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Source: http://www.sltrib.com/news/ci_13428669
State doctor: Disease outbreaks will throw curves
Health care ?Physicians told not to let unreliable test results drive treatment decisions.
By Brooke Adams
The Salt Lake Tribune
Updated: 09/26/2009 06:01:32 PM MDT
In an infectious disease outbreak -- whether it's the 2009 H1N1 flu or cryptosporidium, which gripped Utah two summers ago -- a rapid response depends largely on local physicians.
"We're never going to get away from -- as smart as our lab tests and technology get -- having smart doctors recognizing new things and doing the right tests, talk to the lab, talk to the public health persons," said Robert Rolfs, state epidemiologist. "Cooperation among many partners is needed to prevent it."
That's key, too, because of these truisms: Outbreaks happen, and what happens next will not be what is expected, Rolfs said.
"Our ability to predict [outbreaks] has been remarkably limited, so we need to be prepared," he said.
Rolfs spoke Saturday at the 11th Annual Continuing Medical Education Conference at the University of Utah School of Medicine. The event is sponsored by the school's alumni association.
Rolfs said a very rapid response around the world to SARS helped contain that disease. The response to the H1N1 influenza was "somewhere in the middle."
"Sometimes it does take very bold, risky leadership to move the world, at a sometimes high cost, to respond quickly enough to these things," Rolfs said.
In 2007 the cryptosporidium outbreak, linked to public swimming pools, resulted in 1,902 confirmed cases of illness. But Rolfs estimates that as many as 40,000 cases went undiagnosed because physicians weren't checking for it.
Since then, there have been very few cases of the illness reported. He attributes that to new pool regulations, a public awareness campaign and UV and ozone treatment systems adopted at public pools.
The unexpected is part of the story with the 2009 H1N1 influenza.
Andrew T. Pavia, a pediatric infectious diseases professor at the University of Utah Health Sciences Center and Primary Children's Hospital, said researchers had keyed in on a different, highly virulent influenza as a likely cause of a pandemic with a high mortality rate.
So experts were surprised when the H1N1 virus emerged earlier this year. Even so, nationwide the response was hampered because of limited lab testing capacity, an ability to determine severity of illness that would result and hospital capacity, Pavia said.
As of Sept. 19, seasonal flu, H1N1 influenza and associated pneumonia have resulted in 10,082 hospitalizations and 936 deaths, according to the Centers for Disease Control and Prevention. Pavia said H1N1 is the only influenza virus now circulating.
About 1,600 of the hospitalizations were for confirmed cases of H1N1, which also was identified in 117 deaths, Pavia said.
The virus continues to affect a younger population and is higher in people with certain underlying conditions, including asthma, diabetes and cardiovascular disease.
Hospitalization rates also have been higher for pregnant women and those who are morbidly obese, have neurocognitive, neuromuscular and seizure disorders, Pavia said.
He said rapid tests have proven "very problematic" and emphasized that physicians should not base clinical decisions on negative test results.
Vaccine stockpiles developed for the H1N1 influenza will be released to states on Monday. One dose appears to be protective for those ages 9 and older and two doses for younger children and infants, Pavia said.
While the expected fall outbreak is already under way in some parts of the country -- hitting 8 percent of the population in the South -- it is just beginning in Utah.
"It's not safe to say that we won't have a major upsurge," Pavia said. "We just don't know."
He said experts anticipate it will look like the spring outbreak but attack rates and volumes will be higher, with small numbers experiencing severe illness.
brooke@sltrib.com
Utah has avoided some common vices
David Sundwall, director of the Utah Department of Health, said the state has "real bragging rights" when it comes to some public health measures. Among them: low rates of smoking.
"It is helpful to be in a state where a majority think they will go to hell if they smoke," he said.
Utah's obesity rate also ranks among the lowest in the nation, though "we're getting fatter faster, and I fear we're going to catch up," said Sundwall, speaking at the University of Utah School of Medicine Alumni Conference on Saturday.
Among challenges: the incidence of sexually transmitted diseases has increased 400 percent since 2002. He said that signals the state needs to do a better job of providing sex education for youth, within community acceptable parameters.
Also, too many people are still uninsured, a problem that is growing among adults ages 19-64. He pegged that state's overall uninsured population at 10.7 percent and said the U.S. Census bureau overestimates the count in its surveys.
"Whatever it is, it's too many," Sundwall said.
Brooke Adams
State doctor: Disease outbreaks will throw curves
Health care ?Physicians told not to let unreliable test results drive treatment decisions.
By Brooke Adams
The Salt Lake Tribune
Updated: 09/26/2009 06:01:32 PM MDT
In an infectious disease outbreak -- whether it's the 2009 H1N1 flu or cryptosporidium, which gripped Utah two summers ago -- a rapid response depends largely on local physicians.
"We're never going to get away from -- as smart as our lab tests and technology get -- having smart doctors recognizing new things and doing the right tests, talk to the lab, talk to the public health persons," said Robert Rolfs, state epidemiologist. "Cooperation among many partners is needed to prevent it."
That's key, too, because of these truisms: Outbreaks happen, and what happens next will not be what is expected, Rolfs said.
"Our ability to predict [outbreaks] has been remarkably limited, so we need to be prepared," he said.
Rolfs spoke Saturday at the 11th Annual Continuing Medical Education Conference at the University of Utah School of Medicine. The event is sponsored by the school's alumni association.
Rolfs said a very rapid response around the world to SARS helped contain that disease. The response to the H1N1 influenza was "somewhere in the middle."
"Sometimes it does take very bold, risky leadership to move the world, at a sometimes high cost, to respond quickly enough to these things," Rolfs said.
In 2007 the cryptosporidium outbreak, linked to public swimming pools, resulted in 1,902 confirmed cases of illness. But Rolfs estimates that as many as 40,000 cases went undiagnosed because physicians weren't checking for it.
Since then, there have been very few cases of the illness reported. He attributes that to new pool regulations, a public awareness campaign and UV and ozone treatment systems adopted at public pools.
The unexpected is part of the story with the 2009 H1N1 influenza.
Andrew T. Pavia, a pediatric infectious diseases professor at the University of Utah Health Sciences Center and Primary Children's Hospital, said researchers had keyed in on a different, highly virulent influenza as a likely cause of a pandemic with a high mortality rate.
So experts were surprised when the H1N1 virus emerged earlier this year. Even so, nationwide the response was hampered because of limited lab testing capacity, an ability to determine severity of illness that would result and hospital capacity, Pavia said.
As of Sept. 19, seasonal flu, H1N1 influenza and associated pneumonia have resulted in 10,082 hospitalizations and 936 deaths, according to the Centers for Disease Control and Prevention. Pavia said H1N1 is the only influenza virus now circulating.
About 1,600 of the hospitalizations were for confirmed cases of H1N1, which also was identified in 117 deaths, Pavia said.
The virus continues to affect a younger population and is higher in people with certain underlying conditions, including asthma, diabetes and cardiovascular disease.
Hospitalization rates also have been higher for pregnant women and those who are morbidly obese, have neurocognitive, neuromuscular and seizure disorders, Pavia said.
He said rapid tests have proven "very problematic" and emphasized that physicians should not base clinical decisions on negative test results.
Vaccine stockpiles developed for the H1N1 influenza will be released to states on Monday. One dose appears to be protective for those ages 9 and older and two doses for younger children and infants, Pavia said.
While the expected fall outbreak is already under way in some parts of the country -- hitting 8 percent of the population in the South -- it is just beginning in Utah.
"It's not safe to say that we won't have a major upsurge," Pavia said. "We just don't know."
He said experts anticipate it will look like the spring outbreak but attack rates and volumes will be higher, with small numbers experiencing severe illness.
brooke@sltrib.com
Utah has avoided some common vices
David Sundwall, director of the Utah Department of Health, said the state has "real bragging rights" when it comes to some public health measures. Among them: low rates of smoking.
"It is helpful to be in a state where a majority think they will go to hell if they smoke," he said.
Utah's obesity rate also ranks among the lowest in the nation, though "we're getting fatter faster, and I fear we're going to catch up," said Sundwall, speaking at the University of Utah School of Medicine Alumni Conference on Saturday.
Among challenges: the incidence of sexually transmitted diseases has increased 400 percent since 2002. He said that signals the state needs to do a better job of providing sex education for youth, within community acceptable parameters.
Also, too many people are still uninsured, a problem that is growing among adults ages 19-64. He pegged that state's overall uninsured population at 10.7 percent and said the U.S. Census bureau overestimates the count in its surveys.
"Whatever it is, it's too many," Sundwall said.
Brooke Adams
