Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is indeed a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.
Hoping these posts help to educate and empower you
to be healthy and create healthy communities.
This week we are talking about disease outbreaks.
In epidemiology, an outbreak is when there is —
“a higher than expected number of cases of disease in a specified place or time.”
We expect a certain amount of disease to occur, but we become concerned when there is more disease than expected. And when more disease is observed in a specific place or time, public health springs into action to prevent the spread of disease, educate healthcare providers who may treat sick individuals, and find the source of infection to stop the outbreak. This is not easy work (as we all witnessed over the past three years) because stopping an outbreak (especially one occurring on a global scale, aka a pandemic) requires individual behavior changes, implementation of new programs and policies, (sometimes) trial and error, and research that may not produce quick or easy to understand results.
When the public health community shares information about an outbreak, it is to protect you, your family, and your community from a disease that is occurring more often than we would expect and that will require your participation to contain.
Most of the time, public health professionals work behind the scenes to create healthy environments, but when announcements about outbreaks of flu, listeria, and Ebola virus disease are made, it is important to take note, heed the warnings, and take steps to prevent infection. Remember — we are all public health.
Listeria Outbreak in Deli Meats & Cheeses
Listeria is a bacteria that can cause serious illness and death in pregnant women and individuals with weakened immune systems (especially the elderly). The bacteria can be found in soil, water, or animal feces. And individuals are infected with listeria by eating it. The bacteria is crazy resilient — listeria can survive refrigeration and freezing.
Currently, six states are reporting cases of listeria linked to contaminated deli meats and cheeses. To date, infections have been reported in New York, Maryland, Illinois, Massachusetts, California, and New Jersey. This is a national outbreak. A total of 16 people have been infected and 13 of them have been hospitalized. According to the CDC —
“The true number of sick people in this outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses.”
The CDC is recommending that anyone who purchased meats or cheeses from a deli get rid of those items immediately (read: do not eat them). Additionally, since listeria can easily spread from contaminated equipment or sources, individuals who had deli meats or cheese should clean their refrigerators and wash any surfaces the meat or cheese may have touched with hot soapy water.
The symptoms of listeria usually occur within four weeks of infection, but can take up to 70 days (more than two months) to appear. Typical symptoms include headache, stiff neck, fever, muscle pain, and (sometimes) loss of balance or convulsions. Do not hesitate to call your healthcare provider right away if you have severe systems after eating meat or cheese from a deli.
Influenza
The flu season is off to an early start in the United States. The hospitalization rate for influenza (right now) is higher than it has been in more than a decade at this point in the fall. And the weekly FluView Report is showing that 4.3% of all visits to healthcare providers across the United States during the past week have been for respiratory illnesses. This percentage is higher than expected at this point in time.
As I’m watching the number of cases, hospitalizations, and deaths from influenza increase early in the flu season, I have been asking myself (and maybe you have been wondering, too) does this early start and record-breaking hospitalization rate mean that the entire flu season is going to epic? Should I be worried about a six-month-long flu outbreak?
The short answer is — we don’t know. The influenza virus is very unpredictable. We simply do not know what an early start and high rates of hospitalization early in the season mean. However, there is good evidence that this could be a severe flu season.
“What a lot of people are implying is because it’s early and levels are high for this time of year that it’s going to be a severe season. We don’t know that. Right now all we can say is we’re off to an early start.” ~ Lynnette Brammer from CDC’s influenza division.
What do we know?
First, the influenza vaccine is safe and effective.
Everyone (who is 6 months old or older) should get vaccinated.
Reports coming out of the southern hemisphere, where the flu season ended in October, show that this season’s flu vaccine is effective. Specifically, the Ministry of Health in Chile found that the current flu vaccine was 49% effective against the H3N2 subtype of the influenza virus. This is the same subtype that is dominant in the United State right now.
Get vaccinated.
Stay home when you are sick.
Wash your hands properly.
Ebola Virus Disease Outbreak in Uganda
On September 20, 2022, the Ministry of Health of Uganda declared an outbreak of Ebola virus disease (EVD) in Central Uganda. As of November 5th, there have been 139 cases of the disease. Of those cases, 39% have died. Many areas of Uganda currently have a three-week lockdown in place — where a dust-to-dawn curfew is being enforced, there is a ban on personal travel, and markets, bars, and churches have all been closed. Additionally, schools are being closed two weeks early because there have been 23 confirmed cases of EVD and eight deaths among students.
To date, there have been no suspected or confirmed cases of EVD outside of Uganda.
This is because the global public health community has been hard at work.
Airline passengers arriving in the United States (and other countries) who have been to Uganda in the past 21 days are undergoing extensive health screenings. In Uganda, public health professionals are working to reduce the risk of wildlife-to-human transmission of EVD through the use of gloves and proper cooking techniques and human-to-human transmission of EVD through the use of gloves and proper handwashing techniques. Additionally, public health is working to contain the outbreak through safe and dignified burial practices (EVD can live and spread through a dead body) and the use of quarantine. Additionally, public health is talking about sex. EVD can spread through semen for up to one year following infection. Therefore, to protect the partners of these individuals, we have to talk about safe sex and condom use.
There is no treatment for EVD. We can only provide supportive care for the symptoms brought on by the disease. And currently, there is no vaccine for the subtype of the virus that is spreading in Uganda.
For those of us living 1000s of miles away from this outbreak, why does this matter? And why should you care?
We live in a global society where the next outbreak in our community is only a plane ride, a sneeze, or a chance encounter with an animal away.
We need to support the work of public health — what we are able to see (and complain about) and that which is invisible to the public must be supported — through increased funding, support, and respect. The work that is being done in Uganda to contain the spread of EVD and stop transmission is protecting you, your family, and your community.
Questions? Want to know more about the work of public health?