Category Archives: Infections

A states obligated to provide expensive hepatitis C drugs?

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By Michael Ollove
Stateline

A handful of federal lawsuits against states that have denied highly effective but costly hepatitis C drugs to Medicaid patients and prisoners could cost states hundreds of millions of dollars.

The drugs boast cure rates of 95 percent or better, compared to 40 percent for previous treatments. But they cost between $83,000 and $95,000 for a single course of treatment.

The class actions, all filed in the last eight months in federal courts in Indiana, Massachusetts, Minnesota and Pennsylvania, present a series of extremes: a deadly epidemic, a treatment that can stop the disease in its tracks, and an enormous price tag.

At least 3.5 million Americans have hepatitis C, a virus spread through blood-to-blood contact that is usually contracted through the sharing of needles or other equipment to inject drugs.

Left untreated, hepatitis C slowly destroys the liver. Medicaid beneficiaries, a low-income population, have a slightly higher rate of hepatitis C infection than the privately insured, and the rate among prisoners is 30 times higher than in the general population.

The U.S. Food and Drug Administration approved the first of the new drugs, Sovaldi, in 2013. Since then, the FDA has also approved two other drugs, Viekira Pak and Harvoni.

But because the drugs are so expensive, state Medicaid programs and prisons have been restricting them to people in the advanced stages of the disease. Continue reading

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Zika quarantine? Good idea or bad?

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Public Health — Seattle & King County expert weighs in

By Dr. Jeff Duchin, MD
Health Officer and Chief of Communicable Disease Epidemiology & Immunizations

DuchinExperts are still learning about Zika virus, and in this time of uncertainty, some some are calling for a quarantine on travelers from areas affected by Zika.

I don’t think it’s a good idea.

This is a transmission electron micrograph (TEM) of Zika virus, which is a member of the family Flaviviridae. Virus particles are 40 nm in diameter, with an outer envelope, and an inner dense core. Additional Information:“Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.”For more information on the Zika virus, follow the link below.

Zika virus — Cynthia Goldsmith/CDC

Quarantine of travelers exposed to Zika virus is neither appropriate nor feasible, and would likely have no meaningful impact on the spread on the disease – but would result in significant negative unintended consequences on travel, commerce, individuals and families.

Quarantine of returning travelers would be costly and complicated to carry out for no real benefit. Although Zika poses a real threat of continued global spread, continuing measures to protect travelers and control the outbreaks where they are occurring, although imperfect, are more appropriate responses.

This is true for a number of reasons.

  1. There is no practical way to identify or screen for who is infected with Zika and potentially capable of transmitting infection. Most infections are asymptomatic and there is no rapid diagnostic test.
  2. In addition, everything we know suggests the threat to the US is not large. Based on experience with other viruses, like dengue and chikungunya, that are transmitted by the same mosquito vectors and have reached the US after large scale epidemics expanded globally, the risk for ongoing transmission or large outbreaks in the US is thought to be low. (In much of the country including the Pacific Northwest, we don’t have the type of mosquitoes that transmit Zika, dengue and chikungunya.) In contrast, the number of persons traveling to and from Zika-affected areas would be extremely large and enter the US at many points, making implementation of quarantine unrealistic even if it was potentially useful.
  3. And, it’s likely that Zika, as dengue and chickungunya viruses have done, will become established in much of the world, meaning that quarantine would need to be continued on an ongoing basis.

Continue reading

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Insurers should be current on emerging treatments for consumers

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MKreidlerPhotoBy Mike Kreidler
Washington State Insurance Commissioner

A growing concern for consumers and health insurers is the cost of prescription drugs and specifically, treatment for debilitating and life-threatening diseases.

Hepatitis C is a good example. New drugs are now used to cure this life-threatening liver ailment with proven success. But the pills are costly, ranging from $55,000 to almost $95,000 per patient for a standard 12-week treatment period.

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, now recommend that most patients receive treatment even if they are in the early stage of the disease versus waiting until it has progressed.

Last November, the federal government encouraged states to ensure that health coverage policies are “informed” by the treatment guidelines noted above. Unfortunately we do not have the authority to mandate that insurance companies abide by the guidelines. However, we do expect insurers to be current on all appropriate guidelines that best serve consumers. That is true for all types of treatments.

We recently asked health insurers in Washington if they were aware of the new guidelines and if they were making any changes to how they were treating patients with this disease. The responses were varied, but there were common themes:   Continue reading

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Yakima County soil tests positive for Valley Fever fungus

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From the Washington State Department of Health

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Coccidioides – CDC/ Dr. Lucille K. Georg

Recent tests expand the area now known to have the Valley Fever fungus

Recent soil and dust samples from several sites in south-central Washington have tested positive for the fungus that causes Valley Fever and for the first time positive samples were found in Yakima County.

The Washington State Department of Health, Yakima Health District, and Benton-Franklin Health District have been working together to understand where the fungus is present and what soil types will support its growth in Washington state.

A total of nine human cases of Valley Fever have been reported from Yakima (4), Benton (3), Franklin (1), and Walla Walla (1) counties since 2010. Soil sampling was initiated as a result of illness reports; samples from several sites in Benton County previously tested positive for the fungus.

While the risk of becoming infected in Washington is thought to be low, soil testing helps health officials identify where the fungus is located, where ill people might have been exposed, and what environmental conditions the fungus needs to survive. Continue reading

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Zika virus transmitted through sexual contact in Texas

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Zika virus/CDC

Zika virus/CDC

Dallas County Health and Human Services (DCHHS) has received confirmation from the Centers for Disease Control and Prevention (CDC) of the first Zika virus case acquired through sexual transmission in Dallas County in 2016.

The patient was infected with the virus after having sexual contact with an ill individual who returned from a country where Zika virus is present. For medical confidentiality and personal privacy reasons, DCHHS does not provide additional identifying information.

“Now that we know Zika virus can be transmitted through sex, this increases our awareness campaign in educating the public about protecting themselves and others,” said Zachary Thompson, DCHHS director. “Next to abstinence, condoms are the best prevention method against any sexually-transmitted infections.”

Zika virus is transmitted to people by mosquitoes and through sexual activity. The most common symptoms of Zika virus are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting several days to a week. Continue reading

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WHO declares Zika virus an global public health emergency | Reuters

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MosquitoThe World Health Organization on Monday declared the mosquito-borne Zika virus to be an international public health emergency as the disease linked to thousands of birth defects in Brazil spreads rapidly.

WHO Director-General Margaret Chan told reporters an international coordinated response was needed, although restrictions on travel or trade were not necessary.

The move should help fast-track international action and research priorities.

Source: WHO declares Zika virus an global public health emergency | Reuters

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Nations across Latin America grapple with rapid spread of Zika virus

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By Lourdes Garcia-Navarro
South America Correspondent/NPR

MosquitoAuthorities in Colombia, Ecuador, El Salvador and Jamaica are encouraging women to delay getting pregnant due to the spread of the mosquito-borne illness, Zika. The virus has been linked to brain damage in infants. Delaying pregnancy is a challenge for women in the region where rape is the cause of many pregnancies, and women have little access to contraception.

 

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Liberia declared Ebola-free, signaling end to West African epidemic | Reuters

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Ebola virusLiberia was declared free of the Ebola virus by global health experts on Thursday, a milestone that signaled an end to an epidemic in West Africa that has killed more than 11,300 people.

But the World Health Organisation (WHO) warned there could still be flare-ups of the disease in the region, which has suffered the world’s deadliest outbreak over the past two years, as survivors can carry the virus for many months and could pass it on.

Health specialists cautioned against complacency, saying the world was still underprepared for any future outbreaks of the disease.

Source: Liberia declared Ebola-free, signaling end to West African epidemic | Reuters

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Malaria treatment fails in Cambodia because of drug resistance: researchers | Reuters

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MalariaMalaria-carrying parasites in parts of Cambodia have developed resistance to a major drug used to treat the disease in Southeast Asia, according to research published on Thursday in The Lancet Infectious Diseases journal.

The drug piperaquine, used in combination with the drug artemisinin, has been the main form of malaria treatment in Cambodia since 2008.The combination is also one of the few treatments still effective against multi drug-resistant malaria which has emerged in Southeast Asia in recent years, and which experts fear may spread to other parts of the world.

Source: Malaria treatment fails in Cambodia because of drug resistance: researchers | Reuters

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How I almost poisoned my family with holiday leftovers

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white-bean-and-ham-soupBy 
Public Health – Seattle & King County

A white bean and vegetable soup seemed the perfect use of the last of the remaining ham from the holidays. I felt pretty pleased with myself for cooking it two days before parents came for a visit–that would give it the right amount of time to reach full flavor, and it would be ready to heat when I got home from work.

By shutting the soup in the cooler, I had created the perfect laboratory for toxins to form.

When I finished cooking, I realized that I didn’t have room in the fridge for the enormous pot of soup. But the outside temperature was plenty cold, so I decided to store it on the outside deck, protecting it from raccoons by putting it inside a cooler. I once again felt pleased with my cleverness as I shut the cooler lid tightly with my soup safe inside.

Second thoughts

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Gonorrhea may soon be untreatable, Britain’s chief medical officer warns – The Washington Post

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A medical illustration of Neisseria gonorrhoeae. (CDC)

The sexually transmitted infection is increasingly caused by strains of Neisseria gonorrhoeae that resist antibiotic treatment. “Gonorrhoea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance,” Davies wrote.

The Guardian reports that a recent outbreak of a superbug strain of the disease — one that doesn’t respond to the antibiotic azithromycin — has put Britain on high alert. Davies urged doctors to use proper treatment protocols. A recent study found t

Source: Gonorrhea may soon be untreatable, Britain’s chief medical officer warns – The Washington Post

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