Measles outbreaks.
Despite persistent outbreaks through much of 2019, the United States was able to hang on to global elimination status for measles-a World Health Organization designation signifying "the absence of endemic measles virus transmission" for at least 12 months. The status, which the United States has held continuously since 2000, was threatened by pockets of measles totaling more than 1,200 cases, 75% of which were in undervaccinated Orthodox Jewish communities, according to the Centers for Disease Control and Prevention (CDC). The resolution of outbreaks in New York City and New York State in September enabled the U.S. maintenance of elimination status. States are moving to increase vaccination rates by removing vaccine exemptions. In 2019, Maine and New York abolished all vaccine exemptions except those needed for medical reasons, joining California, Mississippi, and West Virginia. A total of 44 states currently allow religious exemptions, while 16 permit personal-belief exemptions.
Vaping causes lung injuries, deaths.
More than 2,290 illnesses and 47 deaths nationwide have been caused by e-cigarette use, or vaping, as of November 20. Most patients are male and under 35 years of age, with a history of using vaping products containing tetrahydrocannabinol (THC). The mechanism and cause of lung injury are still unknown, although investigators are focusing on vitamin E acetate as a "chemical of concern." Patients present with symptoms of pneumonia, but there is no evidence of infection; the lung injury appears similar to a chemical burn. The CDC advises avoiding all vaping products containing THC, and maintains that no e-cigarette product is safe, even as an alternative to smoking. Several states have banned flavored e-cigarettes or are developing legislation to ban vaping products.
Opioid crisis update.
Preliminary data from the U.S. Department of Health and Human Services suggest a 2.8% decrease in overdose deaths from opioids in 2018 from 2017-the year the opioid epidemic was declared a national emergency. Multipronged efforts to reduce mortality appear to be helping. Data compiled by the American Medical Association's Opioid Task Force show a 12.4% decrease in opioid prescriptions -meaning 20 million fewer prescriptions-in 2018 from 2017. The number of patients receiving medication-assisted treatment (MAT) at federally funded health centers increased 142% from 2016 to 2018. Eighteen states have removed barriers, such as prior authorization by health insurance plans, to accessing MAT. And, the number of naloxone prescriptions increased 338% from 2016 to 2018, indicating expanded access to the overdose-reversing drug.
Depression in children.
Some 13.3% of adolescents ages 12 to 17, or 3.2 million young people, experience a major depressive episode each year, according to the National Institute of Mental Health, with rates higher in females, at 20%, than males, at 6.8%. Only 40% of these adolescents received treatment. Rates of suicidal ideation and plans, attempts, and deaths by suicide have been rising each year among adolescents ages 12 to 17 and young adults ages 18 to 26 since the mid-2000s. Researchers in the April Journal of Abnormal Psychology have attributed the increase to a generational shift, hypothesizing that the rise in use of social media and electronic communication in general along with known decreases in sleep duration in this age group may be factors.
Whole blood in trauma resuscitations.
San Antonio, Texas, has become the first major metropolitan city to use whole blood in the prehospital setting throughout its regional trauma network, as reported on August 1 in ISBT Science Series. The safe and effective use of whole blood in military settings prompted exploration of its use for hemorrhage and trauma in civilian settings, where blood typically has been administered as components. Whole blood provides the correct physiological replacement and maintains coagulation factors, compared with component therapy, which yields reduced hematocrit and platelet counts. Whole blood may also provide a survival advantage, although safe storage in prehospital settings remains a concern, indicating avenues for further study.-Joan Zolot, PA