Week 11 ~ Chikungunya May Soon Say Hello to the U.S.

I had never heard of Chikungunya until this semester's epidemiology class. This is probably because the viral disease mainly occurs in Africa, Asia, and the Indian subcontinent. Today, chikungunya has been identified in nearly 40 countries in Asia, Africa, Europe, and in late 2013, the Chikungunya virus was found for the first time in the Americas on islands in the Caribbean (CDC, 2014; WHO, 2014). Now there is concern that this disease may soon make its way into the United States.

Chikungunya is a viral disease transmitted to humans by the bites of infected female mosquitoes. There is no medicine to treat this disease, so treatment is focused on relieving the symptoms: "Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash" (WHO, 2014). Symptoms usually begin within 3-7 days after being bitten by an infected mosquito. Most patients start to feel better within a week or two after symptoms appear and will fully recover, but the joint pain (which can be very severe and debilitating) may continue for weeks or even months (CDC, 2014). But the good news is, once you are infected you become immune to the virus.

The first documented outbreak of chikungunya with autochthonous (native) transmission in the Americas occurred in December 2013: France reported 2 laboratory-confirmed cases of the disease in the French part of the Caribbean island of St. Martin. Since then, there have been confirmed cases of local transmission in the Dutch part of St. Martin, Anguilla, British Virginia Islands, and a few other islands (WHO, 2014). According to Rob Quinn's online article for USA Today (2014), there have now been more than 25,000 cases reported in the Caribbean region as of mid-April. There have also been reported cases in French Guiana, a French region on the northeast coast of South America. Public health officials suspect the virus may already be in Puerto Rico, and they believe it could spread to the southern United States within months (McGowan, 2014).

Aedes aegypti - Yellow Fever Mosquito

In her article (2014), McGowan includes a quote by Kristy Murray from Baylor College of Medicine: "We have cruise ships coming in every day [from the Caribbean]. We have the vectors here and the perfect conditions for spread."

I completely agree with this statement. The Caribbean is a very popular place to travel on a cruise, so the risk of Americans being bitten and becoming infected seems somewhat high. However, the strain of chikungunya that is spreading in the Caribbean is most commonly transmitted by Aedes aegypti, the yellow fever mosquito. This species can only survive in the warmest parts of the country: Alabama, Florida, Georgia, Louisiana, Mississippi, South Carolina, southern Texas, as well as parts of southern Arizona and a few California cities (McGowan, 2014). This could definitely limit transmission, which is good news if the virus does end up spreading into the U.S.

Aedes albopictus - Asian Tiger Mosquito

In other outbreaks around the world a different strain of the chikungunya virus was carried by Aedes albopictus, the Asian tiger mosquito. This is a very invasive species which first appeared in Houston in the 1980s. It is now found from Illinois to New York, meaning it can survive in colder environments unlike the yellow fever mosquito. Right now, researchers do not know whether the Asian tiger mosquito can efficiently transmit the chikungunya strain that is currently circulating in the Caribbean (McGowan, 2014). If it can, though, the disease could easily travel very far past the southern states.

Prevention is definitely a key component when dealing with the current outbreaks and the possible spreading of the disease to the U.S. Although an infected individual cannot directly transmit the virus to another human, the risk of spreading the disease is greater when infected and non-infected people don't take precautions. People traveling to chikungunya-affected areas should take extra precautions because they could end up being the ones who start a U.S. outbreak. Wearing mosquito repellent and covering up as to not expose a lot of skin can definitely decrease the chance of being bitten by an infected mosquito. People who have already been infected in the past should not be any less cautious. Although they cannot contract the disease again, they can still be bitten and carry the virus, increasing the chance of infecting other mosquitoes who may bite them. This then increases the number of infected mosquitoes, which of course will raise the risk of spreading the disease.

References
1. Centers for Disease Control and Prevention. (2014). Chikungunya virus. Retrieved from http://www.cdc.gov/chikungunya/
2. Quinn, R. (2014). Next stop for Chikungunya virus: The U.S.? USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2014/04/22/newser-chikungunya-virus/8003463/

3. World Health Organization. (2014). Chikungunya. Retrieved from http://www.who.int/mediacentre/factsheets/fs327/en/ 

4. McGowan, K. (2014). Chikungunya, a highly infectious disease, may soon arrive in the U.S. Al Jazerra America. Retrieved from http://america.aljazeera.com/articles/2014/4/21/chikungunya-a-highlyinfectiousdiseasemaysoonarriveintheus.html

5. Photo (top): http://www.cdc.gov/chikungunya/image/maps/CHIK_Americas_Larger_Area_Map.gif

6. Photo (2nd from top): http://images.medicinenet.com/images/government/yellow-fever-mosquito.jpg 

7. Photo (2nd from bottom): http://upload.wikimedia.org/wikipedia/commons/e/ea/Aedes_Albopictus.jpg

8. Photo (bottom): http://cdn2-b.examiner.com/sites/default/files/styles/image_content_width/hash/77/0b/770bee3b72379afd48446ce3536977e4.jpg?itok=j-3TzAxG

Week 10 ~ Autoimmune Disease in Women

Autoimmunity was named a major women's health issue by the Office of Research on Women's Health at the National Institutes of Health (NIH). This condition appears to be the underlying cause of more than 100 serious, chronic illnesses. According to the American Autoimmune Related Diseases Association (AARDA), autoimmune disease (AD) affects about 50 million Americans, and more than 75% of these individuals are women. There are more than 80 known types of autoimmune diseases, and in each one of "these ADs, the underlying problem is 'autoimmunity' - the body's immune system becomes misdirected and attacks the very organs it was designed to protect" (AARDA, 2014). When the body is unable to tell the difference between self and nonself, it produces autoantibodies that end up attacking normal cells by mistake.

There has been practically no general focus on autoimmunity as the underlying cause of many diseases. This is due to the fact that autoimmune diseases cross over many different medical specialties (e.g., rheumatology, neurology, and cardiology), and these specialties tend to focus only on singular diseases within their particular category. The AARDA states that autoimmune diseases "have been cited in the top ten leading causes of all deaths among U.S. women age 65 and younger. Moreover, these diseases represent the fourth largest cause of disability among women in the United States" (2014). The top five autoimmune diseases that affect women much more frequently than men are Hashimoto's thyroiditis (10:1 ratio), systemic lupus erythematosus (9:1), Sjogren's syndrome (9:1), antiphospholipid syndrome-secondary (9:1), and primary biliary cirrhosis (9:1).

Just like women are more susceptible than men, different ethnic groups are more susceptible to certain autoimmune diseases as well. For example, African-American, Hispanic, Asian, and Native American women are two to three times more likely to develop systemic lupus erythematosus (SLE or lupus) than Caucasian women. In 2013, two different epidemiological studies confirmed that lupus disproportionately affects young African-American women, and it was discovered that the incidence rate is much greater than previously thought. The studies also showed that these women tend to develop lupus at a younger age than white females.

Estrogen may play a role in the cause of many autoimmune diseases. Using lupus as an example again, women tend to experience worsening of symptoms during pregnancy and also during their menstrual periods. If estrogen does indeed play a part, this would explain why the majority of autoimmune disease sufferers are women. More research still needs to be done, though, in order to learn more about the role estrogen could possibly play in autoimmunity. If researchers end up discovering this theory is correct, this could significantly improve prevention and treatment strategies and hopefully find a cure to many of these diseases.
 
It is believed that several autoimmune diseases are passed down from parents to their children. The National Institute of Aging (NIA) researchers have discovered "five of 89 independent variations in human genetics that are believed to be responsible for autoimmune conditions, from celiac disease to multiple sclerosis" (Krans, 2013). It was found that these gene variations are linked to how the body produces immune system cells, and they have a crucial effect on how many of these cells the body produces. More research on this topic could lead to determining exactly how autoimmunity and genetics are connected, which could definitely aid in the development of more preventative measures as well as possible solutions to a cure.



References 
1. American Autoimmune Related Diseases Association. (2014). Autoimmune disease in women. Retrieved from http://www.aarda.org/autoimmune-information/autoimmune-disease-in-women/
2. Office on Women's Health. (2012). Autoimmune diseases fact sheet. Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html
3. Herndon, J. (2014). System lupus erythematosus. Healthline. Retrieved from http://www.healthline.com/health/systemic-lupus-erythematosus
4. Krans, B. (2013). More genetic clues to autoimmune disorders discovered. Healthline. Retrieved from http://www.healthline.com/health-news/ms-inherited-genes-affect-autoimmune-disease-risk-092713
5. Photo (top): http://blog.23andme.com/wp-content/uploads/2012/05/Autoimmune1.jpg
6. Photo (middle): http://graphics8.nytimes.com/images/2007/08/01/health/adam/17134.jpg
7. Photo (bottom): http://ashpauls.files.wordpress.com/2010/04/autoimmune.jpg

Week 9 ~ Anxious About Anxiety

What causes anxiety disorders in children? Why do some kids only experience a normal, healthy amount of anxiety while others end up being consumed by their excessive worries, anxious thoughts, and stressful events? Like many diseases and disorders, it is not exactly known what causes anxiety disorders, but there seem to be several factors that play a role: brain biochemistry, genetics, stressful life circumstances, learned behavior, and an overactive fight-flight response are all significant risk factors for anxiety disorders.

Throughout my child and adolescent years I experienced many anxiety-filled moments, some happening for no reason at all it seemed. I remember camping in West Virginia with my family and becoming anxious after eating some peanut butter. I had eaten peanut butter all my life and wasn't allergic to it, but for some reason thoughts started racing through my head. I started worrying that there was a possibility I was now allergic to it, causing me to become even more anxious. As my stress level grew, I started to feel like my throat was closing up, which of course caused me to panic even more. Then my mind turned to the fact that we were up in the mountains with no cell service, miles from the nearest town. I jumped from one anxious thought to another until finally I got my mom to drive me to a doctor. Of course, once we arrived I started to feel better and my anxiety subsided. My throat was never actually closing up; I was just having a panic attack. I was only 10 or 11 at the time, so as my "episode" was happening I didn't realize it was all just anxiety. I had dealt with feeling anxious or nervous before, but I don't think I had ever experienced a panic attack. Now I would know how to manage my anxiety before it had time to turn into a full-blown panic attack, which is fortunately why I never experience them anymore :)

It wasn't until middle school that I was diagnosed with generalized anxiety and also social anxiety disorder. I don't really remember being in preschool, but my parents said I was very quiet and hardly ever talked when I was at school. But once I got home it was like I was a completely different person, the "real" me who my teachers and classmates didn't get to see. My parents learned that this was known as selective mutism, but thankfully I started to become a little more talkative and comfortable with my surroundings in elementary school. Even now I am still one of the quieter people when I'm in many social situations (not including being with family or friends), but I have come a long way from my "selective mutism" days. 

In high school, one of my main worries each day at school was whether or not my face would turn red. This may sound funny or trivial to many people, but it made each day a lot more difficult and stressful than it had to be. I never had this issue before high school. I don't even think I ever noticed that I blushed after being embarrassed until a friend in middle school mentioned something about it. Then I started becoming more self-conscious about my blushing, and in high school is when it really grew into a problem for me. I started blushing for no reason at all except for the fact that I was thinking about it and hoping not to blush. Then my friends would point it out and playfully make fun of me. And what do you think this caused? Even more blushing. When I say “blushing” I don’t mean just slightly pink or red cheeks. It was excessive. My entire face would turn a very noticeable shade of red, and I would feel like my whole head was on fire. Many times I would lie my head down on the desk until it went away. When I was dealing with this blushing problem I discovered that there is actually a term for what I was going through. Erythrophobia is the fear of blushing, which is exactly what my fear was. I would bring on my blushing by worrying that I would blush, which was a very hard anxiety to overcome. Instead of blushing due to embarrassment, I would become embarrassed because of blushing. Once I got to college, though, it seemed that my whole fear and anxiety over blushing just disappeared. Of course I blush every now and then, but I am definitely free of a problem that used to impact me every day at school. I don’t know exactly why things changed so suddenly, but I feel that a significant part was the fact that I wasn’t focusing on it as much because of all the new experiences and distractions in college. I didn’t even realize it at first, but once my thinking changed, my old anxieties went away.

This is why I feel that what we allow our mind to focus on and how we think and talk to ourselves play a big role in whether or not one develops an anxiety disorder. How we react to one situation can turn into a domino effect and end up influencing our responses to other events. We are creatures of habit, so how we start to deal with our feelings and emotions when we are children can easily follow us as we get older. I have always wondered what made me so different from my siblings when it comes to experiencing anxiety. We were all created by the same two people, and yet they do not have any sort of anxiety disorder. This is where nature vs. nurture comes in. We may be genetically related, but we each had a different experience growing up. I was in preschool and daycare a lot as a young child because both of my parents worked full time. When I was about 3 or 4 we moved to a new town where I started kindergarten a year or two later. It was only half-day kindergarten, but since my parents both worked I would go to daycare for the other half of the day. I remember feeling very uncomfortable at daycare, and some of the kids were intimidating or mean at times. When my sister (who is 2.5 years younger than I) went to kindergarten my mom was only working part-time, so she got to come home after school instead of going to daycare. Once my younger brother started school my mom wasn’t working at all, so no daycare experience for him either.

I grew up in a very good home. My parents are both extremely great people, very responsible, loving, and encouraging. I feel that they were a little too overprotective at times, but this also helped keep me out of unsafe or risky situations. They encouraged my siblings and I to each play at least one sport and learn a musical instrument. I think this is partly why I love music so much. In general we were all raised about the same, but when looking at the specifics there are differences. It doesn’t have to be a huge, traumatic event that can trigger anxiety or lead to a more anxious personality. I predict that one reason I may experience more anxiety than my siblings is because I spent the first two and a half years of my life as the only child with just my parents. This could be why I was so shy when I started preschool. I had some little friends I would play with, but I didn’t have any siblings who I lived and interacted with every day. When my brother and sister were born they had another kid around right from the beginning, so it may have been easier for them to transition to preschool.

I decided to just focus on the nurture aspect and how a person responds to stressful situations because I find it all extremely interesting. There is so much to consider when thinking about how and why each person is the way he or she is. Two people can grow up in the same type of household but have two completely different personalities. Each little part of life impacts us in some way, even if we may never notice it. I feel that anxiety disorders are developed due to a combination of genetics, the brain’s biochemistry, and all the big and little moments, events, and situations a person experiences.




References
1. KidsHealth. (2014). Anxiety disorders. Retrieved from http://kidshealth.org/parent/emotions/feelings/anxiety_disorders.html#
2. Photo (top): http://kirstyne.files.wordpress.com/2007/09/anxiety.jpg
3. Photo (2nd from top): http://www.chicagonow.com/daily-miracle/files/2013/03/panic_attack.jpg
4. Photo (middle): http://static.ddmcdn.com/gif/fear-4.gif
5. Photo (2nd from bottom): http://www.icare4autism.org/wp-content/uploads/2012/08/nature_vs_nurture2.jpg 
6. Photo (bottom): http://www.shelbycollinge.com/wordpress/wp-content/uploads/2013/02/life.jpg

Week 8 ~ Say Hello to Measles

There is a current outbreak of measles in New York City that has spread to at least 21 people as of Tuesday, March 25, 2014. According to the city's Health Department, there are 10 pediatric cases and 11 adult cases. These cases range from three months to 63 years old. Amy Movius MD states in her article, "This year is shaping up to be the worst for measles cases in the US for many, many years" (2014). In 2000, measles was actually declared effectively eradicated from the United States. It did not circulate within our population due to the high vaccination rates of Americans. Now the disease is back, and unvaccinated people should highly consider becoming vaccinated.

3-D model of the measles virus

Measles, also known as rubeola, is a highly contagious respiratory disease caused by a virus, which shares the same name as the disease. This virus usually grows in the cells that line the back of the throat and lungs, and it can spread very easily through the air. It can also live on infected surfaces for up to 2 hours, so a person doesn't even need to be near an infected person in order to get sick. The onset of symptoms usually begins about 7-14 days after a person has been infected. In a typical case of measles, the infected individual may first experience a cough, fever (mild to moderate), red eyes, running nose, and sore throat. Tiny white spots (Koplik's spots) found inside the mouth may appear two or three days after the start of symptoms. A red or reddish-brown rash appears three to five days after symptoms begin. This rash normally develops on the individual's face near the hairline and will then spread down to the neck, trunk, arms, legs, and feet. Along with the rash, the infected person's fever may rise to 104 degrees Fahrenheit or higher.

A rash develops 3 to 5 days after symptoms begin

The measles vaccine didn't become available until the 1960s. Before then, there were 3 to 4 million cases per year in the United States. These large numbers of cases lead to about 500-600 deaths every year, and even many of the survivors ended up suffering from pulmonary and neurologic injuries caused by the infection. In the early 2000s, very little cases were reported each year, and all of those cases were brought back to the United States by individuals who had traveled to other countries where the disease still circulates. As years went on, though, more cases began to appear in the US. It was the worst in 2011, where there were 220 reported cases of measles. This rising number of cases is very likely due to more people choosing not to vaccinate. It is predicted that 2014 will surpass the number of cases in 2011; 80 cases have already been confirmed this year, and the outbreaks in NYC and other parts of the country will most likely continue to add to this number.

The outbreak in New York City began when measles was brought back to the US by unvaccinated individuals who had been traveling abroad. This goes to show how extremely important it is to be vaccinated. Someone may have traveled to another country for vacation or a business trip with no thought of contracting a disease, and now many others are infected because that person chose to travel abroad without being immunized. Once the measles virus was brought back to NYC, it was spread to many places including hospitals and health clinics, classrooms, different types of public transportation, and possibly airports and other large public places. The CDC has also tracked one individual who may have exposed the virus to up to 100 cancer patients. Of course it's a serious issue no matter who contracts measles, but cancer patients may have a much harder time combating the disease.

The majority of measles cases could have been avoided by a simple vaccination, so hopefully this outbreak has spread more awareness to how important being vaccinated really is. I have learned a lot more about measles just be reading about the outbreak in NYC. I did not know how extremely contagious it is. It can also lead to potentially fatal consequences like encephalitis and pneumonia. I feel that more people should be properly educated about this vaccine, and also informed of how quickly it spreads and the possible effects it can have on infected people.




References
1. Movius, A. (2014). Measles 2014: new reminders of old lessons. WABI TV5. Retrieved from http://wabi.tv/2014/03/25/measles-2014-new-reminders-old-lessons/
2. Mercogliano, A. (2014). NYC measles outbreak grows to 21 cases. PIX 11. Retrieved from http://pix11.com/2014/03/25/nyc-measles-outbreak-grows-to-21-cases/#axzz2x5GKwL1O
3. CDC. (2013). Overview of measles disease. Retrieved from http://www.cdc.gov/measles/about/index.html
4. Photo (top): http://img-new.cgtrader.com/items/19343/measles_virus_3d_model_max_48b80d2a-0fdc-46b7-807c-ed76e587e07f.jpg
5. Photo (2nd from top): http://classconnection.s3.amazonaws.com/624/flashcards/476624/jpg/clipboard05d.jpg
6. Photo (2nd from bottom): http://www.healthline.com/hlcmsresource/images/slideshow/mmr-vaccine/slide01_girl-getting-vaccine.jpg
7. Photo (bottom): http://www.gov.im/media/389484/measles_logo.jpg

Week 7 ~ Insect Sting Allergies

Hymenoptera venom allergy is simply an allergy to an insect sting. But to be more specific, it is "an immunoglobulin E (IgE)- mediated hypersensitivity to the venom of insects in the insect order Hymenoptera" (Paschall, 2014). I have always been interested in how some people don't have much of a reaction at all to a bee sting, while others could die without being treated. I don't know too much about this, though, so I thought it would be a good topic to research, especially why the allergy usually doesn't manifest until after the first couple stings. I have never been stung before, but for some reason I am not a big fan of bees, wasps, yellow jackets, etc. Whenever I happen to encounter one, I tend to overreact more than the average person probably does :) When I was younger I was always afraid of being allergic to them. My good childhood friend was very allergic to bees, so that is what probably caused me to be more paranoid about it.

Being stung by one of the insects in the order Hymenoptera can lead to systemic reactions. These types of reactions cause signs and symptoms throughout the body, some only mild while others life threatening. Mild systemic reactions may include flushing of the skin, uticaria (hives), and angioedema (swelling under the skin). More severe, or life-threatening, systemic reactions (also known as anaphylaxis) can include bronchospasm (a sudden constriction of the muscles in the walls of the bronchioles), laryngeal edema (a swelling caused by fluid accumulation in the soft tissues of the larynx), and hypotension. As stated in one source, "Venom-induced anaphylaxis can be particularly severe and is a leading cause of fatal anaphylaxis" (Tracy, 2013).

An insect sting allergy can develop at any age. Systemic reactions to Hymenoptera venom occur in about 3% of adults and in only about 1% of children younger than 17 years, which is interesting because children are stung more often than adults. Many of the reactions that children have are just mild, and large local reactions to stings are also more common in children (incidence of 20% for children and 10% for adults). The prevalence of insect sting allergy is twice as high in males as in females. This may be due to environmental factors such as increased exposure rather than genetic factors like inherent susceptibility. According to an online article from the Cleveland Clinic (2014), "There is no clear association with other allergies, and only 30% of patients with venom allergy are atopic. In addition, insect sting allergy is statistically not more likely to occur in persons with a family history of sting reactions." I found this last piece of information pretty interesting because I assumed it could be inherited.

In the United States, there are at least 50 deaths per year caused by insect sting reactions, and about one half of these deaths occur in victims with no prior history of a sting reaction. This number may be pretty large due to the fact that these people probably aren't as prepared to deal with the reaction since they have never experienced one before. Another interesting fact is that most fatalities (80%) occur in adults older than 40, and just 2% of fatalities occur in individuals younger than 20 years (Paschall, 2014). Perhaps the sting reactions grow worse over time or the body starts to become more sensitive to the venom as it ages. Another reason for this could be because older adults have obviously been alive longer, giving them more opportunities to have been stung more than once: "At least one prior sting is required to sensitize a person to venom, and sensitization is more likely to occur following multiple simultaneous stings or subsequent stings occurring over a relatively short period of time" (Paschall, 2014). Since an older person has been alive longer than a younger person, the older person is more likely to have had more sting reactions throughout his/her life compared to a child. The more severe reactions that one experiences, the higher his/her chance of fatality becomes.

It is crazy how the little stinger of a bee has the potential to cause such severe reactions in a person's body. The body is just trying to protect itself from the venom, but the immune system ends up overreacting and doing more harm than good. Thankfully these life-threatening systemic reactions are not common, but they are possible and do occur. As stated above, the two main risk factors for developing an insect sting allergy are 1) having multiple stings at one time and 2) being stung sequentially at close intervals. These two factors relate to an individual's environment, lifestyle, etc. rather than his/her biology such as the immune system. I was having trouble, though, finding more biology-related risk factors. For example, not everyone who experiences multiple stings at once ends up developing an allergy. So what makes them different from those who do develop the allergy?



References
1. Paschall, V. L. (2014). Hymenoptera venom allergy. Cleveland Clinic. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/hymenoptera-venom-allergy/
2. Tracy, J. M. (2013). Diagnosis of hymenoptera venom allergy. UpToDate. Retrieved from http://www.uptodate.com/contents/diagnosis-of-hymenoptera-venom-allergy
3. Photo (top): http://bee-stings.net/bee_stinger2.jpg
4. Photo (middle): http://pics.davesgarden.com/pics/2006/08/29/mygardens/40fec6.jpg
5. Photo (bottom): http://justoutsidetheboxcartoon.files.wordpress.com/2012/04/img_0605.jpg

Week 6 ~ Drowsy Driving

Discussing road traffic injuries in class on Monday got me thinking about different risk factors that can lead to car crashes. We see and hear many commercials and advertisements about not drinking and driving or texting while driving, but not as many about not driving while fatigued or sleep deprived. Driving in this condition can be just as dangerous or even more dangerous depending on the situation, and the National Highway Traffic Safety Administration estimates that "one in every six deadly car crashes results from a fatigue-impaired driver" (Kotz, 2010). According to a study by the AAA Foundation for Traffic Safety, about 41% of drivers say they've fallen asleep at the wheel. It is pretty well known that it's more risky to drive while tired, but, just like drunk driving, people still do it.

Every state has laws against drunk driving, but New Jersey is the only state in the nation that has a law against driving while sleep deprived. Because the majority of the country has no laws about this, I feel that it leads many people to pass over how serious and dangerous it can be. This results in people not considering the fact that they're fatigued when they choose to drive somewhere, which puts themselves and other people on the road at risk. I think that one reason most of the states don't have any laws regarding this issue is due to the fact that sleep deprivation would be difficult to test or enforce, while BAC can be tested through a breathalyzer or blood test.

The law that New Jersey has put in place is called Maggie's Law; it was named after a 20-year-old who was killed by a driver who fell asleep at the wheel. It states that any driver who causes a fatality after being awake for 24 straight hours or more can be prosecuted for vehicular homicide. Although it is good that New Jersey has put a law into place, it seems hard to prove whether or not someone has been awake for 24 hours or more unless they decide to admit to it. Also, no prosecution can take place unless some sort of crash has occurred. Thankfully, many drunk drivers each day are pulled over and arrested before having the chance to cause serious damage on the road, either because they were driving recklessly or stopped at a check point. You don't really hear about sleep-deprived drivers getting pulled over and charged with anything unless their sleep-deprivation has resulted in an "accident."

The President of the AAA Foundation, Peter Kissinger, stated, "Sleepiness decreases awareness, slows reaction time, and impairs judgement, just like drugs or alcohol" (Kotz, 2010). Many of the effects from fatigue are so similar to those of alcohol, but at the same time, identifying drivers who are intoxicated is easier than spotting drivers who are tired. It is unfortunate that many of these sleep-deprived people aren't noticed until after they have hit another car, run off the road, hit a tree, etc. It seems like there should be a better way to enforce not driving while sleep deprived, but for now we can just make sure to keep ourselves educated, aware, and smart about when we should and should not drive. 

It is important to spread awareness and really emphasize to others the importance of not getting behind the wheel when tired. Many times people may not be aware of how tired they really are, so really becoming familiar with the warning signs of drowsiness is very crucial. I think there should be more commercials, advertisements, and programs devoted to educating and advocating for not driving while fatigued. It would also be beneficial to include more of this in driver education courses in order to inform new drivers about the seriousness of driving this way. Many deaths and injuries could have been prevented by just a simple choice of not to drive or of going to bed earlier. A lot of times people are just thinking about themselves and where they need to be, but effectively spreading awareness about this dangerous driving condition can hopefully work toward changing the choices people make.
 


References
1. Kotz, D. (2010). Driving drowsy as bad as driving drunk. US News. Retrieved from http://health.usnews.com/health-news/family-health/sleep/articles/2010/11/08/driving-drowsy-as-bad-as-driving-drunk 
2. Photo (top): http://blog.zenbedrooms.com/wp-content/uploads/2012/12/driving-whilst-tired.jpg
3. Photo (middle): http://www.fmcpestwire.com/wp-content/uploads/2013/04/DrowsyDriving.jpg
4. Photo (bottom): http://www.drivingcasualtiesdown.org/misc/fckeditorFiles/image/DfT%20Images/Tiredness.JPG

Week 5 ~ Vaccinating Against Poverty

When I typically think of poverty, I think of how it can lead to diseases that affect millions. But just like poverty can result in disease, disease can also cause poverty. It can go either way, and I never really thought about this before. An article I found by Dr. Peter Hotez, Science for the Poor: Making Vaccines to Combat Poverty (2014), asks the question: "Is it possible to vaccinate against poverty?" I'm guessing that if the average person were to hear this question, he or she would initially find this question somewhat odd or amusing. Some may understand the meaning right away, but for others it may take some time to really grasp the interpretation of the question.

My answer to this question is yes, it is possible to vaccinate against poverty. Of course it's not possible to create a vaccination or medication that directly prevents or treats poverty. Although, that would be very cool :) But it is possible to vaccinate against diseases that usually lead to poverty and/or keep people trapped in this impoverished state, thereby, also helping to vaccinate against poverty. When thinking about epidemiology, it is important to consider various connections, causes, risk factors, trends, correlations, etc., and how one action may lead to more than one type of change. Sometimes it can be a domino effect, so it is important to think of all the possibilities that can occur and how one change can either negatively or positively impact another aspect of health.

According to Dr. Hotez's article, there is an estimated 2.4 billion people who live on less than $2 per day, as well as 1.2 billion people who live on less than $1.25 per day (known as the bottom billion). Most of the bottom billion and many of the people living on less than $2 a day are held prisoners of poverty due to a group of diseases called neglected tropical diseases (NTDs). These are a group of parasitic and bacterial infections that cause significant illness for these people. Some include trichuriasis, hookworm, lymphatic filariasis, trachoma, Chagas disease, and ascariasis. 

The CDC website states that "NTDs impair physical and cognitive development, contribute to mother and child illness and death, make it difficult to farm or earn a living, and limit productivity in the workplace" (2011). All of these factors then lead to poverty because people can't function the way they need to. Even though most children don't need to work right now, their physical and/or intellectual development could become stunted: this can greatly impact their ability to work and support their families in the future. This just shows that NTDs are not only negatively affecting people today, but it is also affecting their lives to come. 

It is very hard to end this nightmare because disease and poverty can be a never-ending cycle: disease leads to poverty, which leads to the continuation and possible addition of new diseases, which keeps poverty going strong, and so on. It can be scary to think about, but it is definitely possible to put a halt to this sequence. Of course it will take a lot of time and effort, but any great change starts with making the first step. One current approach toward limiting these diseases is an annual mass treatment consisting of a package of essential medicines. They target several NTDs at once and cost just 50 cents per person. The WHO describes this method as "preventive chemotherapy." Over time, and with other supportive measures, it is leading to the elimination of lymphatic filariasis and trachoma, as well as river blindness in some cases.

The development and testing of some "antipoverty vaccines" are also underway. Like I discussed earlier, these vaccines would improve health, while also helping to lift the burden of poverty. Hookworm infection is a leading cause of anemia and childhood malnutrition in Africa, Asia, and the Americas, so a prototype hookworm vaccine has been developed and is now going through clinical trials. Modifications of this vaccine are also being worked on so it can target other parasitic infections as well.  There is also a new schistosomiasis vaccine being created that will soon undergo clinical trials.

These different approaches toward the fight against disease and poverty are all substantial steps being made that will hopefully make a vast difference in many people's lives. The creation of certain vaccines and new discoveries being made can help us advance toward being able to successfully and effectively vaccinate against poverty and end the harsh, brutal cycle for good.



References
1. Hotez, P. (2014). Science for the poor: making vaccines to combat poverty. Huffington Post. Retrieved from http://www.huffingtonpost.com/peter-hotez-md-phd/science-for-the-poor-maki_b_4731187.html
2. CDC. (2011). Neglected tropical diseases. Retrieved from http://www.cdc.gov/globalhealth/ntd/ 
3. Photo (top): http://www.newerapolitics.org/uploads/1/3/2/0/13202651/5049487_orig.png
4. Photo (middle): http://cdn.bionews-tx.com/wp-content/uploads/2013/04/size_550x415_P152HammondRwanda04.png
5. Photo (bottom): http://www.fairlawnavenueunited.ca/images/end_poverty.jpg

Week 4 ~ Diseases Jumping Species

Diseases that can jump from one species to another is a pretty freaky topic to think about, especially when the disease is transmitted from an animal to a human (this is known as zoonoses). According to an article by Robert Roy Britt (2011), there are more than 3,000 zoonoses we can catch directly through touch and more than 4,000 from bites. It's weird to think that these tiny, "invisible" agents can do so much damage to living things. "The cross-species infection can originate on farms or markets, where conditions foster mixing of pathogens, giving them opportunities to swap genes and gear up to kill previously foreign hosts (i.e. you)" (Britt, 2011). It's a bit scary but also very fascinating how bacteria and viruses deadly to one species can evolve to infect a completely different species. When these types of diseases start causing outbreaks, things can get pretty difficult and hectic (especially when there is no vaccine for the disease).

One major example of this type of disease is the group of influenza A viruses, which are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). The CDC's website (2012) says there are 17 different hemagglutinin subtypes and 10 different neuraminidase subtypes. Interestingly, all of these subtypes but one have been found among birds; H17N10 has only been found in bats. I also found it intriguing that most influenza viruses either cause asymptomatic or mild infection in birds, but when they transfer over to humans they can be much harsher.

I was also reading on the CDC website about pigs and influenza because I was curious how pigs, birds, and humans can all be connected when it comes to certain influenza viruses. Pigs are an interesting species because they can be infected with human and avian influenza viruses as well as their own (swine influenza viruses), and it's possible for them to be infected with two different species' influenza viruses at the same time. In this sort of situation, the creation of a new virus is possible by the mixing of genes among the two existing viruses. 

This could possibly lead to a change in the influenza A viruses known as antigenic shift: "if a pig were infected with a human influenza virus and an avian influenza virus at the same time, the viruses could mix (reassort) and produce a new virus that had most of the genes from the human virus, but a hemagglutinin and/or neuraminidase from the avian virus. The resulting new virus would likely be able to infect humans and spread from person to preson, but it would have surface proteins (hemagglutinin and/or neuraminidase) not previously seen in influenza viruses that infect humans" (CDC, 2012).

As seen from the above example, antigenic shift occurs when a new influenza A subtype infects humans. Due to the new surface proteins not previously seen in human flu viruses, people would have little to no immune protection against this new virus. This foreign virus could have the potential to cause illness and also be easily transmitted from person to person. If this were the case, then an influenza pandemic could easily occur. Fortunately, influenza infections transmitted directly from animals to humans is unusual, but of course it is still possible. Being aware of the possibilities and knowledgeable about these viruses is essential, even if the chances are low.

Life cycle of the parasitic microbe T. gondii

While doing some reading on zoonoses, I came across a few articles about a parasitic microbe that is commonly found in cats and can be transmitted to humans (Toxoplasma gondii). I have heard that cat litter is unsafe for pregnant women but never knew exactly why, so I was curious to learn more about this parasitic microbe. According to Ker Than's article "Study: Cat Parasite Affects Human Culture" (2006), infection by T. gondii could cause some people to become more prone to some forms of neuroticism, which could lead to differences among cultures if enough people were to become infected. This article also stated a finding by a U.S. Geological Survey scientist, Kevin Lafferty, that people living in countries with higher rates of T. gondii infection scored higher on average for neuroticism. I found this information about T. gondii very interesting because psychology is fascinating to me, especially mental disorders and possible causes.

T. gondii tissue cyst in mouse brain

This parasite is excreted by cats in their feces and causes toxoplasmosis. Pregnant women who become infected can end up transmitting the disease to the fetus, and in some cases severe brain damage or even death can occur to the baby. Another article I found also discusses the possibility of T. gondii affecting the human brain: it "may be changing connections between our neurons, altering how we act and feel" (Mcauliffe, 2012). In the early 1990s, a Czech scientist, Jaroslav Flegr, began to suspect that a single-celled parasite had invaded his brain and was subtly manipulating his personality. Flegr discovered in 1990 that he had T. gondii, and from then on he started researching more and more about the parasite. He learned that it can only sexually reproduce inside cats, so once the parasite is inside another animal or human host it starts working to return back to a cat. Flegr believes T. gondii may be able to manipulate behavior in other species in order for it to make its way back to the body of a cat so it can reproduce.

Reading about this parasitic microbe got me pretty interested in the possible affects it can have on the human brain. I'm glad it can't reproduce in species other than cats because who knows what it could do to our population if the neuroticism theory is true. Learning about new disease-causing organisms really gets me thinking about how many there are out there that we haven't even discovered yet. There could be some that function in ways we can't really even imagine right now, and maybe others could be beneficial to our health in some significant way rather than threatening. There is so much to learn and discover about diseases and their factors. I'm excited to continue growing my knowledge with this subject and encountering new and fascinating information.


References
1. Britt, R. R. (2011). 10 deadly diseases that hopped across species. Live Science. Retrieved from http://www.livescience.com/12951-10-infectious-diseases-ebola-plague-influenza.html 
2. CDC. (2012). Transmission of influenza viruses from animals to people. Retrieved from http://www.cdc.gov/flu/about/viruses/transmission.htm   
3. Mcauliffe, K. (2012). How your cat is making you crazy. The Atlantic. Retrieved from http://www.theatlantic.com/magazine/archive/2012/03/how-your-cat-is-making-you-crazy/308873/
4. Than, K. (2006). Study: cat parasite affects human culture. Live Science. Retrieved from http://www.livescience.com/933-study-cat-parasite-affects-human-culture.html
5. Photo (top): http://www.colourbox.com/preview/4326388-26830-swine-flu.jpg
6. Photo (middle): http://www.intechopen.com/source/html/44112/media/image6.jpeg
7. Photo: (bottom): http://upload.wikimedia.org/wikipedia/commons/3/3c/Toxoplasma_gondii_tissue_cyst
_in_mouse_brain.jpg

Week 3 ~ Could Lyme Disease Be Sexually Transmitted?

Deer tick on the right

Last spring it was recommended by my doctor that I have some blood tests done because I was feeling very fatigued all the time, as well as other symptoms that caused me to feel out of it most of the day. I have come across the term "brain fog" many times, which is definitely what I was experiencing. After reviewing the results, my physician highly suspected that I had Lyme. I don't ever remember being bitten by a deer tick, but since they are so small many people never realize they've been bitten. I have been camping every year since I was in elementary school and enjoy working outside during the summer, so the possibility that I had at one time or another been bitten by a deer tick was very likely. Lyme disease is becoming more and more common (or at least more people are being diagnosed with it). I have heard of many people around my town who have it and are being treated for it. This past summer I had a Lyme test done. My blood was taken and cultured for a certain amount of days. The results came back inconclusive, but my doctor was still leaning toward Lyme (apparently the Lyme tests are not very accurate). Then near the end of 2013 my sister ended up having her blood taken to be tested. Just like for me, our physician thinks she has Lyme as well. After meeting with our doctor many times, my family has noticed that she seems to focus a lot on Lyme disease and feels that it is the cause of many people's unknown symptoms. I was planning on starting treatment with antibiotics this month, but now my mom thinks we should get a second opinion first before moving forward.

I just recently came across an article discussing how Lyme disease could possibly be sexually transmitted. I have never heard this before or even thought about it, so it really peaked my interest. I have done quite a bit of research on Lyme disease ever since my doctor first suggested it, but I have never read or heard about this possibility. I decided to search for other articles to see what other information I could find. There was a study done recently that suggests that Lyme disease may be sexually transmitted. An abstract of the research was published in the January issue of the Journal of Investigative Medicine. According to the CDC, though, Lyme disease can only be transmitted through the bite of an infected tick.

Causative agent: B. burgdorferi

Lyme disease is a tickborne infection caused by the Borrelia burgdorferi bacteria. This corkscrew-shaped bacteria is known as a spirochete, and it ironically resembles the agent of syphilis. The study that was done tested semen samples and vaginal secretions from three groups of patients: "control subjects without evidence of Lyme disease, random subjects who tested positive for Lyme disease, and married heterosexual couples engaging in unprotected sex who tested positive for the disease" (The Dispatch, 2014). All of the control subjects tested negative for B. burgdorferi in the semen samples and vaginal secretions. All the women with Lyme disease tested positive for the bacteria in vaginal secretions; however, only about half of the men with the disease tested positive for the spirochete in semen samples. One of the heterosexual couples with Lyme disease showed identical strains of B. burgdorferi in their genital secretions.

Since we just discussed last class about disease transmission, I thought this was an interesting topic to talk about. Even if the CDC is right and people cannot contract Lyme through sexual contact, it is an interesting idea to think about. If Lyme disease is in fact able to be transmitted sexually, that would explain why the disease is becoming more and more prevalent. In 2013, the CDC announced that Lyme disease is more common than previously thought, and there are over 300,000 new cases diagnosed each year in the United States.

I thought it was very interesting that one of the married couples had identical strains of the bacteria. Of course this could just be a coincidence or they could have been bitten around the same time in an area with ticks carrying the same strain, but this definitely supports the prediction. But this brings up the question why the other married couples did not have identical strains. They could have possibly both contracted the disease before they met or before they started having unprotected sex, but it doesn't seem like the study took into consideration when each person was diagnosed with Lyme.

I think there should definitely be more studies to research this Lyme STD theory. Even if it most likely seems that Lyme disease can only be transmitted by infected ticks, I believe it would be very beneficial for more research and studies to be done not only on this specific Lyme disease topic but on Lyme disease in general. Many people are being misdiagnosed and may never know they have Lyme disease (or may not find out for years), and others may be diagnosed with Lyme but not actually have it. From what I have learned about this disease over the past year, it seems that Lyme disease is not as researched as it should and could be. The more information we know, the better protected against it we can be. Reading about this STD prediction also got me thinking about other insect-borne diseases and if any of them have the possibility of being sexually transmitted. There is a lot to think about and consider when researching how diseases can be transmitted, but the more we learn about each disease and how they work the better we can be at preventing, treating, or managing them.


References
1. Borreli, L. (2014). Is Lyme Disease Contagious? Clues Hint That It May Be A Sexually Transmitted Disease. Medical Daily. Retrieved from http://www.medicaldaily.com/lyme-disease-contagious-clues-hint-it-may-be-sexually-transmitted-disease-267964
2. The Dispatch. (2014). Is There A Risk Of Getting Lyme Disease In The Bedroom? Yes, According To One Study. Retrieved from http://www.theglobaldispatch.com/is-there-a-risk-of-getting-lyme-disease-in-the-bedroom-yes-according-to-one-study-73842/
3. Photo (top): http://fyi.uwex.edu/news/files/2013/04/Deer-tick-on-right.jpg
4. Photo (bottom): http://cvmdl.uconn.edu/images/borrelia.jpg

Week 2 ~ History of People and Their Discoveries

In my last epidemiology class we discussed the basic principles of epidemiology and learned about a few very important epidemiologists throughout history. These people included John Snow, Myron Wegman, and George Comstock. Disease origins, causes, preventions, and treatments have been discovered because of these and many other epidemiologists. It was interesting learning about these people and how they contributed their time, effort, and brains in order to break past the unknown and make important discoveries, which in turn ended up positively affecting the public health. After learning about some of the greatest people of epidemiology, I thought I would share what I have learned outside of class about some other epidemiologists and their work. 

James Lind was a surgeon in the English navy, and in 1747 he noticed that many sailors were suffering from scurvy (a condition that causes swollen and bleeding gums, loss of teeth, spots on the skin, and exhaustion). Dr. Lind was determined to find a cure for scurvy, so while he was at sea he decided to perform a simple experiment among some of the sick sailors. He divided twelve of the men into six groups, changing the diets of each group: "For example, one drank a quart of apple juice a day, while another received two spoonfuls of vinegar three times a day" (Asher, p. 14-15). By performing this experiment, Lind discovered that the men who ate two oranges and one lemon a day recovered right away. From then on, the British navy made sure to supply citrus fruits to all the sailors for their voyages.

Another important discovery was made by Dr. Joseph Goldberger, a physician in the U.S. government's hygienic laboratory, in the early 1900s. Pellagra (a disease caused by a lack of vitamin B) was killing many poor southerners around this time. At this point no one knew the cause of pellagra, but most doctors thought it originated from some type of bacteria or virus. Dr. Goldberger performed a series of research experiments, and the results of his tests showed that it was nutrients missing from people's diets rather than germs that caused the condition. He wanted to prove that his results were definitely correct, so on April 26, 1916, Dr. Goldberger injected the blood of a pellagra sufferer into his assistant's arm and his assistant did the same to him. They even wiped their noses with tissues already used by people with the disease. Both Dr. Goldberger and his assistant remained healthy, which seemed to prove their argument about the disease.

These discoveries are just two of many that have been made by epidemiologists throughout history. If these types of people didn't exist it would be hard to imagine what the world would be like today, but it would definitely be very different. In class we learned that epidemiology is the core science of public health, and I definitely agree with that. It contributes so much and impacts public health in such a big way.


References 
1. Asher, D. (2003). Epidemiologists: Life tracking deadly diseases. New York, NY: The Rosen Publishing Group, Inc.
2. Photo (top): http://commons.wikimedia.org/wiki/File:Michael_Zeno_Diemer_-_Ship_at_Sea.jpg
3. Photo (bottom): https://www.healthtap.com/user_questions/209132-what-are-health-benefits-of-getting-a-vitamin-b-shot 

Week 1 ~ Intro to Epidemiology

Welcome to my first blog post :)

http://www.agencypost.com/2012-communications
-trends-for-nonprofits/

Since this is my first post for HTH 450 (as well as my first blog post ever) I am having a bit of trouble thinking of what to write, but I know it will become easier as I go. I have never had to make a blog for a class before, so I'm excited for this new type of assignment! As of right now I have some knowledge about epidemiology, but I know there will be so much more to learn and discover throughout this course. 

http://kintalk.org/discussion

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syndrome-still-a-quandary

Last class (our first class of the semester) something was brought up that I had never really thought about before, and I found it very interesting. Our professor (Dr. Wallis) asked the class if we thought breast cancer is more prevalent now than in the past. It seems like more people are getting breast cancer nowadays, but in actuality this is most likely not the case. Dr. Wallis went on to explain that breast cancer only appears to be more prevalent today because of the new and advanced technology and testing being used. Because of this, more people are being tested resulting in more people being accurately diagnosed with cancer. There is also more awareness now about breast cancer than in the past, so this is another reason why it may seem more prevalent. As breast cancer research continues and more diagnoses are made because of today's better technology, awareness about this cancer grows and grows.

Just learning about that gave me a new perspective about epidemiology and what we will be learning. Not only is it the study of health, disease, and the population, but within that is so much more to learn, recognize, consider, analyze, compare, etc. When it comes to studying trends, correlations, or anything else it seems that there is a lot more than meets the eye, which I'm sure can be very challenging at times. I feel that this course will require a good amount of critical thinking which we can also use in other areas of our lives as well.