CDC says STD cases in U.S. rose to record high in 2018 as funding lags

Oct 8 (Reuters) – The number of Americans who were diagnosed with a sexually transmitted disease (STD) last year rose to a record high, U.S. health officials said on Tuesday, partly because funding for local health departments has dropped.

Nearly 2.46 million cases of chlamydia, gonorrhea, syphilis and other STDs were reported in 2018, the U.S. Centers for Disease Control and Prevention (CDC) said in a report. The total includes some 1,300 cases of congenital syphilis in newborns.

The rate of infection climbed steadily between 2014 and 2018, resulting in a 71% jump in the number of syphilis cases, a 63% increase in gonorrhea and a 19% rise in chlamydia during that period.

5 PHOTOSSTDs under the microscope: See what they look likeSee GallerySTDs under the microscope: See what they look likeSyphilis is a sexually transmitted infection caused by the spirochete bacteriumHuman pap smear showing chlamydia in the vacuoles at 500x and stained with H&E.Illustration of an infection as a result of the Chlamydia bacterium. Chlamydia trachomatis is responsible for a large part of infertilities, by obstructing the Fallopian tubes, preventing the egg from being fertilised and carried to the uterus.Gonococcus (neisseria gonorrhoeae) is the bacterium responsable for gonorrhea. In men the symptoms are acute burning when urinating and some discharge (clap). In women the symptoms are burning when urinating, bartholin’s cyst, cervisitis, salpingitis.HIV infection. Computer artwork of HIV particles in the bloodstream.Up Next

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Budget cuts at the state and local level resulting in staff reductions, clinic closures, less screening and patient follow-up has accounted for the increased disease rates, in addition to decreased condom use, health officials said.

“The resurgence of syphilis, and particularly congenital syphilis, is not an arbitrary event, but rather a symptom of a deteriorating public health infrastructure and lack of access to health care,” Gail Bolan, the CDC’s director of STD Prevention, said in the report.

Antibiotics can cure chlamydia, gonorrhea and syphilis, but many people fail to get screened and treated for the diseases.

The CDC’s annual STD prevention budget decreased in purchasing power by 40% from 2003 to 2018, according to data released by the National Coalition of STD Directors, an association of local health officials. The CDC’s financial data was first consolidated into the U.s. Health and Human Services financial reports in 2003.

Half of STD cases occur in people between the ages of 15 and 24 years old and can lead to health complications including infertility and increased risk of contracting HIV.

In 2018, the CDC received reports of nearly 1.8 million cases of chlamydia, some 580,000 cases of gonorrhea and more than 115,000 cases of syphilis. Of the 1,306 cases of congenital syphilis in 2018, 78 resulted in stillbirths and 16 in infant death.

(Reporting by Gabriella Borter in New York; Editing by Frank McGurty and Bill Berkrot)

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Changing the cybersecurity culture

Ransomware and malware attacks continue to plague hospitals and institutions, scoring frequent and disruptive hits. Internal data breaches are commonplace. Risk-laden network links with external agencies and partners abound. Security weak-spots are discovered in legacy systems and new applications alike. Clinicians working around medical device security protocols expose chinks of vulnerability in the IoMT.

Anyone building a picture of the state of cybersecurity in healthcare globally would struggle to find encouragement for the beleaguered hospital CIO, with many organisations apparently unable to break out of a reactive cycle and shift to more proactive defence strategies.

Bold statistics do little to improve the anecdotal picture. In April, the US Department of Health and Human Services reported 44 healthcare data breaches for the month, a record. The fact that the number of individuals affected fell by 29% from 963,794 to 686,953 compared with March was not exactly grounds for optimism, given the potential scale of the impact. 

Cyber risk and privacy management specialist IT Governance publishes a monthly blog of data breaches reported worldwide. The healthcare sector is well represented and while these lists are a litany of phishing, ransomware and DDoS attacks, they are also peppered with more banal cybersecurity failures that hint at the cultural challenge of managing risk in many institutions. These range from unauthorised employees accessing patient records to coding errors that unwittingly expose records. 

The June post referenced the accidental sharing of 37 patients’ email addresses in an invitation to a support group distributed by NHS Highland. Meanwhile in New York State, a member of the Independent Health Insurance company was emailed documents containing personal information on more than 7,600 fellow members. And a web advertising company helping law firms to sign up possible clients exposed 150,000 records from an unsecure database, containing personal details of accidents, injuries and illnesses.

Verizon’s 2019 Data Breach Investigations Report underlines the extent to which, when it comes to managing cybersecurity risk, internal processes and policy enforcement failures (59%) are more likely than external threats (42%) to leak data. Despite this, leading cybersecurity experts suggest there is cause for cautious optimism in the way some hospitals are building more proactive strategies despite their complex cultural and technological legacies.

Signs of progress

Dave Kennedy, founder and senior principal security consultant at TrustedSec, says a number of his healthcare clients have made significant cultural adaptations and now do a very good job of cybersecurity management. But this is not something that can be solved overnight by throwing more people and resources at it.

“Being more proactive means having the ability to fix issues as they are identified over time,” he says. “The biggest challenge for a hospital CIO is being able to communicate the likelihood and impact of a breach and introduce whatever is necessary prevent it. And describing possible impact to a board is difficult.”

Kennedy advocates recruiting people specifically to build sustainable programs that will help an institution move away from an infrastructure riddled with missing patches and misconfigurations. A more frequent patch management program for applications and systems is a core recommendation, alongside enhanced – and enforced – multifunctional password management. 

He says it is also vital for IT leaders to have high visibility into their infrastructure, with comprehensive log management. The window of risk is often greatest between an attacker’s initial breach of an administrative system and their subsequent passage into clinical and patient record systems – the point at which it becomes a major issue.

“On average it takes two hours to respond to a breach,” he says. “You can’t prevent everything but you can try to respond to and remove the threat faster than the attacker can break through to other systems.”

Application weakness

Elliott Frantz, CEO of Virtue Security, has previously spoken of the cybersecurity weaknesses caused by hospitals running unnecessary IT services and in particular, the vulnerability of applications in their runtime state. He agrees that system visibility is crucial to seeing and understanding the risk level at any given time. Proactively aiming to reduce the hospital’s overall risk and exposure is, he says, a more effective strategy than what has often seemed the default setting – an ongoing game of “crushing ants”!

“These are such highly connected environments,” he says. “A lot of employees need access to a lot of systems – and this creates inherent risks. Traditionally, a hospital has wrapped technology around its business, leading to multiple segregated pieces. Instead, they need to use technology to solve security by design. The positive sign is that a lot of new network and virtualisation technology is helping to create less exposed infrastructures.”

He would like to see more being done to improve application security. “We have seen a lot more hospitals taking a bigger interest in tackling application security problems, and that’s a good thing,” he says. “But the picture has not improved substantially.”

For Jason Gillam, CIO at Secure Ideas, the main issues to be addressed are often more cultural than technological. He points out that low-level attacks and breaches are particularly successful – and do not necessary require sophisticated high-tech solutions. 

Soft target

The threats themselves remain relatively unchanged, and healthcare is a soft target made softer by the nature of ‘businesses’ that have never considered themselves to be technology companies. This often leads to lax technical competence when it comes to cybersecurity. Where a breach occurs because of a misconfigured server or database, it is generally because somebody did something at a relatively basic level without understanding the consequences for security.

“In healthcare security, we’re taught above all else that life and limb are important,” he says. “So data and personal information are not always the top priority, and this drives what happens. A lot of activity that might be considered suspicious in any other industry is overlooked. We need to make a cultural shift from cybersecurity as a compliance check-box to doctors treating the protection of their patients’ personal data as a priority,” he says. 

While Gillam has noted some examples of this happening, the sea-change is nowhere near enough. Healthcare faces a major challenge in invoking such a huge cultural shift across its often massively dispersed environments – and as the statistics suggest, progress continues to be at shuffle pace. Cybersecurity is not about to relinquish its status as the biggest thorn in the CIO’s side any time soon.   

This article was first published in the newest issue of HIMSS Insights, which looks at cybersecurity in healthcare. Healthcare IT News and HIMSS Insights are HIMSS Media publications.

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Rare Mosquito-Borne Virus EEE Spreads Across Several States

A rare mosquito-borne virus has sickened an unusually high number of people and led to 9 deaths.

So far this year, seven states have identified a total of at least 29 cases of eastern equine encephalitis (EEE) in humans, according to public health departments in Massachusetts, Michigan, New Jersey, Rhode Island, Connecticut, North Carolina, and Tennessee.

The sickness occurs infrequently among people, but it can cause a brain infection that is often lethal. The Centers for Disease Control and Prevention (CDC) estimates that about 30 percent of those who contract EEE die, and many of those who survive suffer from chronic neurological problems.

On September 26, 2019, the Massachusetts Department of Public Health confirmed three deaths from EEE in the state, bringing the nationwide death toll to at least 9.

The Center for Food Security and Public Health at the Iowa State University of Science and Technology calculates that between 1964 and 2010, there were six cases a year on average with one to two deaths annually.

“We don’t expect this to be an epidemic, but the higher than usual number of cases and the severity of the virus has raised public concern,” says William Schaffner, MD, an infectious disease specialist and a professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee.

What Is EEE and How Is It Spread?

Sometimes called triple E or sleeping sickness, eastern equine encephalitis is a type of arboviral disease, meaning the virus is spread to humans by the bite of an insect — in this case a mosquito.

The disease is commonly maintained in birds. Mosquitoes then can transmit it from birds to humans or horses, for example. The virus was first recognized in horses in 1831 in the northeastern United States, according to the American Association of Blood Banks. Scientists recognized it in humans in 1938, following a widespread outbreak in children that resulted in 30 cases of fatal encephalitis (an inflammation of the brain usually caused by a viral infection).

“On the good news side, the virus is still relatively rare, and a very, very small proportion of mosquitoes are actually infected,” says Stephen Rich, PhD, a professor of microbiology at the University of Massachusetts in Amherst and an expert in zoonotic diseases (those that originate or are maintained in natural animal populations but occasionally affect human populations). “That’s not to say don’t worry about it, but do not let this rule your life.”

This disease also cannot be spread from person to person, unlike viruses like the flu.

What Are the Symptoms?

A person will experience signs of illness usually 4 to 10 days after being bitten by the infected mosquito, according to the CDC.

The illness can produce fever, headache, irritability, restlessness, drowsiness, anorexia, vomiting, and diarrhea. The CDC notes that in many cases, the symptoms last one to two weeks.

“In milder cases, the illness may be self-resolving as your body fights it off,” says Dr. Rich.

Dr. Schaffner emphasizes that the virus can be “very nasty,” and there is no cure or specific treatment that will get rid of the disease.

“Once you get bit, the virus has an attraction to the central nervous system, in particular the brain,” he says. “When it finds its way there, it begins to destroy the cells of the brain.”

The disease can produce a progressive stupor that leads to a coma. A patient may suffer from convulsions and general muscular spasms.

“Symptoms can present abruptly and put people into intensive care where they can receive intravenous fluids, proper nutrition, and treatment for any convulsions, as their body fights off the infection,” says Schaffner.

He stresses that the fatality rate is high, and even people who recover may be left with disabilities because brain cells are destroyed by the virus.

An article in The Washington Post illustrated how fast and devastating EEE may be. After contracting the virus, a Michigan man reportedly went from being perfectly healthy to brain dead in just nine days.

Why Is the Disease Rate Higher This Year?

Although no one reason has been ascribed to the uptick in illness this year, Rich speculates that a larger mosquito population may have contributed.

“We had a very wet spring here in Massachusetts,” he says, “and when there’s lots of water, there’s lots of mosquitoes.”

Richard Pollack, PhD, the senior environmental public health officer at Harvard University, adds that possible contributing factors may include a new strain of virus that could be stronger and more readily transmitted, changes in climate that may have enhanced mosquito abundance and longevity, or changes in the landscape that may have enhanced habitats for mosquitoes, such as higher water tables in white cedar swamps or in cattail wetlands.

How Can People Protect Themselves?

Because mosquitoes often breed in standing, stagnant fresh water, Rich suggests that people empty out any planters, old tires, or other receptacles that may be holding water.

In areas where infected mosquitoes have been detected, residents are advised to wear long-sleeved shirts and pants, as well as mosquito repellent with the active ingredient deet. Rich recommends the insecticide permethrin because, he says, it kills mosquitoes whereas deet simply repels them.

Individuals may also want to avoid going out at dawn and dusk when mosquitoes tend to be more active.

“In Massachusetts and Rhode Island, we are seeing some schools closing down evening activities like football games because many people do not want to run the risk of getting bit by mosquitoes,” says Rich.

Several communities that have detected infected mosquitoes are undertaking large-scale pesticide spraying efforts.

“These pesticides have pretty good safety profiles, and they’re usually sprayed in off hours when people are less likely to be outside,” says Rich.

Dr. Pollack also urges residents to get involved with local efforts to help control the disease.

“Contact your local board or department of health and your regional mosquito control abatement district to discuss what you can do to help them, and to learn what you and they might do to reduce your risks,” he says.

Rich adds that a cold snap in the weather would also help. “When a good hard frost comes, that’s the end of the season and you won’t worry about mosquitoes again until the spring,” he says.

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