I just posted comments on the problems associated with eating raw oysters when low and behold, I see a message from the USFDA that reports an outbreak of campylobacter diarrhea acquired from consumption of raw milk.  Twelve (12) individuals have developed intestinal infections from drinking unpasteurized milk.  More cases may follow.

Here’s the problem….cow poop.  Yes, I said the “p” word!

You can’t sterilize a cow’s udder without harming the cow.  So the surface of the udder gets contaminated with dirt with cow poop and then the milk that comes through the udder gets contaminated with the bacteria in the cow poop dirt on the cow’s udder.  What better way to grow gobs of cow poop bacteria than to immerse them into a vat of milk!!

Refrigeration isn’t enough.

So the protection for we who like milk on our cereal in the morning comes from heating the milk to the point of killing the bacteria.  This process was developed in France by a microbiologist named Louis Pasteur.  So in his honor we call this heating process, “Pasteurization”.

Pasteurization works very nicely thank you.  It eliminates the risks one takes in drinking raw milk with cow poop seasoning.  Whether pasteurization affects the flavor of milk or not is really inconsequential.  Whatever flavor difference one might get from unpasteurized milk to me isn’t worth the risk of spending hours on the toilet.

Besides, despite the billboards of stars sporting fake milk mustaches, milk is meant for baby cows.  Adult humans can do well without drinking milk from any mammal.

Of course personally, ice cream is a different topic.  I think ice cream must be a vitamin.

Guilford County Department of Public Health would like to help you get your adolescent or college-aged child off to a healthy beginning this coming school year. Sometimes we think shots are only necessities for young children, but adolescents and college students need them as well.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommend a series of immunizations for adolescents. A complete list of the CDC recommended immunizations are on our website, www.guilfordhealth.org under Immunizations. In this article, several immunizations will be covered; some of these are required by the state, while some are recommended.

Here are the requirements relating to school entry for the upcoming school year:

a tetanus/diphtheria/pertussis(whooping cough) or “Tdap” booster for children who are:
a) entering 6th grade in public school on or after August 1, 2008, if five or more years have passed since the last dose of this vaccine, or
b) 12 years of age on or after August 1, 2008 and who are educated in a private school, home-school or a non- traditional school, if five or more years have passed since the last dose of Tdap, and
c) students enrolling in college or university for the first time on or after July 1, 2008.

a second dose of the mumps vaccination (called MMR-measles, mumps, rubella) for persons who are enrolling in a school, college or university for the first time on or after July 1, 2008.

Remember that if North Carolina requires the immunization, it will be available free at your local public health department. If this vaccination is recommended, there may be a fee, but most major insurances are accepted, which can lower your out of pocket expense. Here are a few of the recommended immunizations for adolescents.

Menactra® offers protection against several strains or types of bacteria that can cause meningitis. Meningitis, which is more prevalent in certain groups, can progress to a very serious bloodstream illness, sometimes causing death.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommends the following groups receive a dose of Menactra® vaccine:
Young adolescents (11-12 years of age) or
Teens entering high school or
College freshman (18 years of age) living in dormitories

Gardasil® is a series of three vaccinations for young women and men ages 9-26, and is on the Recommended Schedule of Adolescent Vaccines for 11-18 year old girls issued by the CDC’s Advisory Committee on Immunization Practices. Gardasil® protects against the four most common high-risk types of the Human Papillomavirus or HPV: two types that cause over 90% of genital warts and two types that cause 70% of cervical cancers.

Last but certainly not least is an annual influenza or seasonal flu vaccine. The CDC recommends that all children including those who are high-risk children (those with asthma, diabetes or other conditions), 6 months to 18 years of age should be vaccinated. In addition, any child 6 months to 18 years of age that lives with a high risk child or adult should be vaccinated. Flu shots for these children are free of charge at the Health Department. Flu shots are generally available beginning in October through the end of flu season (April/May) and are formulated annually based on the strain of flu that is predicted be the most active that season. For the 2011flu season, it is anticipated that the seasonal flu will contain the 2009 H1N1 flu strain so only one flu vaccine will be needed.

Many of these vaccines can be given in one visit, but some vaccines, like Gardasil® require three visits over a six month period.

Call your adolescent’s health care provider or the Department of Public Health at 641-5563 in Greensboro or 845-7655 in High Point to make an appointment for these and other immunizations. Take your adolescent’s shot record with you to the appointment. This is a very important health record and it should be kept up to date and stored in a safe place.

There is new buzz about problems with Rotarix vaccine. It has been held for the next several months while pediatricians, the vaccine manufacturer and federal agencies knuddle over the problems.

The basis of their concerns are:

Rotavirus is a virus that causes diarrhea and is the single most common cause of GI illnesses worldwide.  Infection with rotavirus leads to half a million deaths each year due to dehydration and malnutrition.  Infants and children suffer the most from the infection.

Universal infant immunization against rotavirus has been recommended by CDC, the American Academy of Pediatrics and the American Academy of Family Physicians as a means of preventing disease, suffering and death.

Two vaccines are available in the United States, RotaTeq and Rotarix.

Rotarix is derived from the most common human strain of rotavirus that has been passaged in cell cultures until it is no longer virulent.  It was licensed for use in the US in 2008.
It is given orally at 2 and 4 months of age.

Studies to date show Rotarix to be effective in preventing rotavirus infection without side effects.

BUT A university research team was testing out a new highly sensitive assay to detect viruses and tried it on Rotarix. They were surprised to find pieces of the virus, porcine circovirus, in samples of the rotavirus vaccine.  The manufacturer, GlaxoSmithKline and FDA have found that the viral contaminant has been present in early batches of the vaccine including those that have been used in clinical studies. Those studies have shown no unexpected problems.

The Food and Drug Administration has asked that administration of rotarix be halted until the significance of this finding is clear.

Porcine circovirus causes a wasting illness in weaned pigs (postweaning multisystemic wasting syndrome).  Laboratory experiments have shown porcine circovirus can infect human cells in culture.   But human disease in nature has never been detected nor is there currently scientific speculation that human illness could occur after exposure. 

If your child received rotarix, you don’t have to worry about it, nor do anything about it. If you want to read the official reports and recommendations, they are available here and here and here and here and here and here and here.

I’ve suspected that the first person to eat a raw oyster was either too drunk to know what they were doing or a freshman college student responding to an pledge challenge (and probably too drunk to know what they were doing).

There are two microbiologic reason to not eat oysters.

1: Oysters syphon seawater. So organisms that normally inhabit seawater are collected by oysters and live within them. The salt-loving (halophilic) bacteria can cause human illness, especially in those humans with iron storage problems (those with alcoholic liver disease). I personally saw a man die after eating a raw oyster at a local restaurant and after he developed shock from the microbe, Vibrio vulnificus. It was memorable to say the least.

2: Oysters syphon seawater. So any microbiologic that aren’t native to seawater but are contaminants in the water will concentrate in the oysters. That means that any fecal contamination of seawater by runoff from land will end up in the oysters. Hence historical concerns about hepatitis viruses (which are carried in human waste into the estuaries and then end up in oysters) are valid. Knowing that cycle (of human to waste to water to oyster) this weekend’s announcement by the US Food and Drug Administration of an outbreak of norovirus (Norwalk agent) contaminating oysters should be of no surprise. (Public Health Agencies Collaborate to Prevent Further Illnesses from Norovirus Outbreak Associated with Oysters Recently Harvested from Area Near Port Sulphur, La.)

Hot sauce doesn’t inactivate bacteria. Sprinkling tabasco sauce on oysters just makes the bacteria taste spicy.

Raw oysters don’t improve sexual powers. If that’s your motive, take a viagra.

The next burning question is “can you eat cooked oysters”?

Yeah, those are probably okay. Nutritionally I still don’t think they are a great idea.

Although North Carolina’s snow and ice have been replaced by flowering trees and blue skies, one characteristic of winter is still with us:  influenza (flu).  The North Carolina Division of Public Health is reporting 5 deaths from influenza in the state in the last reported week ending 20 March. There have been 98 deaths from influenza so far this year.  Some areas of the United States are reporting increases in severe illness and hospitalizations due to H1N1.  These illnesses are mostly in middle aged adults with underlying medical conditions, especially lung diseases.  There are certain risk factors that can make having the flu even worse.  These include asthma, chronic lung disease, conditions which result in a weakened immune system (like cancer or cancer treatment, HIV, etc.), obesity, and pregnancy.

It is absolutely not too late to get your flu shot. We have both seasonal and H1N1 influenza vaccines ready to give, besides getting the H1N1 vaccine now will make any immune response to next year’s seasonal flu vaccine that much more protective.”

The H1N1 flu vaccine is available for persons 6 months of age and older.  Seasonal flu vaccine is available for persons 4 years of age and older. Call 641-5563 for an appointment at the 1100 E. Wendover Avenue, Greensboro site or 845-7655 for the 501 E. Green, High Point location. There is no out of pocket cost for the vaccines but do please bring your insurance, Medicaid, or Medicare card at the time of your appointment, if you have one.

The Animal Control Program of the Guilford County Department of Public Health is announcing its low cost animal rabies vaccination clinic schedule for 2010. The cost of the rabies vaccination will be five dollars ($5.00) per shot per animal.   Cash and personal checks will be accepted.  Clinics are scheduled at the following locations:

Wednesday,April 28, 2009, 4:00 p.m. to 7:00 p.m., WGHP FOX 8 studio, 2005 Francis Street, High Point, NC  27263.

Saturday, July 10, 2010, 9:00 a.m. to 1:00 p.m., Summerfield Fire Department, 7400 Summerfield Road, Summerfield, NC 27358.

Saturday, August 28, 2010, 9:00 a.m. to 1:00 p.m., Fire District #28.  Station ,6619 NC 61 North, Gibsonville, NC 27249.

Saturday, October 9, 2010, 9:00 a.m. to 1:00 p.m., Pleasant Garden Town Hall, 4920 Alliance Church Road, Pleasant Garden, NC 27313.

North Carolina law requires that all domestic pets, whether living inside or outside, age four months or older must be vaccinated against rabies.  For your pet’s safety and the safety of others at these clinics, dogs must be leased and cats must be in carriers.

For more information or educational programs available, please contact the Guilford County Department of Public Health at 641-7777 or visit www.guilfordhealth.org.

According to the NC Diabetes Prevention and Control Branch, diabetes is on the rise in the US. In 2009, 11.3 percent of US adults or 22 million people had diabetes.  In North Carolina, 643,000 adults had diagnosed diabetes and another 376,000 adults have pre-diabetes. Adults are not the only ones developing diabetes.  The Centers for Disease Control and Prevention (CDC) estimates that for children born in 2000, one in three will develop type 2 diabetes sometime during their life.  African Americans and American Indians have the highest prevalence in our state.  To address the burden of this disease, Guilford County Department of Public Health is joining the American Diabetes Association in asking the American public – Are you at risk of developing diabetes?

On the 22nd annual American Diabetes Association Alert Day, March 23, 2010, we are encouraging you to join the Stop Diabetes movement by taking the Diabetes Risk Test to find out if you are at risk for developing type 2 diabetes and if you are at high risk, to speak with your health care provider.

The Diabetes Risk Test requires users to answer simple questions about weight, age, family history and other potential risk factors for type 2 diabetes.  The Diabetes Risk Test will show you whether you are at low, moderate or high risk for pre-diabetes or diabetes.  If you are at high risk, you are encouraged to talk with your health care provider.  Join the movement to Stop Diabetes and get your free Diabetes Risk Test (English or Spanish), healthy lifestyle tips and more.  Call 1-800-DIABETES (1-800-342-2383) or visit stopdiabetes.com.   Although Diabetes Alert Day is a one-day event, the Diabetes Risk Test is available all year long.

In addition, Guilford County Department of Public Health offers a diabetes education program for adults. Classes are provided along with hands-on learning.  Initial individual assessments, monitoring of HbA1c, and follow-up appointments are included.  Persons interested in joining the program are welcome to call 641-8030, extension 2 for more information or to set up on appointment.  There is no cost to the participant.

For more information, contact the American Diabetes Association at stopdiabetes.com or 1-800-342-2382; the NC Diabetes Prevention and Control Branch at http://www.ncdiabetes.org/ or Guilford County Department of Public Health’s diabetes program at 641-8030, extension 2.

Many people think of tuberculosis (TB) as an extinct disease. Unfortunately, this is not the case in Guilford County or around the world. That is why Guilford County Department of Public Health and others continue to use March 24, World TB Day, as an opportunity to focus attention on this communicable disease. World TB Day commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that cause TB.

TB disease was once a leading cause of death in the United States. Effective treatments and education have greatly reduced the death rate, but have not eliminated the disease altogether. In 2008, North Carolina reported 335 cases of TB disease; Guilford County recorded 21 cases. Guilford County Department of Public Health follows a large number of individuals with latent TB Infection annually, providing preventive medications.

TB is spread through the air from one person to another when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. The bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as kidney, spine, and brain. TB in the lungs or throat can be infectious. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with active TB disease are most likely to spread it to people they spend time with every day, because they have prolonged contact with those individuals. This includes family members, friends and coworkers. People with active TB disease can be treated and cured if they seek medical help. However, new drug-resistant strains are appearing that are difficult to treat. If not treated properly, TB disease can be fatal.

Not everyone infected with TB bacteria has TB disease. Some of them have latent TB infection. These people do not become sick; they do not have any symptoms and cannot spread TB to others. However, some people with latent TB infection go on to develop TB disease.
It is important for people with latent TB infection to take medicine so that they will not develop active TB disease.

World TB Day won’t be a celebration until TB is eliminated. But it is an opportunity to educate the public about the seriousness of TB and how it can be stopped. For more information about TB, visit the Guilford County Department of Public Health website at www.guilfordhealth.org or call 641-7777. For more information about TB and World TB Day, visit the NC Department of Health and Human Services, Division of Public Health, TB Control Branch at www.epi.state.nc.us/epi/tb/ or the Centers for Disease Control and Prevention website at www.cdc.gov/tb.

Our bodies put on fat when we eat more calories than we burn.

So how is the best way to burn calories?….easy…walk, run, bike, skip, swim for as much time as your schedule will allow (or even more time.  I mean this is your life we’re talking about here.).

Two suggestions:

1. Don’t start with a sport or activity that requires that you purchase new outfits.  (I think Yvonne Chouinard said that originally, which is hugely ironic since he founded Patagonia clothing company).   Shorts and a T-shirt will suffice for almost all activities.  But if you are venturing into the foot movement variety, get a decent pair of running/walking/hiking shoes.

2. Find a friend or friends to join you.

Years ago I was running in Battleground Park.  Behind me came this guy running at twice my speed and with half my effort.  I made some sarcastic remark about him making me eat his dust.  He just grinned (it was meant to be a joke and he got it) and hung back with me.  So we started talking and, for years afterwards, met in the park to run together.

The point I’m making is that having someone with whom to exercise makes all the difference in the world.

First, it adds a degree of safety.  If you live in a neighborhood that may not be as safe as you would like, exercising in a group will add a level of security you wouldn’t have by yourself.  Ross and I would run before dawn in the park.  Not advisable if you are alone!

AND, I find that having the expectation that my friends are waiting for me to join them eliminates all those mental excuses we make in our heads about how tired we are, or how much other things we need to be doing…or more likely, if you are like me and exercise early in the morning, how it is so much easier to get another hour of sleep.

So whatever you decide to do, do it in old clothes with friends who don’t care that you are wearing old clothes.

Shakoor Hajat, Madeline O’Conner and Tom Kosatsky just published a “state of the art” review of what is known about and what is recommended to prevent hot weather impacts on humans (Lancet 2010;375:856-62).  This was a monumental effort involving the systematic review of 2099 papers and 60 websites.  They found that there are conflicting views on what should be done to prevent heat related illnesses and they made suggestions about what we should do based on scientific evidence.  Their advice boils down to (and this is taken from their article directly):

1. “Generally, increase fluid intake during periods of hot weather.  Elderly individuals should drink water frequently without waiting for thirst, and carers (caregivers) should be alert to the fluid status in individuals who are unable to care for themselves (eg, bedridden patients, children, cognitively impaired individuals).”

2. “Susceptible people should stay in a cool or air-conditioned environment during periods of hot weather…..  Wear loose-fitting clothes and take frequent showers or baths.”

3. “Reduce normal activity levels during hot weather.”

4. “Patients taking drugs that can potentially impede heat loss (diuretics, anticholinergics, neuroleptics) should be given preseasonal recommendations by their physicians about how to monitor themselves (eg, regular bodyweight measurements to monitor hydration status).

So stay cool this summer and drink plenty of water.