West Virginia, Tennessee and North Carolina have issued advisories for the Zika virus, urging caution, particularly for pregnant women traveling to areas where the disease is circulating.
According to the Centers for Diease Control and Prevention, 35 cases of Zika virus have been confirmed in the continental United States, only two of which were in Appalachia. However, Zika virus is possibly linked to birth defects in babies born to mothers who contracted the disease while pregnant. Therefore, the CDC has urged caution for pregnant women from any state traveling to regions (such as Brazil and Central America) where the disease is known to originate.
Zika is primarily contracted through mosquito bites – pregnant women can pass the virus on to their fetus; it also can be transmitted from blood transfusions or through sexual contact.
There is no vaccine for Zika virus. However, 80 percent of those who contract the virus don’t show symptoms, according to the Health Advisory from West Virginia’s Bureau for Public Health. Those with symptoms may experience fever, joint pain and a rash. Hospitalization and death due to Zika are rare.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.
On the one end is stage I, on the other stage IV. Several subgroups are in between. For stage I patients, the five-year survival rate is 92 percent. For stage IV, that number drops to 11.
“If you’re screened early enough you can prevent yourself altogether from having cancer,” said Kevin Tephabock, senior manager of primary care systems for the American Cancer Society. His job is to work with health care facilities in West Virginia, Virginia, Delaware, Maryland, and Washington D.C. to improve cancer screening rates. Currently only about 63 percent of West Virginians are getting screened.
“For years, colonoscopy was the gold standard…and colonoscopy helps significantly. It decreases colorectal cancer mortality about 30 percent,” he said. “However, many people were not comfortable with the idea of having a colonoscopy. So now there is actually some new testing out there that’s available.”
Called Fecal Occult Blood Tests, they basically test for blood in feces. They are available at primary care facilities and can be taken home by the patient, used, then returned to the doctor or lab. If a polyp or cancer is suspected, further testing is needed.
Screenings are covered by insurance. A new nationwide initiative called 80 by 18 is attempting to increase screening rates to 80 percent by 2018. (Governor Tomblin was the first U.S. governor to sign the pledge.) State officials hope to achieve this goal, in part, by working with primary care facilities.
“In West Virginia one of our bigger barriers is just geographically,” said Tephabock. “We have somewhat of a shortage in terms of GI docs…and so someone in southern WV may have a very difficult time finding a GI doc.”
The screenings find precancerous polyps that can then be surgically removed. That’s it. You continue getting your screenings every year, but other than that, no major life changes.
Credit Kara Lofton / WVPB
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WVPB
Chris Stadelman receives treatment for stage IV colorectal cancer at Charleston Area Medical Center Cancer Center
“As I’ve told several people it’s a day and a half of really unpleasant experience, but it’s a whole lot better than carrying a chemo pack around every two weeks for the rest of your life,” said Chris Stadelman, Governor Tomblin’s Director of Communications.
Stadelman was diagnosed with stage IV colorectal cancer last year at the age of 44 – too young to have needed a screening by federal guidelines.
“I have now been through 28 rounds of chemotherapy,” he said. “Going every two weeks for about 4 hours in the David Lee Cancer Center and then have a 46-hour infusion that’s done through a shoulder badge, a little pack, that I take with me.”
He has been in treatment since October of last year. All the test results so far have been as positive as can be expected. He will likely be in treatment for the rest of his life.
“I had a sense something was wrong and I waited and I waited,” he said. “So paying attention to something that may seem like nothing – well I’m too young for that to happen – clearly a lot of us are not too young for that to happen so I think it makes sense to go ahead and get those screenings if you sense anything might possibly be wrong.”
Credit Crystal Collins / WV Public Broadcasting
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WV Public Broadcasting
Stadelman hid his diagnosis for months. He said he’s not entirely sure why. Then added, “I don’t want people to treat me any differently. I want to go about my job the same way…But the more I thought about it I have, because of my job with the governor’s office, because of my experience in media, I have opportunities and connections to help someone else.”
“I think that one to one connection makes such a difference. You can read the studies and hear about what you’re supposed to do, but knowing someone this has happened to makes a big difference for anyone. I have some credibility when it comes to telling people to go get your colonoscopy and get checked and pay attention to things.”
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.
The most common way children are exposed to lead these days is from the lead-based paint almost universally found in homes built before 1980. (Lead-based paint was outlawed in the late ’70s.)
When the paint deteriorates and chips, it causes dust particles that can be inhaled or even eaten (think slobbery teething toy belonging to a 10-month-old on the floor next to an old baseboard covered in lead-based paint).
Credit Kara Lofton / WVPB
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WVPB
Kelly Reindel-Swan’s youngest daughter poses in her living room. Her older sister, Laurel (who is asleep) had elevated blood lead levels when she was around the same age.
In some West Virginia counties, as many as 86 percent of the homes were built before 1980, according to the 2000 U.S. Census. Poverty compounds exposure risk; fixing paint is expensive.
But the Childhood Lead Poisoning Prevention Program, which essentially just tests and monitors children under the age of 6 for elevated blood levels (and provides medical care when necessary), seems to be making a difference. From 1997 to 2013, elevated blood lead levels in children under the age of 6 have dropped from 2.26 percent to .37 percent of the population.
(Last year, the CDC redefined “acceptable blood lead levels” from 10 micrograms to 5 micrograms per deciliter.)
Terrifying Results
But for those in the .37 percent, the experience of having a child test high on blood lead levels can be both confusing and terrifying.
“Our experience was with my child who’s almost 5 so it’s been awhile,” said Kelly Reindel-Swan, of Ohio County. “But we just had the standard one-year blood test for lead levels.”
The Reindel-Swans lived in an old home (more than 100 years old). Even though their daughter never had symptoms of lead exposure and their home was in good condition, the 15-month-old tested high.
Credit Kara Lofton / WVPB
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WVPB
Reindel-Swan was shocked and immediately began implementing steps to decrease family exposure, such as increasing handwashing, taking off shoes when entering the home and cleaning with disposable wipes (to lessen the chance of cross-contamination).
Testing for Lead Poisoning
In a recent interview, West Virginia Commissioner of Health Rahul Gupta said lead poisoning often causes no initial symptoms. Its complications generally arise later and include behavior or attention problems, hearing problems, reduced IQ, slowed body growth, aggressive behavior, hearing loss and infertility, among other things.
Through the government program, children are tested at primary care facilities for elevated blood lead levels at 1 and 2 years of age. Results are reported to the state and high-risk counties are monitored closely. In West Virginia, those include Brooke, Lewis, Mineral, Monongalia, Ohio, Roane and Wirt.
A few years after Reindel-Swan’s daughter was found to have lead in her blood, her nephew, a boy belonging to her younger brother Danny, also tested high. A state employee came to their home to figure out where the contamination was coming from.
“She found in our house, what she basically already knew because she has tested so many houses, and that’s that all the woodwork had been painted with a lead-based enamel, and also everything on the exterior of the house,” Swan said.
The tester explained that lead-based paint used to be the best paint available – it was incredibly durable – and so it was used to cover interior woodwork and anything on the outside of the house.
“And that’s problematic because your woodwork is the stuff that’s constantly abraded – you have wooden windows that are sliding up and down, so you have paint dust coming off of them all the time, doors where they rub on the top of the door against the door jam, and then the exterior of the house obviously tends to chip a lot anywhere it is exposed to weather,” Swan explained.
An Expensive Problem
In some West Virginia counties, as many as 86 percent of the homes were built before 1980, according to the 2000 US Census. Poverty compounds exposure risk; fixing paint is expensive.
“We were so fortunate to have the time and resources to address the problem and the problems were relatively small and easy to deal with,” Reindel-Swan said.
She explained that her family ended up replacing all the windows in their home – an expense they would not have been able to manage had family members not been able to step in and provide financial assistance. Although a state lead tester came to her home, the state was unable to provide monetary assistance for remediation.
“I know so many families who even shy away from having their kids tested because they are terrified that they won’t be able to fix the problems because of the expense especially,” she said. “It’s a big issue in older homes.”
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.
The week a healthcare worker in West Virginia completes his 21-day monitoring period after a month in Liberia.
Scott Laney – Epidemiologist (NIOSH)
Epidemiologist Scott Laney works for the National Institute for Occupational Safety and Health in Morgantown. NIOSH is a branch of the Centers for Disease Control and Prevention and sends people all over the world to investigate diseases.
Scott Laney came to Morgantown six years ago to investigate the respiratory health of coal miners, but as things continued to escalate with the Ebola epidemic in Africa, he felt duty-bound to volunteer in relief efforts.
Laney has a background in infectious diseases, and molecular epidemiology and tumor virology. Before being recruited to NIOSH in 2008, he was part of then joined the Epidemic Intelligence Service in 2006, a CDC-program.
He volunteered in August. Two weeks later, he was on a plane to Liberia.
Credit Scott Laney / CDC
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CDC
Laney putting together chlorine handwashing buckets for affected communities.
Liberia
Laney spent the first three or four days in the capital city of Monrovia designing case-control studies for healthcare workers—to help figure out how exactly so many healthcare workers are falling ill. Then he spent much of October in the rural western county of Bong.
A letter home: “… I am currently working in one of the most impacted areas in Western Africa where prior to my arrival no one had yet visited. My focus has been centered around the village of Mawah in Bong county – an isolated community that is far off the beaten path and virtually inaccessible. This village of 850 people housed a traveler from Monrovia some time back for one evening as he was passing through by foot. This individual had Ebola and an incredible outbreak occurred as a result. In the last month numerous people have died and I have arranged transport by ambulance of 25 more in the last 10 days…”
Laney’s work was part of the effort to get a real idea of how many people are being affected by the disease.
QUICK FACT: In March of this year, the first Ebola infection was recorded in Liberia. To date, the CDC reports, over 6,000 cases and over 2,000 deaths.
Laney would go out to visit communities and log records of all of his experiences—everything from cultural interactions and observations, to observing burial techniques.
Laney Log: 10-7-14 … The stories I heard to today are too countless to tell but this village is hypervigilant. They have been strictly instructed not to accept any outsiders into the village. There are multiple road blocks and men at these locations making sure that does not happen. I asked Dr. Freeman what would happen if a visibly sick individual approached the village and he said the guards were instructed to tell them to go away by any means necessary. At night a family of 6 from the bush – two of which were ill – were taken in by a community member in Bong mines. The community threatened to burn his house down if he did not send them away. Fortunately, ambulances were in route and these two patients were taken to an ETU. The father and children were sent back to the bush. …At the river we heard a rumor that a party of individuals were suggesting that someone should go to Mawah and poison the water to kill the villagers so no one from there could enter into other communities…
Credit Scott Laney / CDC
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CDC
From Laney Log: …We returned to observe the burial of the body. I witnessed the removal of the body and burial and the donning and doffing of PPE by the burial team. It was no where near as elegant as the IMC teams response at the stadium but the few breaches were addressed and I provided guidance on the issues moving forward….
Laney says he encountered a culture steeped in a terrifying epidemic with all the tragedy and discord that comes with it. But the only thing about his experience that surprised him was discovering, upon his return home 21-days ago, how the American public and politicians were responding to people like him, healthcare workers returning home.
A Return Home
Laney returned home October 17th.
He was screened before he left Liberia, then upon entering the U.S., then again at the CDC. Finally he made his way home to his young family in Preston County. He didn’t have too difficult a time. But the story is different for many colleagues.
The CDC just released recommendations detailing appropriate measures to take to monitor health workers who have worked around Ebola. For the past 21 days, Laney has been recording and reporting daily temperature and symptom assessments.
An email from CDC: Dear Anthony "Scott" Laney, Thank you for taking the time today to discuss the CDC active monitoring protocol and for your recent service to the CDC Ebola Response. This email confirms the 21-day monitoring activities and documentation we discussed on the phone. Your monitoring timeframe ends on 11/8/14. We ask that you: • Monitor and record your temperature twice a day (morning and evening). • Monitor yourself for unexplained fatigue, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain or unexplained bleeding or bruising. We request that you also send your temperature and your symptom assessment to the CDC IMS Employee Active Monitoring email box by completing the information in the boxes below and replying to this email by noon each day until your end date of 11/8/14….
Another email from the CDC: Dear CDC staff, Thank you for your service to the Ebola response. We have received feedback that some employees and family members of employees have encountered difficulty going to school or work due to restrictions imposed upon them based upon fear. In order to ease your transition back to your home and workplace and to alleviate employer and school fears, we have drafted three letters for CDC employees returning from Ebola-related deployments: 1. A letter for family and close contacts; 2. A letter for persons determined to be at no identifiable risk, to be distributed to all employees determined to be at no identifiable risk after completion of the post-deployment risk assessment; (most of you are not in this category.) 3. A letter for persons determine to be at low (but not zero) risk, to be distributed to all employees determined to be at low (but not zero) risk – typically, these would be employees deployed to Liberia, Sierra Leone, or Guinea. …
In West Virginia:
Laney also points out that his community in West Virginia, especially in Preston County, has been a reliable source of comfort and encouragement. He says he hopes that attitude persists for other West Virginian healthcare workers who will soon also be returning home.
As to whether or not Laney will return to continue public health efforts in Africa—he says it’s possible he’ll go back the spring.
