CDC Investigations Identify Vitamin E Acetate As “Culprit Of Concern” In The Vaping Lung Injury Outbreak Discovery Called A “Breakthrough” CDC laboratory investigations of 29 samples of lung washings from patients with e-cigarette vaping product associated lung injury (EVALI) have found vitamin E acetate in all 29 samples . CDC Principal Deputy Director Anne Schuchat speaking during a telebriefing for the media called the findings “a breakthrough in the investigations”. She added that that the samples came from patients from ten different states which made the findings more robust in incriminating vitamin E acetate. Also, vitamin E acetate has been
identified in samples tested by the Food and Drug Administration and some state health department laboratories. Other Toxicants? The CDC lab investigated many other substances which might serve as potential toxicants in the vaping products such as plant oil, petroleum distillates such as mineral oil, mediumchain triglyceride oils and terpenes. No other potential toxicants were detected in the samples tested so far. - Vitamin A con't on page 2
New Study Shows How Measles Virus Infection Has Both Immediate And Lasting Impact As A Cause Of Death
In This Issue -3UK Public Health Issues Manifesto -62018 Epi Faculty Survey Launches -8Notes on People
Mortality Burden is Astonishing It is recognized from epidemiologic studies that the risk of death from measles is increased even after the acute phase of the illness. This has been perhaps most notable in African children. The mechanism for this effect has not been well understood. Now an international team of more than a November 2019
dozen researchers led by Michael Mina from Harvard’s School of Public Health has provided evidence that measles virus (MV) infection actually infects immune cells and causes immune suppression against a much wider variety of pathogens than simply - Measles cont'd on page 4 •
Volume Forty •
Number Eleven
-10Near Term Epidemiology Event Calendar -11Marketplace
-Vitamin A 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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Cannabis Another significant finding is that tetrohydrocannabinol (THC), the principal psychoactive component of cannabis, was found in 23 of 28 samples tested, reaffirming earlier leads that EVALI is more likely in products containing this ingredient. Nevertheless, CDC is being cautious and not saying that all cases of EVALI are caused by Vitamin E acetate. There may be more than one cause. Illinois Data Speaking at the same telebriefing, Illinois chief medical officer and state epidemiologist Jennifer Layden reported on state investigations which found that the majority of their cases had used THC containing products, particularly prefilled cartridges obtained from informal sources such as friends or family members. Cases reported using numerous different products and had a high frequency of use.
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Comparison Group To create a control group, Illinois investigators created an online survey for Illinois adults who use e-cigarette
Recommendations According to Layden, these findings reinforce current national recommendations not to use e-cigarette or vaping products that contain THC especially those from informal sources. Since a small proportion of EVALI cases report only exposure to nicotinecontaining e-cigarette or vaping products, halting the use of all ecigarette or vaping products is considered the prudent action to take at this time until information is more certain about the causative agent(s). ■
Key Facts about Vitamin E Acetate
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or vaping products and using the same questions that were asked of EVALI patients. Researchers were looking for risk factors associated with being an EVALI case. Some 4,631 adult Illinois residents who were recent e-cigarette users completed the survey. Among respondents, 94% used nicotine containing products and 21% reported use of THC containing products. Compared to vaping residents in the same age group, EVALI patients were 2 times more likely to report exclusive use of THC products, to use them more frequently, and to be 9 times more likely to obtain the products from informal sources such as a dealer off the street or a friend.
Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products. Vitamin E is a vitamin found in many foods, including vegetable oils, cereals, meat, fruits, and vegetables. It is also available as a dietary supplement and in many cosmetic products, like skin creams. Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning.
Source: Centers for Disease Control and Prevention
UK Public Health Society Issues Public Health Manifesto Calls For Action On Nine “Most Pressing” Public Health Challenges Prompted by the election campaign underway in the United Kingdom, the Royal Society of Public Health has identified what it considers to be the most pressing challenges facing public health. It called for bold action in the areas of taxation, regulation, and legislation which it called the most effective interventions for driving sustained improvements in population health. The eight priority areas and sub-areas are listed below with key reasons for selecting them. 1. Reducing health inequalities There is a gap of almost 20 years in life expectancy between the most and least deprived areas of England. Inequalities are the first priority area. 2. Addressing the digital determinants of health Because time spent online is taking an increasingly larger proportion of people’s lives, there are more and more ways online activity can impact population health. The RSPH calls these elements the “digital determinants of health” and cites challenges with loss of self-esteem among young people, increased exposure to online misinformation, online gambling, and online shopping which keeps people at home. Others have called online pornography a major public health issue. 3. Adopting a health in all policies approach The RSPH advocates a radical rethinking of budget goals to view making population well-being as the
key outcome. This would necessitate a moving away from the description of social goals as related only to income and economic growth. To do this, one idea is to create a composite Health Index which could take the place of Gross Domestic Product (GDP) or be considered alongside it.
“Inequalities are the first priority area."
4. Harnessing the Wider Workforce In a novel concept, the RSPH estimates that 20 million persons with the potential to positively impact population health through their paid or unpaid work could be recruited to help support the 40,000 core public health workers directly involved in prevention. Examples of these potential partners are Fire and Rescue Services, Community Pharmacy, and Housing Associations among others. 5. Protecting the Public’s Health A priority in this arena is improving the national immunization program, creating stricter limits on air pollution to improve air quality, improving food safety by making sure food safety powers and regulation are fully utilized, and preventing infections due to tattooing, body piercing, and other invasive procedures.
“...one idea is to create a composite Health Index which could take the place of Gross Domestic Product..."
6. Tackling obesity. Obesity in adults is on the rise and is now at record high levels even for young children. - UK cont'd on page 5
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-Measles cont'd from page 1 the measles virus itself. Methods
“...measles virus “may have been associated with up to 50% of all childhood deaths from infectious diseases..."
Using an assay that tracks the diversity of antibodies, the researchers examined blood samples from children in the Netherlands before and after infection with MV during a 2013 outbreak. They showed that infection caused an 11-73% loss in the pre-existing antibodies acquired by individuals from past encounters with pathogens. Thus, the they show that the impact of measles infection is both immediate and persists for an extended period to make survivors more vulnerable to death from other infectious diseases. Astonishing Impact
“...an already valuable measles vaccine has now been shown to be even more valuable..."
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In their paper published in Science in November, the authors make the astonishing suggestion that in the prevaccine era measles virus “may have been associated with up to 50% of all childhood deaths from infectious diseases, mostly from non-MV infections.” This is because it could take measles survivors months or years to recover the kind and quality of immune protection they had before MV infection. Vaccine Safe & Valuable The good news from the report is that infection with attenuated measles vaccine virus through vaccination does not appear to produce the same immunosuppressive effects. This means that an already valuable measles vaccine has now been shown to be even more valuable because it can protect from a much wider variety of infectious causes of death. In fact, the authors offer the hypothesis that by preventing measles and what they call “immune
amnesia” the introduction of measles vaccine in the mid 1960’s could have reset overall baseline morbidity and mortality rates to lower levels. Measles Control According to the World Health Organization (WHO), measles epidemics occurred every 2-3 years in the prevaccine era and caused an estimated 2.6 million deaths each year. We know from the WHO that the increased use of measles vaccine between 2000-2017 when a new measles elimination initiative was launched has succeeded in raising vaccination coverage with at least one dose to 85%. (Two doses are optimal). Associated with this vaccination initiative, global measles deaths have decreased by 80% from an estimated 545,000 in 2000 to 110,000 in 2017. Altogether, this program has prevented an estimated 21.1 million deaths, according to WHO. However, measles has been resurging more recently with declines in measles vaccination since 2017 and it still causes over 100,000 deaths globally each year. For example, last month the Epidemiology Monitor reported than an ongoing outbreak in the Democratic Republic of the Congo has claimed 4,000 children’s lives because of failure to achieve adequate vaccination coverage. Also, WHO reports that several countries have recently lost their measles freestatus. The results of the Harvard study could reenergize efforts to increase coverage even higher to help prevent not only measles deaths but also hundreds of thousands more caused by MV infection. ■ Join us on our Facebook page at: https://bit.ly/2U29gUA
-UK cont'd from page 3 7. Children’s oral health UK lacks full implementation of water fluoridation, which it calls the principal measure which can improve the oral health of children and the nation as a whole. 8. Tackling the harms from drugs The RSPH calls criminal justice approaches “counterproductive” and request changes in drug policy to decriminalize possession of illegal substances. Also stronger tobacco control measures are called for to enhance the progress already made in
lowering smoking rates. Finally, alcohol consumption is creating a huge expenditure for the National Health Service and the group calls for actions to lessen the burden. 9. Funding Prevention Services Cuts in funding need to be restored, particularly to deprived areas where cuts have been proportionately greater than in the least deprived areas. To read the full Public Health Manifesto, visit: http://bit.ly/35i7ggJ ■
“...request changes in drug policy to decriminalize possession of illegal substances."
2020 Epidemiology Event Calendar We are currently gathering events for The Epidemiology Monitor's annual calendar issue that will be published in late December. To ensure that your event is included please submit it on our website at: http://epimonitor.net/Post-an-Event.htm
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Announcement
2019 National Survey of Faculty Salaries in Academic Epidemiology Being Launched This Month Readers---Please Check Mailing List Here To Make Sure Your Department or School Will Be Participating
“...identifies and promotes competitive compensation for faculty members."
“...it has also increased the response rate."
The Epidemiology Monitor in collaboration with the University of Pennsylvania, Perelman School of Medicine will be sending a link in December to complete the 2019 salary survey of academic epidemiology salaries for the latest academic year 2018-2019. The survey, sent to over 100 departments of epidemiology and preventive medicine, identifies and promotes competitive compensation for faculty members. The continued partnership between the University of Pennsylvania and The Epidemiology Monitor has not only helped to better publicize the survey and its results, but it has also increased the response rate. As was done last year, the University will perform the analysis of de-identified data, but will be blinded from all identifying institutional information. One institutional representative from each participating institution should provide all anonymized faculty salaries within their division or department of epidemiology. To perform the
analysis, the University of Pennsylvania will have access to the information only after it has been stripped of any institutional identifiers. Responses will be due in mid-February, allowing respondents adequate time to collect the information for analysis and publication by early spring 2020. The names of the departments to be surveyed are listed here with the name(s) of the contact person being asked for the salary information. If your group is not listed, or the incorrect person is named, please contact us and we will add your institution or seek to identify a representative who can fill out the survey on behalf of your group. Please contact Lisbeth Dennis dennisls@pennmedicine.upenn.edu from the University of Pennsylvania if you have specific questions regarding the survey. For other questions, please contact The Epidemiology Monitor at editor@epimontor.net â–
2019 Participating Institutions Click Here to check the current list of institutions Please contact us to be added 6
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
Elected: Charles Branas, PhD, Professor of Epidemiology and Chair of the Department of Epidemiology at Columbia University to the National Academy of Medicine. According to the Academy, Dr Branas’ election recognizes an individual who has demonstrated outstanding professional achievement and commitment to service. The Academy cites his pioneering novel geographic science and placebased design to solve critical issues like gun violence, and showing that removing urban blight reduces gun violence and improves mental health.
Appointed: Traci Green, as professor and director of the Opioid Policy Research Collaborative at Brandeis University effective January 1, 2020. Green was formerly associate professor of emergency medicine and deputy director of the Boston Medical Center Injury Prevention Center. According to the University, Green has extensive experience as a faculty member and epidemiologist focusing on the areas of drug use, addiction, and overdose prevention.
Appointed: Aisha Dickerson, PhD, as assistant professor and Bloomberg Professor of American Health in Environmental Challenges at the Hopkins School of Public Health Department of Epidemiology as of July 15. Dickerson was formerly on a postdoctoral fellowship in the departments of Epidemiology and Environmental Health at the Harvard Chan School of Public Health.
Honored: Cari Kitahara, PhD, with the Van Meter Award Lecture by the American Thyroid Association at their annual meeting in Chicago. Dr Kitahara is an investigator in the Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, at the NIH’s National Cancer Institute. The award is for an investigator younger than 45 years who has made outstanding contributions to thyroid research. Dr Kitahara is credited with elucidating the role of obesity in the rising incidence of thyroid cancer.
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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
2020 Epidemiology Event Calendar We are currently gathering events for The Epidemiology Monitor's annual calendar issue that will be published in late December. To ensure that your event is included please submit it on our website at: http://epimonitor.net/Post-an-Event.htm
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Multiple Faculty Positions The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh invites applications for two full-time tenure track faculty positions. Applications will be reviewed until positions are filled. Please include position # on all correspondence. Send letter of intent, curriculum vitae, and the names of three references c/o K. Hanahan, Department of Epidemiology, University of Pittsburgh, 5127 Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, email: mailto:kmh231@pitt.edu. The University of Pittsburgh is an Affirmative Action/Equal Opportunity Employer and values equality of opportunity, human dignity and diversity. EEO/AA/M/F/Vets/Disabled.
ASSISTANT PROFESSOR / ASSOCIATE PROFESSOR Position #0138483 This is a full-time faculty position at the level of Assistant or Associate Professor in the tenure stream. The position is available immediately and requires a doctoral degree in epidemiology or in a related discipline with post-doctoral training in Epidemiology. Successful candidates will have expertise and training in the epidemiology of chronic disease and aging, with research experience including but not limited to the epidemiology of physical function, mobility, and disability and the intersection with the physical and social environment. Preference will be given to candidates who have expertise with advanced imaging techniques and novel physical and cognitive assessments. We seek a team scientist who is interested in developing his/her own independent program of research and who has the potential of sustained research funding. The faculty member will join a multi-disciplinary academic department with an extensive collaborative research portfolio and a robust teaching program in the School’s fully accredited programs. The successful candidate will be expected to establish and maintain a strong record of collaborative research, extramural funding, and publications; participate in the teaching and mentoring of master’s and doctoral students within the Department of Epidemiology; and contribute to the mission of the Graduate School of Public Health through service. Salary will be commensurate with experience.
ASSOCIATE PROFESSOR / PROFESSOR Position #0138492 This is a full-time faculty position at the level of Associate Professor/Professor. The position is available immediately and requires a doctoral degree in epidemiology or another doctoral degree with advanced training in epidemiology, a track record of funded research in the epidemiology of chronic disease, in particular cardiovascular disease, and experience in the conduct and analysis of large cohort studies. The successful candidate will be responsible for leading research in the epidemiology of chronic disease, which could include cardiovascular disease, obesity and diabetes, or nutrition. Of particular interest are candidates who bring expertise in novel risk assessment methodologies applied to human population research and the coordination of multi-center studies. These may include biochemical, genetic, or imaging methods or personal or environmental monitoring. The individual will lead a program of research demonstrated by independent research funding, publication of manuscripts and leadership at local, national and international research conferences. The successful candidate will advance the Department’s curriculum and will mentor doctoral students, post-doctoral fellows, and junior faculty within the epidemiology program. The position is in the tenure stream. Salary will be commensurate with experience.
Molecular Epidemiology Tenure Track Faculty Position The Wadsworth Center and the Division of Epidemiology within the New York State Department of Health in Albany, NY, are jointly seeking an outstanding scientist at the Associate or Assistant Professor level to establish a competitive, grant-funded research program in Molecular Epidemiology. We envision that the position will advance the study of pathogen outbreak dynamics by applying data analytics and disease modelling methods that will synergize with classical public health methods to more effectively predict and control outbreaks. A particular focus will be the use of AI to understand the host-pathogen-environment interaction during outbreaks as well as biological and environmental determinants of infectious disease emergence, transmission, pathogenesis and immunity. Applicants employing innovative, cutting-edge techniques to these areas are especially encouraged to apply. The Wadsworth Center (https://www.wadsworth.org/) is the country’s most comprehensive state public health laboratory with a staff of about 800 that includes over 100 doctoral level scientists. The Center provides a dynamic research environment focused on infectious, genetic and environmental diseases and their impact on human health. The Division of Epidemiology encompasses the Bureaus of Communicable Disease Control, Immunizations, Tuberculosis Control (including the Refugee Health Program), and Healthcare Associated Infections, along with an overarching Statistical Unit managing extensive disease databases. Both the Division of Epidemiology and the Wadsworth Center have a major role in mitigating the impact of antimicrobial resistance in NYS and are working with industry in a unique public-private partnership to develop a statewide disease surveillance system. The successful applicant will join a core group of scientists applying advanced public health diagnostics, genomics, and molecular epidemiology to address public health challenges caused by recurring and emerging pathogens. The successful applicant will receive a highly competitive start-up package, 12-month salary, access to outstanding core facilities including next generation sequencing and bioinformatics, and access to the Department of Health’s extensive disease databases. Optional educational opportunities are provided through the University at Albany’s School of Public Health. PhD, MD or equivalent degree with experience in one or more of the following; infectious disease, public health, epidemiology, molecular biology/molecular diagnostics, data analytics, statistics, bioinformatics, or related, and relevant postdoctoral research experience required. To Apply: Applicants should submit their curriculum vitae, 3-page research plan and contact information for at least three references to wcphgc@health.ny.gov, referencing “Wadsworth Molecular Epidemiology”. Review of applications will be performed on a rolling basis and continue until the position is filled. AA/EOE.
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.
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