Tuesday, December 6, 2016

Get Your Influenza Questions Answered Today

Ever wonder how the influenza vaccine gets created every year if flu viruses keep evolving? Now’s your chance to ask the experts!

Between noon and 2 pm today, scientists from the Centers for Disease Control and Prevention (CDC) are hosting a flu vaccine “Ask Me Anything” (AMA) on Reddit. John Barnes, PhD, research microbiologist and team lead for the Influenza Genomics Team in the Influenza Division at CDC will answer questions about how the flu vaccine is created and advanced molecular detection (AMD) technology. AMD technology uses genomic sequencing (mapping the DNA of flu viruses) to create better-performing vaccines. Dr. Barnes and his team also will be taking questions about all things related to the flu and its vaccine, so head over there after noon to get all your nerdy science questions on influenza answered!

Also taking place at noon, the Texas Department of State Health Services (DSHS) is hosting a Twitter chat using the hashtag #DSHSFluChat. Twitter users can ask questions about flu prevention, the flu vaccine, and what to do if you get sick; tag it with #DSHSFluChat, and DSHS will be there with an answer.

Join the online discussions, then go out and spread your knowledge (NOT the flu)!

Thursday, December 1, 2016

World AIDS Day Reminds Us How Far We Have Come ― And How Far We Have Yet to Go ― To Stop HIV/AIDS

By John T. Carlo, MD
Dallas Physician
Chief Executive Officer, AIDS Arms

Today, December 1, is recognized as World AIDS Day. Since 1988, this day has been globally recognized as a day of commemoration for the more than 34 million people who have died since the virus got our attention back in 1981. 

Today we can celebrate The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), now showcased in President George W. Bush’s Presidential Library, as one of our greatest achievements, resulting in the largest mobilization ever of resources and efforts to fight a public health emergency. Prior to PEPFAR, and other groups such as the Bill and Melinda Gates Foundation, the number of people living with HIV in sub-Saharan Africa receiving life-saving treatment was 50,000; today it is more than 9 million. 

Here in the U.S., and in Texas, similar successes have been achieved, including better testing and immensely better treatments. However, World AIDS Day 2016 should also serve as a reminder that we are not finished with our challenges of HIV in our communities. New infection rates continue to climb in groups such as African American women, young gay men, and those sharing needles when using illicit drugs. While new treatments work so well ― we are on the verge of concluding that someone successfully treated is not infectious, and we now even have a pill which can be taken to prevent an HIV infection from occurring ― there is still a tremendous amount of work to be done. 

Today should serve as an important reminder that we all need to keep HIV on our minds, especially when thinking about the health of our patients. As a reminder, according to the Centers for Disease Control and Prevention, everyone between ages of 13-64 should be tested for HIV at least once. It’s not about determining whether someone is at risk or might be infected, it is about the clear health advantage of diagnosing HIV early, and the reality that most newly infected individuals had no identified risk factor or perceived risk. 

Finally for all of our physicians, nurses, social workers, and community members who have remained on the front lines during this crisis, World AIDS Day serves as an important day of recognition for your commitment to caring for our sick, overcoming the incredible fear and stigma still even today associated with AIDS, and doing the tremendous work to impact the lives of so many both here in Texas and around the world.

Dr. Carlo is chief executive officer of AIDS Arms, Inc., which combats HIV/AIDS in the community by improving the lives and health of individuals living with the disease and preventing its spread. Dr. Carlo also is vice chair of the Texas Public Health Coalition and former medical director of Dallas County Health and Human Services.

Friday, November 18, 2016

Let’s “Get Smart” About Antibiotics

This week is Get Smart About Antibiotics Week, and Texas physicians are raising awareness of appropriate antibiotic use. Antibiotics can’t fight viruses, so taking them for colds, flu, most sore throats, bronchitis, and many sinus and ear infections won’t help you get better.

In fact, taking antibiotics when you have a viral infection can actually cause more harm than good, because it increases your risk of getting an antibiotic-resistant infection later. Additionally, there are healthy bacteria in your gut that help break down nutrients for you to absorb. Taking antibiotics when it isn’t called for kills off some of these good bacteria, allowing harmful bacteria to grow in their place.

[Related: How Overuse of Antibiotics Is Creating Drug-Resistant Bacteria]

The Centers for Disease Control and Prevention created this helpful chart identifying which diseases can be fought successfully with antibiotics ― and which ones can’t.

Tuesday, November 15, 2016

Treatment to Prevent HIV Promising ― If Key Patients Can Get It

Austin family physician Cynthia Brinson, MD, says identifying candidates for HIV pre-exposure prophylaxis requires setting aside any assumptions physicians may have about the patient's risk for contracting HIV.

Physicians can block HIV spread with a little-known treatment — if they can identify high-risk patients and administer the treatment to them. The questions can be difficult for physicians to ask, however. The questions can be personal, and they can be awkward for a patient to answer; but they are necessary to determine whether a patient’s sexual behavior or drug use puts him or her at risk of contracting HIV (human immunodeficiency virus). When patients are at risk, doctors can prescribe the treatment, HIV preexposure prophylaxis (PrEP), that might curb that risk drastically, reports the Texas Medical Association’s (TMA’s) Texas Medicine magazine.

That's why family physician Cynthia Brinson, MD, strives to get all the information she needs, including uncomfortable-but-pertinent details on sexual behavior, when assessing patients for the Austin PrEP Access Project (APAP). The volunteer clinic provides HIV PrEP to patients susceptible to the virus that causes AIDS.

“I’ve heard many patients say, ‘I don’t want to talk to my physician because [he or she] wouldn't approve of what I’m doing,’ whether that’s true or not,” Dr. Brinson said. “And the physicians are making assumptions by saying, ‘I’ve known my patient a long time, and [the patient is] in a monogamous relationship.’ I think when we make assumptions about the people we know, we’re not really seeing people in the full context of a life.”

In the three decades since AIDS first became the United States' biggest public health scare, panic over the disease and HIV has largely disappeared. But the virus persists, especially in Texas, where Texas Department of State Health Services figures show more than 82,000 people were living with HIV in 2015.

The PrEP pill and treatment can stop that number from growing by preventing people from contracting HIV. Large clinical trials showed consistent PrEP use reduces people’s risk of getting HIV from sex by more than 90 percent and reduces the risk of getting it from drug injections by more than 70 percent, according to the Centers for Disease Control and Prevention (CDC). But many people at high risk don’t know PrEP exists, let alone how accessible it can be. APAP and other PrEP clinics around the state are working to change that ― starting with the type and tone of questions physicians ask patients.

Dr. Brinson said it’s important for physicians to set aside what they think they know about the patient and ask the questions they need to ask. She says when she tries to assess a patient’s risk factors for HIV, she avoids asking leading questions.

“I’ll ask patients if they’re involved with anyone sexually. And if they say no, I might ask them, ‘Well, if you were to be involved with someone sexually, would that be a male, a female, or both?’ and let the patient take it from there,” she said.

Yet physicians might not always ask the right questions because of the demands of a clinic visit or discomfort with taking a sexual history and discussing details of sexual relationships.

Houston adolescent medicine fellow M. Brett Cooper, MD, a member of TMA’s Committee on Child and Adolescent Health, said merely asking patients if they’re sexually active isn't gleaning enough information.

“For the adults right now, you’re missing out on that 18-29 [age group] if you’re not asking, ‘What gender are your sexual partners? Are you having sex under the influence of substances, whether that’s drugs [or] alcohol? How many partners are you having?’ That’s where CDC recommendations for putting people on it [PrEP] come into play, is your behaviors,” he said.

Dr. Cooper said physicians hope to reach the people at greatest risk more effectively. He said minorities tend to underuse many of the available services, and the highest diagnosis rates show up in African-American men having sex with men.

“The theory behind it is that there’s a lot more stigma in the minority communities around [men] having sex with men, whether you identify as gay or not,” Dr. Cooper said. “Then if you show up at a clinic for PrEP, people will look around and be like, ‘I know this person, I know [that] person.’ ”

Dr. Brinson agrees lack of awareness and patient trust prevent high-risk patients from accessing PrEP. She said eradication of HIV is possible, though; the goal of APAP is to see no new infections in Austin by 2020. While PrEP has been successful in gay white communities, she said her clinic has trouble reaching into the communities it would like to reach, such as Hispanic, African-American, and underserved communities.

We must do something to stop this continual infection rate,” she said.

Friday, November 11, 2016

Saturday Is World Pneumonia Day

This Saturday, Nov. 12, is World Pneumonia Day. It was created to raise awareness of the dangers of pneumonia, especially to children and the elderly, and to promote the pneumococcal vaccine as a way to protect against the disease.

Pneumonia is the world’s leading infectious killer of children under age 5, despite being preventable with vaccination. The pneumococcal vaccine is recommended for all children younger than 5 and for all adults 65 and older, according to the Centers for Disease Control and Prevention. The vaccine not only protects against the most common type of pneumonia, but also against meningitis and blood infection caused by the Streptococcus pneumonia bacteria.

Dallas infectious disease physician Ed Dominguez, MD, a member of TMA’s Be Wise ― ImmunizeSM Physician Advisory Panel, stresses the importance of getting vaccinated against diseases like pneumonia to his patients. He says even though these vaccines might not cover all strains of the disease, they help guard against life-threatening complications.

“The vaccines for influenza and pneumonia are effective in preventing severe complications, like death, from these diseases, although mild infections may still occur,” he says. “When a person notes that he still contracted the flu after receiving a flu vaccine, I always respond, ‘See? It worked, because you survived to tell me about it!’ ”

(The flu vaccine also helps protect against pneumonia, because severe cases of influenza infection can lead to pneumonia.)

Pneumonia is a devastating disease, but it is preventable through vaccination. For more about World Pneumonia Day, visit stoppneumonia.org.

Wednesday, November 9, 2016

Vaccinations Help Spread Holiday Cheer, Not Illness

‘Tis the season to gather and share pumpkin pie, fun with family and friends, and, unfortunately, bugs that can make people very sick. Physicians urge everyone to get a few key vaccinations now — before holiday gatherings — to help keep holidays healthy for the whole family, from the babies to the grandparents.

“Making sure you’re protected from serious, possibly deadly, diseases helps prevent you from passing on an illness, like flu, that might prove much worse for a loved one,” said Erica Swegler, MD, an Austin family physician and member of the Texas Medical Association’s (TMA’s) Be Wise — ImmunizeSM Physician Advisory Panel. Infants, pregnant women, and the elderly are among those most at risk for developing a serious complication from an infectious disease that could be passed unintentionally to them.

The vaccinations that can most protect you and others this holiday season are:

  • Influenza (or flu): Everyone six months of age and older, including pregnant women, needs a yearly shot.
  • Tdap (protects against tetanus/lockjaw, diphtheria, and pertussis/whooping cough): Pregnant women need this shot in the third trimester of every pregnancy to protect their infant. Other adults need this shot once, then a Td every 10 years. Children and teens who are up to date on their vaccinations should have received this shot as part of their childhood and adolescent vaccinations. 

Whooping cough, or pertussis, is especially dangerous for infants. The Texas Department of State Health Services says more than half of babies under 1 year of age who get pertussis must be hospitalized. Many will have serious complications, like pneumonia or apnea (slowed or stopped breathing), and some become so sick they die. That’s why pregnant woman are encouraged to get a pertussis booster shot during pregnancy, to protect their newborn infant.

However, infants can catch pertussis from other family members or caregivers. Pertussis symptoms in teens and adults can be mild, so a parent, sibling, cousin, or an aunt or uncle might unknowingly spread pertussis to a baby.

“If you’ll have an infant at your holiday gatherings, it’s especially important other family members are up to date with their shots because the babies are too young to get vaccinated for some illnesses,” said C. Mary Healy, MD, another member of TMA’s Be Wise — Immunize Physician Advisory Panel.

And because babies require a series of pertussis vaccinations, they are not fully protected from whooping cough until they’re close to 18 months of age.

Flu poses a threat, too. Babies can’t get vaccinated for flu until they are at least six months old. Flu shots are recommended for everyone older than six months, including pregnant women.

Until they can get their shots, babies rely on the vaccinations of those around them to avoid catching serious diseases, said Dr. Healy, a pediatric infectious disease specialist in Houston. And for both flu and whooping cough shots, your body needs about two weeks to develop the best protection, so you shouldn’t wait to get vaccinated, added Dr. Healy.

Flu can be serious for many people, from the young to the old. According to the Centers for Disease Control and Prevention, more than 20,000 U.S. children younger than 5 years of age end up in the hospital each year because of flu complications, such as pneumonia. Nearly 70 percent of hospitalizations from flu-related illness are in people who are over age 65. And most (up to 85 percent) flu-related deaths are among the elderly. Flu can also cause pregnant women to go into labor early.

“Vaccinations are one of the easiest and safest ways to protect yourself and those around you from getting sick,” said Dr. Swegler. “Don’t sideline yourself or someone else from holiday festivities this year by passing along an illness that could have been prevented … and try to keep your distance (about 6 feet) from anyone who shows up sick at a holiday gathering to avoid catching germs from their sneezing or coughing,” said Dr. Swegler.

Based on your age and health conditions, vaccinations are needed throughout your life to protect you from illnesses like pneumonia and shingles. Check with your doctor to make sure you’ve had all the shots you need.

TMA has these resources, in English and Spanish, for more information:

Tuesday, November 8, 2016

Residents Line Up for Lamar County’s “Drive Thru, Prevent the Flu” Free Vaccination Clinic

By Amanda Green, MD
Paris, TX Physician

The Lamar Delta County Medical Society and Alliance, in conjunction with the Paris Lamar County Health District, recently gave 360 flu shots to drivers and passengers as part of their “Drive Thru, Prevent the Flu” initiative. Funded by the Texas Medical Association’s Be Wise ― Immunize℠ program and a community grant by the Texas Medical Association Foundation, the event enabled residents to receive free flu shots in the comfort of their car.

Lines of cars greeted the health professionals when they arrived on the scene to start giving those community-protecting flu shots. The event was held in conjunction with the Festival of Pumpkins in Paris, and one of the flu shot recipients showed up wearing a mask that was even scarier than getting a flu shot!

Dr. Green is an internal medicine physician in Paris, TX, and Medical Director for the Lamar County Health Department.

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