Title: Cepeda: An Epidemic's Allies Reside In The Schoolhouse
September 29, 2012
Lubbock Online

Abstract: It’s been an alarming few days of obesity-related news. First, the Robert Wood Johnson Foundation released the results of its “F as in Fat” report, projecting half of U.S. adults will be obese by 2030 unless Americans make drastic dietary changes.

Then The New York Times reported, according to data published by the University of Illinois at Chicago, white people lacking a high school diploma are experiencing sharp drops in life expectancy, reversing generations of progress to extend life spans. There are many possible reasons, including higher rates of smoking and a spike in prescription overdoses, but the skyrocketing rate of obesity is a known suspect.

Tuesday marked the release of the most recent report from Mission: Readiness, an organization of about 300 retired generals, admirals and senior civilian military leaders who are trying to spread the word that obesity, and specifically childhood obesity, is a dire national security risk.

The report, called “Still Too Fat to Fight,” takes on cheap junk foods readily available in our schools. According to Mission: Readiness, students in the U.S. consume almost 400 billion calories from junk food sold at schools each year.

This will come as no surprise to anyone who has spent time in high schools — especially those in lower-income communities — where students routinely turn down their free or reduced-price breakfasts or lunches in favor of sacks of salty snacks and high-sugar beverages. And though grade-schoolers usually can’t get away with waiving their federal nutrition guideline-monitored meals, they often have a wide variety of cakes, cookies, candy and chips available to add to them — either in the cafeteria or from vending machines.

The report features some cringe-worthy statistics: One in four young adults is unable to serve in the military because of excess body fat, and even many of the ones who do manage to enlist are at high risk of injury. The military’s health insurance system, according to Mission: Readiness, spends “well over $1 billion a year on treating weight-related diseases such as diabetes and heart disease” in addition to the cost of musculoskeletal injuries resulting from inadequate physical fitness and low levels of bone density that may be related to the plunge in dairy intake and a corresponding rise in childhood consumption of sodas and sugary drinks over the past 35 years.

In the civilian population, studies recently named obesity the most expensive public health issue, costing the country more than $190 billion annually.

During a teleconference the American Beverage Association held last May, President and CEO Susan Neely told reporters that over the course of the last three years ABA’s voluntary efforts to curb sugar in schools has resulted in a 97 percent decline in full-calorie soft drinks in schools, and marketing of soft drinks to children under 12 decreased 96 percent since 2004.

She estimated a savings of approximately 1 trillion calories. In view of recent data establishing a strong causal link between limiting sugary drinks and a reduction in childhood obesity, this is a big step in the right direction.

So there is reason to be optimistic. We can reduce childhood obesity, we just have to keep pressure on the makers of all the goodies that entice our children when they’re out of our reach.

At least we’re not alone — if Uncle Sam says we’re all at risk when our kids have full access to junk at school, there’s a good chance more people will begin to demand that schools put a stop to it (Lubbock Online, 2012).

Title: Doctors Have Mixed Feelings On School Vaccinations
Date: October 3, 2012
Fox News

Abstract: Colorado doctors mostly support local efforts to give kids their flu shots and other vaccines at school - but they also have misgivings, a new study shows.

In particular, they threw more support to school flu shots, versus other vaccinations. They were also worried about how school vaccinations would affect their record-keeping and their bottom line.

The study, reported in the journal Pediatrics, looked at doctors' feelings on so-called school-located vaccination - one-day "clinics" where local health officials and school districts offer kids flu shots or other vaccinations.

The programs are seen as a potential way to bring more kids up-to-date with government-recommended vaccinations.

Since 2010, the U.S. has advised nearly all Americans age six months and up to get an annual flu shot.

Even though only a minority follow that advice - about 43 percent of Americans did during the 2010 flu season - that still translates to more than 100 million people clambering for the flu vaccine within the space of a few months.

"To get all of those people into the doctor's office is impossible," said Dr. Judith Shlay of the Denver Public Health Department, the senior researcher on the new study.

In Denver, a project funded by the Centers for Disease Control and Prevention has provided in-school flu shots, as well as vaccinations recommended for older kids and teenagers: the meningococcal meningitis vaccine, the human papilloma virus (HPV) vaccine and the "Tdap" vaccine against tetanus, diphtheria and pertussis (whooping cough).

For the current study, Shlay's team wanted to know how pediatricians and family doctors felt about school vaccinations.

Of the 584 doctors who responded to the survey, most supported in-school flu shots.

About two-thirds were in favor of their privately insured patients getting the shot at school, while around three-quarters liked the idea for their patients on Medicaid.

A financial consideration likely factors in there, since the federal government provides free vaccines for kids on Medicaid, but doctors may have a tough time being reimbursed for the administration costs. Shlay's team found less support for kids getting other vaccinations at school. Half of pediatricians and 59 percent of family doctors were for it when it came to patients with private insurance; 59 percent and 67 percent, respectively, supported it for Medicaid patients.

One concern was that if older kids get all their vaccinations at school, they won't come in for routine check-ups. Many doctors were also worried they'd have a hard time keeping their patients' records straight.

"If we give vaccinations in schools and the doctor doesn't know about it, then that's a concern," Shlay said.

There is a way to address that, though. Colorado, and all other U.S. states, have computerized immunization registries that offer a consolidated record of children's vaccination histories.

"That's a really important tool," Shlay said.

But of the doctors in this survey, about one-third were not participating in Colorado's immunization registry.

If more providers get involved in state registry systems, that could help ease worries over record-keeping, Shlay's team writes.

Many doctors were also concerned about their bottom line. Most were at least somewhat worried that if an unpredictable number of patients got their vaccinations at school, their offices would have a tough time estimating how many vaccine doses to have in stock.

Shlay said that's a legitimate concern, since the vaccines for older kids and teens are expensive. (The retail price of the HPV vaccine, for example, is about $130 per dose.)

"If (doctors) end up with unused, expired vaccines, that's a problem," Shlay said. The potential waste, she added, is a concern not only for doctors, but for everyone who needs the vaccines.

So that may mean doctors' offices will need to be more careful in terms of inventory, Shlay noted.

But even if your child gets vaccinated at school, that's not a replacement for check-ups with the doctor.

"There's more to health and healthcare than just vaccines," Shlay noted.

It's important, she said, for doctors, public health officials and schools to all work together to make school vaccination programs effective - and, in the bigger picture, get all kids their appropriate vaccinations.

A government study last year found that that goal is fairly far off: Only 49 percent of U.S. teens had received the first of three doses of the HPV vaccine, while 63 percent had gotten the meningitis vaccine and 69 percent the Tdap shot.

"School-located vaccine programs are an important approach to augment vaccine delivery," Shlay said (Fox News, 2012).

Title: Should Schools Close During Bad Flu Outbreaks?
October 30, 2012
Fox News

A new U.S. government study suggests that during a serious flu epidemic, closing schools can keep people - especially kids - out of the ER.

Now, researchers say, the big questions include, When is it best to close schools? And what are the downsides?

The study, reported in the journal Clinical Infectious Diseases, looked at what happened in two Texas communities during the H1N1 "swine" flu epidemic of 2009. In one community, schools were closed as a precaution; in the other, they weren't.

It turned out that in the district where schools shut down, there were fewer ER visits for the flu.

What's more, among kids age 6 and up, there was no increase in flu-related ER trips, while that rate doubled in the community where schools stayed open.

"The effect was most dramatic among school-age children," said Dr. Martin S. Cetron, of the Centers for Disease Control and Prevention (CDC).

There have been skeptics who've doubted that school closures could have much impact during a major flu outbreak, according to Cetron.

"They've said, well, people will just congregate in malls or other public places," explained Cetron, who directs the CDC's division of global migration and quarantine, and worked on the study.

But schools are different from malls, Cetron pointed out, with kids being in close contact with each other all day long.

He said he thinks this study, along with others, "settles" the question of whether school closures are effective. "Should this be an arrow in our quiver? I think the answer is ‘yes,'" Cetron said.

But lots of other questions remain.

"Under what conditions could (school closures) be warranted?" Cetron said. "What level of severity is needed?"

And if schools are closed, he noted, what are the downsides? Parents will have to stay home from work, or find child care. And kids and teachers will have to make up the lost school time somehow. So the expected benefits of school closings would need to be worth the troubles.

Prediction is Difficult
Every year, between five percent and 20 percent of Americans get the flu, contributing to some 36,000 deaths. The elderly and people with chronic medical conditions, like heart or lung disease, are among those most at risk.

But the 2009 H1N1 flu epidemic was noteworthy in that it hit children and healthy young adults hard.

The current study looked at two adjacent counties in Texas: Tarrant County, which closed its schools for eight days after a few kids were diagnosed with H1N1; and Dallas County, where schools did not shut down after a few cases were detected.

Before Tarrant County's school closures, the flu accounted for about 3 percent of all ER visits to area hospitals; during the closures, that rate inched up to just over 4 percent. But the increase was bigger in Dallas County during the same time period: from 3 percent, to just over 6 percent.

The impact was most clear among kids ages 6 to 18. In Tarrant County, there was no increase in the proportion of ER visits blamed on the flu. In Dallas County, the figure more than doubled, from about 5 percent to 11 percent.

"It's important to point out that this was a pre-emptive school closure," Cetron said. "Usually, most closures we see are reactive."

Predicting how a flu outbreak might affect a local area is far from easy. It's not like tracking a hurricane, for instance, Cetron pointed out.

Decisions on school closures are made locally. For school districts to make wise decisions, Cetron said communication with local and state health agencies is key (Fox News, 2012).

Title: Mumps Outbreak Traced To Face-To-Face Schooling, Study Suggests
November 1, 2012
Fox News

A face-to-face educational method used among Orthodox Jews apparently led to a U.S. outbreak of mumps in 2009 and 2010 even though most of those infected had been properly vaccinated, according to a U.S. study.

The outbreak, detailed in the New England Journal of Medicine, indicates how close, repeated contact with an infected person can overwhelm the mumps vaccine, the researchers said.

"The risk of infection with mumps may be higher when the exposure dose of virus is large or intensely transmitted," wrote lead author Albert Barskey, of the U.S. Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respirators Diseases, and colleagues.

This may also explain why the mumps vaccine tends to be less effective among household contacts than among school or community contacts, they added.

In the mumps outbreak, 3,502 cases were reported over a one-year period beginning in June 2009 in New Jersey, New York City and New York State's Orange and Rockland counties. A camp in the Catskill Mountains was the source.

The researchers, from the involved state health departments and the CDC, studied 1,648 of those cases, nearly all of them Orthodox Jews. The researchers found that 89 percent had received the recommended two doses of mumps vaccine.

Many attended a religious school known as a yeshiva, where boys receive intense training with a study partner known as a chavrusa, who sits across a narrow table. The teaching method often involves animated discussions and the partners are switched several times a day.

The researchers wrote that "chavrusa study, with its prolonged, face-to-face contact," probably resulted in high exposures to the virus, and these "overcame vaccine-induced protection in individual students."

The large families in Orthodox Jewish communities also contributed to the spread, Barskey told Reuters Health in a telephone interview.

"As the outbreak went on, we started to see younger and older cases, and females as well. What that suggests is there was spread in the households. From family it would jump to a new school," he said.

"The chavrusas played the biggest role. The households played a lesser role."

The source of the outbreak was eventually traced to an 11-year-old boy, who had himself received two vaccine doses but nonetheless picked up the disease in the United Kingdom, where fears about vaccination had led to a large mumps outbreak.

That child attended the camp, which had about 400 Orthodox Jewish boys (Fox News, 2012).

Title: Virus Breaks Out At NYC School Being Used As Storm Shelter
November 6, 2012
NBC New York

A Brooklyn high school being used as a shelter for Sandy victims has to be shut down and sanitized after about a dozen storm refugees came down with a stomach virus.

Mayor Bloomberg said John Jay High School will be closed Wednesday instead of opening for classes as scheduled.

"The school will be thoroughly cleaned and then reopened," Bloomberg said.

The mayor said none of the sickened storm victims was severely ill. The cleaning is being done as a precaution, he said.

Thousands of city residents from low-lying areas stayed in shelters as Sandy smashed the tri-state.

Bloomberg also said 10 schools that suffered storm damage or lost power will open Wednesday. The majority of city schools reopened on Monday.

Another 47 schools still won't be open Wednesday. Bloomberg said parents should check to see where those students will need to report (NBC New York, 2012).