Stories about: public health

Viral discussion: Epidemics experts sound off on the future of infection control

Image of flu virus, which experts think will eventually lead to future epidemics
Is the next flu pandemic around the corner?

During the 1918 influenza pandemic, the average life expectancy in the U.S. dropped below 40 years old. Today, public health and medical professionals need to be actively preparing for the next great pandemic, according to leaders of the Massachusetts Medical Society, The New England Journal of Medicine and Microsoft founder Bill Gates, who delivered the keynote address at a Boston-based meeting on April 27 called Epidemics Going Viral: Innovation vs. Nature. Here’s recap of what we heard from various panelists.

The five key drivers of epidemics are population growth/urbanization, travel, animals, environmental/climate changes and conflicts/natural disasters, according to Harvey Fineberg, MD, PhD, President of the Gordon and Betty Moore Foundation and former president of the Institute of Medicine. When it comes to predicting and preventing the next epidemic, Fineberg believes that data from a social media platform like Twitter isn’t going to help identify the next big outbreak.

But John Brownstein, PhD, an epidemiologist and Chief Innovation Officer at Boston Children’s Hospital, disagreed with that idea.

“I believe it’s possible for Twitter to find the next microbe,” Brownstein said. “This information comes in real time and at global scale.” Attendees who were live tweeting with the hashtag #epidemicsgoviral were quick to highlight this difference of opinion.

Uber flu shot, “a cool millennial thing to do”

Anne Schuchat, MD, deputy director of the Centers of Disease Control, busted the myth that non-vaccination rates are rising. She explained that media stories about anti-vaccination supporters can make it seem as though vaccination rates are falling when they actually aren’t.

“Less than one percent of kids aren’t vaccinated in the U.S.,” Schuchat said.

But some vaccinations, like the annual flu shot, still have big gaps to close. Brownstein described how a partnership with Uber — dispatching flu vaccines and nurses to people’s homes — was able to influence people to get their first-ever flu shot.

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News Note: Norovirus outbreak threatens the Olympics

The HealthMap team at Boston Children's is currently tracking norovirus at the Olympics
The Computational Epidemiology Team at Boston Children’s Hospital tracks online, informal sources for disease outbreak monitoring and real-time surveillance of emerging public health threats through a platform called HealthMap. This is an image of what their surveillance dashboard is currently tracking (Feb. 15, 2018) in South Korea. Visit http://www.healthmap.org/en/ for more.

The 2018 Winter Olympics have brought nearly 3,000 delegates from 206 countries together in PyeongChang, South Korea. But just a week after kicking off on February 8, the games and its attendees are already being interrupted by a fast-spreading norovirus outbreak.

Norovirus is an extremely infectious disease transmitted through food, water or by touching a contaminated surface. Infection causes inflammation of the stomach and intestines, which can lead to symptoms including stomach pains, nausea, vomiting and diarrhea.

In PyeongChang, there have already been 199 confirmed cases of norovirus — many of those sickened have been security guards hired for the games. Due to severe gastrointestinal symptoms, 41 guards have been hospitalized and more than 1,200 were placed in quarantine. 

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Under the hood of healthcare innovation: Jared Hawkins and the digital phenotype

Jared Hawkins Boston Children's Hospital

What does it take to change healthcare for the better? In the second of a two-part series on digital health innovators at Boston Children’s Hospital, we profile Jared Hawkins, MMSc, PhD. Like Gajen Sunthara, MSc, featured in part one, Hawkins was named among MedTech Boston’s 40 Under 40 Healthcare Innovators for 2017.

Jared Hawkins, director of informatics at Boston Children’s Innovation and Digital Health Accelerator (IDHA), brings a formidable skill set to his work. With a PhD in Immunology from Tufts University School of Medicine and an MMSc in Biomedical Informatics from Harvard Medical School, his background combines biomedical research (immunology, virology, oncology, genomics) with data science, visualization, computational modeling and software development.

His current work spans an equally diverse range of topics, touching on population and public health, patient experience, decision support and pharmacogenomics. A faculty member in the Computational Health Informatics Program, Hawkins is wired into the digital health ecosystem. He serves as a scientific advisor and co-founder of Raiing Medical (home temperature and fertility tracking) and is the head of engineering and co-founder of Circulation (non-emergency medical transportation via Uber).

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Predicting influenza outbreaks faster with a digitally-empowered wearable device

Influenza viruses. Outbreaks can be predicted using digital health tools like Thermia.The Thermia online health educational tool, developed at Boston Children’s Hospital, has enabled one-month-faster prediction of seasonal influenza outbreaks in China, via its digital integration with a commercially-available wearable thermometer. The findings appear in a new study published in the American Journal of Public Health.

 “The fact that we were able to predict influenza outbreaks faster than China’s national surveillance programs really shows the capacity for everyday, wearable digital health devices to track the spread of disease at the population level,” says the study’s lead author Yulin Hswen, who is a research fellow in Boston Children’s Computational Epidemiology Group and a doctoral candidate at the Harvard T. H. Chan School of Public Health.

China has 620 million mobile internet users who can theoretically access the standalone Thermia application from any computer, smartphone or even the Amazon Alexa assistant.

Although the Boston Children’s team has previously demonstrated that social media can be used to track disease, this is the first time they’ve shown that outbreaks can be predicted through an integrated wearable device and online tool.

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Tracking the public health effects of the Rio Olympics: HealthMap

Olympics Brazil Zika Health Map
Athletes around the world are converging on Brazil. What effects will this have on Zika and public health generally? (Nuno Lopes/Pixabay)

This past week, the 2016 Summer Olympic and Paralympic Games began in Rio de Janeiro, Brazil, with more than 11,000 athletes and 500,000 international fans expected to arrive. As a major mass gathering, the Olympic Games are always vulnerable to disease outbreaks. This summer, all eyes in public health are on the concurrently occurring Zika virus and the under-reported H1N1 influenza outbreak in Brazil.

According to the European Centre for Disease Prevention and Control (ECDC), visitors to the 2016 Games are most at risk for gastrointestinal illness from waterborne pathogens and mosquito-borne infections, including dengue, chikungunya and Zika virus. So far in 2016, we have seen an estimated 165,000 cases of Zika virus, 1,345,286 cases of dengue, 137,808 cases of chikungunya and more than 6,500 cases of H1N1 influenza, with an additional 1,233 deaths from H1N1 — all in Brazil alone.

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Is it time to expand anti-obesity programs beyond schools?

heavy child running ShutterstockSchools have manned the front lines in the battle against childhood obesity. Through the Healthy, Hunger-Free Kids Act of 2010, First Lady Michelle Obama has promoted low-cal lunches, fresh produce and more. Now, she hopes to ban junk food and soda marketing in schools.

Are these efforts enough to turn the tide? Offering healthy foods and promoting physical activity at school may not be enough to negate the impact of other unhealthy influences in students’ homes and neighborhoods, according to Tracy Richmond, MD, MPH, of Boston Children’s Hospital’s Division of Adolescent Medicine.

Richmond recently published a study in PLOS One that looked at how a school’s physical activity or nutrition resources might influence fifth grade students’ body mass index (BMI).

The study focused on 4,387 students in Birmingham, Ala., Los Angeles and Houston. “We wanted to find out if certain schools look ‘heavier’ because of their composition—meaning that kids at higher risk of obesity, like African American girls or Hispanic boys, cluster within certain schools—or whether something structural in the school influences BMI, like the facilities or programs offered,” explains Richmond.

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Population health: Bringing together medical, public health and payer communities

The people who deliver care are starting to think in terms of population health.
The people who deliver care are starting to think in terms of population health.
A growing number of health care professionals are looking at their patients not just as individuals with unique concerns but also as members of larger groups with common problems and needs. This broader, population-based framework could lead to better health outcomes for more people, according to Jonathan Finkelstein, MD, MPH of Boston Children’s Hospital.

“The health care system is changing from one that’s more reactive to illness—you come see the doctor when you’re not well—to one that’s more responsible for the promotion of health for defined groups of people,” he explains. While individual patients will always be treated as, well, individuals, the concept of population health can help providers “figure out the most appropriate services within a set of limited resources for specific groups.”

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Think you have strep? Answer two questions and check the big data

shutterstock_141722230Do you have a fever?

Do you have a cough?

If you’re sitting at home with a sore throat, your answers to those two questions could be enough to tell whether you should see a doctor for a strep test, thanks to a new risk measure created by Kenneth Mandl, MD, MPH, and Andrew Fine, MD, MPH, at Boston Children’s Hospital.

Called a “home score,” the measure combines the two questions above, your age, and data on the level of strep activity in your geographic area. The basic idea is that your symptoms, plus the big picture of what’s happening in your neighborhood, is a strong enough predictor to for you to go to the doctor for a throat swab.

Thought it’s just a research tool for now, if it were it were packaged into an app and fed the right data (localized strep test results from a health center or medical testing company, for example), the home score could allow someone with a sore throat to make an informed decision about whether they should consider going to the doctor.

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Yes, PCPs can help youth with smoking, but can we get incentives to align?

Teen girl smoking cropped-shutterstock_108536432Claire McCarthy, MD, has been a primary care pediatrician and writer for more than 20 years. She blogs for the Huffington Post, Boston.com and the Children’s pediatric health blog, Thriving. She practices at the Children’s Hospital Primary Care Center. Follow her on Twitter @drClaire.

When I read about the report from the U.S. Preventive Services Task Force saying that pediatricians can “move the needle” when it comes to youth smoking, I had a few different reactions.

My first reaction was:  Cool! I don’t want youth to smoke. We all know the health problems it causes. It’s good to know that we can make a difference.

My second reaction, as I thought about it more, was:  Duh. Of course we can make a difference. We primary care pediatricians are perfectly positioned to influence the health behaviors of youth. We have relationships with them and their parents. We see them regularly, we have the opportunity to build trust and to get to know and understand them. We talk to them about all aspects of their health and well-being. While they don’t always listen to us, there’s always the chance they will.

And then, as I thought about it even more, my reaction was:  Is anyone going to help us do it?

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Mapping obesity with Facebook

What you like on Facebook might say something about how obese your neighborhood is. (Dry Martini/Wikimedia Commons)
If one of my Facebook friends were to look through my list of “likes,” they’d find that I’m interested in music, cars, science and photography, among other things (and not necessarily in that order).

But if a researcher were to look across Boston at what people who are like me like—and post and share—on Facebook, a snapshot of data could tell them something else: roughly how obese metro Boston is.

That’s essentially what John Brownstein, PhD, and Rumi Chunara, PhD, concluded in a study recently published in the journal PLoS ONE. In it, they combined Facebook interest data—an aggregate of what people “like,” post on their timeline or share on others’ timelines—with health survey data to geographically correlate activity or television interests with obesity rates. 

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