January 2020 - The Epidemiology Monitor by The Epidemiology Monitor

Progress In Achieving Worldwide Polio Eradication Is Reversed

In This Issue

Risk Of International Spread Is Now At Highest Point Since 2014 “Gravely concerned”. That’s how the International Health Regulations (IHR) Emergency Committee meeting at the World Health Organization last month reacted to the latest update on the progress of the international polio eradication program.

by December 31, according to the Global Polio Eradication Initiative (GPEI). Recommendation Because it saw no significant success yet in reversing the trend, IHR recommended that countries with the potential to cause international spread should conduct intensified activities. The three countries where polio wild

The group noted the significant increase in wild polio virus type 1 cases to 113 globally as of December 11, 2019 compared to 28 for the same period in 2018. In fact, the total number of wild polio cases in 2019 rose to 163

This slogan was created to help block Washington State from revoking the option for parents to claim a philosophical exemption to vaccination The slogan is one local example of the spread of misinformation and a threat to public health. Another very current vaccine example is the rejection of polio vaccination by parents in Pakistan which is threatening the January 2020

-52019 in Review -6Notes on People

- Polio con't on page 2

-7In Remembrance

New Center To Study The “Epidemiology Of Misinformation” “Vaccines…the more you KNOW, the more you NO!

-32020 Flu Season Trends

success of the worldwide polio eradication effort. Partnership The University of Washington (UW) and the State University of Washington have created a statewide partnership to study “the epidemiology of misinformation” and combat the spread of misinformation and disinformation. This is to be accomplished by creating an - Misinformation cont'd on page 4 •

Volume Forty One •

Number One

-9Near Term Epidemiology Event Calendar -12Marketplace

-Polio 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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virus type 1 remains endemic are Pakistan, Afghanistan and Nigeria. This latter country has not had wild polio cases in three years but is still technically considered endemic. Pakistan and Afghanistan are often referred to as an epidemiological block because of the polio activity in the border area. More Complications If the increase in wild polio cases was not enough, further alarm was caused by multiple outbreaks of circulating vaccine derived poliovirus strains in the four WHO regions of Africa, the Eastern Mediterranean, South-east Asia, and the Western Pacific. The cause of the alarm is the rapid emergence of vaccine derived polio virus type 2 strains in several countries and this is “unprecedented and very concerning and not yet fully understood”, according to IHR. Roland Sutter, former head of polio research at World Health Organization, told Science News “We are clearly in the most serious situation we have been in with the program.” Background on Viruses

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Three wild polio virus strains (types 1, 2, and 3) are recognized, and types 2 and 3 were certified as eradicated in 2015 and 2019 respectively. This was achieved through the broad use of live attenuated oral polio vaccine (OPV) containing vaccine virus against all three types (trivalent vaccine OPV). However, these vaccine viruses have the capacity to circulate and mutate causing paralytic polio in some children. The GPEI reported 259 such cases of circulating vaccine derived

polio virus in 2019. Thus, while the number of wild polio cases has declined 99.99% since 1988 according to the Centers for Disease Control and Prevention, the existence of these vaccine derived polio cases is an unavoidable but negative consequence of using live vaccine. Type 2 Challenges To prevent vaccine derived polio, the use of the trivalent vaccine was halted in 2016 after the eradication of type 2 and bivalent vaccine with only type 1 and type 3 vaccine viruses was used. A monovalent type 2 vaccine was created to help control outbreaks of vaccine derived type 2. However, the number of vaccine derived outbreaks has been larger than expected and it is unclear how frequently and how widely these type 2 vaccine derived strains will circulate. There is added concern on the part of public health authorities since use of type 2 live vaccine was halted after the eradication of the live virus and millions of children are not protected against this vaccine derived virus. Some of the actions recommended by the IHR to combat the current situation are: 1. Officially declare poliovirus transmission as a national public health emergency and implement or maintain all required measures to support polio eradication. 2. Ensure that all residents or longtime visitors get vaccinated against polio. 3. Intensify crossborder efforts by significantly improving coordination at - Polio con't on page 4

Flu Season Trend Suggests Widespread Illness But Fewer Deaths And Hospitalizations To Occur This Year Illness Seen Especially Among Younger Age Groups Early reports about the 2019-2020 flu season have indicated widespread activity throughout the country with all regions experiencing cases above baseline illness levels. Despite this increase as of early January, overall hospitalizations were occurring at a rate similar to what has been seen in other recent flu seasons. The good news is that both hospitalizations and the percent of deaths due to pneumonia and influenza remain low. Cause of Lower Impact The Centers for Disease Control and Prevention cites the relatively higher prevalences of influenza B virus (Victoria) and influenza A (H1N1pdm09) virus as the most likely explanation for these results since these viruses are more likely to affect children and younger adults than elderly persons. And flu B has been isolated in two-thirds of the clinical specimens tested in the early part of the

season. In recent weeks, these two viruses have caused an equal number of cases nationally. Health Burden Adults 65 and older still have the highest rate of hospitalization followed by children 0-4 years of age. While these trends are encouraging, CDC nevertheless estimates that almost 13 million cases, 120,000 hospitalizations, and 6,600 deaths from flu have occurred this season. As of early January 2020, there have been 39 influenza-associated pediatric deaths, approximately twothirds of them associated with influenza B. Preliminary evidence shows that 100% of the influenza A H1N1 viruses characterized match this year’s vaccine reference viruses for flu H1N1 and 66% of the influenza B Victoria match the vaccine reference strain. ■

“...these viruses are more likely to affect children and younger adults..."

“...6,600 deaths from flu have occurred this season."

2019 Salary Survey - FINAL Reminder The link to the 2019 salary survey of academic epidemiology salaries for the latest academic year 2018-2019 is now available. The survey link, which is being sent via email to over 100 departments of epidemiology and preventive medicine, identifies and promotes competitive compensation for faculty members. To see if your organization and/or contact person has received this survey link please CLICK HERE. If your department is not included, please contact Lisbeth Dennis from the University of Pennsylvania if you are interested in receiving the survey link to complete on behalf of your institution Responses will be due on Tuesday, February 18, 2020, allowing respondents adequate time to collect the information for analysis and publication by early spring 2020.

“You can’t solve human health issues until you solve the information integrity issue.”

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an interdisciplinary Center for an Informed Public in the information school at UW.

all levels to substantially increase vaccination coverage of travelers crossing the border and of populations that live near the border. 4. Intensify efforts to increase routine immunization coverage.

According to UW President Ana Mari Cauce, “If we care about common goals---things like safe communities, justice, equal opportunity---we have to care also about facts, truth, and accuracy… Misinformation can be weaponized. It has been weaponized to divide us and to weaken us.” Health Matter In an earlier article from the University of Washington Information School, Jevin West the inaugural director of the new Center said “the reason we want to devote a lot of effort and thinking to this is that it’s involved with every aspect of society…You can’t solve climate change until you solve the information problem. You can’t solve human health issues until you solve the information integrity issue.”

Misinformation The IHR urged all countries, particularly those in Africa, to remain on high alert for the possible importation of vaccine derived polio virus type 2 and to respond to these importations as a national public health emergency. IHR noted that resistance to vaccination among certain populations is a significant factor in the spread of outbreaks, particularly in Pakistan and Angola. It urged renewed efforts to combat myths and misinformation about vaccines. This need is recognized in the US as well as shown by the creation of a new Center for an Informed Public (see related story in this issue.) ■

Toxic Speech

“Thinking in epidemiological terms highlights that toxic speech is a community problem..."

The initiative in Washington state is somewhat reminiscent of a call for the study of “the epidemiology of toxic speech” which was described in the February 2018 issue of The Epidemiology Monitor: http://bit.ly/38jYGQ4 In an interview with the University of Connecticut’s Lynne Tirrell, she told the Monitor “Toxic speech, like any toxin, is a threat to the well-being and even the very lives of those against who it is deployed…Thinking in epidemiological terms highlights that toxic speech is a community problem in need of social solutions.” ■

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The Year in Review--- Key Headlines From Articles In 2019 Hopkins Inquires About The State Of Epidemiology As Part Of Department’s 100th Anniversary Celebration / January 2019 Is The Field In The Midst Of An “Identity Crisis”? Link: http://bit.ly/2NWC40v Science Group Resists What It Calls “Sidelining” Of Public Health And Environmental Science By The Trump Administration / February 2019 Up To 40,000 Extra Deaths And Thousands More Loss Work And School Days Anticipated Link: http://bit.ly/365fjh3 Measles Outbreaks In US Unfolding In A Familiar Epidemiologic Pattern / March 2019 CDC Testimony Calls Situation A Wake-Up Call About US Vaccination Challenges Link: http://bit.ly/2v6wjXp CDC Reports Explosive and Widespread Increase In Hepatitis A Cases In Specific Population Subgroups / April 2019 Urgent Control Measures Called For Link: http://bit.ly/2G9e0mo Judge Cancels Trial And Appoints Mediator In Glyphosate Litigation / June 2019 Epidemiology Called “Loosey-Goosey Field” Link: http://bit.ly/37dS1H2 Congo Ebola Outbreak Declared An International Emergency / July 2019 Unparalleled Situation Impeding Control Measures Epidemiologists Banned From Participating In Hot Zone Link: http://bit.ly/369ID5K WHO Epidemiologist Killed While Combatting Ebola Congo Is Buried In His Native Cameroon / May 2019 Link: http://bit.ly/2G5VUBT US Outbreaks Of Acute Flaccid Myelitis Still Posing Several Mysteries / August 2019 Identifying Risk Factors Called “A Public Health Priority” Link: http://bit.ly/2RvNXeK CDC Epidemiologist Seeks Whistleblower Protection For His Stance On Climate Change Issues / September 2019 With Politics And Science In Tension, Taking A Stand To Defend Science Can Exact A Heavy Toll Link: http://bit.ly/2R9rPYI Investigations Identify Vitamin E Acetate As “Culprit Of Concern” In The Vaping Lung Injury Outbreak / November 2019 Discovery Called A “Breakthrough” Link: http://bit.ly/2NIpQZ1 New Study Shows How Measles Virus Infection Has Both Immediate And Lasting Impact As A Cause Of Death / November 2019 Mortality Burden Is Astonishing - Measles Vaccine Even More Valuable Than Previously Thought Link: http://bit.ly/38mYlfq

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: Tabatha Offut-Powell as a Community Star by the National Organization of State Offices of Rural Health. The award recognizes those making an impact on rural health. Dr Offut-Powell created a My Healthy Community data portal which contains a large amount of Delaware health-related data organized by geographic region. Offut-Powell is the Delaware state epidemiologist and Chief of Epidemiology, Health Data and Informatics. She told local media, “We see things differently because of [data]…It makes us ask ourselves, ‘Do we need to address that? What can we do differently?” Appointed: Joel Kaufman, as the new editor-in-chief of Environmental Health Perspectives (EHP), the journal published by the National Institute of Environmental Health Sciences at the National Institutes of Health. Dr Kaufman is Professor of Environmenal and Occupational Health Sciences, Medicine, and Epidemiology at the University of Washington, Seattle. In an EHP news release, Kaufman shared his vision for the journal, saying “EHP is, and should remain, the premier international scholarly journal of the environmental health sciences.”

Promoted: Tim Jones, as the chief medical officer for the Tennessee Department of Health. Dr Jones has served as the Tennessee state epidemiologist and director of the Communicable, Environmental Disease and Emergency Preparedness Division since 2007 and as assistant commissioner in 2012. According to the Department, Dr Jones is an internationally recognized expert in epidemiology and communicable and foodborne diseases.

Awarded: to Emeka Okafor, a five year Mentored Research Scientist Award from the National Institute on Drug Abuse to study the effects of drug use, particularly cannabis, on treatment outcomes of patients with HIV. Okafor is assistant professor of epidemiology in public health at Baylor University.

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Remembering Some Of The Epidemiology Colleagues We Lost In 2019 Died: Bill Jenkins, on Feb. 17 in Charleston, S.C. He was 73. The cause of death was sarcoidosis. Bill was a former CDC epidemiologist who worked to address racism in health care and had been a champion for the participants in the Tuskegee study. As one acquaintance paid tribute, “…his whole life spoke powerfully for racial justice and healing especially in public health, past and future, and the role we all can play in making that a reality—not by denial but by acknowledgement, however painful, and active repair. Oh, I miss that laugh. . .”

Died: Melinda Moore, on January 17, 2019 of ovarian cancer at age 68 at her home in Darnestown, Maryland. She was a former Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention (CDC) and had a career in global health in over 45 countries while employed by CDC, at the Department of Health and Human Services, and at RAND. Her obituary in the Washington Post states “she will be remembered for her adventurous spirit, moral and intellectual leadership, and eternal optimism.”

Died: Gina Pugliese, age 70 on March 4, 2019 of complications from uterine cancer. Gina was an expert on infection control and hospital epidemiology. Minnesota epidemiologist Michael Osterholm described her as a pioneer in the field and told the Chicago Tribune that “Gina was one of the most respected colleagues in our business—she was never wrong because of doing her homework to always know the facts.” She most recently served as Vice President of the Safety Institute at Premier Healthcare Alliance.

Died: Paul Godley, 61, of a heart attack, on March 31, 2019 while recovering from a previous heart attack. Godley was adjunct professor of epidemiology at the Gillings School of Public Health. Til Sturmer, chair of the department, called Godley “a major force in medicine and epidemiology whose work made a significant difference in oncology (specifically prostate cancer) and in reducing health disparities”.

Died: Alan Kristal, 66, Fred Hutchinson Cancer Research Center epidemiologist of pancreatic cancer on March 22, 2019. He studied how diet can lower cancer risk. His colleagues paint a vivid picture of him—“he will be especially remembered for being an iconoclast, for having a wicked sense of humor, and for his authenticity,” and “the excellence of Alan Kristal’s science is no accident…It is the result of high intention, sincere effort, and intelligent execution. What a beautiful legacy.”

- Remembering con't on page 8

Remembering Some Of The Epidemiology Colleagues We Lost In 2019

Died: Sarah Luna, age 31, in a plane crash in Metlakatla Harbor Alaska. She was a senior epidemiologist in the Liver Disease and Hepatitis Program of the Alaska Native Tribal Health Consortium and was traveling to the area in partnership with the Diabetes team. The Consortium described her as a person truly committed to the health and well-being of Alaska Native people.

Died: August Hale Vandermer, from hepatic failure earlier this ear in Prince Frederick, Maryland. He was a senior epidemiologist during his career with the US Environmental Protection Agency and had served as EPA's representative in the United Nations Environmental Program.

Died: John Last, age 92 on September 11, 2019. He was professor epidemiology and community medicine at the University of Ottawa beginning in 1969 and Emeritus Professor at the time of his death. He worked in multiple areas of public health and was perhaps best known in epidemiology for his work as the editor of the first four editions of The Dictionary of Epidemiology. He also edited four editions of Public Health and Preventive Medicine and a leader in the development of ethical standards for epidemiology and public health. We always found him to be a cheerful, knowledgeable, and interesting colleague to talk with over the years at multiple epidemiology conferences.

Died: Philip Nasca, suddenly at age 77, on December 6, 2019. He had held numerous positions in his career including Director of Cancer Epidemiology at the New York State Department of Health, and Dean of the University of Albanyâ&#x20AC;&#x2122;s School of Public Health. According to his obituary, he will be especially remembered for creating the Center for Global Health and for the many partnerships that were created and have thrived because of the Center. Friends and colleagues are planning a tribute and a celebration of his life at a future date.

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

February 2020 February 3-5 http://bit.ly/352CzfT Short Course / Mendelian Randomization / University of Bristol / Bristol, England February 3-7 http://bit.ly/3539f92 Short Course / Advances in Genome-Wide Association Studies / Erasmus MC / Rotterdam, The Netherlands February 3-21 https://bit.ly/2JId5dN Short Course / Climate Change & Health / University College London / London, England February 10-11 http://bit.ly/2DUFqvk Conference / 2020 National Health Policy Conference / Academy Health / Washington, DC February 10-11 http://bit.ly/2YykFzg Conference / 2020 Health Datapalooza / Academy Health / Washington, DC February 10-12 http://bit.ly/2E2pDL6 Short Course / Causal Inference in Epidemiology / University of Bristol / Bristol, England February 10-28 http://bit.ly/2sTfuhj Summer Program / Public Health Summer School / University of Otago / Wellington, New Zealand February 17-21 https://bit.ly/2zz5EAS Winter Program / Winter School in Clinical Epidemiology / UMIT / Tirol, Austria February 17-21 http://bit.ly/3479sa5 Short Course / Advanced Clinical Trials / Erasmus MC / Rotterdam, The Netherlands February 20-22 http://bit.ly/34bRKC1 Conference / 30th Annual Scientific Meeting of the JEA / Japan Epidemiological Association / Kyoto, Japan February 21-22 http://bit.ly/2Pdh4Ud Conference / 2020 Northwest Tribal Health Conference / Tribal Epidemiology Centers / Portland, OR February 24-28 http://bit.ly/2P2HN5O Short Course / Using R for Statistics in Medical Research / Erasmus MC / Rotterdam, The Netherlands February 24 - March 13 http://bit.ly/36hmEKR Short Course / Infectious Disease Epi & Global Health Policy / University College London / London, England

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Near Term Epidemiology Event Calendar March 2020 continued from page 9 March 2-4 http://bit.ly/36fpmAn Conference / Teaching Prevention / APTR - Association for Prevention Teaching and Research / San Antonio, TX March 2-6 http://bit.ly/33XqJSJ Short Course / Intensive Course in Applied Epidemiology / University of Aberdeen / Aberdeen, Scotland March 3-6 http://bit.ly/2P1uouz Conference / EpiLifestyles 2020 Scientific Session / American Heart Association / Phoenix, AZ March 9-12 http://bit.ly/2Pq0dfD Conference / Integrated Foodborne Outbreak Response and Mgmt (INFORM) 2020 Conference / Multiple / Atlanta, GA March 9-12 http://bit.ly/2YqNE82 Short Course / Environmental Health Risk (formerly Analyzing Risk) / Harvard University / Boston, MA March 9-13 http://bit.ly/2s6QPpm Short Course / Genetic Epidemiology / University of Bristol / Bristol, England March 11-13 http://bit.ly/2P1O4OT Meeting / 2020 Epidemiology and Laboratory Capacity (ELC) Annual Meeting / Centers for Disease Control & Prevention(CDC) / Atlanta, GA March 12-13 http://bit.ly/353kNZY Conference / 93rd Annual Meeting - American Epidemiological Society / AES / Atlanta, GA March 16-18 http://bit.ly/2sZXhyT Short Course / Epigenetic Epidemiology / University of Bristol / Bristol, England March 16-20 http://bit.ly/38rqnaL Short Course / Clinical Trials: Conduct and Analysis 2020 / Kings College London / London, England March 16 - April 3 http://bit.ly/2s5C6Le Short Course / Perinatal Epidemiology & Maternal Health / University College London / London, England March 20 http://bit.ly/2E0uZ9K Short Course / Advanced Epigenetic Epidemiology / University of Bristol / Bristol, England March 18-20 http://www.icreid.com/ Conference / International Conference on (Re-)Emerging Infectious Diseases / Africa CDC - Centres for Disease Control and Prevention / Addis Ababa, Ethiopia March 18-20 http://bit.ly/2slJB0G Conference / 2020 ASPPH (Assn of Schools & Programs of Public Health) Annual Meeting / ASPPH / Arlington, VA March 22-24 http://bit.ly/34XZw3L Conference / 44th Annual Conference - American Society of Preventive Oncology / ASPO / Tucson, AZ

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Near Term Epidemiology Event Calendar March 2020 continued from page 10 March 22-27 https://bit.ly/2RPzuJl Short Course / Pharmaco-epidemiology and Drug Safety / Erasmus MC / Rotterdam, The Netherlands March 23-25 http://bit.ly/2EeQbIY Conference / 2020 Annual Conference on Vaccinology Research / National Foundation for Infectious Diseases / Washington, DC March 25-27 http://bit.ly/2E0pPKF Conference / Annual Meeting - Society for Veterinary Epidemiology / SEVPM / Westport, Ireland March 26-27 http://bit.ly/38mpccj Short Course / Multiple Imputation for Missing Data / University of Bristol / Bristol, England March 26-30 http://bit.ly/2t8sqjP Conference / 6th Decennial International Conference on Healthcare Associated Infections / IDSA - Infectious Disease Society of America / Atlanta, GA March 31 - April 1 http://bit.ly/2P0QY6w Conference / Public Health Research and Science Conference 2020 / Public Health England / Manchester, England

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Cancer Epidemiology and Health Services Research A postdoctoral fellowship position is available in the Department of Population and Data Sciences at the University of Texas Southwestern Medical Center and Harold C. Simmons Comprehensive Cancer Center, a NCI designated comprehensive cancer center. The interdisciplinary faculty in the Department of Population and Data Sciences conduct $15 million dollars of externally funded interdisciplinary population-based research annually. The successful applicant will perform data analyses and literature reviews and will be expected to assist with manuscript preparation and publish research results. He or she will also be encouraged to attend and present research results at scientific conferences, participate in study meetings, and develop and pursue their own synergistic research questions. The fellow will be provided opportunities to develop and polish any skills and experiences to prepare for future career goals. We are seeking motivated applicants with rigorous training and experience in epidemiologic and/or biostatistical methods. Successful applicants will have a PhD, ScD, or DrPH in epidemiology, public health, biostatistics, health services, informatics, or other related fields. Applicants should possess strong statistical, interpersonal, and communication skills. Experience with SAS, healthcare claims-based analysis, particularly Medicare claims, survival analysis, and analysis of SEER or other cancer registry data is highly desirable. Content knowledge or expertise related to cancer and cancer survivorship, particularly breast or colorectal cancer, is also desirable. Applicants with strong interest and methodologic skills in quantitative methods related to lead time bias and competing risks are particularly sought after.

Candidate review will start immediately, with an anticipated start date of Spring/Summer 2020. Two years (with potential for an additional year), starting spring/summer 2020.

For full information: CLICK HERE

Senior Physician in Occupational Medicine / Full or Associate Professor The Faculty of Biology and Medicine (FBM) and Unisanté invite applications. Starting date is to be agreed. Your profile:  MD, with FMH in occupational medicine,  Solid experience in the field of occupational health,  Background in psychosocial and/or organizational work factors,

 Teaching experience,  Good knowledge of French or the ability to acquire quickly,  Good knowledge of English,  Proven ability to work in an interdisciplinary context.

Application: In English, will include a motivation letter, a curriculum vitae, a copy of the five most relevant publications, as well as names and contact information of three referees, a brief statement of research interests and teaching experience and a copy of diplomas. It should be submitted online to wwwfbm.unil.ch/releve/application/ as a single PDF file. The full job description is available on the same link or by scanning this QR code. Deadline: February 23rd 2020 (23:59 GMT+1) Contact: Prof. Jacques Cornuz (Jacques.Cornuz@unisante.ch), General Director of Unisanté We offer a pleasant working atmosphere in a multicultural, diverse and dynamic academic environment. There are possibilities for continuing professional education and a multitude of activities and other benefits to discover. UNIL is committed to promoting gender equality and diversity and strongly encourages applications from female candidates. www.unil.ch/egalite

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