estIt’s almost World Lung Cancer Day, so listen up, West Virginians! 

For so many of us, we live in a culture clouded with cigarette smoke. Our parents smoked, their parents smoked and even now that we know how deadly it can be, smoking is still a big problem in our state.

And with World Lung Cancer Day approaching on Aug. 1, it’s important that we know the facts. 

Last year, the United Health Foundation listed West Virginia as the least healthy state in the U.S. when it comes to tobacco use. In West Virginia, 23.8% of residents reported smoking at least 100 cigarettes in their lifetime and currently smoke daily. The national average is 15.9%. These numbers are lower than past years, and smoking rates are slowly decreasing, but West Virginia still has some work to do.

There are a lot of factors that affect West Virginia’s high rate of smoking. One of them is poverty. Generally, those with an annual household income of $25,000 or less are more likely to smoke cigarettes than those with an annual household income of $75,000 or higher. With West Virginia being one of the country’s most impoverished states, it becomes much more likely that people here may smoke.

Even those affected by secondhand smoke are at risk. Secondhand smoke, which is the combination of smoke from the burning end of a cigarette and smoke breathed out by smokers, contains more than 7,000 chemicals and can still cause cancer. According to the Centers for Disease Control and Prevention, 2.4 million non-smoking adults since 1964 have died from secondhand smoke. Sadly, many of those affected by secondhand smoke are young children and teens living in a household with a smoking family member. 

While teens affected by secondhand smoke do not make the choice to be exposed, teens are also fighting the risks of smoking themselves. In 2019, 13.5% of high school students in West Virginia reported smoking cigarettes, compared to the national rate of 6%. 

Lately, though, if you walk past a group of teenagers or a high school party, you are much more likely to see clouds of sweet-smelling vapor than smoke. While the number of cigarette-using high schoolers in West Virginia is high, more high school students report using e-cigarettes or vapes. Last year, 19.6% of high schoolers vaped regularly.

There is not a lot of research done on vaping, and since it is a fairly new practice, we likely won’t see the effects for years to come. Still, studies have shown correlations between vaping and contracting lung cancer later in life. Research has also shown vaping leads to a greater likelihood of smoking cigarettes in the future. 

Not only that, but in August 2019, hospitals began reporting a surge of lung illnesses in vape users, including some in their teens and 20s. As of February 2020, there were a total of 2,807 hospitalizations or deaths reported by the CDC from all 50 states, the District of Columbia, and Puerto Rico and the U.S. Virgin Islands. Sixty-eight of those were deaths that took place in 29 states and D.C.

The best way to avoid lung cancer is to avoid tobacco and vaping. Tobacco use is not only the leading cause of lung cancer, but also damages nearly every organ, weakens the immune system and leads to stroke, heart disease, respiratory disease and diabetes. 

It’s difficult to quit smoking or vaping, as most people become dependent on the addictive drug nicotine found in tobacco and vapes. While it takes time and effort to quit smoking, there are plenty of benefits. Quitting smoking increases your quality of life and life expectancy and lowers your risk for virtually every disease. Even if you’ve smoked for many years, you will still benefit from quitting. 

The best course of action is a combination of medication and counseling. The West Virginia Tobacco Quitline is a program for those who want to quit using tobacco, and is available free or low-cost, depending on your insurance. Participants can sign up online to receive calls with coaches to assist in quitting. The calls are free, and smokers are twice as likely to quit smoking when they have a coach.

The program also offers an eight-week supply of nicotine patches, lozenges or gum. Just call 1-800-QUIT-NOW to get started with the West Virginia Tobacco Quitline.

While quitting might feel impossible, millions of people have been successful in quitting smoking for good. Why not make some strides towards a healthier life today?

It’s time to talk about that alphabet soup of viruses, hepatitis. 

After all, there are five types of hepatitis, an inflammation of the liver — A, B, C, D and E.
Today happens to be World Hepatitis Day, but that is not the reason for the notoriety. 
Hepatitis has been creeping — and in some instances, exploding — into the news in the past few years. 

First it was hepatitis C. Anyone born between 1945 and 1965 should automatically be tested for Hep C. Of the estimated 3.2 million people chronically infected with hepatitis C in the U.S., approximately 75 percent were born during that time frame.

Hepatitis B also has been on the rise in West Virginia. The number of Hep B cases in West Virginia nearly doubled between 2011 and 2015, going from 1,232 to 2,436. It might seem like a small number, but West Virginia has the highest instance per capita of hepatitis B in the nation, as well as the highest rate of hepatitis C.

And West Virginia was part of a nationwide hepatitis A outbreak that began with unsheltered individuals in San Diego and reached the Mountain State in March 2018. The outbreak was determined to be over by Aug. 24, 2020, by which time 2,732 cases had been reported to the state Office of Epidemiology and Prevention Services, part of the West Virginia Department of Health and Human Resources. 

It included an outbreak that took place at a fast-food restaurant in Morgantown in October 2019 that required Monongalia County Health Department to reach out to customers who had been there during a certain time frame to offer them a hepatitis A vaccine. 

Because there are three primary types of hepatitis, an inflammation of the liver, they can be difficult to tell apart. Some of these infections — hepatitis A, B and C — are caused by a virus. Here is a breakdown:

• Hepatitis A travels via the oral-fecal route, i.e., from eating food or drinking water that has been contaminated. It has an acute stage and can be resolved, although it also can require hospitalization and cause death. If infected children contaminate their fingers and then touch an object, other children who touch that object and then put their fingers in their mouths can become infected. Same goes for restaurant employees who do not wash their hands thoroughly after using the restroom. There is no cure but there is a vaccine. In 2018, according to the Centers for Disease Control Prevention, 12,474 new cases were reported and increased 850% between 2014 and 2018. 

• Hepatitis B is more likely to be transmitted sexually or through the sharing of needles. The opioid crisis has contributed to the rise in Hep B. According to the CDC, 3,322 new hepatitis B cases were diagnosed in 2018. Like hepatitis A, there is no cure but there is a vaccine. Incidence in children is low because of childhood vaccinations. More than half of the cases occurred in individuals ages 30-49 years. 

• Hepatitis C is blood-borne, so it can be contracted by sharing needles or also from getting an organ transplant, blood transfusion or blood products before July 1992. In 2018, there were 3,621 new cases reported, largely among individuals 20-39 years old, which is consistent with those impacted by the opioid crisis. There is a cure, albeit an expensive one, but no vaccine to prevent it.

Symptoms of hepatitis A, B and C can all include jaundice, or a yellowing of the skin or eyes; fever, loss of appetite, nausea, vomiting; abdominal pain; gray-colored bowel movements and dark urine. 

With hepatitis A and B, prevention includes getting vaccinated (either individual vaccines for each one or Twinrix, which protects against both), as well as avoiding behaviors that can lead to the viruses. 

For hepatitis A, this includes thorough hand-washing after going to the bathroom and before cooking and eating food. For hepatitis B, this includes not sharing needles and razors and avoiding sex with an infected person. 

Because there is no vaccine to prevent hepatitis C, avoiding behavior that leads to this virus and getting tested are your best defenses.

Hepatitis D and hepatitis E are very rare and someone must have hepatitis B in order to develop hep D and hep E. And while it is rare, hep E is especially virulent for pregnant women.

In addition to getting the vaccine, another way to avoid hepatitis A is good hand hygiene. It is recommended to wash hands thoroughly with soap and water for 30 seconds --
about the time it takes to sing the “Happy Birthday” song twice — after using the bathroom and before eating or preparing food.

MCHD Clinical Services offers free testing for hepatitis B and C as well as vaccines for B and C: either individually or as the dual vaccine. Call 304-598-5119 to make an appointment.

Returning to school this fall should look a lot different than last year.

Schools are due to be open and thanks to the variety of COVID-19 vaccines available, including Pfizer’s that has been approved for ages 12 and up, that’s going to be safer than in-person classes were last year.

But parents also should remember that their children need to get other vaccines in order to be healthy, keep their fellow students safe and comply with West Virginia law.

Children still need to be protected against vaccine-preventable diseases such as measles, chickenpox, pertussis and diphtheria. 

August is National Immunization Awareness Month. As has become strikingly clear during the past 17 months, vaccines are a vital tool in the public health toolbox. 

Diseases such as polio and smallpox have been eliminated in the United States, and a resurgence of measles outbreaks a couple of years ago illustrated what can happen when individuals let down their guard when it comes to inoculations.

And, of course, the COVID-19 pandemic is a great example of how cases and deaths lowered dramatically once vaccines ramped up — and also how once a new and dangerous variant popped up, those who remain unvaccinated became the ones suffering the most.

The Centers for Disease Control and Prevention has information on vaccines needed at every stage of life, including children, teens, adults, pregnant women and travelers. 

Because it’s time for students to get their back-to-school vaccines, we’re focusing on kids who are around ages 5 through early adulthood. 

Here are just a couple of examples why vaccines are important. 

It seems like a long time ago, but let’s not forget that in October 2019, there was concern about a case of hepatitis A in a food worker at an area restaurant. Monongalia County Health Department worked to vaccinate individuals who had eaten there during a certain window of time.

And again, there’s the measles. Previously considered eliminated in the United States since 2000, a 2019 outbreak resulted in 1,282 cases in the United States in 2019. The CDC reported 13 cases in 2020 and two so far in 2021. Because of West Virginia’s strict vaccination laws, none of these cases took place in West Virginia. 

The CDC offers an easy-to-read guide on vaccinations that babies should receive from infanthood to the age of 6. These are the mandated vaccines that the state of West Virginia requires students to get in order to attend public school. 
 
For children who have been vaccinated according to the current schedule, here is a list provided by the CDC of recommended vaccines for students between the ages of 7 and 18:

• All preteens and teens need a flu vaccine every year. Some children 6 months through 8 years of age require two doses of flu vaccine. Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine, should get two doses of vaccine this season. The first dose should be taken as soon as the flu vaccine is available, and the second dose should be received at least 28 days after the first dose. In following years, only one dose is needed. Flu vaccines are always important, but vitally so now.

In addition to an annual flu vaccine, three vaccines are recommended specifically for preteens: 

• HPV vaccine protects against HPV infections that can cause cancer later in life, including that of the cervix, for which women can be routinely screened, as well as mouth/throat, anus/rectum, penis, vagina or vulva, for which people are not routinely screened. 

• Tdap is a booster shot to help protect preteens from whooping cough, tetanus and diphtheria. Tdap not only protects the child from these diseases, but also keeps them from giving whooping cough to a young baby who does not have immunity yet.

• Meningococcal conjugate vaccine protects against meningitis and bloodstream infections (bacteremia or septicemia). These illnesses can be very serious, even fatal.
MCHD Clinical Services has made some changes in order to be as safe as possible during the pandemic. Forms are sent online the day prior to the appointment, and when you arrive, you can call from your phone to alert us that you’re here. You will be registered and payment will be taken over the phone. Then your temperature will be taken at the entrance. Patients should go to the upper level to the front door. 

If you haven’t gotten your child vaccinated yet, there is still time. Call your health care provider. Or make an appointment at Monongalia County Health Department’s Clinical Services at 304-598-5119. 

Dr. Mark E. Rogers has recently seen two, three or even four cases of Lyme disease daily at WVU Urgent Care at Suncrest Towne Centre, one indication that the tick-borne illness is on the rise in Monongalia County.

“This year, it’s really taken off,” Dr. Rogers said. “We’re seeing multiple cases every day.”

In fact, the entire county is diagnosing an average of one COVID-19 case a day, and he personally hasn’t seen one since about mid-June. So when a patient comes in complaining of a low grade fever, malaise, fatigue and joint pain, his first thought is often Lyme disease — an illness caused by the bite of a blacklegged “deer” tick — rather than COVID-19.

“Some of the people, we still test for COVID, but I’m telling my patients that the big thing to watch out for is Lyme disease right now,” Dr. Rogers said.

Cindy Graham, RN, a Monongalia County Health Department nurse who helps with Lyme disease investigation, said she started seeing bloodwork-confirmed reports of the illness in mid-June. “It really went crazy,” she said. 

Lyme is a reportable disease, so medical practitioners who diagnose it via bloodwork or with a bull’s-eye rash at the site of the tick bite must send the report to the health department. The bull’s-eye rash, also known as erythema migrans (EMs), is a symptom that sets a Lyme disease diagnosis apart from COVID-19 and other illnesses. 

The bull’s-eye rash is left by the tick feasting on the host’s blood, during which disease transmission can occur. The Centers for Disease Control and Prevention estimates that the tick must feed on the host’s blood for between 36 to 48 hours before the tick transmits the disease.

Graham follows up with the reporting practitioner on all cases as well as patients who have  positive bloodwork and/or the rash.

“If the patient has that bull’s-eye rash, I call the patient and ask where they’ve been, does anybody else have it, if they found a tick,” Graham said. “It seems like there have been more people with EMs this time than last year.”

But if a practitioner diagnoses Lyme based solely on symptoms minus the bull’s-eye rash, then that case would not be reported to the health department, which means that confirmed cases figures are actually probably low.

This rise in Lyme disease has received news coverage from WBOY in Clarksburg and WCHS in Charleston. 

The Mountain State is one of 15 states, plus the District of Columbia, listed by the CDC as having a high incidence of Lyme disease. Nearby Pennsylvania topped the 2019 data, with 6,763 confirmed cases and 2,235 probable cases. West Virginia’s numbers were lower, at 703 confirmed and 182 probable, although this data is two years old.

The West Virginia Department of Health and Human Resources’ (DHHR) Zoonotic Disease Group provided updated numbers this week. However, last year’s statewide number of 1,062 Lyme cases compared to 205 so far in 2021 is misleading, according to Michael L. Abshire, a Zoonotic Disease Group research specialist.  

“The 2021 numbers look small, but they also do not show all the cases that have been reported so far, only the ones that have been investigated and are confirmed,” Abshire said.

By comparison, at this same time in 2020, the state had 243 Lyme cases, Abshire said. Dr. Diane K. Gross, MCHD’s regional epidemiologist, added that the number of Lyme cases tends to increase exponentially in late summer, and also that the COVID pandemic has probably led to late reporting of cases, which would be another reason why current confirmed numbers seem low.

Dr. Gross also noted that while the DHHR’s official Lyme number for Monongalia County is 17, she has 26 potential cases that still need to be evaluated. 

The 2020 number of 1,062 also shows an increase in statewide cases since 2017, when 648 cases were reported. The number rose to 671 in 2018 and 898 in 2019.

Both Dr. Rogers and Graham said they have seen Lyme diseases in patients of all ages. Individuals can get it while out hiking or camping, but Graham said she has heard a lot of accounts in which individuals reported getting it just working or playing in their yards.

“Generally, it’s around their home,” Graham added. “They haven’t traveled anywhere.”

Ticks can be found anywhere on the body, but common places include skin folds such as behind the knees, under armpits, around the beltline, in the groin and behind the ears, as well as on the scalp, Dr. Rogers said. 

And even though a mature deer tick has a distinguished look, with black legs and a red and black body, they might not always be so obvious.

“They can be very tiny nymphs, smaller than a poppy seed,” Dr. Rogers said. “People come in and don’t recall having a tick bite. But they have the symptoms or the rash.”

Graham said that many people never actually see the tick. Those who want to remove it, rather than wait for a health care practitioner’s help, should do so with tweezers, making sure to get a firm grip on it in order to get the head out.

“I use the same procedure that the CDC recommends,” Dr. Rogers said. “Get as close down to the skin where the mouth meets the skin and firmly grasp them and pull them up with traction. The skin is going to tent and it will pop off.”

If the head remains embedded, Dr. Rogers uses a tiny needle to flick it out like a splinter. “There are some people who think that you shouldn’t mess with it by monkeying around with it, that you are more likely to get infected,” he said. “If I can get it out, I do.”

But even though many individuals never see a tick, it’s always a good idea to look for them. The CDC (cdc.gov/ticks) provides a lot of information on tick prevention. This includes checking yourself and your pets daily when you return from outdoors.

Prevention actually starts before you step out the door. Clothes and gear can be treated with products that contain 0.5% permethrin and individuals also can use Environmental Protection Agency-registered insect repellents that contain diethyltoluamide, or DEET.

Anyone planning on spending time outdoors should also consider wearing long sleeves and/or long pants. 

In some situations, such as when multiple members of a family have been diagnosed with Lyme disease contracted while spending time in their yard, Dr. Rogers also suggests considering treating the yard with pesticides. 

Chad Carpenter, assistant director of Pesticide Programs at the West Virginia Department of Agriculture, said individuals should read and understand the pesticide label and follow all “use precautions and restrictions” before applying it.

“If there is a section for personal protective equipment, make sure this is followed,” he added.

Lyme disease is treated with the antibiotic doxycycline. Dr. Rogers prescribes a one-time dose as a prophylaxis if the patient is not experiencing any symptoms. Someone who does have symptoms would get a longer course of the medication, he said, maybe 10 to 21 days.

The bacteria that cause Lyme disease will clear up if treated properly, Dr. Rogers added. Problems can occur if Lyme disease gets into a joint or nerve, where permanent damage can result.

“One misconception is that there is this chronic Lyme disease, where people might be on antibiotics for months or years,” he said. “That’s not something we have evidence for.”

Lyme disease is found primarily in the mid-Atlantic and Northeast regions of the United States. CDC surveillance maps (cdc.gov/lyme/datasurveillance/maps-recent.html) show that more of the state’s instances of the illness have been found in northern West Virginia. 

Neither Dr. Rogers nor Ed Abbott, RN, who also investigates Lyme disease for MCHD, know for certain why Lyme disease is on the rise, although both believe weather could be a factor.

“That’s what I would like to know,” Dr. Rogers said. “I know it seems like we’ve had milder winters, but that’s hypothetical. But my guess is that we have more surviving through milder winters.”

Also, Abbott added, the COVID pandemic has prompted individuals to spend more time outdoors.

MCHD’s Threat Preparedness program conducts tick surveillance, and Abbott said that recently, more ticks have been found in shady areas. “So it could be that, because of the heat, ticks are seeking shady areas,” Abbott said, noting that humans also have the tendency to gravitate toward cooler places when they are outdoors. 

Tick surveillance was suspended last summer because of the COVID-19 pandemic, said Jamie Moore, MCHD’s Threat Preparedness program director. 

“However, we’ve resumed dragging for ticks this summer, although efforts have sometimes been hampered by rain,” he said.

Tick surveillance is conducted to learn what ticks are in the area and to send off specimens to the state lab to be tested for disease.

So far, surveillance has been done in Monongalia, Preston and Marion counties, with plans to also move into Harrison, Doddridge and Taylor counties. These are the members of the six-county Preparedness Action Coalition Team (PACT), one of the DHHR’s West Virginia Surveillance Regions.

“We plan to send Threat Preparedness staff to the Vector Biology Boot Camp in upstate New York later this year,” Moore said. “This is an event we’ve attended in the past so we can keep our knowledge of dealing with pests such as ticks and mosquitoes updated.”

It’s been nearly a year and a half since Monongalia County Health Department’s six Women, Infants, & Children’s offices have opened their doors to participants.

Luckily, like many others dealing with the pandemic, technology has come in handy so that the federal food assistance program, officially titled the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), could continue to operate. 

Food supplements funds are loaded onto an Electronic Benefit Transfer (EBT) card, and WIC already had introduced an app called Pacify that provides 24/7 breastfeeding support for mothers. And signups and counseling took place over the phone.

But breastfeeding classes, which were open to anyone, not just participants who qualify for WIC, have been shut down in all six counties in which MCHD WIC operates: Monongalia, Preston, Marion, Harrison, Doddridge and Taylor.

“And we’ve missed seeing our participants face-to-face,” said Cami Haught, MCHD WIC’s program director.

Slowly, however, that’s all going to change. Starting Aug. 1, the offices in Morgantown, Kingwood, Fairmont, Bridgeport, West Union and Grafton will re-open.

For one month, Haught said, only new participants will be visiting the offices to sign up. “And then, on Sept. 1, we will be opening 100%.”

WIC offers nutritional counseling and benefits, breastfeeding counseling and support and health screenings, immunizations and referrals, to those who qualify. 

Those who qualify for WIC are individuals who meet income guidelines and also are: 

• Pregnant women
• Women breastfeeding an infant up to the infant’s first birthday
• Postpartum women up to six months after delivery or end of pregnancy
• Infants up to their first birthday
• Children from age one until their fifth birthday

Income guidelines are updated yearly and are generous. Gross annual income for a family of one is $23,828 or under; for two, $32,227; for three, $40,626 and for four, $49,025. You can see the full list on our website.

For those who might be interested in joining when offices reopen, here’s how the initial visit will go. 

“New participants come in and bring in their pay stubs,” Haught said. “If they are on Medicaid, they will automatically qualify.”

After participants qualify, all participants — mothers and children — move on to the lab, where a technician gets a weight, height and performs a finger stick to get iron levels.  

“Then they go to see a nutritionist, and they’re going to ask them some questions about their diet and fruits and vegetables consumption, and dairy consumption and sweetened drinks, if they smoke or consume alcohol before or during the pregnancy,” Haught said.

The nutritionist will then go over the nutrition package with the participant. Foods that can be purchased with WIC benefits have been expanded in recent years and include not only fresh fruits and vegetables, beans, peanut butter and dairy and bread items, but also frozen fruits and vegetables, yogurt, and a wider selection of whole wheat grain options and breakfast cereals.

And about two years ago, Once Upon a Farm items, created by actress and West Virginia native Jennifer Garner, also made it to the WIC list. 

Finally, if the participant is or will be breastfeeding, she would meet with a breastfeeding counselor. “If they are pregnant, they talk about breastfeeding and what to expect, and if she has delivered, they can help with latching and positioning, and they can check if baby is receiving enough breast milk,” Haught said.

After that initial assessment, the participant will have an appointment every three months. Every other appointment is an online assessment, so participants generally only need to visit their local WIC office twice a year.

MCHD WIC also celebrates Breastfeeding Awareness Month, which is August. Prior to the pandemic, this was done with an annual walk and event at the WVU Erickson Alumni Center. After skipping these events in 2020 and 2021 because of the pandemic, it will be returning in 2022.

And even though WIC doesn’t reopen until Aug. 1, there will be weekly drive-through events at each office every Thursday in July. 

Last week’s event was held in Marion County. The other events will be held from 4-6 p.m. July 8, Cornerstone Community Church in Preston County; 4-6 p.m. July 15, Blueville Church of the Nazarene in Taylor County; 3-6 p.m. July 22, Clarksburg City Park for Harrison/Doddridge counties and 3-6 p.m. July 29 at the MCHD WIC office in Morgantown. 
Participants will receive a goody bag with items such as a WIC cup and a book, such as “The Very Hungry Caterpillar” or “Monsters Don’t Eat Broccoli.”

​“We just want to get people excited about being able to come to the clinic again and to let more people know that we are here,” Haught said. “We want to encourage everyone to come out and get signed up on the program if they do qualify.”