Pertussis, the whooping cough bacteria -- CDC photo

The number of cases of whooping cough in Washington state increased by more than 50 percent between 2010 and 2011, the State Department of Health reported Wednesday.

Last year there were 912 cases in the state — the highest in six years — up from 608 cases reported in 2010.

In recent years, adolescents and adults have accounted for an increasing proportion of cases, health officials said.

“The number of reported cases is just the tip of the iceberg,” State Health Officer and pediatrician Dr. Maxine Hayes said. “Many young people and adults who get pertussis may not know they have it and don’t seek medical attention.

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

Initially, an infection may seem like a cold, but patients then go on to develop a severe, persistent–often wracking–cough that can last for weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

Adolescents and adults often get a much milder case of whooping cough, but they can still spread it, the Department of Health warned.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants. Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Who should get the vaccine?

The U.S. Advisory Committee on Immunization Practices has issued new pertussis vaccination recommendations:

• Pregnant women to get pertussis vaccine (Tdap) later in pregnancy (after 20 weeks’ gestation). Women who get Tdap vaccine before or during pregnancy pass on extra protection against pertussis to their babies.

• Anyone who takes care of or has close contact with babies to get pertussis vaccine, ideally at least two weeks before beginning close contact with the infant. This includes siblings of infants who should be up-to-date on DTaP and other recommended immunizations.

• Tdap vaccine is available for adolescents and adults through age 64. But adults 65 and older who expect to have close contact with babies younger than 12 months should get a dose of Tdap to help protect the baby from pertussis.

• Health care workers of all ages who have contact with infants should get vaccinated too.

Protection wears off so you may need a booster

Most people get a series of pertussis vaccines when they’re kids, but protection wears off over time. The Department of Health recommends people substitute a Tdap vaccine for one routine tetanus (Td) booster, which is needed every 10 years; people should get it sooner if they’re in close contact with young kids or live in an area where there are pertussis cases. There’s no minimum time period between getting Td and Tdap vaccines. Only one Tdap vaccine is recommended in a person’s lifetime.

Vaccines available for free for kids under 19

All recommended vaccines are offered to all kids under 19 at no cost through health care provider offices participating in the state’s Childhood Vaccine Program.

Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee.

People who cannot afford the administration fee can ask their regular health care provider to waive the cost.

Adults should talk to their insurance carriers about coverage for pertussis vaccine.

To learn more:

• Visit the PKIDS Online pertussis information page.

• Contact your local health agency  or the Department of Health’s Office of Immunization and Child Profile at 360-236-3595.

Main sources of sodium include many common foods

From the CDC

Nearly all Americans consume much more sodium than they should, according to a report from the Centers for Disease Control and Prevention.  Most of the sodium comes from common restaurant or grocery store items.

The latest Vital Signs report finds that 10 types of foods are responsible for more than 40 percent of people’s sodium intake.

The most common sources are breads and rolls, luncheon meat such as deli ham or turkey, pizza, poultry, soups, cheeseburgers and other sandwiches, cheese, pasta dishes, meat dishes such as meat loaf, and snack foods such as potato chips, pretzels and popcorn.

Some foods that are consumed several times a day, such as bread, add up to a lot of sodium even though each serving is not high in sodium.

“Too much sodium raises blood pressure, which is a major risk factor for heart disease and stroke,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “These diseases kill more than 800,000 Americans each year and contribute an estimated $273 billion in health care costs.”

The report notes that the average person consumes about 3,300 milligrams of sodium per day, not including any salt added at the table, which is more than twice the recommended limit for about half of Americans and 6 of every 10 adults.

Top Sources of Sodium in Our Diet

• Breads and rolls

• Cold cuts and cured meats

• Pizza

• Poultry

• Soups

• Sandwiches

• Cheese

• Pasta dishes

• Meat dishes

• Snacks

The U.S. Dietary Guidelines recommend limiting sodium intake to less than 2,300 milligrams per day.  The recommendation is 1,500 milligrams per day for people aged 51 and older, and anyone with high blood pressure, diabetes, and chronic kidney disease, and African Americans.

Key points in the Vital Signs Report:

• Ten types of foods account for 44 percent of dietary sodium consumed each day.

• 65 percent of sodium comes from food sold in stores.

• 25 percent of sodium comes from meals purchased in restaurants.

• Reducing the sodium content of the 10 leading sodium sources by 25 percent would lower total dietary sodium by more than 10 percent and could play a role in preventing up to an estimated 28,000 deaths per year.

Reducing daily sodium consumption is difficult since it is in so many of the foods we eat.  People can lower their sodium intake by eating a diet rich in fresh or frozen fruits and vegetables without sauce, while limiting the amount of processed foods with added sodium.

Individuals can also check grocery food labels and choose the products lowest in sodium.  CDC supports recommendations for food manufacturers and restaurants to reduce the amount of sodium added to foods.

“We’re encouraged that some food manufacturers are already taking steps to reduce sodium,” said Dr. Frieden. “Kraft Foods has committed to an average 10 percent reduction of sodium in their products over a two year period, and dozens of companies have joined a national initiative to reduce sodium.

The leading supplier of cheese for pizza, Leprino Foods, is actively working on providing customers and consumers with healthier options.  We are confident that more manufacturers will do the same.”

To learn more:

• To learn more about ways to reduce sodium, visit www.cdc.gov/salt.

• For more information on heart disease and stroke, visit http://www.cdc.gov/heartdisease/.

• Reducing sodium is also a key component of the Million Hearts™ initiative to prevent a million heart attacks and strokes over the next five years.

• To learn how to reduce sodium using the DASH eating plan, visithttp://www.nhlbi.nih.gov/health/health-topics/topics/dash/.

Photo: Sigurd Decroos

The good news: Teen pregnancies are at their lowest rate in nearly 40 years, resulting in fewer abortions and births, according to data from the Guttmacher Institute, a research organization focused on sexual and reproductive health.

The report shows that about 7 percent of U.S. teen girls between the ages of 15 to 19 were pregnant in 2008 — a decline from the high of more than 11 percent in 1990.

Abortions among teen girls fell from a peak of more than 4 percent in 1988 to about 1.8 percent in 2008, the lastest year for which data is available.

The bad news: While overall rates have dropped, there is still a major gap among white, Hispanic and black teenagers. Non-Hispanic white teen pregnancy rates fell by 50 percent from their peak; Hispanic teen pregnancy rates, 37 percent; black teen pregnancy rates, 48 percent.

Yet, according to the report, “the abortion rate among black teenagers was four times the rate for non-Hispanic whites, while the rate among Hispanic teenagers was twice the rate for non-Hispanic white teenagers.”

“The disparity has pretty much been unchanged,” said Kathryn Kost, co-author of the report. “If you think of these rates as lines on a graph, they are all going down, but the distance between them is pretty much unchanged.”

Kost said the increase in contraceptive marketing has helped to reduce pregnancies, but Heather Boonstra, a senior public policy associate at Guttmacher said the cost of contraceptives continues to be a factor. Boonstra said increasing the age limit for dependent health care coverage to 26 will increase access to birth control for many teens.

“There’s plenty of evidence that shows that if you take away cost in the equation,there is going to be better contraceptive use, fewer unintended pregnancies, fewer abortions, better birth outcomes,” she said. “The health care reform law was not designed with teens in mind, but … the more parents that are insured, the more teens or their dependents are insured, so certainly that will help.”

Bill Albert, the chief program officer of The National Campaign to Prevent Teen and Unplanned Pregnancy, said the decreased rates are a sign of progress, but more remains to be done. He noted that three out of 10 girls are pregnant by the age of 20.  Among the campaign’s initiatives is one focused on the Latino community and a new website geared to educating young women about birth control.

“In a way the message is let’s celebrate today, and then get back to work this afternoon,” Albert said. “I think this underscores the need to continue to invest as the current admin has in proven efforts to prevent teen pregnancy.”

Photo by Sigurd Decroos of CobraSoft.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

In an interview with LocalHealthGuide, the school’s dean, Dr. Howard Frumkin, said a new strategic plan was needed to enable the school to meet the “very big, cross-cutting challenges facing public health,” ranging from the rise of new technologies, such as genomics, to looming global problems, such as climate change.

The document, University of Washington School of Public Health: Strategic Plan 2012-2020, is the result of a nearly year-long process that involved discussions involving the school’s faculty, staff, students and other stakeholders.

“We began with a focus on big, bold, new ideas that would orient us to next few decades of public health challenges,” Dr. Frumkin said, “But what emerged over time was a concern that by focusing on those big, emerging challenges we would neglect the enormous strengths that we already have.”

A major concern, Dr. Frumkin said, was that at a time when state funding for higher education is being slashed and federal funding is leveling off the school’s core programs could be undermined if ambitious new programs began to draw on diminishing resources.

To address those concerns, Dr. Frumkin said, the plan takes a two-pronged approach that aims to strengthen the school’s “core” teaching, research and service programs while also moving to address the new challenges of the coming decades.

In the end, “we came to a very robust consensus on a balance between our existing assets and the new directions in which we want to move,” Dr. Frumkin said.

Seven goals to strengthen the school’s core programs

• Strengthen Teaching

• Strengthen Research

• Strengthen Collaborations with Community Partners

• Globalize the School

• Improve Diversity

• Enhance School Community

• Promote the School

Although the school’s core teaching program is already very strong, Dr. Frumkin said, more needs to be done to incorporate new science into the curriculum and develop the cross-disciplinary approaches that will be needed to address the “upstream” issues that affect health, Dr. Frumkin said.

“Improving health means you have to have a broad, collaborative, interdisciplinary approach where public health expertise might, for example, be blended with social work expertise, urban design expertise, educational approaches, and so on,” Dr. Frumkin said. All new courses will in include curricula that include a broader, big picture approach, he said.

UWSPH Fast Facts:

• Founded in 1970

• 1,014 students (76% women, 7% international, 30% minority)

• 208 undergraduates, 806 graduate students

• Faculty: 251 full, 147 adjunct, 476 affiliate & clinical – 874 total

• Departments: Biostatistics, Environmental & Occupational Health Sciences, Epidemiology, Global Health, Health Services

• $130.8 million (69% Federal Grants & Contracts, 15% State & Local Funds, 1% Gifts & Endowments, 14% Foundations, Industry, etc.)

• Ranked sixth in the nation in the 2011 US News and World Report survey of graduate schools of public health, and third among publicly funded schools of public health.

Hitting the ground

Students will also receive more training in practical policy implementation, said Dr. Frumkin. “The employers are telling us that our students are very good at analytics and that they are very good at working with data, but they don’t necessarily have the practical skills, ranging from creating and managing budgets to going to the county commission and making the case for a public health program,” Dr. Frumkin said. “When you hit the ground and begin practicing public health, you have to have a whole set of skills that aren’t really captured by a more academic approach.”

As part of an effort to develop such skills, the school will broaden its collaborations with local agencies and community organizations, especially through the school’s student practicum programs, Dr. Frumkin said.

Such programs and other initiatives will increase the school’s involvement in communities around the state and region, he said.

Bio: Dr. Howard Frumkin

Dr. Frumkin has a special interest in environmental health, climate change and healthy community design.

Before he was appointed dean of the UW School of Public Health in 2010, he served at the U.S. Centers for Disease Control and Prevention (CDC) from 2005-2010, where he was the first director of the National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, and later served as Special Assistant to the CDC Director for Climate Change and Health.

From 1990-2005, Dr. Frumkin was Professor and Chair of Environmental and Occupational Health at Emory University’s Rollins School of Public Health and Professor of Medicine at Emory Medical School.

His research interests include: the public health aspects of the built environment, climate change, energy policy, and nature contact; the toxic effects of chemicals; and environmental health policy.

He has co-edited or co-authored a number of books, including:

• Urban Sprawl and Public Health
• Emerging Illness and Society
• Environmental Health: From Global to Local
• Making Healthy Places

Diversity

Although the school already has a significant number of minority and international students, more can be done to make the school more diverse in culture and outlook, Dr. Frumkin said.

As part of the effort to promote diversity, the school plans to expand its outreach to local high schools, community colleges and other institutions by offering courses and other programs designed to encourage minority students to pursue careers in public health.

“Through such conduits or pipelines, I think we can build pathways through which students from under-represented groups can get into public health and serve their communities,” Frumkin said.

Emerging Challenges

• Global Environmental Change and Human Health

• Genomics and Public Health

• Obesity, Food, Physical Activity, and Health

• Health Policy and Health Systems

• Public Health Implementation Science

• Social Determinants of Health

Emerging Challenges:

The health effects of global environmental change are a particular interest of Dr. Frumkin and he believes the school already is well positioned to become a world leader in the field.

The UW’s Department of Global Health, for example, has already launched a “Climate Change and Global Health” initiative, which is focusing on threats to food and water security due to climate changes, he noted.

The school will also be able to harness the existing expertise of such programs as UW’s Colleges and Schools of Environment, Built Environments and Engineering.

Genomics and public health

The school is also well-placed to become a leader in the application of genetics and genomic science to public health, Dr. Frumkin said, with its Institute for Public Health Genetics and  Center for Genomics & Public Health and the opportunity to collaborate with the researchers at other UW programs, such as the Department of Genome Sciences and the School of Medicine’s Northwest Institute of Genetic Medicine and the Northwest Genomics Center.

Socioeconomic determinants of health

Although listed last, an effort to address the socioeconomic determinants of health will be a important part of the school’s plan to tackle “upstream” problems that directly affect health, such as education, living conditions and access to community services,  Dr. Frumkin said.

“If you’re committed to improving health, you can’t avoid people’s circumstances,” he said. ”We know the poverty is the most accurate predictor of bad health.”

By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm