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.

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Test could boost newborn cystic fibrosis screening

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Illustration of the lungs in blueBy Barbara Feder Ostrov
KHN

Stanford University scientists say they’ve devised a more accurate and comprehensive DNA test to screen newborns for cystic fibrosis, the most common fatal genetic disease in the United States.

Affecting about one in 3,900 babies born in the U.S., cystic fibrosis causes mucus to build up in the lungs, pancreas and other organs, leading to frequent lung infections and often requiring lifetime treatment for patients, whose median lifespan is 37 years.

Every state screens newborns for cystic fibrosis, but the current sequence of tests can miss cases, threatening babies’ lives.

The new method described in a recent article in The Journal of Molecular Diagnostics, promises to be more efficient and cost-effective, researchers said. It may also improve screening for non-white babies, for whom cystic fibrosis is rarer and harder to diagnose.

The new method promises to be more efficient and cost-effective and may also improve screening for non-white babies in whom cystic fibrosis harder to diagnose.

“I think this is a major advance. It offers the promise of potentially eliminating the false negative results that lead to missed cases,” said Dr. Philip Farrell, a former dean of the University of Wisconsin School of Medicine and Public Health, and a nationally-known expert on cystic fibrosis screening for newborns. “If you miss a case, you’ve got a baby out there who has a significant possibility of dying undiagnosed.”

Cystic fibrosis is caused by a defect in the CFTR gene, which regulates the movement of water and salt out of the body’s cells. In California, current genetic screens look for 40 of the most common mutations of the CFTR gene in newborns.

Yet any of the more than 2,000 known mutations in that gene could play a role in the disease, and there are likely others that have not yet been discovered.

The new test uses “next generation” DNA sequencing that can quickly and more cheaply look at the entire CFTR gene, not just selected mutations. It does not require an extra blood sample. Rather, it uses the tiny amount of blood drawn from the common newborn heel stick test that’s already used to screen for a number of diseases, including cystic fibrosis.

The researchers say this advance can enable testing labs to review many newborn samples at a time and reduce costs, allowing a technology previously used only to diagnose individual cases to be applied to a large population. Continue reading

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Administration will continue to push Obamacare expansion, HHS chief says

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HHS Sec. Burwell says ‘beat goes on’ as agency seeks to expand health law’s influence

By Mary Agnes Carey
KHN

Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellDepartment of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.

In addition to the health law, Burwell’s agency is juggling many other priorities these days, including coordinating her agency’s response to the emerging threat of the Zika virus, President Barack Obama’s “Moonshot on Cancer” initiative and the growing epidemic of opioid abuse.

“The beat goes on,” she said during a briefing with reporters at HHS headquarters. 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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Obamacare enrollment tops expectations

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By Phil Galewitz
KHN

2016 Obamacare Enrollment Tops Expectations At 12.7 Million

ACA health reform logoAbout 12.7 million Americans enrolled in private health insurance through the federal and state marketplaces for 2016, the Obama administration said Thursday.

Sign-ups in the third enrollment period for the Affordable Care Act’s online marketplaces — and the last that will be completed while President Barack Obama is in office — easily topped last year’s amount and also beat the administration’s modest forecast.

The 2016 enrollment period began Nov. 15 and ended Jan. 31. Except for limited exceptions such as job losses, Americans will have to wait until mid-November to enroll again.

About 4 million enrollees on healthcare.gov this year enrolled in the coverage for the first time.

The annual Obamacare enrollment numbers routinely draw debate. Supporters boast that millions of people have gained coverage.  Detractors stress millions remain uninsured because they can’t afford coverage and that not enough healthy young adults are enrolling. The latter issue threatens the business case for insurers, causing them to lose money and raise prices or drop out of the exchanges.

Of the 12.7 million consumers enrolling in marketplace coverage, more than 9.6 million came through the federal healthcare.gov exchange that handles 37 states. The rest, 3.1 million, selected a plan through the 13 state-based marketplaces.

About 4 million enrollees on healthcare.gov this year enrolled in the coverage for the first time, according to the Department of Health and Human Services.

At the end of last year’s enrollment period, 11.7 million people had chosen plans,  but that figure dropped to 9.3 million by September because not everyone paid premiums and some found coverage elsewhere, such as through employers.

In October, the White House estimated that 10.1 million Americans would have health care coverage through the exchange at the end of 2016, a figure that counts people who paid and were covered at the end of the entire year.

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A voter’s guide to the health law

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GOP LogoBy Julie Rovner
KNH

Nearly six years after its enactment, the Affordable Care Act remains a hot-button issue in the presidential race — in both parties.

“Our health care is a horror show,” said GOP candidate Donald Trump at the Republican debate in South Carolina Dec 15.

Texas Sen. Ted Cruz, winner of the Iowa caucuses, said at the debate in Des Moines Jan. 28 that the health law has been “a disaster. It is the biggest job-killer in our country.”

Democratic LogoDemocrats largely support the law, but even they can’t agree on how to fix its problems. Hillary Clinton said at the Jan. 25 town hall on CNN that she wants to “build on the ACA. Get costs down, but improve it, get to 100 percent coverage.”

Clinton’s rival for the nomination, Vermont Sen. Bernie Sanders, acknowledged that “the Affordable Care Act has done a lot of good things,” but added that “the United States today is the only major country on earth that doesn’t guarantee health care to all people as a right.” Sanders is pushing a government-run “Medicare for All” plan instead.

In some cases candidates are bending the truth. But in general, both praise and criticisms of the law are accurate. That’s because the health law is so big and sweeping that it has had effects both positive and negative.

Here is a brief guide to some things the health law has — and has not — accomplished since it was signed by President Barack Obama in 2010. Continue reading

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CDC warns of the danger of drinking while pregnant

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From the US Centers for Disease Control and Prevention

Alcohol and Pregnancy

Why Take the Risk?

An estimated 3.3 million US women between the ages of 15 and 44 years are at risk for exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy, according to a new CDC Vital Signs report.

Screen Shot 2016-02-04 at 10.24.26 AM

The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol.

  • Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.
  • About half of all pregnancies in the US are unplanned and, even if planned, most women will not know they are pregnant until they are 4-6 weeks into the pregnancy when they still might be drinking.

Every woman who is pregnant or trying to get pregnant – and her partner – want a healthy baby. But they may not be aware that drinking alcohol at any stage of pregnancy can cause a range of disabilities for their child.

It is critical for healthcare providers to assess a woman’s drinking habits during routine medical visits; advise her not to drink at all if she is pregnant, trying to get pregnant, sexually active, and not using birth control; and recommend services if she needs help to stop drinking.

For this Vital Signs report, scientists from CDC’s National Center on Birth Defects and Developmental Disabilities analyzed data from the 2011–2013 National Survey of Family Growth, which gathers information on family life, marriage, divorce, pregnancy, infertility, use of birth control, and men’s and women’s health.

National estimates of alcohol-exposed pregnancy were calculated among 4,303 non-pregnant, non-sterile women aged 15–44 years.

A woman was considered to be at risk for an alcohol-exposed pregnancy if she was not sterile, her partner was not known to be sterile, and she had vaginal sex with a male, drank any alcohol, and did not use birth control in the past month.

Women can:

  • Talk with their healthcare provider about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.
  • Stop drinking alcohol if they are trying to get pregnant or could get pregnant.
  • Ask their partner, family, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.
  • Ask their healthcare provider or another trusted individual about resources for help if they cannot stop drinking on their own.

Healthcare providers can:

  • Screen all adult patients for alcohol use at least yearly.
  • Advise women not to drink at all if there is any chance they could be pregnant.
  • Counsel, refer, and follow up with patients who need more help.
  • Use the correct billing codes so that alcohol screening and counseling is reimbursable.

FASDs are completely preventable if a woman does not drink alcohol during pregnancy.

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Licking wounds, insurers move to limit health-law enrollment

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Twenty-dollar bill in medicine bottleBy Jay Hancock
KHN

Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals in ways that consumer advocates say seem to discriminate against the sickest and could hold down future enrollment.

In recent days Anthem, Aetna and Cigna, all among the top five health insurers, told brokers they will stop paying them sales commissions to sign up most customers who qualify for new coverage outside the normal enrollment period, according to the companies and broker documents.

“The only explanation I can see for them doing this is risk avoidance — and that is discriminatory marketing “

The health law allows people who lose other coverage, families with new children and others in certain circumstances to buy insurance after enrollment season ends. In most states the deadline for 2016 coverage was Jan. 31.

Last year, these “special enrollment” clients were much more expensive than expected because lax enforcement allowed many who didn’t qualify to sign up, insurers said. Nearly a million special-enrollment customers selected plans in the first half of 2015, half of them after losing previous coverage. Continue reading

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NIH scientists discover genetic cause of rare allergy to vibration

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3d ChromosomeFrom the National Institutes of Health

Scientists at the National Institutes of Health have identified a genetic mutation responsible for a rare form of inherited hives induced by vibration, also known as vibratory urticaria.

Running, hand clapping, towel drying or even taking a bumpy bus ride can cause temporary skin rashes in people with this rare disorder.

By studying affected families, researchers discovered how vibration promotes the release of inflammatory chemicals from the immune system’s mast cells, causing hives and other allergic symptoms.

Their findings, published online in the New England Journal of Medicine on Feb. 3, suggest that people with this form of vibratory urticaria experience an exaggerated version of a normal cellular response to vibration.

“The findings from this study uncover intriguing new facets of mast cell biology, adding to our knowledge of how allergic responses occur.” — Anthony S. Fauci, M.D, Director, NIAID Director.

The study was led by researchers at the National Institute of Allergy and Infectious Diseases (NIAID) and the National Human Genome Research Institute (NHGRI), both part of NIH. Continue reading

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Reproductive technology linked to birth defects, childhood leukemia | Reuters

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Women who use in vitro fertilization (IVF) and other reproductive technologies may be more likely to have children with certain cancers or developmental delays than their peers who conceive the old-fashioned way, two new studies suggest.

The increased risk of complications may be due at least in part to advanced maternal age and other health factors that lead women to try assisted reproductive technology (ART) in the first place, say authors of both studies published today in Pediatrics.

They also caution that the findings are too preliminary to deter women from trying to conceive this way.

Source: Reproductive technology linked to birth defects, childhood leukemia | Reuters

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Uninsured rate in Washington state drops by half to 7.3 percent

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From the Office of the Insurance Commissioner

Screen Shot 2016-02-03 at 9.16.09 PM

The number of people without health insurance in Washington state has dropped from 14.5 percent in 2012 to an estimated 7.3 percent or 522,000 people in 2015, according to a new report issued today by Insurance Commissioner Mike Kreidler.

Nearly every county in Washington saw a drop in the uninsured.

The report highlights the positive impact of the federal Affordable Care Act in Washington with county-by-county data on the uninsured and the law’s effect on many segments of the population.

“Today, there are nearly 470,000 fewer uninsured people in our state,” said Kreidler.  “Nearly every county in Washington saw a drop in the uninsured rate, illustrating how the Affordable Care Act has delivered on its promise to improve access to health coverage in our state.”

Among the report’s key findings, from 2012 to 2014:

  • Adams, Yakima, and Grays Harbor counties experienced the largest decline in uninsured.
  • Kitsap County had the lowest uninsured rate at 5.6 percent.
  • Kittitas County had the highest uninsured rate at 14.5 percent.

Continue reading

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Inslee appoints Acting Secretary for DSHS, launches national search for new secretary

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LashwayBioOlympia, Feb. 3 — Gov. Jay Inslee Tuesday announced he is appointing Patricia Lashway, Assistant Secretary for the Department of Social and Health Services’ Services and Enterprise Support Administration, to serve as Acting Secretary of the 17,500-employee agency.

The Department provides assistance to 2.5 million of Washington residents providing behavioral health and developmental disability services, aging and long-term care and child and family support, juvenile rehabilitation, and food and cash assistance.

Outgoing Secretary Kevin W. Quigley, who has served as DSHS Secretary since Inslee took office in 2013, announced his resignation January 5 and will depart the agency on Feb. 22. Lashway’s appointment will begin Feb. 23.

In her current position, Lashway is responsible for day-to-day management of the Department. Prior to that, she was the DSHS Senior Director of Policy and External Relations where she oversaw strategic development, legislative and policy initiatives.

Her career with DSHS began in 1988 at what was then the Aging and Disability Services Administration, where she served for almost nine years as the Director of Residential Care Services.

Her team was responsible for developing a nationally recognized statewide complaint resolution and investigation unit that provided the foundation to serve all long-term care consumers in the state and their families.

Prior to state service Lashway worked in the legal field and has spent her career, including overseas duty as a Peace Corps volunteer.

“This is a critical time for the Department, especially with the challenges surrounding mental health services, and I’m confident our team, with the support of the governor and legislature, will ensure we provide the critical services to those who need them,” said Lashway. “I look forward to this assignment and appreciate the confidence by both the governor and my colleagues.”

Lashway received a bachelor’s degree from the University of Oregon, a juris doctorate from Seattle University and is a member of the Washington State Bar Association.

A national executive search will begin next week for a new DSHS Secretary.

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