Summer brings West Nile Virus threat

06/05/2017 12:00 PM
TAHLEQUAH, Okla. – As spring turns to summer, more people will venture outdoors for activities, which means increased exposure to mosquitos and possibly the West Nile Virus some mosquitos carry.

Experts at the Centers for Disease Control believe WNV is established as a seasonal epidemic in North America that flares up in the summer and continues into the fall.

According to the CDC, the virus can be a life-altering and sometimes fatal disease. In 2012, the CDC reported 5,674 confirmed human cases of WNV with 286 of them resulting in death. The CDC states that every state in the U.S., except Hawaii and Alaska, reported WNV cases in 2012. In Oklahoma, 178 humans were diagnosed with WNV with 15 deaths in 2012, according to the Oklahoma State Department of Health.

The CDC states that about one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks. Approximately 80 percent of people who are infected with WNV will not show any symptoms at all, according to the CDC.

The CDC has predicted it could be a bad year because of weather conditions that promoted breeding of the mosquitoes that spread the virus to people.

In Oklahoma, the WNV season runs from May to November. People are at greatest risk of exposure to infected mosquitoes from July through October in the state. People of any age can become ill after being bitten by an infected mosquito, but those over the age of 50 are at greater risk of developing serious illness involving the nervous system.

The OSDH advises use of insect repellents – particularly those containing DEET, picaridin, oil of lemon eucalyptus (PMD), or IR 3535 – when outdoors. The types of mosquitoes that transmit WNV are most active during early morning and evening hours, so take mosquito bite precautions during those times. It is also recommended to drain or treat standing water around your home with a mosquito larvacide to reduce mosquito-breeding sites.

How does WNV spread?

Most often, WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals.

In a small number of cases, WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby.

How soon do infected people get sick?

People typically develop symptoms between three and 14 days after they are bitten by an infected mosquito.

How is WNV infection treated?

There is no specific treatment for WNV infection. In cases with milder symptoms, people experience symptoms such as fever and aches that pass on their own, although even healthy people have become sick for several weeks. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment, including intravenous fluids, help with breathing and nursing care.

What should I do if I think I have WNV?

Milder WNV illness improves on its own and people do not necessarily need to seek medical attention for this infection though they may choose to do so. If you develop symptoms of severe WNV illness such as unusually severe headaches or confusion, seek medical attention immediately. Severe WNV illness usually requires hospitalization. Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WNV.

What is the risk of getting sick from WNV?

People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites.

Is there a vaccine against West Nile encephalitis?

No, but some groups are working towards developing a vaccine.

What can be done to prevent outbreaks of WNV?

Prevention and control of WNV and other arboviral diseases is most effectively accomplished through integrated vector management programs. These programs should include surveillance for WNV activity in mosquito vectors, birds, horses, other animals and humans and implementation of appropriate mosquito control measures to reduce mosquito populations when necessary. Additionally, when virus activity is detected in an area, residents should be alerted and advised to increase measures to reduce contact with mosquitoes.

How often should repellent be reapplied?

In general you should re-apply repellent if you are being bitten by mosquitoes. Always follow the directions on the product you are using. Sweating, perspiration or getting wet may mean that you need to re-apply repellent more frequently. Repellents containing a higher concentration (higher percentage) of active ingredient typically provide longer-lasting protection.

Which mosquito repellents work best?

CDC recommends using products that have been shown to work in scientific trials and that contain active ingredients that have been registered with the Environmental Protection Agency for use as insect repellents on skin or clothing. When EPA registers a repellent, they evaluate the product for efficacy and potential effects on human beings and the environment. EPA registration means that EPA does not expect a product, when used according to the instructions on the label, to cause unreasonable adverse effects to human health or the environment.

Of the active ingredients registered with the EPA, CDC believes that two have demonstrated a higher degree of efficacy in the peer-reviewed, scientific literature. Products containing these active ingredients typically provide longer-lasting protection than others:


• Picaridin

Oil of lemon eucalyptus, a plant-based repellent, is also registered with EPA. In two recent scientific publications, when oil of lemon eucalyptus was tested against mosquitoes found in the U.S. it provided protection similar to repellents with low concentrations of DEET.

Can insect repellents be used on children?

Repellent products must state any age restriction. If there is none, EPA has not required a restriction on the use of the product.

According to the label, oil of lemon eucalyptus products should NOT be used on children under 3 years. In addition to EPA’s decisions about use of products on children, look to the opinion of the American Academy of Pediatrics. The AAP does have an opinion on the use of DEET in children. AAP has not issued recommendations or opinions on the use of picaridin or oil of lemon eucalyptus for children.

What guidelines are available for using a repellent on children?

• When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children’s eyes and mouth and use it sparingly around their ears.

• Do not apply repellent to children’s hands.

• Do not allow young children to apply insect repellent to themselves; have an adult do it for them.
• Keep repellents out of reach of children.

• Do not apply repellent under clothing. If repellent is applied to clothing, wash treated clothing before wearing again.

How else can I protect children from mosquito bites?

Using repellents on the skin is not the only way to avoid mosquito bites. Children (and adults) can wear clothing with long pants and long sleeves while outdoors. DEET or other repellents such as permethrin can also be applied to clothing, as mosquitoes may bite through thin fabric. Also, mosquito netting can be used over infant carriers.

Prevention Tips

Be aware of peak mosquito hours

The hours from dusk to dawn are peak biting times for many species of mosquitoes. Take extra care to use repellent and protective clothing during evening and early morning or consider avoiding outdoor activities during these times.

Install or repair screens

Some mosquitoes like to come indoors. Keep them outside by having well-fitting screens on both windows and doors. Offer to help neighbors whose screens might be in bad shape.

Dispose of breeding grounds

Also, it may be possible to reduce the number of mosquitoes in the area by getting rid of containers with standing water that provide breeding places for mosquitoes.

Help reduce the number of mosquitoes in areas outdoors where you work or play, by draining sources of standing water. In this way, you reduce the number of places mosquitoes can lay their eggs and breed.

At least once or twice a week, empty water from flowerpots, pet food and water dishes, birdbaths, swimming pool covers, buckets, barrels, and cans.

Check for clogged rain gutters and clean them out.

Remove discarded tires, and other items that could collect water.

Be sure to check for containers or trash in places that may be hard to see, such as under bushes or under your home.


12/08/2017 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation physician Dr. James H. Baker was recently awarded a Mastership through the American College of Physicians for his contributions. According to ACP, “Election to Mastership recognizes outstanding and extraordinary career accomplishments and achievements, including the practice of internal medicine, academic contributions to our specialty, and service to the College.” During review of candidates, the ACP’s Awards Committee considers several qualities, including strength of character, perseverance, leadership, compassion and devotion. Clinical expertise and commitment to advancing the art and science of medicine are also taken into account by the committee. “I am so honored to receive this award from my peers and colleagues at the American College of Physicians,” Bake said. “I thank our Oklahoma ACP Chapter of 1,000 internal medicine physicians and medical students for nominating me.” Baker, of Muskogee, is a general physician with more than 30 years of experience. He serves as medical director for CN Three Rivers Health Center and the tribe’s Wilma P. Mankiller Health Center. Baker completed medical school at the University of Oklahoma in 1982 and completed his internal medicine residency at Kansas University in 1987. The mastership is the third award Baker has received from the ACP, including the Meritorious Service Award in 2014 and the Laureate Award in 2015. He is a former governor of the Oklahoma chapter of ACP and a current member. The ACP will honor 2017-18 master recipients at the organization’s annual convention in April 2018 in New Orleans. For more information, visit <a href="" target="_blank"></a>.
12/05/2017 12:00 PM
TAHLEQUAH, Okla. – According to an Oklahoma influenza summary for Nov. 19-25, the influenza geographic spread is “widespread” within the state. The report states that there were 162 positive rapid flu tests at sentinel sites with 78 percent of those positive specimens being influenza A. The summary also states that between Sept. 1 and Nov. 28, 105 influenza-associated hospitalizations were reported to the Acute Disease Service with ages ranging from 0 to 95 years with a median of 62 years of age. The report states that two influenza-associated deaths have been reported among residents of Johnston and McClain counties, and officials said that Oklahoma is experiencing a higher than normal level of influenza activity early in the season. “Our influenza-associated hospitalizations are the highest they have been at this time of year since the 2009-2010 pandemic,” Dr. Sohail Khan, Cherokee Nation health research director, said. “Our influenza-associated hospitalization count is three weeks ahead of the 2014-2015 season when our influenza activity peaked in December and declined to minimal levels by the end of March. This early activity does not mean we will have a more severe season. It does indicate that more influenza will be circulating during the holidays.” Flu, or influenza, is a contagious respiratory infection caused by a variety of flu viruses. Symptoms of flu involve muscle aches and soreness, headache and fever. It enters the body through the mucus membranes such as the nose, eyes or mouth. “Every time you touch your hand to one of these areas, you are possibly infecting yourself with a virus,” Khan said. “This makes it very important to keep your hands germ-free with frequent and thorough hand washing. Encourage family members to do the same to stay well and prevent flu.” Khan said there are three types of flu viruses: A, B, and C. He said type A and B cause the annual influenza epidemics that have up to 20 percent of the population sniffling, aching, coughing and running high fevers. Type C also causes flu, however type C flu symptoms are less severe. The flu is linked to between 3,000 and 49,000 deaths and 200,000 hospitalizations each year in the United States, and seasonal flu vaccines are created to try to avert epidemics. Khan said the best way to prevent seasonal flu is to get vaccinated each year, but good health habits such as covering a cough and washing hands often can help stop the spread of germs and prevent respiratory illnesses such as the flu. There also are flu antiviral drugs that can be used to treat and prevent flu. To prevent the spread of flu, Khan said to avoid close contact; stay home when sick; cover mouth and nose; clean your hands; avoid touching your eyes, nose or mouth; and clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. He also suggests getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.
12/05/2017 08:00 AM
TAHLEQUAH, Okla. – In 2015, the Cherokee Nation became the first tribe to launch an elimination project with the U.S. Centers for Disease Control and Prevention to screen and treat tribal citizens for hepatitis C. And since the project’s inception, more than 40,000 people have been screen. CN officials proclaimed Oct. 30 as Hepatitis C Awareness Day and said the tribe continues its efforts to reach it goal of screening 80,000 patients. “Hepatitis C is a virus that affects primarily the liver but it can affect other organs, too. It was isolated in 1989, although we knew it existed long before that time,” Dr. Jorge Mera, CN director of infectious disease, said. Hepatitis C was identified as non-A or non-B hepatitis before it was labeled as a third virus. Symptoms are not present unless it has not been identified or treated for a period of time and cirrhosis of the liver sets in. “The symptoms are basically symptoms of cirrhosis. So anything that inflames the liver for many years may end up causing a lot of scarring of that liver and when the scarring is sever enough we label it as cirrhosis,” Mera said. The virus can be contracted several ways. Mera said in approximately 90 percent of cases, people who inject drugs and share needles, syringes or paraphernalia, contract it. In the past, blood transfusions played an important role in contracting the virus until 1992 when blood banks began checking for it. Tattooing in a non-professional parlor can also play a role. There is also a small chance, roughly 5 percent, that a mother can transmit the disease to her newborn child, Mera said. He said there are ideal and practical ways to prevent the disease from spreading. “Ideal would be that people would not use illegal drugs and not inject them. We know that we can mitigate that but we will never reach zero on that. That’s a reality. People have been using illegal drugs for millenniums, and it’s not going away soon,” Mera said. He said if people use drugs they should use clean needles and syringes each time they inject and to not share needles with anyone. He added that there is a need for needle and syringe exchange services, which is illegal in Oklahoma. Other tribes and places in the United States, such as New York City and San Francisco, are creating their own hepatitis C elimination programs. “Now the advantage they have over us is that they have needle and syringe services. It’s going to be very difficult to eliminate hep C if you don’t have needle and syringe services because there will be a point that people will continue to transmit, and I can only go and catch them and treat them. But I would like to cut that transmission,” Mera said. To prevent the disease’s consequences once it is contracted is for people ages 20 to 72 years old to get screened. “We offer free screenings and free treatments at W.W. Hastings Hospital in Tahlequah, Oklahoma,” Mera said. “In Cherokee Nation, 3.4 percent of Cherokees ages 20 to 72 are positive for hepatitis C. In other Native American communities there have been reported rates as high as 8 percent and also lower rates.” He said hepatitis C is the top “killer of blood-born pathogens” than any other reportable disease of the CDC and has killed more than the rest of the reportable diseases combined. “Hepatitis C mortality is greater in Native Americans in general than non-Native American populations in the United States,” Mera said. Mera said the screening process is simple and all one has to do is request a screening in the Urgent Care or with their providers at W.W. Hastings Hospital. The screening contains a blood drop, in which results are ready in 24 hours. He said treatment options, depending on the severity of the virus, is taking a pill regiment for eight to 12 weeks, in which 95 percent cure rates have been seen. “It’s the only chronic infectious disease that you can cure and, to my knowledge, is the only chronic disease you can cure. Because you can’t cure diabetes or high blood pressure, those you have to treat for life, or HIV for that matter. But this is eight to 12 weeks and you’re done.” He said though the treatment is simple the hard part is getting people to get tested. Roughly 50 percent of the population of the 85 percent goal has been screened. Approximately 78 percent have tested positive and more than 90 percent have been cured of the virus. “On cure rates we’re meeting our goal. On screening we still have a ways to go. And in engagement of care there’s still room for improvement,” Mera said. “I would really like to eliminate hepatitis C from Cherokee Nation. That would be my goal.”
11/24/2017 02:00 PM
TAHLEQUAH, Okla. – During the Nov. 13 Health Committee meeting, Secretary of State Chuck Hoskin Jr. said Health Services Executive Director Connie Davis had resigned and was being replaced in the interim by Dr. Charles Grim. Davis, whose career experience spans over 28 years in the health field, began her career at W.W. Hastings Hospital in 1988. In 2004, she joined Tahlequah City Hospital as vice president of patient care and chief nursing officer until she became the Cherokee Nation’s Health Services executive director in 2012. “She is going to devote some more time to her family, particularly her mother,” Hoskin said. “We certainly appreciate her service. Dr. Grim has been named interim executive director of Health, effective immediately.” Grim, a CN citizen, is a retired assistant Surgeon General and rear admiral in the Commissioned Corps of the U.S. Public Health Services. During his career, Grim has received honors and awards, including a Lifetime Achievement Award from the Oklahoma Area Indian Health Service, Health Leader of the Year from Commissioned Officers Association of U.S. Public Health Service, Community Leadership Award from the CN as well as multiple U.S. Public Health Service medals and citations, including the U.S. Surgeon General’s Exemplary Service Medallion. Since 2013, Grim has served as Health Services deputy director, in which he was second in charge of Hastings Hospital, eight outpatient health centers, Emergency Medical Services, finance and billing services, facilities management, the Jack Brown Youth Regional Treatment Center and a host of public health and community health services and programs. Prior to that, Grim served as Health Services senior director of for more than three years. Preceding his CN employment, Grim spent 26 years working for Indian Health Services in numerous clinical, administrative and executive leadership positions. In 2002, President George W. Bush appointed him as director of IHS with a unanimous Senate confirmation. During that time he administered a nationwide multi-billion dollar health care delivery program, with 12 administrative regional offices and over 16,000 employees. Grim holds a bachelor’s degree in microbiology from the University of Oklahoma, a doctorate of dental surgery from the University of Oklahoma College of Dentistry and a master’s degree in health services administration from the University of Michigan School of Public Health. “When I retired from the Indian Health Service and got hired to work for the Cherokee Nation it was pretty incredible for me. It’s a dream come true. I thought I might go the rest of my career and never get to work here. I’ve learned a lot over the years, both educationally and experientially and the thought that I have got to apply a lot of that here for my tribe and my citizens and my people has really meant a lot,” he said during the Health Committee meeting. Grim also thanked Davis for her time as Health Services executive director. “We have one of the biggest tribal health systems in the country, one of the largest populations to serve in the country, and she did a very, very good job of trying to stay on top of all the issues that were thrown at us on a daily basis. She had a good team of people around her, many of those sitting behind me but some of them you never see. You see some of them in your clinic when you’re going around, but I just wanted to thank her publically…” he said. Grim will serve as interim director until an executive director is named. “We always want to fill positions parentally, and the resignation was just tendered so naturally our first move was to name an interim, and we could not have a more capable interim than Dr. Grim. As the days and weeks pass we will be looking at a permanent person to fill that position, but we have all the confidence in the world in Dr. Grim,” Hoskin said.
11/15/2017 04:00 PM
CLAREMORE, Okla. – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair on Dec. 7 in the hospital’s Conference Room 1. Hospital officials said the fair is set for 10 a.m. to 2 p.m. to assist their Native American veteran patients in applying for eligibility for health care services through the VA. “We will have Claremore Indian Hospital benefit coordinators and representatives from the VA and Disabled American Veterans to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.” If already enrolled, call 918-342-6240 or 918-342-6559 so a hospital official can update your file.
11/13/2017 12:00 PM
TAHLEQUAH, Okla. – According to a Cherokee Nation Communications release, the tribe’s Health Services has screened more than 40,000 tribal citizens for hepatitis C after becoming the first tribe in the country to launch an elimination project two years ago with the U.S. Centers for Disease Control and Prevention. Principal Chief Bill John Baker declared Oct. 30 as Hepatitis C Awareness Day in the CN as tribal and Health Services officials gathered for a proclamation signing ceremony. The release states the tribe’s goal is to screen 80,000 patients between age 20 and 65 for hepatitis C during a three-year period. In October 2016, the tribe had screened 23,000 patients. “When this program started in 2015, we had high hopes for what it would mean for the long-term health of Cherokee Nation citizens,” Baker said. “The positive results have been beyond even our highest expectations. We have treated and cured more than 680 people with a 90 percent success rate. That success is allowing people once afflicted with the hepatitis C virus to live healthier and happier lives. The Cherokee Nation Health Services staff has collaborated with international infectious-disease experts to create and sustain this modern health care blueprint. It’s not often a disease can be completely eliminated from a citizenry, but it’s something we are achieving in the Cherokee Nation with our hepatitis C efforts.” Of those screened, about 1,200 patients tested positive and more than 680 patients are either currently being treated for hepatitis C or have been cured. “The Cherokee Nation is demonstrating to other communities across the United States how to effectively test and treat those living with hepatitis C and prevent new infections, so that someday the threat of hepatitis C will be eliminated,” Dr. John Ward, director of CDC’s Division of Viral Hepatitis, said. Hepatitis C is a liver infection caused by the hepatitis C virus, usually through the transfer of blood. Most people become infected with the hepatitis C virus by sharing needles, through unlicensed tattooing or because they had a blood transfusion before 1992. For some people, hepatitis C is a short-term illness, but for about 70 percent of people who become infected, it becomes a long-term, chronic infection, according to the CDC. Dr. Jorge Mera, Health Services’ Infectious Disease director, said the project continues to gain momentum with his office looking more at prevention of hepatitis C and the potential increase from the opioid crisis happening throughout the United States. “Our efforts now need to be directed at preventing hepatitis C, which in the United States today is driven by injected drug use,” Mera said. “Prevention strategies include expanding our medication-assisted treatment program for opioid addiction. We are also beginning a serious discussion about needle- and syringe-exchange programs.” Health Services has partnered with the CDC and the Oklahoma Department of Health to track and share knowledge. For more information about the elimination project or to get screened, visit <a href="" target="_blank"></a>.