Monthly Archives: July 2013

  • Emergency First Aid & Treatment Guide - Smartphone App

    Emergency First Aid Treatment & Guide - App for Phone or Android! Emergency First Aid Treatment & Guide - App for Phone or Android!

    The Emergency First Aid and Treatment Guide features include: international emergency numbers, current CPR guidelines and steps on what to do. It covers emergencies ranging from choking, to burns and heat exhaustion. This app is .99 cents and available for both Android and Apple devices.

    Click here to get app

  • Aspirin - Risk of Liver Damage - Recall

    Mislabeled Aspirin Increases Risk of Liver Damage

    FDA is alerting consumers, pharmacy and health care professionals to a nationwide recall of one lot of 81 mg Enteric Coated Aspirin Tablets because of the possibility that the tablets in these bottles may actually contain tablets with 500 mg of acetaminophen, the active ingredient in other pain relievers such as Tylenol. The aspirin, intended for the treatment of minor aches and pains, was manufactured and packaged by Advance Pharmaceutical Inc. under the label of Rugby Laboratories.

    Risk: Consumers who inadvertently take 500 mg of acetaminophen are at risk of severe liver damage if they take other drugs containing acetaminophen, consume three or more alcoholic drinks every day, or have liver disease. The label directions on the mislabeled products instruct patients to take four to eight  tablets every four hours, but not more than 48 tablets in 24 hours. Consumers who take 48 tablets daily of the defective product may be ingesting up to 24,000 mg of acetaminophen, which is six times the maximum recommended daily dose. The affected lot Enteric Coated Aspirin Tablets is Lot 13A026 with an expiration date of January 2015.

    AspirinRecommendations

    • Consumers who have the affected lot should immediately discontinue its use and return it to the pharmacy or store where it was purchased.
    • Consumers should contact their physician or health care professional if they have experienced any problems that may be related to taking or using this product. Signs of liver damage include abdominal pain and swelling, yellowish discoloration of the skin and eyes, and dark urine.
    • Consumers with questions may contact Advance Pharmaceutical Inc., Monday-Friday, 9 a.m.-5 p.m. ET at 631-981-4600, Ext. 308.

    For More Information

  • The World Didn't Come to an end in 2012...What's next?

    With National Preparedness Month coming up in September, we reflect back on last year and "The End of The World" as purportedly predicted by the Mayan Calendar for 12/21/12... Hm... Still here, aren't we?

    As NASA put it - If you're reading this story, it means the world didn't end on Dec. 21, 2012. Despite reports of an ancient Maya prophecy, a mysterious planet on a collision course with Earth, or a reverse in Earth's rotation, we're still here.

    Are you prepared for whatever comes next? Preparedness is essential, as we often remind our readers, and you'll hear a lot more in this over the next weeks as the 10th Annual US National Preparedness Month comes up in September 2013 - but first, let's see what else NASA has to say about "The End is Nigh"...

    The Mayan connection "was a misconception from the very beginning," says Dr. John Carlson, director of the Center for Archaeoastronomy. "The Maya calendar did not end on Dec. 21, 2012, and there were no Maya prophecies foretelling the end of the world on that date."
    › Read More About the Mayans

    Video: Why The World Didn't End - NASA Scientist David Morrison Debunks the Myths
    For years leading up to the supposed apocalypse, NASA scientists worked to dispel the myths and answer questions on a host of 2012 topics:


    Blue Marble - High-Res Image of the Earth › View larger
    A 'Blue Marble' image of the Earth taken from the Visible/Infrared Imager Radiometer Suite (VIIRS) instrument aboard NASA's Suomi NPP satellite. This composite image uses a number of swaths of the Earth's surface taken on January 4, 2012. Credit: NASA/NOAA/GSFC/Suomi NPP/VIIRS/Norman Kuring

    Question (Q): Are there any threats to the Earth in 2012? Many Internet websites say the world will end in December 2012.

    Answer (A):The world will not end in 2012. Our planet has been getting along just fine for more than 4 billion years, and credible scientists worldwide know of no threat associated with 2012.


    Q: What is the origin of the prediction that the world will end in 2012?

    A: The story started with claims that Nibiru, a supposed planet discovered by the Sumerians, is headed toward Earth. This catastrophe was initially predicted for May 2003, but when nothing happened the doomsday date was moved forward to December 2012 and linked to the end of one of the cycles in the ancient Mayan calendar at the winter solstice in 2012 -- hence the predicted doomsday date of December 21, 2012.


    Q: Does the Mayan calendar end in December 2012?

    A: Just as the calendar you have on your kitchen wall does not cease to exist after December 31, the Mayan calendar does not cease to exist on December 21, 2012. This date is the end of the Mayan long-count period but then -- just as your calendar begins again on January 1 -- another long-count period begins for the Mayan calendar.


    Q: Is NASA predicting a "total blackout" of Earth on Dec. 23 to Dec. 25?

    A: Absolutely not. Neither NASA nor any other scientific organization is predicting such a blackout. The false reports on this issue claim that some sort of "alignment of the Universe" will cause a blackout. There is no such alignment (see next question). Some versions of this rumor cite an emergency preparedness message from NASA Administrator Charles Bolden. This is simply a message encouraging people to be prepared for emergencies, recorded as part of a wider government preparedness campaign. It never mentions a blackout.
    ›Watch the Video


    Q: Could planets align in a way that impacts Earth?

    A: There are no planetary alignments in the next few decades and even if these alignments were to occur, their effects on the Earth would be negligible. One major alignment occurred in 1962, for example, and two others happened during 1982 and 2000. Each December the Earth and sun align with the approximate center of the Milky Way Galaxy but that is an annual event of no consequence.
    › More about alignment

    "There apparently is a great deal of interest in celestial bodies, and their locations and trajectories at the end of the calendar year 2012. Now, I for one love a good book or movie as much as the next guy. But the stuff flying around through cyberspace, TV and the movies is not based on science. There is even a fake NASA news release out there..."
    - Don Yeomans, NASA senior research scientist

    Q: Is there a planet or brown dwarf called Nibiru or Planet X or Eris that is approaching the Earth and threatening our planet with widespread destruction?

    A: Nibiru and other stories about wayward planets are an Internet hoax. There is no factual basis for these claims. If Nibiru or Planet X were real and headed for an encounter with the Earth in 2012, astronomers would have been tracking it for at least the past decade, and it would be visible by now to the naked eye. Obviously, it does not exist. Eris is real, but it is a dwarf planet similar to Pluto that will remain in the outer solar system; the closest it can come to Earth is about 4 billion miles.


    Q: What is the polar shift theory? Is it true that the Earth's crust does a 180-degree rotation around the core in a matter of days if not hours?

    A: A reversal in the rotation of Earth is impossible. There are slow movements of the continents (for example Antarctica was near the equator hundreds of millions of years ago), but that is irrelevant to claims of reversal of the rotational poles. However, many of the disaster websites pull a bait-and-switch to fool people. They claim a relationship between the rotation and the magnetic polarity of Earth, which does change irregularly, with a magnetic reversal taking place every 400,000 years on average. As far as we know, such a magnetic reversal doesn’t cause any harm to life on Earth. Scientists believe a magnetic reversal is very unlikely to happen in the next few millennia.
    › More about polar shift


    Q: Is the Earth in danger of being hit by a meteor in 2012?

    A: The Earth has always been subject to impacts by comets and asteroids, although big hits are very rare. The last big impact was 65 million years ago, and that led to the extinction of the dinosaurs. Today NASA astronomers are carrying out a survey called the Spaceguard Survey to find any large near-Earth asteroids long before they hit. We have already determined that there are no threatening asteroids as large as the one that killed the dinosaurs. All this work is done openly with the discoveries posted every day on the NASA Near-Earth Object Program Office website, so you can see for yourself that nothing is predicted to hit in 2012.


    Q: How do NASA scientists feel about claims of the world ending in 2012?

    A: For any claims of disaster or dramatic changes in 2012, where is the science? Where is the evidence? There is none, and for all the fictional assertions, whether they are made in books, movies, documentaries or over the Internet, we cannot change that simple fact. There is no credible evidence for any of the assertions made in support of unusual events taking place in December 2012.
    › Why you need not fear a supernova
    › About super volcanoes


    Q: Is there a danger from giant solar storms predicted for 2012?

    A: Solar activity has a regular cycle, with peaks approximately every 11 years. Near these activity peaks, solar flares can cause some interruption of satellite communications, although engineers are learning how to build electronics that are protected against most solar storms. But there is no special risk associated with 2012. The next solar maximum will occur in the 2012-2014 time frame and is predicted to be an average solar cycle, no different than previous cycles throughout history.
    › Video: Solar Storms
    › More about solar storms

  • Nine Dangers at the Beach - Rip Currents | Shorebreak | Lightning | Tsunamis | Sharks | Jellyfish | Heat and Sunburn | Harmful Algal Blooms | Water Quality

    Trips to the beach aren't always fun in the sun. From strong currents and dangerous marine life, to lightning and contaminated water, plan your visit to the beach this summer with the following safety tips in mind. NOAA Safety Information on: Rip Currents | Shorebreak | Lightning | Tsunamis | Sharks | Jellyfish | Heat and Sunburn | Harmful Algal Blooms |  Water  Quality

    Rip Currents

    Quahogs collected during a surfclam and ocean quahog research survey. Smooth water located between breaking waves could signal the presence of a rip current.
    Rip currents account for more than 80 percent of rescues performed by surf beach lifeguards. They are powerful, channeled currents of water flowing away from shore that quickly pull swimmers out to sea. Rip currents typically extend from the shoreline, through the surf zone, and past the line of breaking waves. The best way to stay safe is to recognize the danger of rip currents. If caught in one, don't fight it! Swim parallel to the shore and swim back to land at an angle. Always remember to swim at beaches with lifeguards.

    Shorebreak

    This image shows cysts of Alexandrium fundyenseShorebreak have caused serious injury and death to both experienced and inexperienced bodysurfers and swimmers.
    A shorebreak is an ocean condition when waves break directly on the shore. Both small and high waves can be equally as unpredictable and dangerous and typically form when there is a rapid transition from deep to shallow water.

    The power of a shorebreak can cause injuries to extremities and the cervical spine. Spinal cord injuries most often occur when diving headfirst into the water or being tumbled in the waves by the force of the waves. Be sure to ask a lifeguard about the wave conditions before going into the water.

    Lightning

    Lightning strikes over a cityThere is no safe place outside when thunderstorms are in the area. If you hear thunder, you are likely within striking distance of the storm.
    Since 2000, an average of 38 people have been killed annually by lightning in the United States. Already in 2013, seven people have died due to lightning strikes. There is no safe place outside when thunderstorms are in the area. When thunder roars, go indoors!  The safest places during lightning activity are substantial buildings and hard-topped vehicles. Rain shelters, small sheds, and open vehicles are not safe.  Wait 30 minutes after the last thunder crack before going back to the beach. Lightning Kills.

    Tsunamis

    Tsunamis are most commonly generated by earthquakes in coastal regions. This map shows wave height in the Pacific Ocean related to the 2010 Japan tsuanmi.
    tsunami is a series of ocean waves generated by any rapid large-scale disturbance of the sea water. Most tsunamis are generated by earthquakes, but they may also be caused by volcanic eruptions, landslides, undersea slumps, or meteor impacts. The tsunami wave may come gently ashore or may increase in height to become a fast moving wall of turbulent water several meters high. Although we can’t prevent a tsunami, the effects can be reduced through community preparedness, timely warnings, and effective response.

    Sharks

    This image shows cysts of Alexandrium fundyenseOnly about a dozen of the more than 300 species of sharks have been involved in attacks on humans. Despite their reputation, they would much rather feed on fish and marine mammals.
    Shark attacks, though rare, are most likely to occur near shore, typically inshore of a sandbar or between sandbars, where sharks can become trapped by low tide, and near steep drop offs where shark’s prey gather. The relative risk of a shark attack is very small, but should always be minimized whenever possible. To reduce your risk:

    • Don’t swim too far from shore
    • Stay in groups – sharks are more likely to attack a solitary individual
    • Avoid being in the water during darkness or twilight when sharks are most active
    • Don’t go in the water if bleeding from a wound – sharks have a very acute sense of smell
    • Leave the shiny jewelry at home – the reflected light resembles fish scales
    • Avoid brightly-colored swimwear – sharks see contrast particularly well

    Jellyfish

    Shrimp riding a jellyfish in Gray's Reef National Marine Sancuary.Jellyfish have the ability to sting with their tentacles. While the severity of stings varies in humans, most jellyfish stings result only in minor discomfort.
    Keep an eye out for jellyfish. All jellyfish sting, but not all have venom that hurts humans. Of the 2,000 species of jellyfish, only about 70 seriously harm or may occasionally kill people.

    When on the beach, take note of jellyfish warning signs. Be careful around jellies washed up on the sand as some still sting if their tentacles are wet. Tentacles torn off a jellyfish can sting, too.

    If you are stung, don't rinse with water, which could release more poison. Lifeguards usually give first aid for stings. Bring a Jellyfish treatment product to the beach with you if you won't be near a Lifeguard. See a doctor if you have an allergic reaction.

    Excessive Heat and Sunburn

    This image shows cysts of Alexandrium fundyenseSunburn can be prevented by covering up, taking shelter, and using sunscreen.
    Too much heat and sun can spoil a vacation. Heat is the leading weather-related killer in the United States, causing more deaths than floods, lightning, tornadoes, and hurricanes combined. Heat disorder symptoms include sunburn, heat cramps, heat exhaustion, and heat stroke.

    Spending the day at the beach can lead to any of these disorders but the most visible is sunburn, which can take up to 24 hours before the full damage is visible. The two most common types of burns are first degree and second degree burns resulting in redness and even blisters.

    When a burn is severe, accompanied by a headache, chills, or a fever, seek medical help right away. Be sure to protect your skin from the sun while it heals.

    Harmful Algal Blooms

    This image shows cysts of Alexandrium fundyenseThis deep red harmful algae, called Lingulodinium polyedrum, often produces brightly colored water discoloration. It has been associated with fish and shellfish mortality events, but its threat to human health is still being evaluated.
    Harmful Algal Blooms (HABs) (popularly referred to as red tides) are dense populations or "blooms" of algae that form in coastal waters. A small percentage of these blooms can be toxic to marine animals and humans. People can get sick by swimming directly in the water and by eating contaminated shellfish. If a sufficient amount of toxins are ingested, the results can be fatal.

    Currently, the combination of satellite imagery, buoy data, and field observations allow scientists to forecast the timing and location of blooms. This allows coastal managers and public health officials to make decisions regarding shellfish harvesting and beach closures to ensure the health of both residents and visitors.

    Water Quality

    beach closure signNOAA's beach and water quality predictions are now available in real-time for Michigan's Lake St. Clair. This will allow the local beach managers and area officials to make timely public health decisions regarding E. coli contamination and beach closures.
    Coastal beaches are among the most treasured natural resources in the nation, but beach closures or advisories caused by poor water quality often prevent the public from enjoying these resources. As water flows from land to coastal waters, it is often contaminated by untreated sewage from boats, pets, failing septic systems, fertilizers, and spills from hazardous substances.

    High levels of bacteria and other chemicals in the water can cause gastrointestinal illnesses in those that swim directly in the water. When visiting the beach, be aware of all beach closures and advisories.  leaf

  • Cardiovascular disease is the number one killer of men and women in the United States.

    Preventing Heart Disease, SCA & Stroke...

    "Did You Know?"

    • Annual-ReportThe Community Preventive Services Task Force’s annual report to Congress outlines proven means to reduce cardiovascular disease and gaps in the evidence about how to prevent it.
    • Cardiovascular disease is the number one killer of men and women in the United States. Almost 16% of US annual health expenditures go towards treating the 83 million American adults who suffer from heart disease and stroke.

    Health professionals can use a range of evidence-based strategies to reduce people’s risks for cardiovascular disease.

    Learn CPR

  • ADA, Title 24, The Americans with Disabilities Act

    The Americans with Disabilities Act (ADA) was signed into law 23 years ago today. ADA provides civil rights protections to individuals with disabilities and ensures equal opportunity in employment; public accommodations; public transportation; state and local government services; and telecommunications.USAVisit Disability.gov for information on disability programs and services throughout the nation. Disability.gov links to resources from federal, state, and local government; academic institutions; and nonprofit organizations.  Continue reading

  • DOL provides grant to assist Arkansas with storm recovery efforts - Just as new Tropical Storm Dorian heads in

    The U.S. Department of Labor today announced a $1,054,112 National Emergency Grant to assist Arkansas with cleanup and recovery efforts after the severe storms, tornadoes and flooding that struck the state May 30 to June 3. See news release below - But Wait there's more!

    StormTropical Storm Dorian begins westward trek

    Trade winds are pushing Tropical Storm Dorian west-northwest across the Atlantic Ocean.

    The National Hurricane Center said that the center of Dorian, which formed on Wednesday morning, was located about 615 miles west of the Cape Verde Island with maximum sustained winds of 50 mph. Present movement is west-northwest at 20 mph.

    The storm is expected to maintain its current course and speed through Friday. Little change in strength is predicted in the next 48 hours.

    Tropical storm force winds extend outward up to 45 miles from the center.

    The present course of Dorian could place it off the north coast of Puerto Rico by Monday night.

    Are you ready to Bug Out? Are you ready to Bug Out?

    News Release

    ETA News Release: [07/23/2013]
    Contact Name: Gloria Della or Jason Kuruvilla
    Email:
    Della.Gloria.D@dol.gov or Kuruvilla.Jason@dol.gov
    Phone Number: (202) 693-4679 or x6587
    Release Number: 13-1466-DAL

    US Department of Labor provides grant to assist Arkansas with storm recovery efforts

    WASHINGTON — The U.S. Department of Labor today announced a $1,054,112 National Emergency Grant to assist Arkansas with cleanup and recovery efforts after the severe storms, tornadoes and flooding that struck the state May 30 to June 3.

    "The destruction caused by this severe storm affected communities across Arkansas," said Eric Seleznow, acting assistant secretary of labor for employment and training. "There is a great deal of recovery work to be done, and the Labor Department is committed to helping Arkansans rebuild their communities."

    The grant was awarded to the Arkansas Department of Workforce Services to restore public lands and infrastructure by providing temporary work to those in need of employment. The funds will be used to assist with cleanup, demolition, repair, renovation and reconstruction of destroyed public facilities and lands in affected communities as well as humanitarian assistance. Of the $1,054,112 approved today, $351,371 will be released initially. Additional funding, up to the approved amount, will be made available to the state as it demonstrates a continued need for assistance.

    On June 25, the Federal Emergency Management Agency declared 11 counties eligible for FEMA's public assistance program. The state plans to target Cleburne, Independence, Polk, Scott, Searcy, Stone, Van Buren and Woodruff for assistance under this grant. Additional counties may be included at a later date if further evaluation warrants their inclusion. More information on designated disaster areas in Arkansas is available from FEMA at http://www.fema.gov/disaster/4124/designated-areas.

    National Emergency Grants are part of the secretary of labor's discretionary fund and are awarded based on a state's ability to meet specific guidelines. For more information, visithttp://www.doleta.gov/NEG/.

    Disaster, Survival & Emergency Preparedness Supplies & Gear

  • Resuscitate a Housefly? Learn Fly CPR!

    Really? Yep - here's how you can "resuscitate" a drowned fly...

    You can learn a lot about a fly by using a few ingredients from around the house.

    HouseflyINGREDIENTS
    •Drowned Fly
    •Salt
    •Paper Towel
    •Popsicle Stick

    INSTRUCTIONS
    STEP 1: Place a drowned fly on a white paper towel.
    STEP 2: Cover the drowned fly with salt and consistently move the fly around in the salt with the popsicle stick until the fly starts moving.

    EXPLANATION
    Flies and other insects breathe through tiny openings along the sides of their abdomen called spiracles. These openings were filled with a liquid causing the fly to drown. The salt draws the liquid out of the spiracles allowing the fly to “breathe” again. Go to www.hookedonscience.org for more experiments that might get you and your family “Hooked on Science.”

  • Forced or Indentured Child Labor

    Are you buying products that come from forced Child Labor? How do you know? Many would not wish to purchase these items (the purchases of which indirectly endorse or support indentured and/or forced child labor.)

    There's an easy way to know that what you buy is not promoting slave labor by children.ChildrenWorkers

    The U.S. Department of Labor's Bureau of International Labor Affairs today announced a revised "List of Products Produced by Forced or Indentured Child Labor," adding six new products from five countries. Federal contractors supplying products on the list must certify the goods were not produced by forced or indentured child labor in accordance with Executive Order 13126.

    Current List of Products and Countries on EO 13126 List

    The current list of products was published in the April 3, 2012 Federal Register and includes the following:

     

    Product Countries
    Bamboo Burma
    Beans (green, soy, yellow) Burma
    Brazil Nuts/Chestnuts Bolivia
    Bricks Afghanistan, Burma, China, India, Nepal, Pakistan
    Carpets Nepal, Pakistan
    Cassiterite Democratic Republic of Congo
    Coal Pakistan
    Coca (stimulant plant) Colombia
    Cocoa Cote d’Ivoire, Nigeria
    Coffee Cote d’Ivoire
    Coltan Democratic Republic of Congo
    Cotton Benin, Burkina Faso, China, Tajikistan, Uzbekistan
    Cottonseed (hybrid) India
    Diamonds Sierra Leone
    Electronics China
    Embroidered Textiles (zari) India, Nepal
    Garments Argentina, India, Thailand
    Gold Burkina Faso
    Granite Nigeria
    Gravel (crushed stones) Nigeria
    Pornography Russia
    Rice Burma, India, Mali
    Rubber Burma
    Shrimp Thailand
    Stones India, Nepal
    Sugarcane Bolivia, Burma
    Teak Burma
    Textiles (hand-woven) Ethopia
    Tilapia (fish) Ghana
    Tobacco Malawi
    Toys China

    News Release

    ILAB News Release: [07/22/2013]
    Contact Name: Gloria Della or Egan Reich
    Phone Number: (202) 693-4679 x4960
    Email:
    Della.Gloria.D@dol.gov Reich.Egan.2@dol.gov
    Release Number: 13-1359-NAT

    US Labor Department updates list of products made by forced or indentured child labor

    WASHINGTON — The U.S. Department of Labor's Bureau of International Labor Affairs today announced a revised "List of Products Produced by Forced or Indentured Child Labor," adding six new products from five countries. Federal contractors supplying products on the list must certify the goods were not produced by forced or indentured child labor in accordance with Executive Order 13126.

    The Departments of Labor, State and Homeland Security published a Federal Register notice updating the list that adds cattle from South Sudan, dried fish from Bangladesh, fish from Ghana, garments from Vietnam, and gold and wolframite from the Democratic Republic of Congo. Public comments were solicited, received, and considered in the agencies’ final determination.

    ILAB published the first list in 2001 and revisions each year from 2010 through 2012. The complete Executive Order 13126 list, a bibliography of sources cited, frequently asked questions, procedural guidelines, and procurement compliance information are available online at http://www.dol.gov/ILAB/regs/eo13126/main.htm.

    Information about ILAB and its program activities is available at http://www.dol.gov/ilab. The notice is scheduled to be published in the July 23, 2013, Federal Register.

  • Dengue in Angola

    The Reality of Outbreak Investigations: Dengue in Angola

    Although the work of CDC employees is frequently glamorized in movies like Outbreak and Contagion, we face the same challenges as any other large, complex organization.

    Angola Angola

    Wanna know a secret? Here it is. Chances are, the same reason you’re reading this blog is why many folks at CDC do what they do: a fascination with infectious diseases and a desire to help others. Although the work of CDC employees is frequently glamorized in movies like Outbreak and Contagion, we face the same challenges as any other large, complex organization: communication, logistics, funding, and teamwork. These challenges become especially apparent when outbreaks occur, such as during CDC’s recent response to a dengue outbreak in Angola. Based on our experiences in Angola, this blog will dispel 5 myths about outbreak investigation that are often dramatized by Hollywood.

    Myth #1 Mystery Disease X

    Residents of Angola drying fish and cookingAlthough Hollywood likes to make it seem like every outbreak is a complete mystery, most of the time when a team goes into the field, preliminary diagnostic testing has already suggested the cause of the outbreak before a foot hits the ground. Nonetheless, whether the cause be viral, bacterial, parasitic, poison or toxin, a critical first step in every outbreak investigation is confirming the cause of the outbreak.

    It was no exception when we were sent to Angola to assist the Ministry of Health respond to a recently identified dengue outbreak in May of 2013.  Dengue is an acute febrile illness that can cause explosive outbreaks. Although most people that get dengue will only suffer fever, headache, body pain, and possibly minor bleeding from the nose or gums, a relatively small proportion of people will develop severe dengue, which can result in hemorrhage, shock, and even death. By the time we were contacted, there were already dozens of sick people that had tested positive with a dengue rapid diagnostic test. Specimens were sent to CDC and the outbreak was confirmed soon after.

    Myth # 2 Rushing into the field on a moment’s notice

    The special red phone in the CDC Director’s office rings, an ominous look draws over their face, and a team is on a plane that evening, right? Not quite. There is a lot of careful planning that has to go into an outbreak response that may last weeks or longer in a country you’ve probably never visited. You have a limited idea of what exactly you’ll be doing once you get there, so you don’t immediately know what equipment and supplies will be needed in the field. In addition, most countries require visas to get in, which can take days or weeks to receive, even in an emergency. Finally, you have to coordinate with the host country to define an appropriate response. What CDC recommends may not be possible for many reasons, from the response being too ambitious to required resources not being available to lack of political support. Therefore, it’s important to pitch the plan to the local officials before arriving in the field. They may not come right out and say it, but hints of trepidation may mean that the plan needs to be revised. For that and many other reasons, flexibility is one of the most important traits that a “disease detective” can have. Before departing for Angola, we proposed to the local health authorities what we believed would be the most informative and feasible response to the ongoing epidemic, and then we tweaked the plan based on the feedback we received from them. 

    Tyler teaching a clinical training session on Dengue Fever in AngolaPriority #1 for the Angola dengue response was to raise awareness of the outbreak in the medical community. During dengue epidemics that occur in large, densely-populated cities like Luanda, the capital city of Angola, typically 5–10% of residents will become infected, so it’s not uncommon for hospital emergency rooms to become overrun with patients complaining of fever and body pain. Although there is no specific medication to cure dengue, early initiation of supportive therapy and close clinical monitoring can reduce the case-fatality rate for severe dengue from ~10% to <0.1%. Therefore, clinicians need to know that a dengue epidemic is occurring, the criteria they should use to determine which patients can go home and which need to be hospitalized, and how best to care for those that are hospitalized. The first week that we arrived, Tyler worked with the Ministry of Health to train >150 clinicians in two days, most of whom were sent home with training materials to train their colleagues.

    Ryan and members of the ministry of health conducting an investigationMeanwhile, Ryan worked with staff from the Ministry of Health’s entomology and vector control programs. The Ministry has an established mosquito control program that is operated by very capable staff; however, in Angola the main concern is malaria, which is caused by a different mosquito than the one that transmits dengue, and the two mosquitoes behave quite differently. There are >3,500 species and subspecies of mosquitoes, and each one has a unique biology. Some mosquitoes like the dengue vector Aedes aegypti prefer to lay eggs in water-filled containers, while others will readily lay their eggs in water on the ground. As an entomologist you have to know where to look for the mosquito you are interested in. After another lesson in the importance of being flexible following some snafus with getting our checked baggage, which contained all of our response supplies, Ryan was finally able to work with local staff to provide training and identify surveillance methods to attempt to control the mosquitoes causing the outbreak.

    Myth # 3 One of the “disease detectives” always gets infected

    Collection of medications to prevent infection while investigating the dengue outbreakDoes being in the field put you at greater risk for being infected with whatever bug is causing the outbreak?  Probably, but we’re sent into the field with a small pharmacy of pills, sprays and ointments to either prevent us from getting sick or to treat us when we do get sick. Moreover, depending on the cause of the outbreak and what we’ll be doing in the field, we may bring additional personal protective equipment with us to keep us from being infected. Despite being vigilant about wearing mosquito repellent, on our last day in Luanda Ryan got bit by ravenous mosquito. He swatted it dead, examined it to identify it as Aedes aegypti, gave me a worried look and said, “I’m done for.”  (Spoiler alert: Thankfully, neither of us ended up getting dengue during this response.)

    Myth # 4 CDC saves the day

    In the movies, CDC is usually portrayed as a public health SWAT team. They storm in, identify the source of the outbreak, institute harsh but necessary containment measures, and ultimately stop the outbreak. In reality, it rarely works that way. First, CDC is only ever involved in an outbreak response by formal invitation from the state or country in which the outbreak is occurring. Second, CDC never acts alone. In Angola, we worked on the outbreak response with local health officials, foreign governments, USAID, World Health Organization, and local non governmental organizations. CDC is a very competent agency, but we rely on collaboration with local and international partners for a successful response.

    Myth # 5 Outbreaks can rapidly spread worldwide

    OK, this one is actually pretty accurate. The ease and frequency of international travel has increased the likelihood of cases from any given outbreak being imported into other cities, especially if the outbreak happens in a large, international city like Luanda. Around the end of our second week in the field, a reportExternal Web Site Icon came online documenting dengue in travelers to Luanda that were diagnosed after returning to their home countries on four different continents.  Because of the oil industry, Luanda receives numerous international visitors each year, and some of them were bringing the unwanted souvenir of dengue back home with them. When physicians see a patient with a fever who has recently traveled to Africa, they are likely to suspect malaria, but not dengue. There were also three other dengue outbreaks in Africa in 2013, so the issue of clinical recognition of dengue was not likely to be limited to travelers returning from Angola. Because of this and the rapidly increasing case count, we decided to release an MMWR to notify clinicians in the U.S. and abroad of the need to be vigilant for dengue as a potential cause of fever in residents of and Children infront of water at sunsettravelers returning from Angola. One of our important findings from the investigation was that genetic analysis of the virus revealed that it had been circulating in this region of Africa for the past 45 years. This meant that this was not a “new” outbreak of dengue, but rather that dengue was actually endemic in Angola and just hadn’t been recognized. These findings were in agreement with to a recent study suggesting that 64 million dengue virus infections occur each year in Africa.

    All in all, this investigation was an excellent example of the international team pulling together to get the job done quickly and correctly, and brought attention to a neglected tropical disease of significant public health importance. It was also a lesson to us that, unfortunately, reality isn’t always what Hollywood would have us believe.

    Insect Repellent

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