Top 3 Public Health News of 2009

This year public health undeniably became a part of our national consciousness. In order to ring in the New Year and reflect on the past year at Veritas Health, I've highlighted below what I believe to be the top three issues in public health of 2009. For those interested, the headlines link to my previous posts on the topic.

Harvard Vaccination Guru Speaks Swine

Still confused about whether the swine flu vaccine is safe?

Don't know whether you should be vaccinated?

Here's an interview published in today's Boston Globe with Dr. Marie McCormick, professor of maternal and child health at the Harvard School of Public Health and the lead advisor on an expert committee that reviewed data related to the safety of the swine flu vaccine.

In response to whether she will get vaccinated, McCormick said, "When it becomes available, I will certainly have it. I do see patients in the fall, and all my patients are younger than 3, so it’s really both for their protection and mine."

Mandated H1N1 Vaccination: Right or...Oh, so Wrong?

A good friend and former colleague inspired this post (thanks Joanne) after realizing how media attention to mandated H1N1 vaccination among health workers has grown in the past few weeks. NPR, Time, the New York Times, ABC News all are covering what is an unprecedented move to require health care workers to be vaccinated against swine flu.

While many hospitals and clinics are requiring employees to get vaccinated, the state of New York is requiring all health care workers with patient contact to receive the H1N1 vaccine or face job loss; resistance to this mandate among health care workers has been overwhelming. Fear of side effects and privacy issues top health workers' concerns. However, an August poll shows a vast majority of the public to be supportive of these vaccine requirements among healthcare employees.

There seem to be several streams of thought regarding this issue:

1. Vaccination of all health care workers is needed to protect the public against swine flu spread by providers who come into contact with sick patients
2. Mandatory vaccination is needed to protect other patients in the hospital setting with compromised immune systems (meaning they easily can come down with an illness, like the flu).

But many nurses object, saying that they have never gotten flu in past seasons, so why now? Why this flu shot? Additionally, opponents to mandatory vaccination highlight the fact that the vaccine is not effective 100% of the time. Nurses also worry about the potential side effects of vaccination, particularly whether it would cause them to get sick with the flu.

Swine Flu Controversies

For more on current controversies over swine flu (including xenophobic reactions from leading talk radio hosts and the slaughtering of pigs in Egypt) see my recent post in Society & Health.

Swine (...I mean H1N1) Flu Hits Harvard

View H1N1 Swine Flu in a larger map

I have been (whether it's obvious or not) avoiding blogging about swine flu, now referred to as H1N1. However, since classes at the Harvard Dental School, Medical School, and School of Public Health were cancelled today, I I decided to take this extra 2 hours in my Friday to write a brief post from a public health students' perspective.

The widely communicated message of "be concerned, but not alarmed" jives well with what I know about the cases that have emerged in the US and suggests that ongoing monitoring will respond to any changes in cases or further mutations of the virus. 

So why is there cause for concern?

• This is a new strain of the flu virus, which means that those who received flu shots last Fall will not be protected against it.
• We still do not know why young, healthy people are dying in Mexico, but not in the US. The US only has 1 confirmed death at this point of a Mexican toddler in Texas. 
• Flu is and always has been a deadly disease. The CDC estimates that nearly 36,000 people die from the flu each year.
  

But not alarm?

• Cases tend to be spreading slowly in the US, mostly to people in close contact with individuals that traveled to Mexico (parents, siblings, children, etc.).
• Tamiflu and Relenza, two stockpiled antiviral medications, are available to treat people who get infected with H1N1.
• Local, State, and Federal governments are collaborating to make sure that resources reach those who need them and have a flu emergency plan.

I must say I was a little surprised that HSPH cancelled classes today (as well as a couple on-campus conferences). Few students have classes on Fridays, so perhaps it was the least disruptive day to do so. Additionally, if more students have been infected the weekend may give time for symptoms to emerge so that others do not get sick, as well.

Nonetheless, I am feeling great (for anyone out there that cares). I am washing my hands frequently (especially after riding public transit) and making sure I eat well and get enough sleep. I always try to avoid sick people -- so that's not a change I need to make. Friends, I encourage you to do the same. Leave your lovely blue masks at home.

To learn more about emerging cases in the US check out the CDC site for global cases of H1N1 see the WHO website. 

I wonder what Google came up with for the Swine flu outbreak. Did they see anything on Google Flu Trends? Check it out here.

Next Steps:

More to come on how an infectious disease, like swine flu, intersects with social determinants of health including discrimination and poverty.

Google Gets Public Health

Flu season is almost upon us. Google "flu" or "flu symptoms" and you are likely to have been picked up by the new Google surveillance system that aims to become an early warning system for regional flu outbreaks and trends across the United States. The New York Times recently reported (and blogged) about the Google.org web tool, called Google Flu Trends, which may be able to save lives.

There are no doubt questions about how well this tool will can reliably predict flu outbreak before people visit the doctor. But it is exciting to hear yet another way that Google is attempting to provide some public health improvements and innovation.

We all know that our Internet use is not exactly private knowledge. But does this surveillance cross the line? I would argue, no. I see little to no harm in Google relaying aggregate data of flu symptom searches from its site to public health organizations. But, would people feel differently if it was monitoring searches for "HIV symptoms" or "HPV symptoms"?

Mobile technology, the internet, and Web 2.0  is increasing in use by people of all ages and incomes. This provides public health practitioners with new opportunities to target outreach and education activities more effectively and to harness the power and creativity of people to change social norms and improve social support. I look forward to seeing where the intersection of internet technology and public health meet next.