Updated guidelines on infant sleep

The American Academy of Pediatrics updated its advice on how to prevent sudden infant death syndrome (SIDS) and other sleep-related deaths in a policy statement released Oct. 24. The guidelines reaffirm recommendations that infants sleep on their backs in the same bedroom as their parents - but on a separate surface, such as a crib or bassinet, without any soft or loose bedding. What's new is that tired parents should never feed their baby on a couch, armchair or other soft surface. "The process of breastfeeding renders a mom sleepy, physiologically," says Lori Feldman-Winter, co-author of the AAP policy statement. If a mother thinks she may fall asleep while feeding, "we actually recommend that she feed the baby in the bed, because feeding the baby in a sofa or an armchair is more hazardous," she adds. The policy statement is here and a news report is here.

For other information on injury prevention please visit Jefferson County Public Health’s Injury Prevention web page.

CDC recommends only two HPV shots for younger adolescents

Fewer shots offer more incentive to prevent HPV cancers

The Centers for Disease Control and Prevention (CDC) announced on October 19, 2016, that it now recommends 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart rather than the previously recommended three doses to protect against cancers caused by human papillomavirus (HPV) infections. Teens and young adults who start the series later, at ages 15 through 26 years, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection.

“Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer,” said CDC Director Tom Frieden, M.D., M.P.H. “This recommendation will make it simpler for parents to get their children protected in time.”

The Advisory Committee on Immunization Practices (ACIP) voted today to recommend a 2-dose HPV vaccine schedule for young adolescents. ACIP is a panel of experts that advises the CDC on vaccine recommendations in the United States. CDC Director Frieden approved the committee’s recommendations shortly after the vote.  ACIP recommendations approved by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR).

CDC and ACIP made this recommendation after a thorough review of studies over several meetings. CDC and ACIP reviewed data from clinical trials showing two doses of HPV vaccine in younger adolescents (aged 9-14 years) produced an immune response similar or higher than the response in young adults (aged 16-26 years) who received three doses.

Generally, preteens receive HPV vaccine at the same time as whooping cough and meningitis vaccines. Two doses of HPV vaccine given at least six months apart at ages 11 and 12 years will provide safe, effective, and long-lasting protection against HPV cancers. Adolescents ages 13-14 are also able to receive HPV vaccination on the new 2-dose schedule.

CDC will provide guidance to parents, healthcare professionals, and insurers on the change in recommendation. On October 7, 2016, the U.S. Food and Drug Administration (FDA) approved adding a 2-dose schedule for 9-valent HPV vaccine (Gardasil® 9) for adolescents ages 9 through 14 years. CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect their preteen patients from HPV cancers.

ACIP, CDC, FDA and partners monitor vaccines in use in the U.S. year-round. These updated recommendations are an example of using the latest available evidence to provide the best possible protection against serious diseases.

Jefferson  County Public Health offers HPV vaccine at its regular immunization clinics located at Jefferson County Public Health. Please call 303-239-7078 for an appointment or more information.

Jefferson County Public Health is part of the Denver Metro Alliance or HPV Prevention.  This is a collaborative project funded by the Colorado Department of Public Health and Environment working to decrease rates of the Human Papillomavirus across the greater Denver Metro area.

Happy & Healthy Eating Reminder: Preventing Foodborne Illness this Holiday Season

No matter how large or small your holiday guest list may be this year, it is important to be aware of safety issues when thawing, preparing, stuffing and cooking your turkey and other holiday meal additions. A few simple steps can help keep foodborne illness off the menu.

Safe Preparation:

• Wash hands with warm water and soap for 20 seconds before and after handling any food. Kids can sing “Happy Birthday” twice to gauge how long they should wash their hands.
• Wash food contact surfaces such as cutting boards, dishes, utensils and countertops with hot, soapy water after preparing each food item and before going on to the next item.
• Kitchen counters and cutting boards can be sanitized using a solution of two teaspoons of unscented chlorine bleach per gallon of water. Spray or wipe on surfaces and allow them to air dry.
• Rinse fruits and vegetables thoroughly under cool running water and scrub sturdy produce with a clean produce brush.
• Don’t rinse raw meat or poultry before cooking. Washing these foods can spread bacteria to the sink and countertops.

Safe Handling and Thawing:

• Thawing turkeys must be kept out of the "danger zone" temperature (between 40 and 140°F) — this is the temperature range where foodborne bacteria multiply rapidly. See Safe Methods for Thawing, (Spanish version).  
• Keep raw eggs, meat, poultry, seafood and their juices away from foods that won't be cooked. Take this precaution while shopping in the store, when storing these foods in the refrigerator at home and while preparing meals.
• Consider using one cutting board for foods that will be cooked (raw meat, poultry and seafood) and another for those that will not (raw fruits and vegetables).
• Keep fruits and vegetables that will be eaten raw separate from raw meat, poultry and seafood. Keep fruits and vegetables separate from kitchen utensils and surfaces used for raw meat until those utensils and surfaces have been thoroughly washed.
• Do not put cooked meat or other food that is ready to eat on an unwashed plate or surface that has held any raw eggs, meat, poultry, seafood or their juices.

Safe Cooking:

• Use a food thermometer to make sure meat, poultry and fish are cooked to a safe internal temperature. Color is not a reliable indicator of doneness. To check a turkey for safety, insert a food thermometer into the innermost part of the thigh and wing and the thickest part of the breast. The turkey is safe when the temperature reaches 165 F. For more information on safe internal temperatures, visit FoodSafety.gov's Safe Minimum Cooking Temperatures
• If the turkey is stuffed, the temperature of the stuffing should be 165 F. Follow these steps to safely prepare, cook, remove, and refrigerate stuffing.
• Bring sauces, soups and gravies to a rolling boil when reheating.
• Cook eggs until the yolk and white are firm. When making your own eggnog or other recipe calling for raw eggs, use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powdered egg whites.

Safe Cleaning and Storage:

• Do not leave foods containing meat, dairy, eggs, fish or poultry out at room temperature. Refrigerate leftovers — and any type of food that should be refrigerated — within two hours. This includes casseroles and pumpkin or other custard pies.
• Never defrost food at room temperature. Food can be defrosted safely in the refrigerator, under cold running water or in the microwave. Food thawed in cold water or in the microwave should be cooked immediately.
• Plan ahead to allow enough time to thaw the turkey in the refrigerator. You will need a day for every 4-5 pounds.
• Don't taste food that looks or smells questionable. A good rule to follow is, “When in doubt, throw it out."
• Leftovers should be used within three to four days.

Remember, only handle and prepare food for others only if you are healthy. It is possible to spread illnesses other than just foodborne illnesses through meal preparation.

• Don’t handle or prepare food for others if you are sick, especially if experiencing vomiting, diarrhea or flu-like symptoms. The bacteria and viruses that cause these types of symptoms can be transmitted easily to food and anyone who eats it.
• Use special care when preparing food for anyone considered at high risk for foodborne illness (older adults, infants and young children; pregnant women; and people with a chronic illness or any other condition that weakens their immune system).

Other resources:
JCPH Food Safety web page.

November is American Diabetes Month

Did you know that 1 in 11 Americans today has diabetes? Despite its prevalence, diabetes is an invisible disease. It affects men and women, people young and old, and people of all races, shapes and sizes. Often there are no outward signs from the 29 million Americans who fight this chronic illness every day. That’s why there is a critical need to foster awareness and education while breaking down stereotypes, myths and misunderstandings about this growing public health crisis that affects so many of us.
This is exactly why the American Diabetes Association marks each November as American Diabetes Month—to bring extra attention to the disease and the tens of millions of people affected by it.

This November, the organization will showcase real-life stories of friends, families and neighbors managing the day-to-day triumphs and challenges of diabetes. The 2016 campaign, sponsored by Colgate Total®, National Oral Care Strategic Partner, invites all of us to use #ThisIsDiabetes to share personal stories and to start a dialogue about what it really means to live with diabetes.

You can also update your Facebook profile picture to help raise awareness—and don’t forget that you can always donate or sign up to become an advocate to help the American Diabetes Association continue their critical work.

To learn more and view #ThisIsDiabetes stories from around the country, check out diabetes.org/adm. Be sure to also follow the American Diabetes Association on Facebook, Instagram, and Twitter.

Jefferson County Public Health has registered dietitians available for consultation on healthy eating and nutrition planning.  Visit the website for information.

Sexually Transmitted Diseases Surge to a National 20-Year High

New data released show the highest combined rates of chlamydia, gonorrhea,and syphilis (STDs) in the U.S. in 20 years,reports the Centers for Disease Control & Prevention (CDC). Annually, there are 20 million new STD cases, costing the U.S. health care system $16 billion. Rates of chlamydia, gonorrhea, and syphilis increased significantly for the third year in a row, reaching a 20-year high. The long-term health consequences posed by STDs are serious and often irreversible, especially if not diagnosed and treated early. Young people ages 15-24 and gay and bisexual men are at highest risk for STDs. Young people face unique barriers to services, including stigma, confidentiality concerns, and limited access to expert STD providers.

STDs can lead to chronic pelvic pain, infertility, and ectopic pregnancy. A pregnant woman can pass STDs on to her baby, leading to serious disabilities or death in the infant. STDs increase the risk for acquiring HIV, especially men who have sex with men, undoing the gains that have been made in HIV prevention and care. For more information on National trends, please see the recently released STD Report at http://www.cdc.gov/std/stats15/.

Colorado is also experiencing historically high rates of STDs, although at lower rates of disease than the national trends. • There were significant increases in chlamydia. The number of male cases has increased over time, but females remained disproportionately impacted and have a rate twice that of males. • Gonorrhea also significantly increased for the second year in a row. Males continue to be disproportionately impacted by gonorrhea in Colorado, but the state is seeing increases in the number of female cases, particularly in 15-24-year-olds.

October 26, 2016 | Volume 16, Issue 43
Syphilis rates have also increased since 2014, accounting for an over 200 percent increase in this disease since 2006. Ninety-eight percent of primary and secondary syphilis occurs in men, in particular men who have sex with men.

Different than national trends, Colorado has not had a congenital syphilis case reported since 2007. Continued vigilance of testing pregnant women and testing and treating men who have syphilis will keep this trend consistent into the coming years.

An effective national and local response to the current STD epidemic will require engagement from many.  Providers should make STD screening a standard part of medical care, especially in pregnant women. With insurance coverage at an all-time high, there are also more opportunities to integrate STD prevention and treatment into prenatal care and other routine visits.

Individuals can talk openly about STDs, get tested regularly, and reduce their risk by using condoms or practicing mutual monogamy if they are sexually active. Parents and providers can have honest conversations with young people about STD prevention.  State and local health departments should continue to direct resources to those hardest hit by the STD epidemic and
work with community partners to maximize their impact.

American Cancer Society’s annual Great American Smokeout

In honor of the American Cancer Society’s annual Great American Smokeout, Jefferson County Public Health (JCPH) is encouraging people who use tobacco to quit for the day or quit for life on Thursday, November 17, 2016.

Regardless of the length of time a person has used tobacco, quitting is possible and worth it. Quitting can take practice, which is why quitting for just one day on the Great American Smokeout can get you closer to being tobacco-free for life. Even if it takes more than one attempt to quit for good, the chances of success increase with each attempt. Just remember, it is never too late to quit, and the body begins to heal as quickly as 20 minutes after quitting.

If you or someone you care about is interested in being tobacco-free for the Great American Smokeout on November 17, 2016, preparing for the day in advance increases the chances of success. JCPH recommends using this nine day quit guide to help prepare to quit for the day or quit for life.

For additional support with quitting tobacco, consider using some of the following resources:

• Call the Colorado QuitLine at 1-800-QUIT-NOW (1-800-784-8669) or visit www.coquitline.org.
• The Wellness Now program at Jefferson Center for Mental Health offers low-cost classes on a variety of topics including quitting tobacco. For more information, visit www.jcmh.org/wellness/. 
• Attend a free tobacco cessation group hosted by Lutheran Medical Center in Wheat Ridge on Tuesdays at 12:00 pm or 5:30 pm. This is a six week drop-in group that provides adults who want to quit smoking with tools and support to achieve their goals. (You do not need to attend all six weeks in order to participate.)
• Visit the Thinking of Quitting page on the Tobacco-Free Jeffco Website. 
• Visit www.tobaccofreeco.org for additional information about secondhand smoke, Colorado tobacco laws, and resources to help with breaking free from tobacco addiction. 

Jefferson County Public Health continues to work toward reducing the toll of tobacco in our communities through sustainable solutions to the problem of tobacco use and exposure. To learn more about current initiatives and how to get involved, visit www.tobaccofreejeffco.com, email tobaccofree@jeffco.us, or call 303-275-7555.

The Power of Preparedness . . . National Preparedness Month Reminds Everyone to Plan and Prepare for the Unexpected

Being prepared at all levels saves lives. Public health emergencies might take the shape of an emerging or rapidly spreading disease, a natural disaster, or an act of bioterrorism. While we can’t always anticipate what the next threat will be or where it will begin, National Preparedness Month presents an opportunity to share how we can all act now to reduce the impact of the unknown.  While the month is celebrated in September, every month is an opportunity to learn and prepare ahead.

This 2016 National Preparedness Month, CDC joined more than 3,000 global, national, regional, and local government organizations, as well as private and public institutions, to promote the importance of being ready for emergencies through the power of preparedness.

• Prepare globally. Diseases know no borders, which is why countries need to work together to stop epidemics quickly and close to the source.
• Prepare to respond. A cornerstone of response, emergency operations centers are where highly trained experts monitor information, prepare for known (and unknown) public health events, and gather to exchange information and make decisions in an emergency.
• Prepare locally. Every response is local, and state and local health departments are first responders for public health emergencies.
• Prepare together. Communities need to work together to help each other, including protecting those with unique needs like children in schools and people with disabilities.
• Prepare yourself. Individuals can take action now by having a family reunification plan and an emergency kit with basic supplies, medicines, and local emergency phone numbers.

For more information on planning and preparing for potential public health emergencies, please visit the Jefferson County Public Health Emergency Preparedness Web Page.   Download and view the CDC infographic on preparedness.