Diabetes awareness month

Diabetes in the United States

Diabetes affects about 25.8 million people in the United States today. About 18.8 million people are confirmed to have diabetes, and about 7 million people do not know that they have diabetes. About 79 million people (25.4 % of population) are categorized as prediabetic and are in danger of developing diabetes. The monetary cost of diabetes for the U.S. economy was about $174 billion in 2007. In 2007 alone, diabetes contributed to about 231,404 deaths in the United States. Clearly, this is a problem that requires serious attention.

What are the types of diabetes?

Type 1 diabetes:

Type 1 diabetes, previously known as insulin-dependent or juvenile-onset diabetes is seen in about 5 to 10% of people with diabetes. It occurs when the body’s immune system destroys cells in the pancreas that produce insulin. As a result, the body produces little to no insulin, resulting in a buildup of sugar in the blood. This form of diabetes is usually seen in children and young adults, but can occur at any age. The majority of the people affected by type 1 diabetes are usually not overweight. There is no known way to prevent type 1 diabetes.

Type 2 diabetes:

Type 2 diabetes, previously known as non-insulin-dependent or adult-onset diabetes, is the most common type of diabetes. It affects 90 to 95% of people with diabetes. Type 2 diabetes occurs when the body is not sensitive to insulin produced by the pancreas which will gradually lead to the pancreas eventually losing its ability to produce insulin. Most people affected with Type 2 diabetes are either overweight or obese.

Gestational diabetes:

This kind of diabetes is only seen in pregnant women and usually occurs in the second half of pregnancy. It is seen in about 7% of all pregnancies in the United States. It is caused by an increase in some hormones during pregnancy that either cause low production of insulin or cause insulin to not work well. This kind of diabetes is mainly seen in women that already have risks for diabetes (see below: who gets diabetes?). Gestational diabetes can adversely affect the baby, and it is important that it is diagnosed early.

What are the signs and symptoms of diabetes?*

Symptoms of diabetes are often ignored because they seem quite harmless.

Type 1 diabetes:

·      Frequent urination

·      Unusual thirst

·      Extreme hunger

·      Unusual weight loss

·      Extreme fatigue and irritability

Type 2 diabetes:

·      Any of the Type 1 symptoms

·      Frequent infections

·      Blurred vision

Gestational diabetes:

·      Frequent urination

·      Unusual thirst

·      Extreme hunger

·      Unusual weight loss

·      Extreme fatigue and irritability

See your primary care provider as soon as possible if you have one or more of these symptoms.

*Note that sometimes, people do not have any symptoms - especially in Type 2 or gestational diabetes. Therefore screening when you are at risk (see below: who gets diabetes?) is important.

Who gets diabetes?

Anyone can have diabetes, but you might be at an increased risk of developing diabetes if you:

·      Are over the age of 45 years old

·      Have a family history of diabetes

·      Are overweight or obese

·      Do not exercise regularly

·      Have been diagnosed with high blood pressure

·      Belong to one of these ethnic groups: Non-Hispanic blacks, Hispanic/Latino Americans, Asian American and pacific islanders, American Indians and Alaska Natives.

·      Are a woman who developed gestational diabetes or had a baby that weighed more than 9 pounds.

How do I know for sure if I have diabetes or not?

Only a healthcare provider can confirm that you have diabetes. If you suspect that you have diabetes or want to be screened for diabetes, make an appointment with your primary care provider. Early detection is imperative in order to avoid complications from diabetes (see below: why treat diabetes?)

How is diabetes treated? Is there a cure?

There is currently no definite cure for diabetes. Ongoing research is targeted at finding a cure for diabetes. People with diabetes however, can live normal lives with appropriate therapy and close monitoring of blood glucose levels.

Type 1 diabetes:

Type 1 diabetes is managed by healthy eating, physical activity and insulin injections. Oral diabetic medications are not helpful in people with type 1 diabetes because their pancreas does not produce insulin, and these drugs need insulin to work. People with type 1 diabetes must balance food intake with an appropriate amount of insulin given by injections or with a pump. Close and frequent blood glucose monitoring is essential.

Type 2 diabetes:

Type 2 diabetes is managed by healthy eating, physical activity and blood glucose testing. In addition to these, oral medications, insulin injections, or both may be necessary to control blood glucose.

Gestational diabetes:

Diet modification with blood glucose testing is usually how gestational diabetes is managed. In some cases, insulin injections or certain oral medications might be needed to control blood sugar.

Note that the ultimate decision on how to manage your diabetes is made by your primary care provider.

Table 1: Available Medications for Diabetes Management

Class of drug	Examples	How it works
Oral Medications
Biguanides	Metformin	Decreases sugar made by the liver, decreases the amount of sugar absorbed by your body and increases insulin sensitivity
Sulfonylureas	GlipiZIDE, GlyBURIDE	Stimulates insulin production in the pancreas and increases insulin sensitivity
Meglitinides	Nateglinide, Repaglinide	Stimulates insulin production and release in the pancreas
Thiazolidinediones	Rosiglitazone, Pioglitazone	Helps make the cells in the body more sensitive to insulin
Alpha-glucosidase inhibitors	Acarbose, Miglitol	Blocks the enzyme that digest starches, resulting in a slower rise in blood sugar
DPP-IV inhibitors	Saxagliptin, Sitagliptin	Helps increase levels of a hormone that helps the pancreas make more insulin and also decreases sugar made by the liver
Injectable Medications
GLP-1 receptor agonist	Exenatide, Liraglutide	Helps the pancreas make more insulin, decreases sugar make by the liver and helps a person eat less
Amylin analog	Pramlintide	Helps regulate sugar made by liver, helps a person eat less
Insulin (Also available as a pump)	Insulin Lispro, Insulin Regular, Insulin Glargine	Works just like the insulin produced by the body to lower blood sugar

Why treat diabetes?

It is very important to manage your diabetes and control your blood sugar levels because there are many complications that can arise from not treating diabetes. Some complications involve:

·      Heart disease: Heart disease is the #1 killer among those with diabetes.

·      Stroke: People with diabetes are 2-4 times more likely to suffer a stroke than those without diabetes.

·      Kidney problems: Diabetes that is not controlled, especially in combination with high blood pressure, can cause damage to the kidney and lead to dialysis.

·      Eyesight: Uncontrolled diabetes can lead to serious damage to the eyes including blurred vision and blindness.

·      Nerves: High blood sugar can damage nerves in any part of the body.

·      Feet: Uncontrolled blood sugar can lead to damaged nerves and damaged blood vessels in the feet. This can lead to amputation.

·      Stomach: High blood sugar can cause nerve damage in the stomach which will lead to nausea, poor digestion and bloating.

·      Erectile dysfunction: Uncontrolled blood sugar can cause erection problems due to nerve damage and blocked blood vessels.

·      Mouth: High blood sugar can cause gum disease.

How can I prevent complications if I already have diabetes?

It’s not easy to deal with a chronic disease such as diabetes, but learning more about diabetes and how to manage it is the first step towards feeling better and living a longer healthier life. Here are some of the things you can do to prevent complications:

To prevent heart disease:

·      Talk to your healthcare provider to see if aspirin is appropriate for you.

·      Keep your blood pressure and cholesterol levels under control and make sure you are compliant with the therapy recommended by your healthcare provider.

·      Exercise 150 minutes per week (5 days a week for about 30 minutes).

·      Read food labels and limit the amount of sodium to less than 1500 mg a day.

·      Increase the fruits, vegetables and low fat dairy products in your diet.

·      If you smoke, consider smoking cessation.

To prevent foot problems:

·      Have your feet checked at least once a year

·      Avoid wearing shoes that don’t fit well

·      If you notice a wound or open sore on your feet, contact your healthcare provider.

To avoid dental problems:

·      See your dentist at least every 6 months.

·      Notify your dentist or healthcare provider if you are experiencing dry mouth, as that could lead to mouth sores and infection.

·      Brush your teeth after each meal and floss at least once a day.

To prevent eye problems:

·      See your eye doctor at least once a year.

·      Keep your blood sugar and blood pressure under control.

Get vaccinated:

·      Influenza and pneumonia infections are more common and more severe in people with diabetes.

·      Get your flu vaccine every year.

·      Make sure that you have gotten your pneumococcal vaccine. If you are more than 64 years old and it’s been more than 5 years since you last got your pneumococcal vaccine, you need to get another one.

·      You should get you tetanus vaccine once every 10 years.

·      People older than 60 years old should get a Zoster (Shingles) vaccine.

Most of the other complications that come with diabetes can be prevented or delayed by keeping your blood sugar close to the goals set by your provder. Also see your healthcare provider or nutritionist to make sure you are eating appropriately.

Where can I find more information?

Additional information can be accessed at:

www.diabetes.org

www.cdc.gov/diabetes/consumer

www.ndep.nih.gov/index.aspx?redirect=true

Written By:

Obiora Uzoukwu, PharmD Candidate, 2013

University of Illinois at Chicago

UIC Pharmacy

References:

1.     American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012;35 Suppl 1:S11-63.

2.     2011 National Diabetes Fact Sheet. Centers of Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/factsheet11.htm.  Accessed September 16, 2012.

3.     Triplitt CL, Reasner CA. Chapter 83. Diabetes Mellitus. In: Talbot RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8^th ed. New York: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?aID=7990956. Accessed September 16, 2012.

4.     Funk JL. Chapter 18. Disorders of the Endocrine Pancreas. In: Funk JL, ed. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6^th ed. New York: McGraw-Hill;2012. http://www.accesspharmacy.com/content.aspx?aID=5371010. Accessed September 16, 2012.

5.     Powers AC, D’Allesio D. Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In: Chabner BA, Brunton LL, Knollman BC, eds. Goodman & Gilmans’s The Pharmacological Basis of Therapeutics. 12^th ed. New York: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?aID=16674366. Accessed September 16, 2012.

National COPD Awareness Month

November is National COPD Awareness Month

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is a common lung disease where airflow is limited making it difficult for a patient to breathe. COPD is chronic, irreversible, and worsens over time. Currently, there is no cure available but it is preventable and the symptoms are treatable.

How common is COPD in the US?

According to the Centers for Disease Control and Prevention (CDC), COPD is the 3rd leading cause of death in the United States. It is estimated that more than 12 million Americans are affected by COPD. In the past it was more common in men; however, since 2000, women have exceeded men in the number of deaths caused by COPD. According to the US Department of Health and Human Services, in 2010, COPD cost the nation $49.9 billion in direct and non-direct medical costs.

What is the difference between chronic bronchitis and emphysema?

COPD refers to two lung conditions, chronic bronchitis and emphysema. Chronic bronchitis and emphysema may both be present in a patient.

Chronic Bronchitis	Emphysema
§  Inflammation of the airways occurs and leads to scarring of the bronchial tubes in the lungs §  Mucus-producing cough is present that  occurs consistently for 3 months at a time for at least 3 months out of a year and seen in 2 consecutive years §  It is typically diagnosed when other causes of lung dysfunction have been excluded	§  Caused by damage to the alveoli (air sacs) in the lungs §  Results in destruction to the walls of the alveoli §  Destruction leads to a reduction in gas exchange in the lungs

What are the most common risk factors for developing COPD?

Major risk factors for COPD include cigarette smoking, air pollution, occupational exposures (dust or chemicals), or genetic disorders. Cigarette smoking is the most common cause of COPD. According to US Department of Health and Human Services, cigarette smoking accounts for 75% of deaths caused by COPD. A genetic disorder, α1-antitrypsin deficiency, may decline a patient’s lung function leading to increased risk of developing COPD.  Patients with α1-antitrypsin deficiency lack a protein that protects damage to the lungs. Overall, most risk factors may be modified and can be avoided, which will reduce the risk of developing COPD.

What are the signs and symptoms of COPD?

Various signs and symptoms are characteristic of COPD and may help distinguish the severity of the disease.  Typical symptoms include cough (with or without sputum), shortness of breath, and wheezing. On physical exam, certain signs are present but may not be seen until later in the disease or in more severe cases. Signs include cyanosis of mucosal membrane (bluish discoloration due to lack of oxygen), barrel-shape chest (deformity of chest wall) due to excess air trapped inside the lungs, increased respiratory rate and shallow breathing, and changes in normal breathing such as pursed (puckered) lips or use of accessory respiratory muscles. Patients may need to stand in a “tripod” position with their hands placed on their knees bending forward in order to breathe more effectively.

How is COPD diagnosed?

Several factors aid help to diagnose COPD. These factors include the patient’s age (> 40 years), constant and worsening shortness of breath, chronic cough with production of sputum, decline in normal activity, and being positive for risk factors of COPD. Typically, when COPD is suspected a patient will undergo spirometry testing. Spirometry is a common pulmonary function test, which measures a person’s breathing. Spirometry assesses a patient’s lung capacity and volume. It is typically done to confirm the presence of airflow limitation and it is very useful in determining a patient’s disease severity.

How do you treat COPD?

The goals of treatment include relieving symptoms, slowing disease progression, prevention and treatment of any complications or exacerbations, improvement of normal activity, and improvement of overall health status. However, since no cure exists, the major focus should be prevention.

·      Lifestyle Changes: Smoking cessation (quit smoking) is the most important step to take in order to prevent and slow the progress of COPD. Smoking cessation is the only confirmed intervention that has been proven to affect long-term decline in lung function. If you or someone you know is having trouble quitting, ask your local pharmacist about treatments available to help quit. Also, if possible, avoid any lung irritants such as air pollution, dusts, or chemicals because they are risk factors for developing COPD.

·      Pulmonary Rehabilitation: This is a wellness program that aims at improving a person’s overall health status. The program includes exercise training, behavioral modifications, nutritional and disease management education, and emotional support. It is a supervised program typically 3 days per week for a total of 6 to 12 weeks.

·      Oxygen Therapy: This may be an option for patients who have severe COPD and low levels of oxygen. Oxygen therapy has been shown to increase the ability to perform daily activities and exercise, improve quality of life, and increase survival. Oxygen is administered nasally typically through prongs or masks and given for > 15 hours per day.

·      Immunizations: The CDC recommends patients with COPD receive an annual influenza vaccine due to serious complications that may occur with the flu in a patient with COPD. Because patients with COPD are at an increased risk of pneumonia, it is also recommended for patients ages 2 to 64 years with a chronic lung disease to receive the pneumococcal vaccine once. In patients > 65 years, a second vaccination is recommended if it has been longer than 5 years since receiving the pneumococcal vaccine.  

Drug Therapy

Bronchodilators: used to relax and enlarge the airways, making breathing easier.

Typically, patients will begin treatment with a short-acting bronchodilator as needed; however, if the disease worsens patients may need a long-acting bronchodilator daily. Short-acting bronchodilators (e.g. albuterol, ipratropium) are only used for immediate relief of symptoms when needed. Short-acting bronchodilators begin working within 5 minutes and work for about 4 to 6 hours. Long-acting bronchodilators (e.g. salmeterol, formoterol, tiotropium) are used when short-acting agents do not provide enough relief and patients experience symptoms on a regular basis. Long-acting bronchodilators work for about 12 hours and are typically given twice a day. Both classes of bronchodilators are given by inhalation using an inhaler. Generally, they are well tolerated with minimal side effects.

Inhaled glucocorticoids (Steroids): used to help reduce inflammation in the airways.

Inhaled glucocorticoids (e.g. fluticasone, budesonide) are never used alone but are combined with bronchodilators; therefore, patients who begin taking a glucocorticosteroid must also be taking a bronchodilator. They are typically given to patients when symptoms or severity of disease worsens. Inhaled glucocorticoids may be limited to short-term therapy because they are associated with more side effects, such as headache, hoarseness, sore throat, and oral candidiasis (mouth infection).

What is the prognosis of COPD?

COPD prognosis is poor if symptoms are left untreated and patients do not make the necessary lifestyle changes such as smoking cessation. Decline in lung function may lead to disease progression, poor quality of life, and possible disability and death. The primary causes of death due to COPD are respiratory failure, cardiovascular events or diseases, and lung cancer. It is important to make lifestyle changes, stay up-to-date on immunizations, and adhere to medications in order to prevent and reduce any complications.

Where can I find more information?

Several resources are available that will provide patients with useful information about COPD. You may also discuss any questions or concerns about COPD with your local pharmacists.

American Lung Association

www.lung.org

Global Initiative for Chronic Obstructive Pulmonary Disease

www.goldcopd.org

National Heart Blood and Lung Institute

http://www.nhlbi.nih.gov/health/public/lung/index.htm#copd

World Health Organization

http://www.who.int/topics/chronic_obstructive_pulmonary_disease/en/

Written by:

Michelle Dudek, PharmD Candidate, 2013

Chicago State University

References:

1.            Chronic Obstructive Pulmonary Disease. National Heart, Lung, and Blood Institute.  http://www.nhlbi.nih.gov/health/health-topics/topics/copd/treatment.html; Updated June 2012. Accessed September 13, 2012.

2.            Chronic Obstructive Pulmonary Disease. American Lung Association. http://www.lung.org/lung-disease/copd/. Accessed September 12, 2012

3.            Chronic Obstructive Pulmonary Disease. Centers for Disease Control and Prevention. http://www.cdc.gov/copd/; updated March 2012. Accessed September 13, 2012.

4.            Williams DM, Bourdet SV. Chapter 34. Chronic Obstructive Pulmonary Disease. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7975888. Accessed September 13, 2012.

Why its important to get a flu shot.

International Infection Prevention Week 2012

In 1896, a physician by the name of Sir William Osler declared,  “Humanity has but three great enemies:  fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.”  During this time period, people were starting to understand some of the causes of infection and disease, but were unable to do much in terms of prevention or treatment.  More than a century later, infection continues to be a worldwide concern.  This is despite the advent of antimicrobials and vaccines, along with improvements in public sanitation, that have had a tremendous impact on reducing complications and deaths associated with infections.  These advancements are not universally available, and infection is still a real problem for many third-world countries.  In fact, the most recent reports indicate that 7 out of 10 deaths in low-income countries are due to infectious diseases, with the top 3 causes being lower respiratory infections, diarrheal diseases, and HIV/AIDS.  Globally, infectious diseases account for 4 of the top 10 causes of death.  In addition to high mortality rates, infectious diseases create a tremendous burden in terms of healthcare costs (emergency care, hospitalizations, prescription medications), loss of productivity (missed work/school days), and reduction in overall quality of life.  This clearly illustrates that infection remains a major health concern and stresses the importance of infection prevention.  This blog entry will provide a basic overview of infectious disease and offer several simple, but effective measures that can be taken to not only protect an individual from becoming sick, but also help prevent the spread of infection to others.

What causes an infection?

Infections are caused by a number of organisms of varying shapes and sizes.  Organisms that have the ability to cause disease in humans are known as pathogens.  These include microscopic bacteria, viruses, and parasites, and larger fungi and parasitic worms.  The table below shows common diseases caused by these pathogens.

Type of Pathogen	Commonly Caused Diseases
Viruses	Common cold, flu, cold sores, chickenpox, AIDS
Bacteria	Pneumonia, tuberculosis, chlamydia, gonorrhea, syphilis
Fungi	Athlete’s foot, jock itch, ringworm, yeast infections
Parasites	Malaria, diarrhea, gastrointestinal symptoms (stomach pain, nausea, vomiting)

International Infection Prevention Week 2012

Microorganisms are found virtually everywhere, including soil, water, food, computer keyboards, doorknobs, and throughout the human body.  There are even microorganisms that permanently reside within the body, called normal flora.  The major sites that these are found are the mouth, nose, throat, and intestines.  The normal flora are a part of the body's natural defense system and protect us by competing with pathogens that invade the body.  Pathogens cause infections by coming into contact with and invading the human body.  Once inside your cells, the pathogens multiply, overwhelm the body’s defenses, and cause harm or disease.

Fever is considered the hallmark of infectious disease.  Other signs and symptoms are specific to the organism causing the infection and its location and may include pain, chills, sore throat, shortness of breath, nasal congestion, stiff neck, diarrhea, nausea, or vomiting.

The reason why you do not get sick every time you are exposed to a pathogen is because the body has a natural defense system known as the immune system.  The main function of the immune system is to find and destroy anything unfamiliar to the body that could potentially cause you harm.  In this manner, the immune system effectively prevents infection, saving you from being miserable and sick.  However, even the best immune system cannot eliminate all disease-causing organisms because of the ability of some pathogens to evade the immune response. 

What can increase my risk of an infection?

There are several risk factors that make an individual susceptible to developing an infection:

·      Contact with people who are sick

·      Weakened immune system

§  Very young children, elderly, critically ill, transplant patients

·      Being in a hospital or nursing home

·      Poor wound care

·      Pregnancy

·      Living in an area affected by a natural disaster

§  Poor sanitation or lack of fresh food or clean water

·      Poor hygiene, eating habits, and living conditions

§  Improper hand washing/teeth brushing

§  Eating junk food, unwashed fruits and vegetables, or perishable foods that have been left out of the refrigerator

§  Unsanitized water, dirty floors, garbage

Simple preventative measures are effective in reducing your chance of becoming ill.  Some useful practices include healthy eating, a clean environment, sufficient sleep, and frequent hand washing.  Also, vaccinations offer an extremely effective method for protection against many diseases.  These practices will not only protect you from contracting illnesses, but they also decrease the spread of diseases to others.

Is hand washing really that important?

Washing your hands is easy to do, takes little time, and is one of the most effective ways to prevent the spread of many common infections.  In spite of this, global studies have shown that people wash their hands with soap only 20% of the time.  This is particularly concerning since it is estimated that proper hand washing could save a million lives per year.

When should  you wash your hands?

It is important to wash your hands frequently, but it is especially important in the following situations:

·      Food preparation and cooking−before, during, and after

·      Before you eat

·      Before touching or washing your face

·      Before taking out contact lenses

·      Before holding a baby

·      Before and after being with somebody who is sick

·      Before and after taking care of a wound

·      After going to the bathroom

·      After spending time with animals

·      After blowing your nose, sneezing, or coughing

·      After handling money

·      After taking out the garbage

How should you wash your hands?

1.     Wet your hands before using soap.

2.     Rub hands together to form a soapy lather.

3.     Make sure you rub all areas of the hand, including between the fingers, back of the hand, the thumbs, fingertips, and under fingernails.

4.     Rub your hands together for at least 20 seconds to optimize the cleansing activity of the soap.  An easy way to pass the 20 seconds is to sing “Happy Birthday” twice.

5.     Rinse your hands well under running water to ensure all the soap and trapped germs and dirt are removed.

6.     Dry your hands with a clean paper towel or air dry them.  Use the towel to turn off the water.

What should you do if you do not have access to running water?

If your hands are not visibly dirty, alcohol-based hand sanitizers containing at least 60% alcohol offer an alternative option.  Hand sanitizers will not remove as many germs as soap and water, but they still help to prevent infection.  These products are easy to use:  squeeze small amount into palm of your hand, then rub hands together, covering all surfaces until dry.

Why should you get vaccinated?

Some diseases, such as smallpox and polio, which were once thought to be incurable have nearly been eliminated from the world thanks to the widespread use of vaccinations.  Several other diseases can now be prevented by vaccines, including hepatitis A and B, human papillomavirus, and tetanus.  Although preventable, these diseases are not benign and individuals unfortunate enough to be infected may experience severe symptoms and complications.  A simple vaccination can ease one’s concerns about ever becoming infected and having to deal with the associated complications and disease burden.  Also, vaccinations are the most effective way to help prevent the transmission of diseases to others.  This reduces the possibility of the infection becoming a much larger, widespread health concern.

Are all vaccines the same?

No, vaccines are broadly classified as either being live or inactived based on the components used to create the vaccine.  The immune system actively responds to these components, and this generally confers protection against disease.  The table below explains key points about the types of vaccines and provides examples of each.

Type of Vaccine	Description
Live, attenuated	·      Weakened or modified versions of live pathogens so that they do NOT produce the disease, but stimulate the immune response.  Infection fighting cells of the immune system will remember the pathogen and be able to eliminate it if you are ever exposed. ·      Have the potential to cause disease, but this is more likely to occur in people with weakened immune systems. ·      Many live vaccines should not be used in pregnant women. ·      Includes vaccines against measles, mumps, and rubella.
Inactivated	·      Organisms have been killed, or killed and purified to only contain components that stimulate immune response. ·      Requires multiple shots over time to build-up and maintain protection against pathogens. ·      Cannot cause disease in anyone. ·      Includes vaccines against hepatitis A and B, diphtheria, tetanus, and pneumonia.

Who should get vaccinated?

Different pathogens target different groups of people.  For instance, pneumonia and shingles are  major concerns for the elderly.  Chickenpox, measles, mumps, and rubella predominantly affect children.  It is important to receive the appropriate vaccinations at the appropriate age.  The Centers for Disease Control and Prevention provides age-based vaccination recommendations.  A link to these easy-to-read schedules can be found at the end of this blog.

Where can I go for vaccinations?

To get the maximum benefit from vaccinations, they must be available to as many people as possible.  There are several locations at UIC that offer vaccinatios:

Wood Street Pharmacy

840 S. Wood St

Chicago IL, 60612

312.996.6887

University Health Services
835 South Wolcott, Room E-144
Chicago, Illinois 60612

312.996.7420

University Village Pharmacy
722 West Maxwell Street
Chicago IL, 60607

312.355.2345

In addition, community pharmacies, walk-in clinics, and your doctor’s office all offer a number of vaccinations.

Insect-borne infections

Infections caused by insects are different from other infections in how the infection is spread.  These insect-borne illnesses cannot be transferred from person-to-person.  Rather, the spread of disease is due to the presence of large populations of infection-causing insects.  As a result, infection prevention measures aim to decrease insect populations and protect individuals from being bitten.

How do insects cause disease in humans?

An insect bite may not only be irritating or annoying, but it may also be very dangerous.  Certain blood-feeding insects (such as mosquitoes or ticks) can carry a variety of disease-causing organisms, such as viruses, bacteria, parasites, and protozoa.  When these insects bite, the pathogens can be transmitted into the body and cause a number of potentially life-threatening infections.

Which insects cause infections?

Worldwide, mosquitoes are responsible for most insect-borne infections.  In the United States, ticks infect the greatest number of people.  Some other insects that have the potential to cause serious disease, include mites, fleas, lice, sand flies, black flies and tsetse flies.  The table below shows some of the diseases caused by these insects.

Insect	Commonly Caused Diseases11
Mosquitoes	West Nile virus, malaria, dengue fever, Japanese encephalitis
Ticks	Lyme disease, Rocky Mountain spotted fever
Mites	Scabies, scrub typhus
Fleas	Plague
Lice	Epidemic typhus, relapsing fever
Sand flies	Leishmaniasis
Black flies	Onchocerciasis (river blindness)
Tsetse flies	African trypanosomiasis (African sleeping sickness)

What is the most effective way to prevent infection and spread of disease caused by insects?

There are several steps that can be taken to lower your risk of being bitten and infected.  Public health measures, such as spraying of insecticide and removing areas where insect may live are effective in decreasing the number of insects.   Personal protection measures, such as topical repellents or insecticide-treated clothing, and staying indoors during periods of high insect activity are also effective in lowering your risk of being bitten.  It has been shown that use of both topical repellents and insecticide-treated clothing offers the best protection from insect bites and infection.  These personal protection products are available at retail or sporting goods stores.

What types of repellent are available and how long do they work?

The table below lists products containing the most-commonly used active ingredients registered by the Environmental Protection Agency (EPA) and their duration of action:

Active Ingredient	Brand Name	Duration of Action
DEET < 10%	OFF! Skintastic	1-3 hours
DEET 10%-30%	OFF! Active, Deep Woods OFF!	4-6 hours
DEET 20%-98.5%	Sawyer	6-12 hours
Picaridin 7%	Cutter Advanced	3-4 hours
Picaridin 15%	Cutter Advanced Sport	6-8 hours

Which repellent is right for me?

Insect repellents are available with a wide variety of active ingredients and formulations, which can make it difficult to choose the right one.  The EPA has a helpful online search tool (http://cfpub.epa.gov/oppref/insect/) that helps you decide on the most appropriate insect repellent depending on your needs.  This tool allows you to search for products based on the duration of time you will need to be protected, which insects you need to be protected from,  active ingredients, and specific product brands.

For more information:

About International Infection Prevention Week:  http://www.apic.org/Education-and-Events/IIPW

About impact of vaccines in the United States:  http://www.niaid.nih.gov/topics/vaccines/understanding/pages/vaccinebenefits.aspx

About vaccine-preventable diseases:  http://www.cdc.gov/vaccines/vpd-vac/default.htm

Easy-to-read vaccinations schedules:  http://www.cdc.gov/vaccines/schedules/easy-to-read/index.html

Centers for Disease Control and Prevention insect repellent search tool: http://cfpub.epa.gov/oppref/insect/#searchform

 

Written by: Mark Knaub, PharmD candidate

University of Illinois at Chicago

UIC Pharmacy

October 2012