Public Health Scan for Apr 16, 2015

News brief

Annual TFAH report notes dramatic cuts in public health funds

In its annual report on public health funding, the nonprofit Trust for America's Health (TFAH) today noted that public health spending continues to decline at both the federal and state levels and recommends not only increased funding but strategically allocated funding.

In "Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts," TFAH noted that combined federal, state, and local public health spending dropped from $241 per person in 2009 to $239 per person in 2013—or $218 when adjusted for inflation, a 10% drop. Total public health spending in 2013 was $75.4 billion.

The organization also noted that the budget for the Centers for Disease Control and Prevention dropped from a high of $7.7 billion in fiscal year (FY) 2005 to $6.93 billion in FY 2015. As noted in previous years, per capita federal spending varied significantly by state, from $15.14 in Indiana to $50.09 in Alaska.

According to a TFAH analysis, 22 states and Washington, DC, decreased their public health budgets from FY 2012-13 to FY 2013-14, and budgets in 17 states decreased for 2 or more years in a row and in 9 states for 3 or more consecutive years. From FY 2008 to FY 2014, the median per capita state spending decreased from $33.71 to $31.06—amounting to a total cut of more than $1.3 billion when adjusted for inflation.

The TFAH report also noted that funds for Public Health Emergency Preparedness—for disaster preparedness and response—dropped from a high of $919 million in FY 2005 to $643 million in FY 2015. And the Hospital Preparedness Program has been cut from a high of $515 million in FY 2004 to $255 million in FY 2015.

In addition to calling for an increase in core public health funding, TFAH recommends that "funding be considered strategically—so funds are used efficiently to maximize effectiveness in lowering disease rates and improving health."
Apr 16 TFAH news release
Full report

CSTE notes marked improvement in states' epidemiology capacity

Overall state-level epidemiology capacity as well as capacity in many specific program areas has increased markedly in recent years, and some measures are at a 14-year high, according to an assessment conducted by the Council of State and Territorial Epidemiologists (CSTE) published today in Morbidity and Mortality Weekly Report (MMWR).

In 2013, a total of 2,752 epidemiologists worked for the 50 US states and Washington, DC, the CSTE reported, an increase of 25% from the 2,193 epidemiologists reported in 2009 and an increase of 10% from the previous high of 2,498 in 2004.

In addition to the number of epidemiologists, all-time high figures since the CSTE began assessing the situation in 2001 were logged for the percentage of state health departments with substantial-to-full capacity for three essential public health services, as well as the percentage with substantial-to-full epidemiology capacity for 8 of 10 program areas.

Among the 51 respondents, 42 (82%) reported substantial-to-full capacity to monitor health status and solve community health problems, and 46 (90%) reported the same capacity to diagnose and investigate health problems and hazards in the community. In contrast, only 18 (35%) reported substantial-to-full capacity to evaluate effectiveness, accessibility, and quality of personal and population-based health services, and 15 (29%) reported the same capacity to conduct research for solutions to health problems.

When compared with results from the 51 jurisdictions from 2004 through 2009, all program areas except substance abuse showed increases in substantial-to-full capacity to their highest levels to date: infectious diseases (98%), bioterrorism/emergency response (82%), maternal-child health (73%), chronic disease (66%), environmental health (49%), injury (45%), occupational health (20%), and oral health (25%).

Despite the improvements, the CSTE noted that more than half of states reported minimal-to-no epidemiology capacity in occupational health, oral health, substance abuse, and mental health. And most health departments still lack critical technology.

The organization concludes, "CSTE recommends that state, federal, and local agencies work together to address the major gaps, including developing a consensus on optimal capacity in these areas and developing a strategy to achieve them."
Apr 17 MMWR report

News Scan for Apr 16, 2015

News brief

Canada reports multi-province E coli outbreak

The Public Health Agency of Canada (PHAC) has detected 12 cases of Escherichia coli O157:H7 infection in four provinces that might be linked to leafy greens, the agency said in a statement yesterday.

Nine of the cases were reported in Alberta and one each in Saskatchewan, Ontario, and Newfoundland and Labrador. Isolates from the patients have matching genetic fingerprints. Illness-onset dates range from Mar 13 to Mar 31.

Although the agency stated that "A specific product has not been identified yet, and the investigation is ongoing," it said a link to leafy greens—such as lettuce, kale, spinach, arugula, or chard—is possible. PHAC said it is collaborating with provincial authorities to monitor for and investigate any new cases.
Apr 15 PHAC statement

4th US vCJD case likely involved exposure in lower-risk country

Disease exposure in the most recently confirmed case of variant Creutzfeldt-Jakob disease (vCJD) in the United States is less clear than in the three previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the country more than a decade before illness onset, researchers reported yesterday in Emerging Infectious Diseases.

vCJD is a rare neurologic disease that has no cure and is always fatal. It is related to bovine spongiform encephalopathy (BSE, or mad cow disease). The illness doesn't manifest itself until many years after infection.

US and UK investigators describe the clinical history of the patient, a Texas man in his 40s who was born in Kuwait but had lived in the United States for 14 years. Symptoms began in late 2012 with depression and anxiety that gradually worsened. Five months later, he experienced numbness and paresthesias of the left face and left arm, which was initially attributed to a recent motor vehicle accident.

From 1 year to 14 months after initial symptoms, he was hospitalized five times for psychiatric manifestations. During one of these visits, he was restless, irritable, disinhibited, and impulsive and exhibited choreiform movements (repetitive and involuntary jerky movements), most pronounced in his left arm.

Extensive investigations for infectious and autoimmune disorders were conducted, and cerebral spinal fluid was sent to the National Prion Disease Pathology Surveillance Center in Cleveland for analysis. Although tests initially came back negative for vCJD, the man was given a diagnosis of "probable vCJD." After the patient's condition deteriorated, he died last year, 18 months after symptom onset. Autopsy confirmed the diagnosis.

The patient had never stayed in the United Kingdom, France, or Saudi Arabia—the most likely countries for contracting vCJD. He had lived in Russia and Lebanon, in addition to Kuwait. The authors determined the man was most likely infected in one of those countries more than 14 years ago, given the number of years he spent there and the amount of British beef imported from the United Kingdom during that time.
Apr 15 Emerg Infect Dis report