US Outbreaks Of Acute Flaccid Myelitis Still Posing Several Mysteries Identifying Risk Factors Called “A Public Health Priority” A comprehensive review and analysis in July by the Centers for Disease Control and Prevention (CDC ) of cases of acute flaccid myelitis (AFM) which causes limb weakness mostly in children reveals many unsolved mysteries (MMWR, July 12). CDC Principal Deputy Director Anne Schuchat speaking at a recent telebriefing said “AFM is a devastating illness for patients and their families…and we want parents to know that we are keeping their
children front and center and working with our partners to better understand this illness, the risk factors, and ways to treat and prevent it.” The unanswered epidemiologic questions are a cause of concern at the CDC which has declared the identification of risk factors for AFM a public health priority. The disease was first recognized as a distinct condition during a severe - AFM cont'd on page 2
Australian Epidemiologist Carves Out A Role On Social Media Blogging, Tweeting, and Podcasting To Counter Misleading Presentations Of Scientific Findings An epidemiologist working in diabetes and chronic disease with Blacktown Hospital in Sydney Australia and calling himself Gid M-K Health Nerd has created a blog on public health and science topics in the media, many of them about misleading articles and headlines. Begun three years ago by Gideon Meyerowitz Katz (aka Gid MK), the blog, which has some 14,000 August 2019
followers, has addressed such topics as: Bacon Is Not The Enemy 5 Misleading Headlines Sponsored By The Food Industry Sugar Isn’t Giving Us All Cancer Roundup Isn’t Poisoning Your Cheerios Blueberries Can’t Treat Heart Disease Relative vs Absolute Risk - Blogger cont'd on page 4 •
Volume Forty
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Number Eight
In This Issue -3Resolution on Racism& Public Health -5Update: 10 Commandments Contest -8Notes on People -10Near Term Epidemiology Event Calendar -11Marketplace
-AFM cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA.
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outbreak of respiratory illness caused by enterovirus D-68 (EV-D68) in 2014. Since then, there have been seasonal peaks between August and October every two years in 2016 and 2018. This seasonality casts suspicion on viruses as the etiologic agents. Cases are found year round and in the oddnumbered years, but the reasons for the two-year peaks or periodicity are a mystery. Laboratory Evidence While respiratory viruses and enteroviruses in particular are suspected as the causative agents, the laboratory evidence is not yet conclusive. Most of the cases have a history of mild respiratory illness or fever less than a week before they developed arm or leg weakness. However, approximately half of cases can be negative for evidence of virus infection in respiratory specimens. Recent Development Another mystery is why the outbreaks have started only in recent times. AFM is a recognized but rare complication of infections caused by West Nile virus, adenovirus, and enteroviruses. However, the first recognized outbreak of AFM was noted in association with the large US outbreak of severe respiratory illness caused by EV-D68 in 2014. The condition is still considered rare with 233 confirmed cases during the 2018 outbreak. Why some children develop limb weakness and others do not is a puzzle. Perhaps there are genetic predispositions not yet identified. Affected children have been previously healthy and nothing unusual about them has been noted to date.
Recent Publications The CDC reports about AFM in the MMWR and in Vital Signs and the telebriefing were timed for the beginning of the 2019 season from August to October when AFM cases have peaked. The CDC goal is to alert everyone to anticipate cases and to report them as early as possible to assure thorough investigations that might provide a better understanding of the epidemiology. Latest Epidemiology During 2018, CDC received reports of 374 persons meeting the case definition for AFM and 233 of these or 62% were classified as confirmed and 26 or 7% as probable. As many as 115 reported persons were classified as non-AFM cases. Confirmed cases had a median age of 5.3 years and were equally distributed by sex. 98% of confirmed cases were hospitalized and 60% of these were admitted to an intensive care unit. No deaths were reported during the acute phase of illness among confirmed cases, but two deaths occurred months after limb weakness onset. Since 2014, the occurrence of AFM has been very widespread with reports coming from 48 states. More Epi Investigation Needed According to CDC, “prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention.” ■
In A Timely Move, Milwaukee County Passes Resolution Calling Racism A Public Health Crisis Many topics vie to be considered a public health problem so as to garner a sense of urgency, new tools to combat the problem, and additional resources. Milwaukee County has gone a step further to declare that racism is not just a problem, but a public health crisis. In passing the resolution, the Board of Supervisors stated that it is the County's responsibility to address racism, including seeking approaches to reshaping the discourse and actively engaging all citizens in racial justice work. In light of recent events in the US, the resolution appears to be well-timed along with other needed interventions. Among the estimated twenty different reasons the County Supervisors cited in their resolution for declaring the crisis are the following: · · ·
Communities of color are disproportionately impacted by social determinants of health Milwaukee is considered one of the most segregated cities in the US with wide health disparities The 2016 infant mortality rate in Milwaukee County among African American mothers was 13.1 per 1,000 live births compared to 4.9 among white mothers.
To address the crisis, the resolution states that the County will advocate for policies that combat racism, and encourage entities at all levels to also recognize racism as a public health crisis. Following is a reprint of the Milwaukee County resolution.
A RESOLUTION Requesting approval to recognize April 1-7 as National Public Health Week and supporting Milwaukee County’s commitment to achieve racial equity and transform systems and institutions impacting the health of our community WHEREAS, National Public Health Week is sponsored by the American Public Health Association to raise awareness of the relationship between the health of individuals and the health of their communities; and WHEREAS, National Public Health Week focuses on a different public health topic every day of the week including, healthy communities, violence prevention, rural health, technology and public health, climate change and global health; and WHEREAS, the promotion of healthy communities is directly related to the health of individuals and encourages expanding public health support networks to decrease racial disparities in health outcomes; and - Resolution cont'd on page 6
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-Blogger cont'd from page 1 Twitter Account
“...both relatively risky and relatively funny but absolutely scientific.”
This latter topic about risk was the trigger for the creation of a Twitter account started three months ago with the handle @justsayrisks. Its tagline is “both relatively risky and relatively funny but absolutely scientific.” Gid M-K identifies a study’s reported relative risk followed by his or the study’s calculation of the actual absolute risk. The goal is to show people that the risk they may have envisioned in hearing or reading about the study in the media was in all likelihood the relative risk and that seeing the absolute risk gives the reader a quite different perspective. Examples
“...he wanted to steal the idea."
Examples posted on the Twitter account include a study which claimed that diabetes could raise the risk of stillbirth by four times or 300-400% whereas the absolute risk was calculated as 1-1.8%. Another reported that people who spend 5 hours or more per day on their phone are 43% more likely to be obese whereas the absolute risk increase was estimated at 1-2%. There are multiple other examples Gid M-K tweets about. Origins
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According to Gid M-K, the account “speaks to people” because of its simplicity. The idea for the Twitter account actually came from the creation of a friend who started a wildly popular Twitter account @justsayinmice. That account advocates countering many misleading headlines in media reports of scientific studies by pointing out early in the article that the study was conducted in mice.
It was a “brilliant idea”, an overnight success on Twitter said Gid M-K. He told the Epi Monitor he wanted to steal the idea by creating relativelyrisky@justsayrisks. Gid M-K had been misled himself by earlier reports about the risks of ibuprofen and heart attacks because the relative risks were presented in a misleading way and he wanted to help correct this misleading approach in the media. He now simply enough just tweets out risks to some 7,000 followers. Podcast Too Not content with a blog and a twitter account, Gid M-K has also started a weekly podcast on Sound Cloud entitled Sensationalist Science which discusses sensationalist headlines and their true explanations. The podcasts have been approximately 10-12 minutes long and have covered such topics as medical mistakes, solvents and autism, red meat, artificial sweeteners, and the moderate drinking myth. Meyerowitz Katz is pursuing a doctoral degree part time in epidemiology at the University of Wollongong in Sydney. To follow Gid M-K go to one or more of the following: Weekly Blog: https://bit.ly/31luQHo Daily Risk Tweets: https://bit.ly/33gJEsN Fortnightly Podcast: https://bit.ly/31su7o0 ■ Join us on our Facebook page at: https://bit.ly/2U29gUA
On The Light Side - New Contest Thou Shalt… Entries Still Coming In For 10 Commandments Contest Sample of Commandments Included Below From our readers:
Thou shalt not commit adulteration of data.
Thou shalt not bear false witness of thy study conclusions.
Thou shalt not covet thy neighbor’s grant score.
You shall not confound the confounders
May the significant effect be ever in your favour
May the causal inference be with you
If thou can't cognite qualitatively... and thou can't cognite quantitatively... take a leaf from the book of a physicist friend, be creative and cognite quantumtatively.
Thou shalt not publish dredged megadata collected for other purposes ... except if it is for the common good ... or it makes for fun reading.... or for political gain. OK, then...thou may.
We continue to receive entries for our mock serious 10 epidemiology commandments contest, but the deadline is fast approaching. To give everyone adequate time after reading this reminder, we are extending the deadline for submission to August 31, 2019 and will announce the winner in our September issue. Readers are encouraged to work together with colleagues to formulate and submit entries which include a full set of 10 mock serious commandments. Rules for the contest are reprinted below. Rules All entries must be received by August 31, 2019 at editor@epimonitor.net. If similar entries are received, the earliest received will have precedence. All entries must be original, created by the contestant, and not previously published elsewhere. The editor reserves the right to make the final selection of the contest winner, and all submissions become the property of the Epidemiology Monitor. Individuals may join together as a group and submit an entry or entries by department, school or other entity. A set must contain at least 10 commandments to win. Fewer than 10 compete for special mention. We reserve the right to nullify the contest if too few entries are submitted, though we think this is unlikely given all the creative entries we have received from our previous contests!
-Resolution cont'd from page 3 . WHEREAS, communities of color are disproportionally impacted by social determinants of health, such as increased exposure to lead, poor air quality, lack of safe places to walk, bike or run, and inadequate health education; and
WHEREAS, Milwaukee is considered one of the most segregated cities in the United States, resulting in wide health disparities among its racial populations; and WHEREAS, race is a social construction with no biologic basis; and WHEREAS, racism is a social system with multiple dimensions, including individual racism, which is internalized or interpersonal and systemic racism, which is institutional or structural and is a system of structuring opportunity and assigning value based on the social interpretation of how one looks; and WHEREAS, systemic racism unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and depletes the strength of the whole society through the waste of human resources; and WHEREAS, racism causes persistent racial discrimination in housing, education, employment, transportation, and criminal justice and an emerging body of research demonstrates that racism is a social determinant of health; and WHEREAS, African Americans comprise 26.2% of Milwaukee County’s total population, the largest throughout Wisconsin counties; and WHEREAS, more than 100 studies have linked racism to negative health outcomes; and WHEREAS, the Wisconsin Department of Health Services determined that African Americans and Native Americans have the highest excess death rates at every stage in the life course, and the infant mortality rate of non-Hispanic black infants is the highest in the nation; and WHEREAS, the 2016 infant mortality rate in Milwaukee County among African American mothers was 13.1 deaths per 1,000 births, compared to their white counterparts, a rate of 4.9 deaths per 1,000 births; and WHEREAS, in 2016, African American mothers were connected to prenatal care during their first and third-trimesters at 59.8% and 9.7% respectively, while white mothers received prenatal care during their first and third-trimesters at 78.6% and 3.3% rates in Milwaukee County; and WHEREAS, County Health Rankings (using 2016 data) place Milwaukee County residents in a tie for 70th out of 72 Wisconsin Counties, indicating that residents averaged 4 “physically unhealthy days� in the past 30 days; WHEREAS, Healthiest Wisconsin 2020 states that, "Wisconsin must address persistent disparities in health outcomes and the social, economic, educational, and environmental inequities that contribute to them"; and
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- Resolution cont'd on page 7
-Resolution cont'd from page 6 WHEREAS, the Wisconsin Public Health Association is committed to achieving health equity and convened a Racial Equity Workgroup in 2017; and WHEREAS, while there is no epidemiologic definition of "crisis", the health impact of racism clearly rises to the definition proposed by Galea: "The problem must affect large numbers of people, it must threaten health over the long-term, and it must require the adoption of largescale solutions”; and WHEREAS, Milwaukee County created the Office on African American Affairs to serve in an integral role in recognizing and aiding in the resolution of Milwaukee County’s racial inequities for the benefit of all of its citizenry, and for the region to achieve its full potential; and WHEREAS, with support from community partners and the Office on African American Affairs, it is Milwaukee County’s responsibility to address racism, including seeking solutions to reshape the discourse and actively engaging all citizens in racial justice work; now, therefore, BE IT RESOLVED, that Milwaukee County will:
Assert that racism is a public health crisis affecting our entire society
Assess internal policy and procedures to ensure racial equity is a core element of Milwaukee County, led by the County Executive and Milwaukee County Board of Supervisors, in collaboration with the Office on African American Affairs, Racial Equity Ambassador Workgroup, and other relevant parties
Work to create an inclusive organization identifying specific activities to increase diversity across its workforce and in leadership positions
Incorporate inclusion and equity into organizational practice, offer educational trainings/activities to expand employees' understanding of how racism affects individuals, the health of marginalized populations, and provide tools to assist members to engage actively and authentically with communities of color
Advocate for relevant policies that improve health in communities of color, and support local, state, and federal initiatives that advance social justice, while also encouraging individual employee advocacy
Encourage other local, state, and national entities to recognize racism as a public health crisis
; and BE IT FURTHER RESOLVED, that the Milwaukee County Board of Supervisors hereby supports Milwaukee County efforts to address public health disparities due to racial inequities throughout Milwaukee County. ■
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Notes on People Do you have news about yourself, a colleague, or a student? Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net Honored: Marion Kainer, with the 2019 National Pumphandle Award from the Council of State and Territorial Epidemiologists. The award is given to an epidemiologist who has made extraordinary contributions to and outstanding achievements in the field of applied epidemiology. Dr Kainer is director of the Healthcare Associated Infections and Antimicrobial Resistance Program at the Tennessee Department of Health. She was a key member of the team which helped to stop the meningitis outbreak linked to a fungal infection caused by steroid injections from a Massachusetts compounding pharmacy in September 2012. This public health action helped save lives. https://bit.ly/2TeDPHI
Honored: Jill Norris, with the Noel Weiss and Tom Koepsell Excellence in Education Award from the Society for Epidemiologic Research. Norris is Professor and Chair of the Department of Epidemiology in the Colorado School of Public Health at the University of Colorado. She has mentored numerous students over the years and has been honored by the University for her mentoring contributions.
Honored: Allison Aiello, with the Carol J Rowland Hogue Mid-Career Award from the Society for Epidemiologic Research. Dr Aiello is Professor of Epidemiology at the University of North Carolina Gillings School of Global Public Health and Adjunct Professor of Social Medicine at University of North Carolina School of Medicine. She leads the Social Epidemiology Program in the department of Epidemiology, Directs the Integrating Special Populations Program of the North Carolina Translation and Clinical Sciences Institute, and Co-Directs the Interdisciplinary Training in Life Course Research Program at the Carolina Population Center.
Honored: Matthieu Domenech de Cellès, with the Lilienfeld Postdoctoral Prize Paper Award. Dr Domenech de Cellès is a post-doctoral fellow in the Biostatistics, Biomathematics, Pharmacoepi and Infectious Diseases unit at the Institut Pasteur in Paris. He works in the field of infectious disease epidemiology, and his research interests include bacterial resistance to antibiotics, vaccine epidemiology, and infectious disease seasonality.
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- People cont'd on page 8
Notes on People - con't from page 8 Honored: Brittany Blouin, with the Tyroler Student Prize Paper Award. Dr Blouin completed her PhD in Epidemiology in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in November 2018. Her research focuses on global health and epidemiologic methods with particular interest in infectious and parasitic diseases, child health and nutrition, and field research. She is currently a consultant on a joint project between UNAIDS and McGill University and a Senior Advisor for the WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control.
Killed: Allison Milner, 36 years old, by a falling tree in a freak accident in Melbourne, Australia. Milner was a social epidemiologist who led Australia's largest study on suicide by doctors. She was an Associate Professor at the University of Melbourne. Colleagues remembered her as "a leader in the field, a brilliant researcher, a generous colleague, and a loving mum." https://ab.co/2OTXzSq
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Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly. This year we will print upcoming events in the Monitor monthly. To view the full year please go to: http://www.epimonitor.net/Events
September 2019 September 7-10 https://bit.ly/2LcQpTM Conference: ACE 2019 / American College of Epidemiology / Pasadena, CA September 23-25 https://bit.ly/2L9Cb6b Conference: 2019 Citymatch Maternal & Child Health Leadership Conference / CityMatch / Providence, RI Sept 30-Oct 25 https://bit.ly/2UxFVT9 Short Course: Intl Course in Applied Epidemiology with Epi Info Training / Emory University / Atlanta, GA Sept 30-Nov 1 https://bit.ly/2EzTHQB Short Course: Intl Course in Applied Epidemiology with Maternal and Child Health Add-on Course / Emory University / Atlanta, GA
October 2019 October 1-4 https://bit.ly/2pNWzQF Conference: 2019 IAPHS Conference / Interdisciplinary Association for Population Health Science / Seattle, WA October 7-8 https://bit.ly/2EzTHQB Short Course: GIS using Epi Info / Emory University / Atlanta, GA October 12-14 https://bit.ly/2ry52Ik Conference: IGES 2019 / International Genetic Epidemiology Society / Houston, TX October 22-24 https://bit.ly/2PuCZmt Conference: AEA Annual Scientific Meeting / Australian Epidemiological Association / Freemantle, Australia October TBA https://bit.ly/2zSBEky Short Course: Clinical Translation of Epidemiology / Erasmus MC / Rotterdam, The Netherlands October TBA https://bit.ly/2EfeSWX Short Course: Public Health Research: Analysis of Population Health / Erasmus MC / Rotterdam, The Netherlands October TBA https://bit.ly/2rtIyYU Short Course: Public Health Research: Analysis of Determinants / Erasmus MC / Rotterdam, The Netherlands October TBA https://bit.ly/2rz5yFK Short Course: Genetic-Epidemiologic Research Methods / Erasmus MC / Rotterdam, The Netherlands
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Faculty Position - Molecular Cancer Epidemiology The Hollings Cancer Center, a National Cancer Institute-designated cancer center, and the College of Medicine at the Medical University of South Carolina (MUSC) are excited to announce an opening for a junior, mid or senior level tenure-track faculty Cancer Epidemiologist who will join the Cancer Control Program and the Department of Public Health Sciences. Investigators whose focus is on understanding the molecular underpinnings of cancer initiation, progression, and survival is a priority. The Hollings Cancer (HCC) has state-of-the-art clinical, research and shared resource facilities. HCC is the only National Cancer Institute (NCI) designated cancer center in South Carolina, with NCI approved programs in developmental cancer therapeutics, cancer immunology, cancer biology, and cancer control, as well as multiple shared resource cores and state-of-the-art clinical and research facilities. These include a highly developed clinical trials office with a growing multi-center trials network and Phase I trials program, a translational science laboratory, a robust biorepository and tissue analysis resource, and a clean-cell evaluation and therapy facility. There are currently 125 HCC cancer scientists holding a portfolio of more than $43M in extramural cancer research funding. A critical scientific mission of HCC is to foster population-based research that will lead to a reduction in cancer morbidity and mortality regionally and nationally. In addition, clinical and translational research at HCC and MUSC is supported by an NIH-funded Clinical and Translational Science Award. Applicants must have a PhD or MD with a strong record of research accomplishments and peerreviewed publications. Successful candidates will be expected to maintain a vigorous, nationallyrecognized research in cancer prevention and control. Based on programmatic fit and interest of the candidate, single or joint appointments to basic science or clinical departments will be made. The HCC will offer competitive start-up funding and access to state-of-the-art core facilities. Located on the Atlantic coast in South Carolina, Charleston boasts one of the nation's most historic downtown areas and offers a superb quality of life including easy access to ocean beaches, extensive outdoor recreation, and internationally renowned arts and cultural events. Interested individuals should email their CV and a summary of future research plans to campbetb@musc.edu and apply on-line at: https://bit.ly/2ZU9XCW
Chanita Hughes-Halbert, PhD Professor Department of Psychiatry and Behavioral Sciences Cancer Control Program Leader Hollings Cancer Center Medical University of South Carolina (MUSC) campbetb@musc.edu
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