Facts you need to know about HIV

By Dr. Yvette Lu.

Today is World AIDS Day.

36.9 million people have HIV worldwide.

About 75,000 people had HIV in Canada at the end of 2014.

About 21% of HIV positive people in Canada are unaware that they have HIV. That’s about 16,200 people in Canada who DO NOT KNOW that they have HIV.

It is estimated that 7 Canadians are infected with HIV every day.

HIV is a virus that attacks the immune system. Without treatment, HIV wears down the immune system to the point where it can no longer fight infections and cancer. When this happens, we say that a person has AIDS. Not everyone who has HIV will develop AIDS.

With the treatment we have today, HIV is a chronic illness and with early and regular treatment, people with HIV may not develop AIDS and can expect to live into their early 70s.

The key to living a healthy life with HIV is early diagnosis and early treatment, so get tested! It’s better to know. Then you can get treatment.

More details on HIV testing in our 4 minute video. Check it out!

 

 

More information on HIV Prevention:

  • Most of HIV in Canada is spread through unprotected sexual contact
  • You can NOT get HIV from casual contact like shaking hands, hugging, or sharing dishes/drinking glasses
  • Some ways to reduce your risk of exposure to HIV:
    • Choose less risky sexual behaviours
    • Use protection consistently and correctly (condoms)
    • Reduce exposure by having fewer sexual partners
    • Get tested regularly for sexually transmitted infections including HIV
    • Ask your partner to get tested before sexual contact
  • If you have ongoing high risk of exposure to HIV, there are medications that you can take to lower transmission rates. This is called pre-exposure prophylaxis. The medications help keep the virus from taking hold in the body, but must be taken regularly to work. (Note: This is not currently funded in British Columbia, but may be funded by private medical insurance.)
  • If you think you have been exposed to HIV, there are medications that can help prevent your body from becoming infected with the virus. This is called post-exposure prophylaxis. You need to see the doctor as soon as possible after the exposure (within 3 days), and take the medications daily for a month for the medications to work properly and reduce your chance of getting HIV.

 

More information at:

AIDS.gov: U.S. Government HIV/AIDS information.

CATIE: Canadian Information about AIDS and Hepatitis C

Smart Sex Resource: a website by the BC Centre for Disease Control

BC Centre for Excellence for HIV/AIDS

 

 
How Can I Prevent HIV Transmission?

 
 

Facts about HIV in Canada

 

 

Preventive Health: Here are the tests you need to do to keep you and your family healthy.

by Dr. Yvette Lu.

 

Last week on Breakfast Television, I reviewed some of the tests that we need to do as we get older.

Here’s the video (5 min):

 

Since we had limited time on the show, here are more details about what we talked about, plus additional information on items that we didn’t have a chance to chat about during the Breakfast Television segment. Preventive health is very important. It’s probably clear to everyone why! If you catch a disease early, you have a better chance of getting it under control and preventing it from causing significant problems in your body. Here are some of the basic tests we use and discussions we have for health prevention. Some people may need additional tests that I haven’t mentioned here (for example, based on their family history), or they may need tests more frequently that what I’ve written below. This list serves only as general guideline, a gentle reminder, and a starting point for talking to your physician. Care should always be individualized to each person.

 

Kids

  • Immunizations (http://www.immunizebc.ca/vaccine-schedules).
  • Dental care.
  • Vision checks, especially in early childhood, then every 18-24 months, or more frequently if needed.
  • Hearing check, especially in early childhood.
  • Regular growth checks for height and weight gain.
  • Talk to your kids about bullying, school, friends, and their mood, particularly stress, sadness and anxiety. An estimated 1.2 million Canadian children and youth are affected by mental illness, but less than 20 per cent will receive appropriate treatment. If you detect mental illness early, you can address it and possibly prevent it from becoming a lifetime problem.
  • Consider checking Iron, especially if diet is unhealthy.
  • Consider checking Vitamin D levels, especially if you live in places that are far from the equator (eg. Canada).
  • Monitor screen time – no more than 1-2 hours per day for children aged 3-18, and none for children under the age of 2. Excessive screen time can lead to attention problems, obesity, school difficulties, sleep disorders, eating disorders, and risky behaviours. In children under the age of 2, the brain is developing rapidly and it’s best for them to interact with people, not screens.
  • Ensure your child gets regular physical activity.

 

Teens

  • Immunizations (http://www.immunizebc.ca/vaccine-schedules).
  • Regular growth checks.
  • Dental care.
  • Vision checks, every 18-24 months or more frequently if needed.
  • Communication: Stay involved in their lives. Find out what their friends are doing, what pressures they’re facing. Talk to your teens about alcohol, smoking, sex, and drugs. Be a supportive presence. Have family dinners.
  • Be aware of potential mood disorders, especially anxiety, depression, and ADHD (Attention-deficit/hyperactivity disorder). 1 out of 7 children and youth in BC are affected by mental illness (about 14%) and 50-70% of mental illness will present before the age of 18. The earlier we detect these conditions, the better the chance we have of treating them successfully.
  • Monitor screen time (as described above, aim for less than 2 hours per day) and physical activity levels.

 

Adults of all ages:

 

Women in their 20s onwards:

 

Adults in their 40s onward:

  • Most guidelines recommend diabetes screening between the ages of 40-45, or sooner if high risk. This is a blood test, and it should be repeated every 3-5 years or sooner if high risk. If sugars are in the prediabetes range, then they should be checked every year. Canadian guidelines recommend testing based on a risk calculator instead of age.

 

Women in their 40s onward:

  • Breast cancer screening: Between the ages of 40-50, mammograms are optional, and can be done up to every two years. After age 50, mammograms are recommended every 2 years until age 75. For those older than 75 years old, mammograms can be done every 2-3 years depending on health status. Mammograms are recommended yearly starting at age 40 for people with a first degree relative (mother, sister, daughter) with breast cancer. Should you start getting mammograms at age 40? For more insight, watch my 4 minute Breakfast Television chat on mammograms: “The Mammogram Controversy“.

 

Adults in their 50s onward:

  • Colon cancer screening – A stool test to check for blood every 1-2 years or a colonoscopy every 5-10 years depending on your risk level, until age 75. In British Columbia, MSP covers stool screening every 2 years for people at average risk, and a colonoscopy every 5 years for people at higher risk (one first degree relative diagnosed at younger than 60 years old, 2 first degree relatives diagnosed at any age, or a history of adenomas).
  • Heart Disease: Talk to your doctor about screening for heart disease to see if you’re at increased risk. Prevalence of heart disease increases after age 45 for men, and after age 55 for women. This involves checking your blood pressure, cholesterol, and talking to you about your risk factors. If you have symptoms and signs of heart disease, your doctor may order additional tests.

 

Men in their 50s onward:

 

Adults in their 60s onward:

  • Pneumococcal vaccine is recommended after age 65 (prevents pneumonia caused by pneumococcal bacteria). People with certain chronic diseases can get this vaccine earlier.
  • Shingles vaccine is recommended after age 60. You can get it starting at age 50, but it is most effective in people age 60-69, partly because the disease is more common in that age group. Shingles is a painful blistering rash caused by a reactivation of the chicken pox virus. It can cause post-herpetic neuralgia, a condition in which people get chronic nerve pain long after the rash has disappeared. The vaccine reduces the risk of getting shingles by 50%, and reduces the risk of post-herpetic neuralgia by 67%. Protection lasts at least 6 years and the vaccine costs approximately $200.
  • Abdominal Aortic Aneurysm screening:  An abdominal aortic aneurysm is an enlargement of a section of the aorta, the major blood vessel that supplies blood to the body. The aorta is normally about the thickness of a garden hose. It runs from your heart through the center of your chest and abdomen. Since the aorta is the body’s main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Screening is recommended in males aged 65-75, especially smokers or previous smokers, or people with a positive family history of Abdominal Aortic Aneurysm. Canadian guidelines recommend screening men aged 65-75 regardless of smoking status. For women, the screening decision is based on risk factors (history of smoking, cerebrovascular disease, and family history).
  • Osteoporosis screening: Osteoporosis is a bone disease which causes bones to become weak and brittle, leading to an increased risk of fractures after age 65. Screening should start at age 65 with a Bone Mineral Density exam, or sooner if you are at increased risk according to risk calculators.

 

Adults in their 70s onward:

 

Adults in their 80s onward:

  • Watch for memory loss.
  • Social issues:  living situation, coping at home, social support, social isolation.
  • Mental illness can be common in the elderly and often presents with physical symptoms like fatigue instead of depressed mood.

 

Websites:

http://www.screeningbc.ca

http://canadiantaskforce.ca/

http://www.uspreventiveservicestaskforce.org/

http://www.aafp.org/patient-care/clinical-recommendations/cps.html

http://healthlinkbc.ca

 

 

The NHL has the Mumps. What are Mumps anyway?

by Dr. Yvette Lu.

Mumps.

We’ve all heard of mumps, but most of us don’t really know what they are. They sound like things that creep out from under your bed, or maybe something green and globby that grows on food you’ve left too long in the fridge.

Most of us were also blissfully unaware that we could get the mumps…

That all changed when our Hockey Canada poster boy Sidney Crosby’s test came back positive for the disease last week.

I talked about the mumps with Breakfast Television’s Jody Vance this week. While we covered the main points, we didn’t have time to get into the details of who needs to be vaccinated and why. So let’s do that now.


First, here’s the video: (it’s about 3.5 minutes long)



What are mumps?

Mumps is a contagious disease caused by the mumps virus. Like I said in the video, for most people it starts off like other viruses: fever, headache, muscle aches, tiredness, loss of appetite. Then, within about 48 hours, 95% of people who get those initial symptoms will get parotitis — swelling of the parotid gland in their face — and the swelling can last up to 10 days.

You may have seen some photos online… like this one:

Sidney Crosby
Source: http://www.cbc.ca/sports/hockey/nhl/sidney-crosby-diagnosed-with-mumps-1.2872807


Why do we care about the mumps?
(other than not wanting a swollen face)

Most people with mumps do recover fully, but some people can have serious complications, and that’s why we recommend that everyone follow the vaccination guidelines for mumps.

Complications include:

  • Viral meningitis (inflammation of the lining of the brain and spinal cord) and encephalitis (inflammation of the brain), especially in young children.
  • Transient or permanent hearing loss in 0.5-5/100,000 cases.
  • Orchitis in 20-30% of post-pubertal (i.e. adult) males. Orchitis is inflammation of testicles and results in severe testicular pain and swelling. Long term complications of orchitis can include testicular atrophy (shrinkage) in up to 30-50%, and impaired fertility in approximately 13% of men.
  • Mastitis (inflammation of the breast) in up to 31%, and oophoritis (inflammation of the ovaries) in 5-7% of post-pubertal (adult) women.
  • Sterility in both males and females if both testicles or ovaries are affected (rare).
  • Increased risk of miscarriage for women in early pregnancy.
  • Injury to organ systems, eg. thyroid, heart, kidney, joints, pancreas (rare).



How is Mumps spread?

Mumps is very contagious. The incubation period (the time from when you contact the virus to when you start showing symptoms) is an average of 16-18 days, and you can be contagious before you start showing symptoms! 15-20% of people have mumps and never show symptoms but can still pass the disease to others!

Remember Ebola? R0 looks at how easily a disease is spread from one person to another. One person with Ebola will spread the disease to, on average, two people. One person with mumps will spread it to an average of ten people in a susceptible population!

Source: http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola


Of course, Ebola is a lot more deadly than mumps, but as we saw above, mumps can still cause serious complications.

A few months ago, there were a lot of questions about whether or not Ebola is spread by airborne transmission. Ebola is not airborne. Mumps, however, is airborne, and can spread through the air on respiratory droplets that can float and infect someone some distance away if they breathe in the particles. Mumps can also be spread by direct contact with secretions from the mouth and nose (kissing, sharing drinks) and by touching objects contaminated with the virus, and then touching your mouth or nose.

So…

  • Wash your hands
  • Don’t touch your face, mouth, or nose with unwashed hands
  • Don’t share food and drinks, particularly not with someone who is sick
  • Don’t kiss anyone who is sick!
  • Clean surfaces frequently, especially if someone in the vicinity is sick
  • Get vaccinated!



Who needs the mumps vaccine?

Most people born in Canada before 1970 were exposed to mumps as a child and have natural immunity to the disease. Most people born after 1970 have had at least one dose of the vaccine. (Note: The US guidelines use a cutoff date of 1956 instead of 1970.)

Check your immunization records to make sure you’ve had at least one dose of the vaccine if you’re born after 1970!!

On your vaccine record, it may appear as “MMR” or “MMRV”. It might also appear as “Mumpsvax”, “Priorix”, “Priorix-Tetra”, or “MMR II”. If you’re not sure, bring it in to your doctor and ask them.

The mumps vaccine is good but it is not 100% effective. It’s about 62-91% effective if you get one dose, and about 76-95% effective if you get two doses. As a result, people at high risk of getting the mumps need TWO doses of the mumps vaccine.

High risk groups include:

  • Children
  • People in secondary and post-secondary educational institutions
  • Military personnel
  • Travellers to outside North America
  • Health Care Workers

If you fall in one of those groups, make sure you’ve had TWO doses of the mumps vaccine.

The mumps vaccine is combined with the measles and rubella vaccines in the MMR immunization. You can also get the mumps vaccine in MMRV – a 4 in 1 vaccine which gives you protection against MMR and Varicella (chicken pox). The mumps vaccine is no longer available on its own. Don’t get the vaccine if you’re pregnant. If you’re immunocompromised, talk to your doctor before getting the vaccine.

Note: All people born after 1970 need two doses of the measles vaccine, so while you’re checking your immunization record for mumps, check it for two doses of measles vaccine as well! All people born in British Columbia after 1996 should have had two doses of MMR if they received their routine childhood immunizations.

Is the MMR Vaccine safe?

A quick note about the MMR vaccine. It DOES NOT cause autism. Multiple studies have shown NO CORRELATION between MMR and autism. If you look on the internet, you will find people claiming that it does, and they are basing their beliefs on a study that has been retracted from the medical literature and shown to be false. The author falsified data and did not follow ethical scientific procedures, and has had his medical license taken away. More on MMR vaccine safety here: http://www.cdc.gov/vaccinesafety/vaccines/mmr/mmr.html

The key to remember is that vaccines are MUCH SAFER than the diseases they prevent. Do you remember all those complications that I listed at the beginning of this post? The reason why we recommend the mumps vaccine is to prevent all those bad things from happening. Those are all real risks, and the chance of them happening is much higher than the chance of getting a major adverse effect from the vaccine.

And the mumps vaccine works. Mumps cases have decreased by more than 99% since the approval of the vaccine in Canada in 1969, from 34,000 cases per year to less than 400 cases per year in the 1990s, to 28 cases in 2003. Since then, there have been a few outbreaks (usually in non-immunized religious communities or on college campuses), but overall, the numbers have remained low. However, since the vaccine is not 100% effective, it’s important for as many people as possible to get immunized so that we can build up herd immunity.

What is herd immunity?

Imagine herd animals huddling in a ring around their young to protect them. They form a barrier so that their young are safe from enemies. In the same way, when most people are immunized, they can fight off the virus and are less likely to spread it. The disease tries to attack them but can’t because these immunized people already have antibodies. The antibodies are like soldiers that fight off the virus and protect the body. In this way, the immunized people create herd immunity, a barrier to prevent disease from spreading to the most vulnerable in our population.

What happens after I get vaccinated?

After you get the vaccine, most people will have antibodies in their blood by 5 weeks after immunization. Most people will be protected with these antibodies, but since the vaccine is not 100% effective, not everyone will be immune. However, even if you catch mumps after vaccination, being vaccinated will help you get rid of the virus faster from your body and will reduce your risk of getting those nasty complications. Neither catching the “wild” mumps virus naturally nor getting the vaccine will guarantee lifetime immunity. However, most people who have caught the disease or who have had two doses of the vaccine will be protected long-term.

What do I do if I think I have mumps?

Treatment for the mumps is supportive. Rest, drink your fluids, and take acetaminophen (Tylenol) or ibuprofen (Advil) if needed. Since it’s a virus, antibiotics will not work. Antibiotics work only on bacteria, not on viruses. If you’re worried you have mumps and are going to see your doctor, call your doctor first to warn them. They will likely have you visit at the end of the day or put you in a separate waiting area so that you do not accidentally infect others. Mumps is so contagious that the government keeps close track of cases to prevent and control outbreaks.

Stay home when you’re sick, so you don’t infect others. You are contagious from a few days before you show symptoms to 5 to 9 days after you start feeling sick. Wash your hands and cough into the crook of your elbow. In particular, stay away from babies, pregnant women, and people who are immunocompromised. These people may not have immunity to the mumps, and/or are at higher risk of complications from the mumps.

Remember! Make sure you’re vaccinated!! Go check… now! And tell your family and friends to check their immunization records as well. Share this and other vaccination information with them. We need to build our herd immunity so that we can all stay safe from preventable diseases.




More information:

US Center for Disease Control: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html
BC Center for Disease Control:
The basics: http://www.bccdc.ca/dis-cond/a-z/_m/Mumps/default.htm
Technical document: http://www.bccdc.ca/NR/rdonlyres/8D7495ED-B903-4B6D-B168-9364660D2001/0/MumpsSeptember2014.pdf
BC vaccination schedules: http://immunizebc.ca/vaccine-schedules
Health Canada: http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-mump-orei-eng.php




How does the time change affect your health?

By Dr. Yvette Lu


 

“Falling back” means an extra hour of sleep and being well-rested, right?

That’s what I thought too, but when I looked it up, I found that studies actually show many people are unable to take advantage of the extra hour of sleep after the end of Daylight Savings Time!

It will take about a week for our bodies to readjust to standard time!

Studies show that people have disrupted sleep, decreased sleep efficiency, and less sleep overall for the first week after the time change. Short sleepers, poor sleepers, those who are sleep deprived, and early risers tend to be most affected. If you find yourself sleeping in for the extra hour Sunday and Monday morning, it may be a sign that you are sleep deprived!

Interestingly, studies on the switch to Daylight Savings Time in the Spring have shown increased numbers of car accidents, workplace injuries, suicides, and heart attacks, and decreased work productivity on the Monday after the switch. For the switch back to Standard Time in the Fall, one study showed an increase in car accidents the Sunday night (tonight!) and another showed a decrease in heart attacks on the Monday morning.


 
How to adapt to the time change:


  • Get more rest – take a short nap if needed
  • Parents with young children may want to adjust their children’s bedtimes gradually 10-15 minutes each day to make it easier on them.
  • Circadian rhythms are affected by light — be around light during the day and turn down lights in the evening
  • No lighted screens (ipads, iphones, ipods, computers) a few hours before bed. Lighted screens activate the awake centers in your brain!
  • Exercise during the day
  • Sleep and wake at the same time every day
  • Avoid caffeine after early afternoon
  • Have a bedtime routine
  • Other tips to improve sleep hygiene: http://www.anxietybc.com/sites/default/files/SleepHygiene.pdf

Also, with the evening coming earlier, be careful on the roads! Pedestrians will be harder to see during rush hour.

With the cold coming, here are some other things to watch out for:

  • Seasonal affective disorder: moodiness or depression that is caused by change in the season and lower light levels. See your doctor if you think you may be affected. You may want to try light therapy.
  • Vitamin D levels: We don’t get enough Vitamin D in the winter in Canada, so take your D3 supplements or get more in food. Food sources of Vitamin D include milk products, fortified products, egg yolk, and oily fish.
    More info: http://www.healthlinkbc.ca/healthfiles/hfile68e.stm


 
Read more about health effects of time changes at: http://www.ncbi.nlm.nih.gov/pubmed/23477947

 

===
Dr Yvette Lu
twitter: @yvettelu

 

Ebola: infectious versus contagious. (plus some info on airborne transmission)

By Dr. Yvette Lu

 

Recently, I talked on Breakfast Television about some of the basics of the Ebola Virus and why you are highly unlikely to get Ebola here in North America (or in any developed country).


 

Here’s the video:

Video link: http://youtu.be/63eoo_Fhbsc?list=PLzxx5hDVqT3u0N5QAIEGCO9MK9y9CIeK_


 

I didn’t have time to get into the concepts of infectious versus contagious.

There has been a lot of confusion about this on the internet and in the media. To understand Ebola and its transmission, it’s important to understand the difference between the concepts of infectious and contagious.

Ebola is very infectious. It is NOT very contagious. What?! Aren’t they the same??


 
No!!

 

How infectious a virus (or bacteria or other disease causing pathogen) is describes how many particles it needs to cause disease.

Ebola is very infectious. As few as 1-10 particles of Ebola entering through a mucous membrane (like the inside of your eye or nose) can give you the disease.

Contrast this to some strains of Salmonella and E. coli, which require thousands of organisms to establish an infection in humans.

How contagious a virus is describes how easily it spreads from person to person.

Ebola is NOT very contagious. On average, one patient with Ebola will spread it to two other people. Transmission of Ebola requires direct contact with blood and body fluids. It is NOT spread by airborne transmission.

Measles is 9 times more contagious than Ebola. One person with measles on average spreads it to 18 people if the population is not immunized. Measles is much more contagious because it can aerosolize and travel through the air on dust particles for long distances (airborne transmission). The complication rate of measles is 1/1000 for encephalitis (inflammation of the brain) and the chance of dying of measles is about 1/3000. You can see now why public health officials and doctors get so anxious when people don’t immunize their children. Measles can spread very rapidly in a vulnerable community and cause a lot of trouble.

Scientists have been studying Ebola since 1976, and there have been over 20 outbreaks in the past 40 years. They have done studies of household contacts of people with Ebola, as well as studies looking at transmission to health care providers. All the studies have shown that although Ebola is infectious, it is not very contagious.

Ebola, because it requires direct contact with blood and body fluids, is difficult to pass from person to person, but because it is infectious, it doesn’t take very much fluid to pass it on, which is how the nurses (who were working with the body fluids – urine, vomit, diarrhea – of a person with Ebola) caught it. Because Ebola is not easily spread by casual contact, household contacts of Thomas Duncan (the Ebola patient) including his girlfriend, son, and two people who lived with him, did not get Ebola. People do not normally touch others’ body fluids. Plus, there is some question about whether or not the nurses were adequately protected early on during the treatment of Mr Duncan (their necks were initially exposed or they may have used the isolation gear incorrectly).


 

This is a great chart here that shows the contagious concept graphically:

Source: http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola


 

Also, we should remember that although we need to be vigilant about and wary of Ebola, HIV/AIDS is still, by far, the leading cause of death in Africa. This is an excellent chart and analysis in this article that explains this (myth number 6):

Source: http://www.vox.com/2014/10/1/6880393/ebola-virus-outbreak-disease-myths-facts-debunked-america


 

Finally, for those still wondering if Ebola will mutate to become airborne, the answer is no. It’s not impossible, of course, but it is highly unlikely. In all our time studying viruses, we have never observed a virus to change its mode of transmission. It’s too fundamental to its way of life. As quoted in this New Yorker article (http://www.newyorker.com/magazine/2014/10/27/ebola-wars), it’s like asking if Zebras will fly. Not impossible, but highly unlikely. A better question to ask is if Ebola can mutate to become better at what it does, sort of like asking if Zebras can change to run faster. For Ebola, this could involve becoming more virulent (replicating faster) or finding a way to hide from our diagnostic tests.

For now, the best thing for everyone to do is to educate themselves about the science, calm the fear, and get the flu vaccine… because flu-related complications cause an average of 23,000 deaths in the US and 3500 deaths in Canada each year. Hmmm… now how many deaths has Ebola caused in North America so far?


 

One.


 

More info about Ebola can be found here:
http://www.who.int/ebola
www.cdc.gov/ebola/


 
===
Dr Yvette Lu
twitter: @yvettelu