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