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Headlines A Worldwide Epidemic, A Local ResponseAs the Avian Flu Spreads Across Europe and Asia, Virginia Must Prepare to Fight Pandemic Flu at Home |
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In today’s age of instant gratification and scientific advancement, most citizens disregard the possibility that a common illness such as influenza, or flu, could have a significant impact on society. With more and more attention being paid to the possibility of a pandemic, or worldwide epidemic, and the infamous H5N1 Avian Flu virus spreading in Asia, Europe and the Middle East, public health experts know that the onset of a pandemic flu would have serious social and economic impacts unlike any seen in most Americans’ lifetimes. With vaccine supplies uncertain, the success of antiviral drugs unclear and unanswered pandemic questions outnumbering those with easy solutions, education and cross-discipline planning for a pandemic is likely the best defense available. The Virginia Department of Health (VDH) has been leading efforts to educate Virginians about the difference between seasonal flu, Avian Flu and a pandemic, and to provide decision makers with tools and tips they can use to prepare for the possibility of a pandemic. The Anatomy of the Flu Each year, the world is faced with a new outbreak of seasonal flu. The flu is a respiratory disease spread mainly by tiny droplets that are released when an infected person sneezes or coughs. Once people have been infected by a certain strain of the flu, they develop immunity. Seasonal outbreaks of flu are caused by strains of influenza virus similar to those of past years. Some people may have built up immunity, and there is also a vaccine for each year’s flu season. But the flu can change to a new Influenza A virus that has not previously circulated, meaning few people are immune to it. This is the first step toward a pandemic. In the 20th century, three pandemics spread across the globe—one in 1918, one in 1957 and most recently in 1968. The 1918 Spanish Flu was the most famous, killing millions and crippling the country. “Pandemics are not something the average person thinks about daily,” said Diane Woolard, Ph.D, M.P.H, director of the VDH division of surveillance and investigation. “For public health experts, each time we have a scare such as those in 1976, 1997, 1999 and the one we’re in right now with the H5N1 Avian Flu, it reminds us that the question is when the next pandemic might hit, not if.” Since late 2003, several Asian countries have seen large numbers of chickens and other birds infected by a strain of avian flu called H5N1. Despite containment efforts, new cases were reported throughout Asia and recently in parts of Europe and the Middle East. By Jan. 30, 2006, 160 human cases had been reported, with a death rate exceeding 50 percent. Two of three critical building blocks for a pandemic are already in place with the H5N1 virus. It is a strain not recognized by the human immune system and it causes severe sickness and death. The missing element is that it has not achieved sustained person-to-person transmission. If H5N1 changes into a form that spreads between people, a pandemic could be likely, so Virginia pandemic flu preparedness efforts are in high gear.
Virginia Preparedness Efforts VDH began its formal pandemic flu preparedness efforts in 2002 with the introduction of Virginia’s first pandemic flu response plan. In early 2005, VDH assembled decision makers from public health, government, law enforcement, emergency medical services, health care providers, hospitals and private industry to help grapple with the complex issues surrounding pandemic flu preparedness and response. The Pandemic Influenza Advisory Committee meets regularly to discuss issues and to recommend next steps in Virginia’s pandemic flu planning efforts. VDH is working with all of its partners to ensure that personal preparedness educational efforts are carried to citizens of every county and city in Virginia. Working with school officials, EMS providers, Rotary clubs, civic associations and the media, VDH aims to engage everyone to think about how they would respond to and keep their families safe during a pandemic. Currently, with input from the Pandemic Flu Advisory Committee, VDH is completing a major revision to its pandemic flu plan. The document, to be released in early 2006, presents an even more detailed action plan for dealing with pandemic flu. VDH has also launched a pandemic flu Web site at www.vdh.virginia.gov/pandemicflu to provide Virginians with the latest information and resources on pandemic flu. The Truth About Vaccines The country’s first line of defense against seasonal flu is the annual flu vaccines. However, current flu vaccines will not protect against a new pandemic strain of flu. And because it takes several months to develop and distribute vaccine for a new strain, a vaccine probably would not be available in the early stages of a pandemic. After vaccines become available, communities will need to work together to communicate and enforce established priorities regarding who will get the vaccine first. This is widely cited as the most difficult, and likely controversial, part of pandemic flu response. Federal guidance has assisted in developing specific priority groups to be vaccinated first, emphasizing getting the vaccine to those who can help treat illness and prevent death, such as health care workers delivering direct patient care. The list also focuses on those at highest risk of complications and death, and those who are essential to keeping public safety and essential services like water and power supplies up and running. Community Control Measures If a pandemic does develop, public health officials will also look at other means to slow community transmission. This could include recommending school closures, encouraging telecommuting and promoting business closures. Isolation and quarantine measures may also be used during the early stages of a pandemic to try to control the disease. “What all Virginians need to understand is that there is no simple answer to the threat of a pandemic,” said Lisa Kaplowitz, M.D., M.S.H.A., VDH’s deputy commissioner for emergency preparedness and response. “Everyone will play an important part in addressing the complex and changing circumstances that will develop when the next pandemic comes to the Commonwealth. For now, the best thing we can all do is educate ourselves about the issues involved and put the proper plans in place to address a pandemic.” For individuals, good hygiene and respiratory etiquette are the best defense against getting sick. Though they sound simple, these steps can have a significant impact on the spread of a pandemic virus.
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| In the News
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Eastern Region Hosts Pandemic Flu Training for Media and Hospitals
The Virginia Department of Health (VDH) and the Hampton Roads Metropolitan Medical Response Systems hosted the first of several training events to educate the public about pandemic influenza, or a worldwide epidemic of flu. The event, held in Norfolk on Thursday Dec. 15, provided a regional training opportunity for media, VDH and hospital representatives to raise media and public awareness about several important issues currently in the news, and others that will develop in the event of a pandemic. Three local health district directors and the Eastern Regional Emergency Preparedness and Response medical consultant made presentations about avian flu, isolation and quarantine, flu vaccine status and a local seasonal influenza update. More than 50 people attended. Two television stations produced news stories as a result of the training.
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African-Americans Urged to be Vigilant about HIV/AIDS
Since HIV was made a reportable disease in Virginia, 65 percent of all reported HIV cases have been among African-Americans. On Feb. 7, The Virginia Department of Health’s (VDH) Division of Disease Prevention will join organizations across the nation to recognize National Black HIV/AIDS Awareness Day. This observation is a national community mobilization effort designed to increase awareness, participation and support for HIV/AIDS prevention, care and treatment among African-Americans. AIDS service organizations, community-based organizations and local health departments across the Commonwealth will sponsor special testing events and educational programs observing National Black HIV/AIDS Awareness Day. The sixth annual observance is aimed at motivating African-Americans to
In 2004, VDH estimated that African-Americans accounted for 62 percent of the reported HIV cases in Virginia. At the end of 2004, there were an estimated 10,200 African-Americans living with HIV or AIDS in Virginia. According to the U.S. Centers for Disease Control and Prevention, in 2003 African-Americans accounted for 50 percent of the estimated new HIV/AIDS diagnoses in the United States. In 2003, 172,278 African-Americans were living with AIDS in the United States. Recognizing the valuable role faith institutions play in the African-American community, the Division of Disease Prevention hosted “Looking Back While Preparing to Move Forward: HIV/AIDS and the African-American Church” in September 2005. The workshop gave participants the opportunity to examine HIV, reflect on the positive influences of the church, identify ways they could become more involved in the prevention of HIV and study two faith-based sex and sexuality courses. The participants unanimously agreed that they would recommend the training to others in the faith-based community. For more information about HIV/AIDS, test sites and other sexually transmitted diseases, contact the HIV/STD/Viral Hepatitis Hotline at (800) 533-4148 or visit the Division of Disease Prevention Web site. A list of statewide activities commemorating National Black HIV/AIDS Awareness Day will be posted on the site on Feb. 2. Events are subject to change.
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VDH Veteran Honored with Child Advocate Award
A career that began behind bars now touches the lives of each of the approximately 100,000 children born in Virginia each year. In 1968, Pat Dewey was providing one-on-one speech and language therapy to juvenile offenders. Today she manages the Virginia Department of Health (VDH) Early Hearing Detection and Intervention Program, which ensures the early identification and treatment of hearing loss for all children born in Virginia hospitals. On Nov. 5, the Virginia Chapter of the American Academy of Pediatrics honored Dewey with its 2005 Child Advocate Award for her work in the early detection of hearing loss among newborns. The award was initiated in 1982 to recognize people who, in the course of more than a year, had significantly contributed to the advancement of child health and welfare in the Commonwealth. Previous recipients of the award include Gov. Mark R. Warner. Dewey was raised in a family of nurses in Dinwiddie County and was expected to go to college. “But I didn’t want any part of pain and needles,” said the 33-year VDH veteran. She settled on a career path when she learned about speech-language pathology, which “sounded a lot like nursing in that you were helping people.” Dewey has spent most of her career helping to identify and treat hearing loss in children, one of the most common birth defects in the United States. When a new law requiring all hospitals to test the hearing of newborns before discharge took effect in 2000, Dewey worked with hospitals to increase the number of children screened. As a result, 98.1 percent of infants born today in Virginia hospitals are screened before they leave the hospital. Those who do not pass the test are referred to an audiologist for follow-up testing. Dewey’s program receives the results of these tests and works with parents and health professionals to ensure that children with hearing loss receive follow-up and intervention services as early as possible. Dewey also initiated development of a Web-based reporting system that allows hospitals to quickly report test results. Over the years, Dewey has secured federal grants to expand resources available for the early detection of hearing loss in children. Last May, Dewey started a hearing aid loan bank to provide infants and children with hearing aids temporarily while their parents work to secure permanent hearing aids. Children with hearing loss often have difficulty in communication and emotional development when identification and intervention for the problem are delayed. Dewey’s outlook on career and life are summed up in a sign hanging on her office wall. It says, “A hundred years from now it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove--but the world may be different because I was important in the life of a child.” Hearing loss affects between one and three of every 1,000 newborns. VDH estimates as many as 300 Virginia children are born every year with hearing loss. To learn more about VDH’s Early Hearing Detection and Intervention Program, click here.
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| Your Community
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Central Virginia Health District Prescribes Books for Children at Check-ups
Children get something extra when they go for a check-up in the Central Virginia Health District (CVHD), headquartered in Lynchburg. Stacey Hinderliter, M.D., is working to do more for children she sees in her clinics than give them pediatric exams. She’s working to help them have better lives. Hinderliter, Director of Pediatrics for CVHD, gives each child she sees between the ages of 6 months and 5 years a new, age-appropriate book when they visit her. She and other CVHD physicians have given about 600 books to children since she started a Reach Out and Read (ROR) Program about six months ago. “We want to start them really young,” Hinderliter said. “The idea is to encourage the family to let the child hear more language and to learn that reading is fun.” ROR is a national, non-profit organization that promotes early literacy by making books a routine part of pediatric care, so that children grow up with books and a love of reading. Currently there are more than 2,500 ROR programs nationwide, including several within the Virginia Department of Health. The ROR national program trained Hinderliter to advise parents about the importance of reading aloud and to give books to children at pediatric checkups, with a special focus on children growing up in poverty. By building on the relationship between parents and medical providers, ROR helps families and communities encourage early literacy skills so children enter school prepared for success in reading. “It’s wonderful because of the look you see on a child’s face and their parents’ faces when they realize they get to take the book home,” Hinderliter said. “I can help them use the books and enjoy them with their children.” Hinderliter graduated from the University of Pennsylvania medical school in Philadelphia and was awarded a fellowship in neonatology at Johns Hopkins University in Baltimore. She came to the CVHD from Pittsburgh where she worked as a neonatologist. She and her husband, along with their 1-year-old daughter, moved to Lynchburg where she worked part-time for the health district before becoming chief of pediatrics in 2004. She saw the ROR program as one that she could easily incorporate into her practice. “Reach Out and Read is a wonderful, innovative program and I am happy that Dr. Hinderliter has been able to bring the program to Central Virginia,” said Katherine Nichols, M.D., director of the Central Virginia Health District. “We are making literacy and reading as fundamental as checking height and weight and administering immunizations in our clinics.” Initial funding for the Central Virginia Health District ROR program came from a start-up grant from the national ROR office. Currently the program is seeking community donations and grant funding. It has received support from Wal-Mart in Bedford and Madison Heights. The CVHD program includes satellite ROR programs at health departments in Amherst, Appomattox, Bedford and Campbell counties. Hinderliter said she would like to see families emphasize reading with their children instead of letting them watch TV and play video games. “It’s a shame some kids grow up and don’t know about books,” she said. “This program can really have a positive impact on a child’s life.”
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Wear Red on Feb. 3 to Support Women in Their Fight Against Heart Disease Wear red on Feb. 3 to show your support for women and their fight against heart disease. It’s all part of Go Red for Women, which is sponsored by the American Heart Association (AHA) and supported by VDH. VDH employees may have seen something about wearing red in CommonHealth’s newsletter, Compass. The VDH Office of Family Health Services partnered with CommonHealth, the employee wellness program for the Commonwealth of Virginia, in promoting this initiative. CommonHealth used the opportunity to further address cardiovascular health and promoted the event in its winter 2006 edition of the newsletter, which reaches 95,000 state employees. Heart disease and stroke are the greatest health threats women face, but only 13 percent know it. By wearing red on Feb. 3 you will help raise awareness of heart disease and empower women to reduce their risk. For more information on women’s heart health or Wear Red Day, visit www.americanheart.org/red or call (888) MY HEART.
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Chesterfield Cancer Awareness Day Reaches out to Hispanic Population
The Chesterfield County Health Department held a Cancer Awareness Day on Saturday, Oct. 29. The event served 160 citizens, with 126 coming from Chesterfield’s growing Hispanic population. Participants were educated on early detection and risk reduction and offered free medical screenings for skin, colorectal, breast, cervical, testicular and prostate cancers. The health department nutritionist provided dietary education and a healthy snack. Women were educated on breast self-exam and nine eligible women were enrolled in VDH’s Breast and Cervical Cancer Early Detection Program. A total of 549 screenings were completed and 28 individuals were referred for further evaluation. The demographics of those served include:
The event’s success was the result of the combined effort of health department staff and volunteer nurses and interpreters, VCU student nurses and volunteer physicians including Dr. Charles Seabury, Dr. Thomas Reams, Dr. Mathew Jones, Dr. Mark Schroeder and Dr. Richard Siemens.
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Fluoride Varnish Program Provides Bright Smiles for Babies
The Virginia Department of Health (VDH) Office of Family Health Services’ Division of Dental Health has launched a preventive oral health program that targets low-income infants and pre-school children, who are at high risk for developing tooth decay in their baby teeth. Bright Smiles for Babies, which began in July 2005, has the potential to reduce decay 40 percent to 60 percent among this population. It provides children with oral screenings and fluoride varnish applications every six months. It also educates their parents in ways to prevent tooth decay. So far, 370 children in Virginia’s 13 Early Head Start Programs have been screened, and 146 have received their first varnish application. All children in the program will receive the varnish by the age of 18 months. As part of the program, the Division of Dental Health also is collecting data over a three-year period to evaluate the effectiveness of the fluoride varnish in preventing tooth decay in the children enrolled in the Early Head Start Program. “We plan to extend the program to include children in other public and private settings, including private pediatricians’ offices,” said Susan Pharr, coordinator of the program, which is funded through a grant from the U.S. Health Resources and Services Administration. Pharr has trained public health dentists and nurses in Lynchburg, Suffolk and the counties of Wise and Russell how to screen and apply the varnish. Dr. E. Sue Cantrell, director of the Lenowisco Health District, plans to start the Bright Smiles for Babies Program in January. “Tooth decay is a huge problem and we have a shortage of dentists and dental hygienists. I think fluoride varnish is a great service to children in underserved areas where access to dental care is limited,” Cantrell said. To expose the program to a wider VDH audience, Pharr has scheduled two videoconferences for VDH medical and dental staff. The dates are Feb. 3, 10 to 11 a.m. and Feb. 10, 2 to 3 p.m. She will provide an overview of the program, explain the training and Medicaid’s participation, and solicit suggestions for implementing the program. Fluoride prevents decay when used systemically through community water systems as well as topically in toothpastes, rinses and gels. Fluoride varnish is a new preventive product and the only one that can be used safely and effectively on the teeth of very young children. It is easy to apply and adheres to the tooth immediately, minimizing the chance of swallowing. Medical and dental providers will be able to apply the varnish. Tooth decay is the most prevalent chronic disease among children in Virginia. Recently released data from the National Health and Nutrition Examination Survey show 24 to 28 percent of children under age 5 in Virginia have tooth decay. Nationally, low-income children have three times more tooth decay than their more affluent peers. Baby teeth are worth saving. “They aid in chewing, speech development, and facial bone development. They also save the space for the permanent teeth,” said Pharr. Bright Smiles for Babies is one of some 50 preventive health programs in the Office of Family Health Services that promote and protect the health of Virginians across the span of their lifetime. Click here to learn more about most Office of Family Health Services programs.
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VDH Staff Get Stuck to Stay Well
About 200 Virginia Department of Health (VDH) employees at the central office in Richmond rolled up their sleeves to receive their flu shots on Dec. 5, 2005. VDH recommends that everyone get vaccinated, especially those people who are at risk of developing complications from influenza, or flu. Vaccination is the best way to prevent the flu and its potentially severe complications.
The flu is caused by a highly contagious virus that is spread easily from person to person, primarily when an infected individual coughs or sneezes. The virus can be transmitted even before flu-like symptoms appear. Immunization provides the best protection against influenza. Flu can cause fever, cough, sore throat, headache, chills and muscle aches. Unlike the common cold, the flu causes severe illness and can be life threatening. Complications from the flu can lead to pneumonia and other serious illnesses, such as infections of the brain and heart. According to the Centers for Disease Control and Prevention, influenza causes an average of 36,000 deaths and more than 200,000 hospitalizations each year in the United States. More people die from complications from the flu than from any other vaccine-preventable disease. There are two types of flu vaccine available in the United States and their formulas are changed each year to attack the strains of the virus that are in circulation. This is why it is important to be vaccinated every year. The best time to receive influenza vaccine is during October and November, however vaccination in December, or even later, can still prevent the flu. January and February are typically peak flu months in Virginia, but increased flu activity can last into March. Protection develops about two weeks after vaccination and may last up to a year. Click here to learn more about the flu vaccine.
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| Accolades
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Pediatric Clinic Named Immunization Champion by Virginia Vaccines for Children
Winchester Pediatric Clinic in Winchester, Va., was chosen by the VDH Virginia Vaccines for Children Program (VVFC) as the “Immunization Champion” for December 2005 and January 2006. The clinic is a large and busy, yet welcoming, pediatric practice that continues to possess and adhere to successful immunization practices and procedures. They have been awarded Gold Stars by the VVFC Program for both outstanding VVFC Program Compliance and outstanding Immunization Rates. Among the factors that contribute to their success, Winchester Pediatric Clinic has an exceptionally dedicated staff that works tirelessly to ensure the health and well being of every child that sets foot in their facility. With office hours Monday through Friday from 8:30 a.m. to 5 p.m. and 6:30 p.m. to 8 p.m., the clinic’s dedication to the children in their community helps even the busiest families fit in a visit. In addition to weekdays, the clinic is also open every Saturday, Sunday and holiday from 9:30 a.m. to 11 a.m. and 6:30 p.m. to 8 p.m. These convenient hours help improve families’ access to health care. “We care about our children’s well-being 365 days a year,” said Karen Wines, R.N. Wines, who serves as the clinic’s point of contact with VVFC, helped design and maintain the clinic’s medical records system, which help ensure that all children are appropriately immunized for their age. Each child’s immunization history is documented on the front cover of their chart, allowing clinic staff to easily review the child’s record and ensure they’re up-to-date every time the chart is pulled from the shelf. This system minimizes missed opportunities and helps bring children up-to-date on their vaccinations. VVFC announces its “Immunization Champion” on a bi-monthly basis coinciding with each publication of its newsletter, The Backpage. Immunization Champions are nominated by VVFC staff and are featured on the VDH Division of Immunization Web site.
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Virginia Medical Reserve Corps and Public Health Volunteer Programs Continue to Grow When the Medical Reserve Program began in Virginia in 2003, there were approximately 1,000 volunteers registered across the state. Today more than 7,000 volunteers are registered with these programs. These citizen volunteers are trained to respond to health and medical situations in support of established local public health and emergency medical response systems. In 2005, 60 of Virginia’s Medical Reserve Corps (MRC) and public health volunteers were deployed to assist in the Gulf Coast region with disaster relief efforts. As 2006 begins, volunteers are still being deployed to assist in the Gulf area, mostly with shelters, behavioral health programs and rebuilding efforts. At the end of 2005, 24 of the 35 health districts across Virginia and one region had MRC or other volunteer programs. These programs include 12 MRC programs funded by the Office of the Surgeon General, seven funded by Metropolitan Medical Response Systems in Hampton Roads and Richmond, some receiving funding from local governments and five health districts developing volunteer programs without the benefit of any direct program funding. There were 19 nationally recognized and designated MRC units at the end of 2005. In addition to volunteer numbers, the scope of these programs has grown, too. Volunteers this year took part in 235 orientation and training programs, with a total participation of 3,422 volunteers. Approximately 75 percent of the MRC and public health volunteers are medically trained. The other 25 percent are not medically trained but have an interest in assisting with public health emergencies. All types of volunteers are being recruited, trained and utilized. In addition to training, these volunteers have assisted locally in public health clinics, mass vaccinations, local and national volunteer meetings and conferences and state and local fairs. They have participated in large numbers in emergency drills in their local communities and across their regions. In 2006 Virginia’s MRC and public health volunteer programs will focus on
There is a position for everyone in the Virginia public health and MRC volunteer program. Register today and to tell others about the program. Visit www.vamrc.org to register and learn more. When emergencies occur in Virginia, you will be glad you did. |
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