Read the latest issue of the IH newsletter, Section Connection!

The latest issue of Section Connection, the IH Section quarterly e-newsletter, is now available!

You can find the latest issue of the newsletter here: http://bit.ly/SectionConnection7

If you can’t access the newsletter for any reason please email Theresa Majeski, Global Health Connections Chair, at theresa.majeski@gmail.com.

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Is Zika still a thing? My experiences as a Zika Case Manager in the field (South Florida)

Zika was a hot topic, but now it seems like it is a thing of the past. People always ask me…”Is Zika still is a thing?” And my response is, “Of course! Just because it has declined, certainly does not mean that it isn’t still a public health threat.”

Interesting enough, comments like “Is Zika still a thing” come from physicians and various public health professionals as well as individuals living in regions with active Zika transmission. Those that express more of a concern include individuals that have planned future travel to the state of Florida and are planning to conceive, or a close family member of someone who is currently pregnant.

What is Zika?

Perhaps you never heard of Zika, or still quite aren’t sure what Zika is exactly. Zika can be described as a virus that spreads to people primarily through the bite of an infected Aedes species mosquito. It is closely related to other flaviviruses such as Zika can also be transmitted sexually from a person that has Zika to their partner as well as from a pregnant woman to her developing fetus, which can result in serious birth defects. Want to learn more about Zika? Check out some other IH section blog posts about Zika here.

My role, criteria for testing, testing/funding limitations

I was hired as one of two Zika Case Managers within my local county health department through funding allocated to the state of Florida by the CDC. One of my duties is to coordinate the testing of suspected local, or travel cases, pregnant women, and any infant born to a potentially exposed pregnant woman. The testing criteria for pregnant women include those who traveled to a Zika-active transmission area, had sexual exposure during pregnancy, or 8 weeks prior regardless of the mother’s testing status, as well as those with any abnormal ultrasound results. Testing is also recommended if the mother was not previously tested. Just like other reportable infectious diseases, it takes effective communication between health professionals at all levels to get quality information across regarding Zika. In order to get the job done, we collaborate with infection control practitioners of local hospitals, nurses, physicians, and other public health clinicians to get samples of babies collected at birth for Zika testing while also making sure that a head ultrasound and hearing test are performed on the baby. This is very important because once the baby leaves the hospital it is almost impossible to get samples collected. A majority of the pediatric clinics don’t have the means to ship the specimens to the state laboratories. Some of the general responses we have received from these clinics include not knowing how to properly prepare the specimens for shipping, having the money to do so, and lack of knowledge about billing the patient’s insurance for the procedure. Although the county health department has the access and ability to ship specimens, it would be a liability for us to ship the specimens if another facility collected the samples.

As of March 2017, the department of health has conducted Zika virus testing for more than 13,020 people statewide. At Governor Scott’s direction, all county health departments were mandated to offer a free Zika risk assessment and testing to pregnant women. Unfortunately, due to a decline in cases, and federal funding allocated to state programs winding down, free testing is no longer accessible to the community, and is only provided on a case by case basis. Zika tests can be pretty expensive ranging anywhere from $200 – $400 when conducted at a commercial laboratory and even more in some cases.

State laboratories have just about depleted federal funds received for testing initiatives. If a patient does not meet testing criteria at our department of health, we recommend testing through affiliated commercial laboratories. In addition to the many changes in testing criteria including requiring patients to show proof of insurance, there has been issues with the insurance companies and patients’ have been incorrectly billed over $1000 for their Zika tests when in fact the test was free. This has been a big issue with tests conducted as far back as November and December which we have recently been made aware of. Mosquito control services specifically for Zika efforts provided by our county health department’s Environmental Health program has ended.

Management of Infants with confirmed, or possible Zika Infection

Currently, we have reached the stage where the pregnant women that are case managed have already given birth. We are now tasked with conducting 24 month active follow-ups of all infants exposed to a positive mother via in utero. We conduct follow-up of the infants exposed regardless of whether the infant tested negative, or positive. These infant follow-ups occur at 2, 6, 12, 18, and 24 months. This is because abnormalities can still occur during child development. A majority of our babies being followed are currently between the 12 and 18 month mark.

Out of all the babies we have tested, and are currently following, only one is confirmed to be microcephalic. Looking into the future, at the 18 month follow-up mark, the infants being followed will have to be re-tested in order to confirm if the antibodies are indeed negative or positive. Another complication with testing these babies will be whether the baby has traveled since it has been born. There is a possibility that the baby could have been infected during travel and not in utero. As of July 31st 2018, Zika contracts for our county health department will end and it is unsure who will take on the responsibility for maintaining the case management of these families.

Community Outreach

Best practices we have utilized as a county has been community outreach which we collaborate across the division of communicable diseases. I have been able to work closely with a CDC field assigned Zika Community outreach nurse to assemble and distribute Zika prevention and testing kits with a specific focus on obstetrician-gynecologist and pediatricians. We have been able to identify the gaps in testing and communication among our health department and local hospitals, clinics, and private physician offices. Additional community outreach activities of focus include visiting women, infant, and children (WIC) clinics throughout the county in order to conduct health education on Zika as well as community health fairs primarily within the Haitian population due to Haiti being one of the top countries which we get the most amount of travel related cases. Unfortunately, these outreach efforts will also end at the end of this summer due to the depletion of funds, and our CDC field assigned nurse’s contract ending.

Where we are now

As of right now, Florida still does not have any identified areas with ongoing, active Zika transmission. Florida is a hotspot for vacationers, especially the counties of Miami-Dade and Broward. Since the local transmission of Zika in 2016 in both counties, it seems that very few individuals consider Zika as being a major concern. Very few physicians’ are screening for Zika. Some still aren’t sure what it is exactly, and how it can affect an unborn fetus. Congenital Zika infection is still a global health threat to pregnant women and their infants. Zika is still a fairly new infectious disease, and we are learning as we go, especially the risks after pregnancy. The reality is that Zika is here to stay. Funding for zika prevention and treatment should be a top priority in order to aid in the health and wellbeing of children and families across the United States.

Kenya Just Banned a Homosexuality Test

Suspicion of having gay sex or relationships is illegal in Kenya and punishable by 14 years in jail. As a result, a group of activists and human rights lawyers in Kenya have been challenging this criminal code and fighting laws that punish LGBT people for being in a relationship or having sex.

One of the most prominent organization leading the issue is the National Gay and Lesbian Human Rights Commission in Nairobi, an organization arguing that LGBT communities are being unfairly targeted. In 2016, the commission received 193 reports of violations, mostly cyber-bullying, blackmail, verbal assault, and physical assault. Other forms of violence and discrimination include eviction, employer termination, or “corrective” rape. Most recently, forced anal exams were still carried out in Kenya despite being considered a degrading form of torture and having no medical merit; while straight people who have anal sex are not considered criminals. Forced anal examinations are usually performed by a healthcare provider at the request of law enforcement officials. These examinations are intended to cause emotional and physical pain and offer no potential benefits to the individual. This could also result in serious mental health concerns such as depression or suicide. This forced homosexuality test is not only a violation of medical ethics but a violation of health equity.

It originated when two men were found and arrested by police because they were thought to be gay. During this time, the court ruled against them and had them get the tests. Little is known about the true prevalence of this practice but the fact that it was codified in legal systems is astonishing. This ruling was reversed in Kenya in March 2018. Many are trying to determine if the ruling on forced anal testing could be an indicator for a turning point for LGBT cases. Promoting equality through health is extremely valuable, especially in this instance, and addressing any barriers could improve the overall health around the LGBT community.

To this day at least nine countries, several of which are in Africa, force anal examinations to investigate or punish alleged same-sex behaviors between consenting men or transgender women. A study from 2016 found that Kenya and several other countries use anal examinations as a means of determining a man’s sexuality. Tunisia, Egypt, Turkmenistan, Cameroon, Lebanon, Uganda, and Zambia, and Tanzania and possibly some others that have reported some instances, such as Syria, are included.  Law enforcement officials should never order the examinations since they lack evidentiary value. Doctors should not conduct them and courts should not admit them into evidence.

Global News Round Up

Politics & Policies

A review of US-funded Ebola recovery projects in Guinea, Liberia, and Sierra Leone by the US Government Accountability Office (GAO) released this week found that, of $1.6 billion appropriated by Congress in 2014 for US Agency for International Development (USAID) in the hard-hit region, $411.6 million has been targeted to 131 specific projects.

Programs, Grants & Awards

Each year we commemorate World TB Day on March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB) and to step efforts to end the global TB epidemic. The date marks the day in 1882 when Dr. Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.

Research

In most health systems, Community Health Workers (CHWs) identify and screen for severe acute malnutrition (SAM) in the community. This study aimed to investigate the potential of integrating SAM identification and treatment delivered by CHWs, in order to improve the coverage of SAM treatment services.

Researchers with the National Institutes of Health (NIH) recently made a breakthrough on the link between iron supplements and worsening malaria infections, as well as curious mutation in African populations.

States that have approved medical cannabis laws saw a dramatic reduction in opioid use, according to a new study by researchers at the University of Georgia.

It seems the multi-billion dollar cannabis industry is having some problems with its employees showing up to work stoned. A recent study published in the American Journal of Industrial Medicine finds that a large percentage of those employed in the businesses of growing and selling weed are getting high either before work at some point during business hours — risking both their safety and that of their co-workers.

Diseases & Disasters

In West and Central Africa, nearly 170 young people are infected with HIV everyday and a disparity in funding has left the youth at risk.

Public Health England has reported a gonorrhea case resistant to the pair of antibiotics (ceftriaxone and azithromycin) that have been typically effective in treating gonorrhea.

For decades now, global health organizations and deep-pocketed philanthropies like the Gates Foundation have worked to eradicate wild poliovirus – and the achievement of that goal often seems tantalizingly close at hand.

The United Nations emergency food relief agency has airlifted over 80 metric tons of vital nutritional supplements to Papua New Guinea – enough to feed approximately 60,000 people in the earthquake-hit country.

Technology

Antibiotics were heralded as life-savers when they became widely available in the 1940s.  Today, they are fast becoming killers themselves. The more any given antibiotic is used, the greater the chances that bacteria will develop antimicrobial resistance (AMR) that renders the drug ineffective.

Environmental Health

The world is facing one of the largest food crises in more than 79 years, and climate change is only making it worse.  Between 2030 and 2050, climate change could kill an additional 250,000 people every year, from malnutrition, malaria, diarrhea and heat stress.

Lebanon’s waste crisis began in 2015 when a huge landfill site closed and government authorities failed to implement a contingency plan in time to replace it; dumping and burning waste on the streets became widespread. The campaign group Human Rights Watch calls it “a national health crisis”.

New research reveals shortening of telomeres due to air pollution in newborn. The researchers analyzed telomeres in the umbilical cord blood of 255 newborns, half of whom were born prior to the coal plant closure and the other half were conceived and born after the plant closure in Tongliang, China.

Equity & Disparities

One of the biggest issues at the intersection of sanitation, poverty and global health, open defecation has also long been one of the hardest to represent visually.

While globally men report a 25% higher cancer incidence than women, a new study reveals the opposite trend in India with more women being diagnosed with cancer than men.

Women, Maternal, Neonatal & Children’s Health

A United Nations employee who says she was sexually assaulted by a top UN official has spoken publicly for the first time, alleging she was offered a promotion if she accepted an apology from the man and claiming that the organization failed to take her complaint seriously.

An international health organization has suspended its partnership with the Heineken beer company because of the controversial use of so-called “beer girls” to promote its products.

Teenage pregnancy – the biggest killer of girls and women aged 15 to 19 in the world – is growing in the east Asia-Pacific region, the only place where the rate is climbing.

Human Rights

UN Security Council members condemned the killing of civilians in Gaza after a peaceful protest turned violent.

Health in All Policies Faculty Development Workshop-June 18-20 in Washington, DC

The World Health Organization (WHO) in collaboration with the Association of Schools and Programs of Public Health (ASPPH) and the National Environmental Health Association (NEHA) invites you to attend a Health in All Policies (HiAP) skill-building workshop from June 18-20 in Washington, DC to build education/training and practice approaches that move policy in support of both health and the environment. Air pollution will be used to provide case examples throughout the workshop.

The deadline for applications is April 25, 2018. To apply online, please visit the ASPPH page here. The WHO site provides more background here.