drugs should be used when indicated, and data from this season show that pH1N1 remains susceptible to these agents. Currently circulating influenza A virus strains have shown resistance to amantadine and rimantadine, also known as adamantanes; therefore, adamantanes are not recommended for antiviral treatment or chemoprophylaxis of currently circulating influenza A virus strains (9).

    Antiviral treatment is recommended as early as possible (ideally within 48 hours of illness onset) for patients with severe illness (e.g., patients hospitalized with influenza) or patients at high risk for serious influenza complications, including children aged <2 years, adults aged ≥65 years, and persons with certain underlying medical conditions (10).††† If treatment can be initiated within 48 hours of illness onset, antiviral medications also may be considered for outpatients with suspected or confirmed influenza who are not known to be at increased risk for developing severe illness (10).

    Influenza surveillance reports for the United States are posted online weekly and are available at http://www.cdc.gov/flu/weekly. Additional information regarding influenza viruses, influenza surveillance, influenza vaccine, influenza antiviral medications, and novel influenza A infections in humans is available at http://www.cdc.gov/flu.