Public Health Warning: People should stop vaping immediately

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Second vaping-related death in state confirmed; people who vape are at risk, officials say

The Oregon Health Authority is issuing a public health warning urging people to immediately stop using all vaping products. On September 26, 2019, the agency confirmed a second vaping-related death in the state.

This is the second death among the five previously reported cases. Oregon’s first fatality was announced on Sept. 3. All five cases are part of a national outbreak of severe lung injury linked to vaping and e-cigarette use.

“People should stop vaping immediately,” said Dean Sidelinger, MD, state health officer. “If you vape, whether it’s cannabis, nicotine or other products, please quit. These are addictive substances, and we encourage people to take advantage of free resources to help them quit.”

He added: “If you haven’t started vaping, don’t start.”

OHA officials say the most recent death was an individual who had been hospitalized with respiratory symptoms after vaping cannabis products. Nationally, there have been more than 800 cases, primarily among youths and young adults, in 46 states and one U.S. territory. A total of 12 additional deaths, including Oregon’s first fatality, have been reported in 10 states.

Those who have fallen ill in Oregon have been hospitalized after experiencing worsening symptoms, including shortness of breath, cough or chest pain. CDC and the FDA have not identified a cause, but all cases have reported e-cigarette use or vaping.

OHA investigators and local public health authorities continue to urge clinicians to be on alert for signs of severe respiratory illness among patients and report any cases.

Before the new illness reports, OHA was already concerned about the health risks of vaping products. A recent report by the agency details the health risks for the products including nicotine addiction, exposure to toxic chemicals known to cause cancer and increases in blood pressure.

Individuals who have recently vaped and are having difficulty breathing should seek medical attention immediately.

If you or someone you know smokes or vapes, we urge you to quit now. Free help is available from the following resources:

Switching to cigarettes or other combustible products is not a safer option.

Public Health Warning: Stop using vaping products

Public health officials have now linked a second Oregon death to the use of vaping products. The Oregon Health Authority urges Oregonians to stop using all vaping products until federal and state officials have determined the cause of serious lung injuries and deaths linked to the use of both cannabis and nicotine vaping products. No vaping products should be considered safe. Until health experts can identify why people who have used these products have become seriously ill, and in some cases died, no vaping product should be used. State health officials will continue to work closely with the federal Centers for Disease Control and Prevention and the Food and Drug Administration to determine the cause of deaths and illnesses in Oregon and across the nation

Oregon Health Authority Media contact: Jonathan Modie, 971-246-9139, phd.communications@dhsoha.state.or.us

GET THE FACTS ABOUT FLU SHOTS

Call 541-889-7279 to schedule an appointment for your FREE flu shot at the Malheur County Health Department before the end of October.

Flu season is nearly here. To help you decide when, where, and how to get vaccinated, we compiled answers to some of the most common questions we see regarding flu vaccinations.

Who should get a flu shot?

Everyone over 6 months of age should receive a flu vaccine yearly, unless a doctor has advised otherwise.

But I’m healthy and getting the flu doesn’t seem like a big deal. Why do I need a flu shot?

No one wants to miss out on their vacation or be two weeks behind at work because of a preventable illness. So while you may be able to get through the flu, why take the risk?

During the 2017-2018 flu season, influenza vaccination prevented approximately 7 million flu illnesses, 109,000 flu hospitalizations, and 8,000 flu deaths.

Even if you’re young and healthy, the flu can lead to serious complications that require hospitalization. Getting vaccinated not only helps prevent you from getting ill, it also decreases the severity of illness if you do get the flu and helps protect those around you who cannot receive the shot because of their age or underlying conditions, such as your grandma or your neighbor’s new baby.

Can I get the flu from the flu shot?

No, flu shots do not cause the flu. This is a common concern but, thankfully, not something that happens.

Flu vaccines given via a needle are made with inactivated (killed) viruses that are not infectious or with just certain proteins from flu viruses, so they cannot cause the flu. And, the nasal spray flu vaccine is made with live viruses that are significantly weakened, so they can give protection but not cause illness.

While vaccinations cannot cause the flu, some people do experience mild side effects, including aches and a low-grade fever. However, when these side effects occur, they are generally mild and tend to last only a day or two.

When should I get a flu shot?

The CDC recommends everyone over 6 months of age receive a flu shot by the end of October. Flu activity generally picks up in the fall and it’s best to get the shot before the virus starts spreading in your community and workplace.

Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine, should get two doses of vaccine this season. All children who have previously gotten two doses of vaccine (at any time) only need one dose of vaccine this season. The first dose should be given as soon as vaccine becomes available.

The flu season usually peaks around February, and can last well into the spring. So, even if you miss the recommended window, it is still worth getting vaccinated later in the season.

What’s the benefit of getting a shot now?

It takes two weeks from the time you receive your flu shot to develop full immunity. The sooner you get the shot, the sooner your body can build that full immunity.

Should I get a flu shot if I’m pregnant?

Yes, flu vaccines are safe for pregnant people. They help to protect both the pregnant individual and their baby from the flu.

During pregnancy, people experience changes in their immune system, heart, and lungs that make them more prone to severe illness from flu. According to the CDC, vaccination reduces this risk of serious, flu-associated respiratory infection and hospitalization in those who are pregnant. In addition, pregnant people who receive the flu vaccine are helping to protect their babies from flu illness for several months after their birth, when they are still too young to be vaccinated themselves. 

What if I’m over 65 years old?

The flu can be particularly serious for people 65 and older because human immune defenses weaken with age. The flu vaccine is the best way to protect against the flu and potentially serious complications.

There are two vaccines that are specifically recommended for people who are 65 years of age or older: the “high dose” vaccine and the “adjuvanted” flu vaccine, Fluad. Both options have been found to be effective at preventing the flu and the CDC does not state a preference for one vaccine over another. The regular flu shot is also a good option if these products are not available.

Where can I get a flu shot?

If you are local to Malheur County, Oregon, come see us at the Malheur County Health Department! Call ahead for an appointment: 541-889-7279. Walk ins are welcome.

You can use the online HealthMap Vaccine Finder or Public Health’s Find an Immunization Clinic page to easily find nearby pharmacy and clinic locations to get your flu shot. Remember to call ahead to ensure that the vaccine you need is currently available, especially if you are interested in the nasal spray flu vaccine or the intradermal flu vaccine.

If you still have questions about flu vaccinations or want to know more, check out our past blog post on flu vaccination effectiveness  or CDC’s FAQ’s about the 2019-2020 flu season.

Article adapted from Public Health Insider post by Lily Alexander. Photos taken by Heather Hazzan as a part of the Self x American Academy of Pediatrics Vaccine Photo Project.

Oregon Health Authority Report on Tobacco Retailer Inspections

The Oregon Health Authority recently released a report highlighting a slight decrease in illegal cigarette sales, but illegal sales of little cigars doubled. For Malheur County, what was most striking was how few stores were inspected, giving us an incomplete snapshot of the scale of illegal sales. Only 8 out of 26 retailers in Malheur County were inspected in 2019.

This incomplete snapshot is particularly concerning given the rise of the vaping epidemic among our youth and the recent fatality in Oregon connected with vaping.

The Oregon Health Authority’s Public Health Division conducts retail inspections in collaboration with Oregon State Police. In 2019, the state inspected 1,100 retailers out of about 3,200 retailers who sell tobacco and e-cigarette products statewide. If a retailer violates the law, a citation is issued to the store’s clerk, manager on duty or owner. The annual inspection report shows which stores passed inspection and which sold illegally to people under age 21.

One of the challenges of our inspection process in the state is that only a few counties in Oregon require a license to sell tobacco – and there’s no state license. This means it is extremely difficult to enforce the minimum legal sales age by holding retailers accountable for illegal sales. A tobacco retail license would make it possible to track who is selling tobacco (and thoroughly inspect each one), educate retailers on how to comply with the law and have meaningful penalties for repeat offenders.

The list of Oregon tobacco retailers that violated the tobacco sales is available on the OHA Public Health Division website here.

For more information about how the tobacco industry markets in Oregon, see the recent Tobacco Retail Assessment Report here.

Oregon ends nearly 50-year participation in federal Title X program in response to Trump administration gag rule

Malheur County Health Department is affected by the termination of Title X funding, but will continue to provide reproductive health services, including birth control, STI testing and treatment, at low to no cost with other funding. Call 541-889-7279 to schedule an appointment.

Published on Oregon Health Authority External Relations August 27, 2019

After the Oregon Health Authority declined to use federal dollars in the wake of new Trump administration rules that prevent health practitioners from discussing abortion with their patients, the federal Department of Health and Human Services directed Oregon to give up its Title X grant or face grant termination. In response, Oregon has no choice but to relinquish funding and end its Title X grant.

Health clinics that received Title X funding provide comprehensive reproductive health care that helps their patients plan the timing and size of their families, prevent unwanted pregnancies, diagnose and treat sexually transmitted infections and detect cancer. Last year Title X-funded clinics served 44,241 Oregonians.

Patrick Allen, director of the Oregon Health Authority, issued the following statement regarding the new federal gag rule and OHA’s decision to leave the Title X program:

Yesterday the Oregon Health Authority faced a deadline imposed by the federal government to withdraw from the Title X family planning program, or face termination for non-compliance. Last week Oregon informed the United States Department of Health and Human Services that we had suspended the use of the federal funds to avoid imposing the administration’s newly implemented gag rule on Oregon women. The federal government has rejected Oregon’s plan.

The new federal gag rule, which was not informed by evidence-based medical practice, bars health care providers from fully informing Oregon women about their most personal reproductive health choices and denies them access to a comprehensive range of health services. Oregon is the lead plaintiff, joined by 19 other states and the District of Columbia, as well as Planned Parenthood Federation of America and the American Medical Association, in a lawsuit challenging the Title X rule.

The federal deadline leaves Oregon no choice but to end our nearly 50-year participation in Title X and relinquish our grant. We cannot violate our own state laws that guarantee Oregon women full access to reproductive health services and prohibit any restriction on benefits, services or information regarding a woman’s right to choose to terminate a pregnancy.

Yesterday the Oregon Health Authority faced a deadline imposed by the federal government to withdraw from the Title X family planning program, or face termination for non-compliance. Last week Oregon informed the United States Department of Health and Human Services that we had suspended the use of the federal funds to avoid imposing the administration’s newly implemented gag rule on Oregon women. The federal government has rejected Oregon’s plan.

The new federal gag rule, which was not informed by evidence-based medical practice, bars health care providers from fully informing Oregon women about their most personal reproductive health choices and denies them access to a comprehensive range of health services. Oregon is the lead plaintiff, joined by 19 other states and the District of Columbia, as well as Planned Parenthood Federation of America and the American Medical Association, in a lawsuit challenging the Title X rule.

The federal deadline leaves Oregon no choice but to end our nearly 50-year participation in Title X and relinquish our grant. We cannot violate our own state laws that guarantee Oregon women full access to reproductive health services and prohibit any restriction on benefits, services or information regarding a woman’s right to choose to terminate a pregnancy.

Oregon stands in solidarity with other states in maintaining that the new Title X rule will reduce access to birth control, cancer screenings and reproductive choices. Oregon is fortunate to have funds available to continue offering comprehensive reproductive health care services. Every person in Oregon should know this federal action will not prevent health clinics and care providers from continuing to offer the full range of high-quality, personalized and trusted reproductive health services they have always delivered.

Vaping Sicknesses Rising: 153 Cases Reported in 16 States

Sean Bills, a West Valley City, Utah resident, on life support in Jordan Valley Hospital. Bills’ family said he was admitted to the hospital Saturday after vaping gave him lipoid pneumonia. More on his story HERE.

Sixteen states have now reported 153 cases of serious, vaping-related respiratory illnesses in the past two months, and many of the patients are teenagers or young adults.

In a statement on Wednesday, the Centers for Disease Control and Prevention said that all of the cases occurred in people who acknowledged vaping either nicotine or tetrahydrocannabinol, known as THC, the high-inducing chemical in marijuana.

Federal and state officials say that they are mystified as to what is causing the illnesses, but that it does not appear that an infectious disease is responsible. No one product or device is common among the cases, the agency said. It also was unclear whether a contaminant in a used cartridge or a home-brewed concoction of vaping liquids contributed to some of the ailments.

The patients, most of whom were adolescents or young adults, were admitted to hospitals with difficulty breathing. Many also reported chest pain, vomiting and fatigue.

The most seriously ill patients had serious lung damage that required treatment with oxygen and days on a ventilator. Some are expected to have permanent lung damage. Some severe cases were earlier reported in Wisconsin, Minnesota, Illinois and California.

In an email, the C.D.C. said that while more study was needed, vaping either cannabis or nicotine could be dangerous.

“E-cigarettes are still fairly new, and scientists are still learning about their long-term health effects,” said Brian King, deputy director for research translation in the agency’s smoking and health office. “Adverse respiratory effects associated with e-cigarette use could be the result of a variety of factors, including intended and unintended constituents of these products.”

Mr. King said numerous ingredients in e-cigarette aerosol could harm the lungs, including ultrafine particles that could be inhaled deeply, heavy metals like lead, volatile organic compounds and cancer-causing agents.

The C.D.C. urged doctors to report suspected cases to their state health agencies. The Food and Drug Administration is also collecting information about illnesses related to e-cigarettes and vaping.

“Oftentimes people are vaping both nicotine and the THC products, so it’s unclear which may be responsible,” said Dr. Michael Lynch, medical director of the poison center at the University of Pittsburgh Medical Center. “Probably this has been happening occasionally and we haven’t been aware of it, because the association with vaping wasn’t necessarily made. Now people are on the lookout, which is good, because we want to make sure we have an understanding of how prevalent an issue this is.”

Article adapted from The New York Times. A version of this article appears in print on Aug. 21, 2019, Section A, Page 13 of the New York edition with the headline: More Youth Getting Sick From Vaping, C.D.C.

7 Things You Should Know About Bats and Rabies

70% of Americans who die from rabies in the US were infected by bats – CDC Vital Signs. But bats are not bad! We need to know more to prevent infection and protect this species that protects us from other diseases.

As the weather warms up, adult bats come out of hibernation, baby bats are learning to fly, and humans get outdoors, which means a big increase in human-bat interactions compared to other times of year. Bats can be infected with rabies and can spread that infection to humans who have bare skin contact with bats or bat saliva. 

Oregon has 15 species of bats. Learn more about them at the Oregon Department of Fish & Wildlife. Bats are flying mammals that can reach speeds of 20 to 30 mph. Some of Oregon’s species migrate south in winter while some remain here and hibernate. Bats have ecolocation which allows them to make high-pitched sounds then listen to the echo of those sounds to locate where objects are. Echolocation helps them find even the smallest insect. 

Kate Cole from Public Health Insider compiled seven important things to know about bats and rabies. Please share this information with your friends, family, and children to make sure they know how to protect themselves from rabies in bats.

7. Bats are the main source of rabies in the United States. 

All mammals can get rabies, but in the United States, bats are the primary animal source of rabies. 

6. If you see a bat, do not touch it!! 

Any bare skin contact with a bat or its saliva, or waking up to a bat in your room, could put you at risk for exposure to rabies. Teach your kids not to touch bats, or any wild animal, and be sure to keep your pets away from bats. Talk to your family about the importance of respecting wildlife from a distance.  

5. If you think you or your children or pets may have touched or picked up a bat, take immediate action: 

  • Immediately wash the area that came into contact with the bat thoroughly with soap and water.  
  • Call your medical provider. If a person has been exposed to rabies, an injection of immune globulin and a series of rabies vaccinations need to be given as soon as possible to prevent infection and death. 
  • If you think you had contact with a bat, try to trap it! Trapping it means it can be tested for rabies and people potentially exposed can get the treatment they need. “How am I supposed to trap a bat?” you ask. Good news – there’s a how-to video.

4Pets are at-risk for getting rabies from bats, too. 

Vaccinate your pets against rabies to protect them in case they are exposed. Talk to your veterinarian to see if your furry family members need to update their rabies vaccine.  

Keep your pet under direct supervision so they don’t come into contact with bats. If you suspect your pet has come into contact with a bat, call your veterinarian, even if your pet is up to date on its vaccinations. Your veterinarian may need to give it a booster shot to protect it! 

3If you have problems with bats getting inside your house, you can do a lot to make your home more bat-proof. 

Putting screens on windows can prevent bats from accidentally flying into your home. Sometimes, bats are attracted to nesting in attics or inside a wall. The Washington State Department of Fish and Wildlife has excellent tips on easy things you can do to your home or building to prevent bats from getting inside

2. Most bats don’t have rabies. 

Although exact numbers are not known, it is estimated that less than 1% of bats are infected with rabies. Unfortunately, you cannot tell if a bat has rabies by looking at it; only testing the brain tissue on a dead bat can confirm if a bat has rabies (live bats need to be humanely euthanized before they can be tested for rabies). So, assume all bats may have rabies and never touch them. 

1. Bats are a vital part of our local ecosystem.  

Don’t let all this information about rabies give you a negative opinion on bats. What bats enjoy is eating large amounts of night-flying insects like mosquitos, termites, and agricultural pests, diminishing mosquito-related diseases and the need for pesticides in our community. In fact, some people try to attract bats to their property to help reduce the number of insects. For information on how to build a bat house for your yard, check out this resource.

Article adapted from Public Health Insider.

Identity-first vs. person-first language is an important distinction

Tara Haelle, the Association of Health Care Journalists medical studies core topic leader, recently wrote a post on the AHCJ’s blog, Covering Health, on how to use respectful language when it comes to how we identify the people who are living with various conditions or disabilities.

Haelle’s post was in response to a question about the acceptability of referring to someone with a condition as a descriptor, such as “epileptic child” or “diabetic adults.” Those constructions are called “identity-first” language, as opposed to “person-first” language where the person literally comes first: “children with epilepsy” and “adults with diabetes.”

The use or not of person-first language is a sensitive, important discussion, not unlike discussion of appropriate and respectful gender terminology in stories involving individuals who self-identify with a non-binary gender (something other than “male” or “female”).

This is a particularly relevant concern in the disability community, where a long history of erasure, exploitation, stigma and misunderstanding has led to strong emotions about how people with disabilities — or disabled people, depending on what someone prefers — are identified and discussed.

This is also true for the importance of person-first language when discussing addiction. “People who use intravenous drugs” or “woman with opioid use disorder” or “person with alcohol addiction,” as opposed to “drug users” or “opioid addict” or “alcoholic.”

As is already clear, person-first language is a complex issue depending on the condition and the person. Usually, with clear diseases like epilepsy and diabetes, it’s always best to use person-first language: men with diabetes, children with epilepsy. Although some controversy exists about obesity as a disease state, person-first language is also recommended: “man with obesity” is preferred to “obese man.”

With mental health disorders, it’s usually best to use person-first: a man with schizophrenia (not schizophrenic) or woman with bipolar disorder (not a bipolar woman). However, when you get to conditions that relate to different ways of perceiving or interacting with the world, person-first is often discouraged by those in that community, the source Haelle prioritizes highest. Two examples are autism and deafness.

Most deaf people prefer identity-first language, not person-first, and they reject “hearing impaired” because many do not perceive an inability to hear as a deficit. It’s always best to confirm with the person if there’s one person involved. If there isn’t, then I default to what the community at large generally uses. For Haelle, a community’s preference trumps even “official” sources, since agencies such as the CDC do not always recommend what the community itself prefers (e.g., deafness here.)

Autism is trickier, and Haelle has relied heavily on the Autistic Self Advocacy Network. Many autistic people see autism as an intrinsic part of their identity — a disability, yes, but one that also confers benefits and is simply a different way of perceiving and interacting with the world. This is where one can most frequently run into challenges.

But this preference isn’t across the board, as the ASAN essay notes. Some may prefer “person with autism,” and sometimes parents prefer “child with autism” while their child prefers “autistic child.” Yet the former can (but not always) connote a perception of autism as an unfortunate disorder or disease that someone wants to be cured while the latter connotes “aspect of my identity that is important to my sense of self.” Hence the importance of asking.

Article adapted from AHCJ blog post by Tara Haelle. July 31, 2019.

Housing as a Platform for Health and Equity

Recently in the American Journal of Public Health, Diana Hernández PhD, and Carolyn B. Swope MPH, assess the current state of research on housing and health disparities, and share recommendations for achieving opportunities for health equity centered on a comprehensive framing of housing.

The links between housing and health are now known to be strong and multifaceted and to generally span across 4 key pillars: stability, affordability, quality and safety, and neighborhood opportunity. Housing disparities in the United States are tenaciously patterned along axes of social inequality and contribute to the burden related to persistently adverse health outcomes in affected groups. Appreciating the multidimensional relationship between housing and health is critical in moving the housing and health agenda forward to inspire greater equity.

Despite the vastness of existing research, we must contextualize the housing and health disparities nexus in a broader web of interrelated variables emerging from the same roots of structural inequalities.

Source: Am J Public Health. Diana Hernández PhD, and Carolyn B. Swope MPH. Published online ahead of print August 15, 2019: e1–e4. doi:10.2105/AJPH.2019.305210

A Framework for Increasing Equity Impact in Obesity Prevention

One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.

In THIS ARTICLE recently published in the American Journal of Public Health, Shiriki K. Kumanyika, PhD, MPHI, proposes a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. The core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health. Kumanyika provides research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Source: Am J Public Health. Shiriki K. Kumanyika. Published online ahead of print August 15, 2019: e1–e8. doi:10. 2105/AJPH.2019.305221

Local Health Departments on the Front Lines of the Opioid Epidemic

According to the National Association of County and City Health Officials, local health departments play a critical role in responding to opioid misuse and overdose within their own communities and are well suited to serve as conveners or supporters of coalitions and partnerships.

According to the Centers for Disease Control and Prevention’s 2018 report, Morbidity and Mortality Weekly Report, 47,600 Americans died because of opioid-related overdoses in 2017—far outpacing the mortalities associated with car crashes in 2017 and those of the peak years of the AIDS epidemic. While success has been made in recent years to curb the severity of the epidemic, these recent numbers are a stark reminder of the continued suffering of individuals, families, and communities across the country.

On the “front line” of the epidemic, LHDs are well suited to serve as conveners or supporters of coalitions and partnerships. This is critical, given that collaboration at the local level is essential to address the multifaceted nature of the opioid epidemic. The coordination of federal, state, and local partners, along with the engagement of community agencies and organizations, is imperative in implementing strategies to prevent and respond to opioid misuse and overdose.

Activities located within a local health department are beneficial because opioid use looks different across jurisdictions. To support individuals living with Opiod Use Disorder (OUD), local health departments can help their communities build out treatment options, including medication-assisted treatment, and can improve community linkages to care for OUD treatment, as well as for other physical and mental health services related to opioid use. They are also well-suited to support active drug use communities and to develop and enhance support systems for individuals engaging in treatment.

The opioid epidemic skyrocketed to public consciousness on the back of the immense suffering addiction has inflicted on American communities. There will always be another crisis, and the lessons learned from a variety of domestic drug use epidemics tell us that when we fail to prepare, we fail far too many. Instead of reactionary responses to each new public health emergency, local health departments have a unique opportunity to harness the national conversation around opioids to push for structural improvements in our official response to drug use of all kinds.

Article by Evans, Higgins, and Stanford. Adapted from Journal of Public Health Management & Practice.