HPV Vaccine

Imagine if you could protect your child against cancer. Turns out, you can – with the HPV vaccine.  To highlight this, the American Cancer Society recently released a video series of HPV-related cancer survivors sharing their stories. These individuals serve as a powerful reminder of the importance of the HPV vaccine and underscore the need for all parents to talk to their children’s doctors to learn more.

Human Papillomavirus (HPV) is a virus spread by close skin-to-skin contact. It is so common that nearly all sexually active adults have had at least one type of HPV at some point in their lifetime.  Around 80 million people in the US currently have HPV and 14 million people are newly infected each year. While most cases of HPV clear on their own, some can cause cancer.

A recent report showed that the current number of cancers caused by HPV is rising with an estimated 30,700 each year. Cervical cancer is the most common cancer caused by HPV in women, while in men; it most commonly leads to a type of head and neck cancer. Overall, HPV is thought to cause more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers.

The HPV vaccine offers the best protection against these cancers when given at the recommended age – which is 2 doses if the patient starts the vaccine series before their 15th birthday and 3 doses if they start on or after their 15th birthday. Younger adolescents have a higher immune response so it’s best to vaccinate early. Young women can get the HPV vaccine through age 26 and young men can receive it through age 21 (age 26 in some cases).

Barnstable County Emergency Shelter System

 

Regional Shelter System

If you can’t leave the area and staying at home is not an option, then you can turn to the regional shelter system. Visit this map for an overview of the shelter system and the location of a shelter near you.

Important things to know about regional shelters

  1. You should look at going to a shelter the same way you would look at going on a trip. If you were planning to go away for a few days you would pack for the trip. The same goes for the shelter. You should arrive with at least three days worth of essentials. You wouldn’t leave your medications at home if you went on a trip, nor should you leave them behind when you go to a shelter.
  2. The stay at a shelter is not a vacation, and a shelter is not a hotel or a pharmacy. It is not a cruise ship but rather a lifeboat. The shelter provides a secure facility, a cot to sleep on, food and water, basic first aid, and functional assistance. Beyond that, it is up to you to pack and bring the essentials of your life including extra clothing, medications, and any medical equipment such as walkers, wheelchairs, and oxygen concentrators.
  3. If you live at home with the assistance of a caretaker, the caretaker must come to the shelter with you. If you have a visiting nurse, make sure you bring your medical supplies and let your nurse know which shelter you will be staying at.
  4. If you are bringing infants, babies, or toddlers to a shelter make sure you bring formula, food, diapers, wipes, changes of clothing, toys, and a “pack ‘n play” or portable crib and bedding.
  5. If you have a pet—a dog or cat, a bird perhaps—the Cape Cod Disaster Animal Response Team (CCDART) component of the shelter system supports the care of your pet(s) while you are in the shelter. Remember, you must check your pet(s) in first with CCDART before checking yourself into the human shelter. Please bring all your pet supplies to the shelter except for crates, which are provided by CCDART. You cannot sleep with your pet(s). Once your pet(s) are in the CCDART shelter, you will be able to see them during visiting hours, typically between 7:30 a.m. and 12:30 p.m. and 2 p.m. to 7 p.m.
  6. The reason every town on the Cape doesn’t have its own shelter is because of the expense and lack of volunteer resources to staff 15 separate shelters across the Cape. Volunteers deliver the vast majority of services provided at the six regional shelters. These volunteers work with groups including the American Red Cross (ARC), the Cape Cod Medical Reserve Corps (CCMRC), the Cape Cod Disaster Animal Response Team (CCDART), Community Emergency Response Teams (CERT), and AmeriCorps.

Powassan Virus

Ticks abound on Cape Cod and can cause a variety of diseases.  The black legged tick (Ixodes scapularis) can carry pathogens that cause the following diseases:   Anaplasmosis, Babesiosis, Borrelia mayonii, Borrelia miyamotoi, Lyme disease, and TickIdentificationPowassan virus.

Ehrlichiosis and Stari are transmitted to humans via the Lone star tick.

Powassan disease is relatively rare but is causing concern because of the severity of the disease  and the rapidity of transmission from tick to human…..minutes rather than hours.  Many people who are infected do not become ill, but those who do can develop encephalitis (inflammation of the brain) and meningitis (inflammation of the covering of the brain and spinal cord).  Other symptoms may include headache, fever, vomiting, confusion, weakness, speech difficulties, loss of coordination, and seizures.  The time from infected tick bite to symptoms can be anytime from one week to one month.  Diagnosis is based on symptoms and lab tests on blood and spinal fluid. This is a viral disease and the antibiotics normally used in tick borne illnesses are not as helpful.  Treatment is supportive and may include hospitalization, respiratory support, and intravenous fluids.

Protect yourself from tickbites.  Stay away from brush and high grass.  Use DEET products on skin and permethrin products on shoes and clothes.  Wear long pants tucked into socks.  Do a tick check as soon as you go indoors and put clothing in a hot dryer first, then wash.  Take a shower within two hours of being outdoors.

Remove ticks as soon as possible.giphy

How to remove a tick

  1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
	clipart image of a tickAvoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–not waiting for it to detach.

 

 

Follow-up

If you develop a rash or fever or above mentioned symptoms within one to 6 weeks after removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.

Zika Update

250px-Aedes_aegypti_feeding

Zika virus continues to be a concern.  There is now a strong suspicion that Zika can be spread through semen.  CDC has received reports of sexual transmission of Zika virus among women whose only risk factor was sexual contact with a male partner with recent travel to Zika areas.  The CDC recommends that pregnant women refrain from traveling to Zika areas and couples planning on becoming pregnant should speak with their health care providers before traveling to countries where Zika virus has been identified.  If travel to these countries is necessary, then precautions to prevent mosquito bites should be implemented.

http://www.cdc.gov/zika/pdfs/zika-pregnancytravel.pdf                                     http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf 

What are the implications for public health practice?  (CDC recommendations)

Men who reside in or have traveled to an area of ongoing Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) with their pregnant partner for the duration of the pregnancy.

 

ZIKA VIRUS

Zika is a virus transmitted by the Aedes mosquito which also spreads dengue, chikungunya, and yellow fever.  Only 25% of people with Zika virus develop symptoms.  Within 2-7 days after an infected mosquito bites, the following symptoms may develop:  rash, slight fever, conjunctivitis, muscle and joint pain, and fatigue.  These symptoms can last a week.  While in the past couple of years this virus was thought to be benign, some severe, rare complications have been documented.  In Brazil there have been 4000 cases of babies born with microcephaly, a condition where the baby has a small head and incomplete brain development.  It is thought that the mothers had the virus while pregnant.  Another condition, noted in 2014, is Guillian-Barre syndrome where the immune system attacks nerve cells leading to muscle weakness and sometimes paralysis.  There is presently no vaccine or cure for the virus and over the counter pain relievers ( no aspirin or non-steroidal anti-inflammatory medications) and fluids are the recommended treatment.  The N.I.H is working on a vaccine.                                                                                    CDC added the following destinations to the Zika virus travel alerts: United States Virgin Islands and Dominican Republic. Previously, CDC issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing: the Commonwealth of Puerto Rico, a U.S. territory; Barbados; Bolivia; Brazil; Cape Verde; Colombia; Ecuador; El Salvador; French Guiana; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Martinique; Mexico; Panama; Paraguay; Saint Martin; Samoa; Suriname; and Venezuela.

Currently, cases of Zika in the United States are from travelers returning from countries where Zika virus has been identified.  The CDC recommends that pregnant women refrain from traveling to countries with Zika virus and that all residents take precautions to prevent mosquito bites.  http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_us.pdf   http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf

Here is the 1/28/2016 CDC telebriefing:  http://www.cdc.gov/media/releases/2016/t0128-zika-virus-101.html

HPV and Gardasil 9

Human papillomavirus is the most common sexually transmitted infection in the United States. You can contract the virus by having oral, anal, or vaginal sex with a person who has the virus and may not even know it. This virus usually goes away on its own, but in those cases where it doesn’t, it can cause genital warts and cancers of the cervix, vulva, anus, vagina, penis, and oral cavity. There is currently no treatment for the virus and each year 27,000 men and women are affected by cancers caused by HPV.

But there is a vaccine, HPV9 (Gardasil), which can prevent these cancers. Most of the time these cancers are caused by 9 types of HPV (6, 11, 16, 18, 31, 33, 45, 52, and 58). Gardasil 9 won’t protect against a virus that a person already has and, like all vaccines, may not protect everyone who receives it. The Advisory Committee on Immunization Practices advises: EFFECTIVE MAR 27, 2015

9vHPV, 4vHPV, or 2vHPV for routine vaccination of females 11 or 12 years* of age and females through 26 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
9vHPV or 4vHPV for routine vaccination of males 11 or 12 years* of age and males through 21 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
9vHPV or 4vHPV vaccination for men who have sex with men and immunocompromised men (including those with HIV infection) through age 26 years if not vaccinated previously.

Who should not receive Gardasil9?
Anyone with an allergic reaction to:
. A previous dose
. Yeast
. Amorphous aluminum hydroxyphosphate sulfate
. Polysorbate 80

What are the most common side effects?
. pain, swelling, redness, itching, bruising and a lump at injection site
. headache, fever, nausea, dizziness, tiredness, diarrhea

Gardasil is given in the upper arm muscle as a series of 3 shots over 6 months. There is no charge to the patient. Please call the Sandwich Public Health Nursing Department at (508- 833-8020) for more information and/or to set up an appointment.

Tick Season is Here Again-With More Diseases Than Ever!

Most people on the Cape are familiar with Lyme Disease, Anaplasmosis/Erlichiosis, and Babesiosis, but have you heard of Borrelia miyamotoi or Powassan virus?  The now well known black legged deer ticks can also carry these diseases.

Scapularis, Ixodes, Insect, Tick, Deer

In general, adult ticks are approximately the size of a sesame seed and nymphal ticks are approximately the size of a poppy seed.
Borrelia miyamotoi is a spiral shaped bacterium carried by deer ticks (which are active any time temperatures are above freezing).  Nymphs are most active from May to July and adults are more active in the fall and spring. Ticks carrying miyamotoi have been found in Sandwich.  Symptoms of a miyamotoi infection are fever, headache, and muscle aches.  Treatment is 2 weeks on the antibiotic doxycycline, which is also used to treat Lyme disease.http://www.nejm.org/doi/full/10.1056/NEJMc1215469

Powassan virus has been identified in patients in Massachusetts.  While it is generally accepted that a tick must be attached to a person for at least 24 hours to spread  infection, this virus seems to infect people in a shorter period of time.  Symptoms can occur from 1 week to 1 month after a tick bite.  As with other tick borne diseases, some people never become ill while others can have illness such as inflammation of the brain and spinal cord, fever, headache, vomiting, weakness, confusion, difficulty speaking and seizures.  Treatment is supportive.  http://www.cdc.gov/powassan/

How can you protect yourself?  Ticks live in wooded, brush filled, and grassy areas, so if you are in these areas here are some things you can do:

1.  Put deet on skin exposed areas (not on face or palms of hands).  The University of Rhode Island’s Tick Encounter website warns:

Repellents play an integral part in your personal protection strategy. Repellents containing DEET are not sufficient to protect against tick bites. DEET only repels ticks to areas where they could bite and even that little protection does not last long. PERMETHRIN kills ticks on contact. Clothing only repellents that contain Permethrin are very effective and provide long-lasting protection. The best protection you can achieve is by using a repellent that contains Permethrin on your clothes and one that contains DEET for your skin.

2.  Spray permethrin on clothes and boots/shoes

Watch videos about applying clothing-only repellent and how well Permethrin treated clothing repels and kills ticks.

3. Wear light colored long pants and long sleeves, tuck pants into socks or boots.

4.  Do a body check when you go indoors

5.  Treat pets with tick repellants

6.  Have a 3 foot tick free perimeter around your yard   http://www.mass.gov/eohhs/gov/departments/dph/programs/id/epidemiology/ticks/, http://www.tickencounter.org/prevention/protect_your_yard

If you do find a tick on yourself, use tweezers to grasp it as close to the skin as possible and pull straight up.  After removal clean the skin with alcohol and put an antibiotic cream on the area.

clipart style image showing the proper removal of a tick using a pair of tweezers

Helpful Hint

icon of a tickAvoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–do not wait for it to detach.

Go on tickreport.com if you want to send your tick to U. Mass. for testing

 

Nuts Are A Healthy Snack

As little as 1 oz of salt free nuts a day can reduce your risk of heart disease.  Multiple large studies have consistently shown a 30% to 50% reduction in heart attacks or sudden death when  a handful of nuts was eaten several times a week.  Walnuts have omega 3 fatty acids which seem to prevent arrythmias from developing.  Almonds increase Vitamin E levels and lower cholesterol.  Vitamin E is an antioxidant which protects cells against damage.  There is some research out of U.C. Davis that almonds may reduce colon cancer as well as heart disease.  Cashews are also high in omega 3 fatty acids.

Instead of a sweet treat, grab a handful of nuts for a nutritious snack!

Heart Health

Every 34 seconds someone in the United States has a heart attack.  When blood, with its oxygen supply, is either reduced or completely cutoff from the heart muscle, cells die and a heart attack occurs.  There are ways to modify your chance of having a heart attack. /What-Are-My-Risks-For-Getting-Heart-Disease-Infographic_UCM_443749_SubHomePage.jsp

Heart disease is the #1 killer of American women. Women’s symptoms may be different from men’s.

  • Neck, jaw, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Right arm pain
  • Nausea or vomiting
  • Sweating
  • Light headedness or dizziness
  • Unusual fatigue

These symptoms can be more subtle than the obvious crushing chest pain often associated with heart attacks.  Women often tend to overlook symptoms.  This American Heart Association video is humorous but has some great take home points.

Diet, exercise, and stress reduction are important factors in heart health. Recommendations include  eating more fish, whole grains, and fruits and vegetables and avoiding trans fats, as well as limiting saturated fats, salt and sugar.  The Mediterranean Diet and The Harvard School of Public Health Healthy Eating Pyramid are two of the diets that promote heart health.                                 http://www.hsph.harvard.edu/nutritionsource/pyramid-questions/

http://health.usnews.com/best-diet/mediterranean-diet
Additional information can be found at:

https://media.heart.org/fc/quiz/index-3.html?xmlHash=d5caa76b92efaeff980beb2e7b9e9199

http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=highbp