CDC investigating potential exposures of American citizens to Ebola in West Africa

On March 13, an American volunteer health care worker in Sierra Leone who tested positive for Ebola virus returned to the U.S. by medevac and was admitted to the NIH Clinical Center for care and treatment.  As a result of this case, CDC is conducting contact tracing of individuals in Sierra Leone, including several other American citizens, who may have had potential exposure to this index patient.  At this time, none of these individuals have tested positive for Ebola. These individuals are volunteers in the Ebola response and are currently being monitored in Sierra Leone.  Out of an abundance of caution, CDC and the State Department are developing contingency plans for returning those Americans with potential exposure to the U.S. by non-commercial air transport. Those individuals will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period.

One of these American citizens had potential exposure to the individual being treated at NIH and is currently being transported via charter to the Atlanta area to be close to Emory University Hospital. The individual has not shown symptoms of Ebola and has not been diagnosed with Ebola. Upon arrival in Atlanta, the individual will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period.

Inadequate Physical Activity Increase Health Care - Costs in the United States

Despite the known health benefits of being physically active, only about half of US adults meet the minimum guidelines for aerobic physical activity. In a recently published study in Progress in Cardiovascular Diseases, CDC and Emory University researchers reported that physically active adults had lower annual direct health care expenditures than adults participating in inadequate levels of physical activity. The study estimated that 11.1% of total health care expenditures were associated with inadequate levels of physical activity. This equates to about $117 billion per year of direct health care expenditures being associated with inadequate levels of physical activity.

In this same study, when adults with any reported difficulty walking from health problem were excluded, 8.7% of health care expenditures were associated with inadequate levels of physical activity. This equates to about $79 billion per year of direct health care expenditures associated with inadequate levels of physical activity.

The considerable financial burden associated with inadequate levels of physical activity in the United States could potentially be reduced by increasing adults’ physical activity to levels consistent with current guidelines and Healthy People 2020 objectives.

Being physically active is one of the most important steps that Americans can take to improve their health. People who are regularly physically active generally live longer and have a lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. The 2008 Physical Activity Guidelines for Americans recommends that adults participate in at least 2 hours and 30 minutes (150 minutes) a week of moderate-intensity equivalent aerobic physical activity and at least two or more times a week of muscle-strengthening activities for health benefits.

Health Care Worker Who Worked While Ill with Pertussis

On September 5, 2014, the public health department of a Maryland hospital was notified of a case of Bordetella pertussis infection confirmed by polymerase chain reaction (PCR) in a staff health care worker (HCW). The HCW experienced onset of diarrhea and malaise (nonrespiratory symptoms atypical of the catarrhal phase of pertussis) on August 26. By September 2, paroxysms of coughing led the HCW to consult a colleague, who ordered the PCR test, prescribed a 5-day course of azithromycin, and advised avoidance of patient care until treatment completion.

Contrary to the hospital's infection control policy, neither the HCW nor the colleague reported the presumptive diagnosis of pertussis to the hospital's public health department. The HCW continued to work in the outpatient department until the positive PCR result was received on September 5, at which time the hospital's public health department was first notified.

The hospital barred the HCW from further work at the hospital while ill, and, in collaboration with local and state public health counterparts, began a contact investigation and stratified patient and HCW contacts by level of exposure.

The HCW had received tetanus, diphtheria, and acellular pertussis vaccine (Tdap) in 2010 and reported an ill family member who had been exposed at school during a widespread outbreak of pertussis affecting the surrounding community in August (1). In all, 47 persons were identified as being exposed to the HCW, including 31 patients ranging in age from 7 days to 12 years (six of whom were too young to receive diphtheria, tetanus, and acellular pertussis vaccine [DTaP]) and 15 HCWs. Of these exposed persons, 22 were considered high-risk contacts (seven patients and 15 HCWs) because they were aged <12 months, or contacts who themselves have close contact with infants under 12 months, pregnant women, or persons with preexisting health conditions at risk for severe illness or complications from pertussis.

All 22 high-risk contacts were assessed for symptoms and received postexposure prophylaxis according to established guidelines (2). Additionally, six HCW high-risk contacts (three staff physicians, two residents, and one nurse) reported symptoms suggestive of pertussis and were excluded from work until completion of a course of antibiotics. No patient contacts reported symptoms. Nasopharyngeal swabs obtained from all symptomatic high-risk contacts were negative for pertussis by PCR. The remaining low-risk contacts, or their identified parents or guardians, were screened for symptoms, informed of the low-risk nature of the exposure, and provided education on the signs and symptoms of pertussis. All 47 persons identified as exposed were contacted by public health investigators.

HCW presenteeism (i.e., working while sick) can jeopardize the well-being of patients and coworkers (3). Because of the need to investigate and limit exposures, clinical activities in a facility can be disrupted when staff members are potentially exposed to transmissible disease. HCWs should not work while ill with a potentially contagious condition.

2/2/14 Health News Cutting Sugar Saves on Health Care - Getting BPA Out of Food Saves Billions - Study Finds Youth with High Levels of HIV

Food crusaders' new challenge: cut sugar to save National Health Service  £50bn a year

The campaigners who helped reduce salt intake in British diets by 15% in seven years have a fresh target in sight. But they fear this struggle will be much tougher – and talks with the health secretary Jeremy Hunt this week could be crucial Continue Reading

Study: Replacing BPA in food products could save billions in health costs

In a first-of-its-kind study, a researcher has estimated that the health-related economic savings of removing bisphenol A from our food supply is a whopping $1.74 billion annually. And that’s a conservative estimate. “This study is a case in point of the  Continue Reading

NIH Research Network Finds Many Youth Have High Levels of HIV

More than 30 percent of young males who had sex with other males and who were subsequently enrolled in a government treatment and research network were found to have high levels of HIV, reported researchers from the National Institutes of Health and other institutions. The health status of the study participants, who ranged in age from 12 to 24 years, was monitored as part of their participation in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Continue Reading