An ongoing dialogue on public health

An ongoing dialogue on public health

Archive for August, 2012

There are currently over 90 cases of human West Nile virus disease reported in Michigan; included among these are 5 deaths. It is early in the West Nile virus disease activity season (usually runs from mid-August through early October), so the number of cases are going to rise, in my opinion substantially, before the 2012 case count has concluded.

I publicly stated that Michigan is having an epidemic of West Nile virus disease (see link). This has apparently bothered some members of the public who accuse me of using inflammatory words to scare people. Let’s explore the terms.

We refer to diseases that are occurring in a steady state as being endemic. According to Last’s Dictionary of Epidemiology, an endemic disease “may refer to the usual prevalence of a given disease within a given geographic area.” Over the past 9 years, the usual annual prevalence of West Nile virus disease in Michigan has been 28 cases and 2 deaths (means) and 19 cases and 2 deaths (medians).

An epidemic, according to Last, is disease activity “clearly in excess of normal expectancy.” In my opinion, 95 cases and 5 deaths in the first two weeks of the typical West Nile virus season in Michigan meets the definition of an epidemic. These are not inflammatory words meant to scare people but are an apt description for the West Nile virus season we are experiencing.

The causes for this higher than expected case count likely have their origin in the hot and dry weather conditions that occurred in Michigan this summer. These are the conditions most conducive to population increases among the Culex species of mosquitoes—the only ones known to transmit West Nile virus to humans in our state.

Michigan is having an epidemic of West Nile virus disease. We should inform the public of this occurrence so that they can adopt appropriate preventive precautions.

The attached article from the Robert Wood Johnson Foundation lays out the case, particularly the economic argument, for improved support for tobacco cessation activities. While some view an aggressive approach to tobacco cessation as a moral imperative to clinical practice others, particularly those who follow a strict “business model” in deciding health care priorities, will take on the issue when there is a positive ROI—Return on Investment. The RWJF Issue Brief highlights three studies that demonstrated a range of 3:1 to 50:1 savings: investment ratio (an attractive ROI). Nonetheless, states fail to apply sufficient resources to tobacco cessation. In 2012, states will receive $25.6 billion from a major legal settlement with the tobacco companies and from tobacco taxes, yet they will use the money for other purposes—less than 2% will be spent on tobacco prevention programs. If we want to lower the morbidity and mortality from tobacco use, we’ll need to invest in prevention efforts up front.