Mosquitoes That Carry Zika Could Bring Deadlier Yellow Fever This Year

By:Larry Barzewski, Sun Sentinel

The Zika scare of 2016 could morph into a yellow fever panic this year if South Florida residents let down their guard when it comes to protecting themselves from disease-carrying mosquitoes.

There hasn’t been a yellow fever outbreak in the United States in more than 100 years, but state health officials are concerned that a large outbreak in Brazil — and other outbreaks in South and Central America — could lead to infected travelers bringing the disease to South Florida, which has the right mosquitoes and climate for it to spread.

The disease is deadlier than the Zika virus. Zika raised alarms because many infected pregnant women gave birth to infants having microcephaly, a condition that causes abnormally small heads and developmental defects. Yellow fever can kill. Brazil reported 1,131 cases and 338 deaths attributable to yellow fever between July and March.

Most people infected with yellow fever will get symptoms so minor they won’t realize they have been infected. Even for those who do notice, the symptoms such as fever, chills and headaches don’t make it stand out from many other illnesses.

But for about 15 percent of the infected, the initial symptoms pass and then come back with a vengeance within a day, causing internal bleeding and jaundice — the yellowing of the skin that gives the fever its name — the failure of the liver and other organs. Of those, up to half die, usually within a week or two.

Reducing the threat

The Centers for Disease Control in March warned travelers not to go to yellow fever hotspots in Brazil unless they were vaccinated.

South Florida officials are hopeful that the stepped-up mosquito control efforts already underway here to curb Zika will help contain any potential yellow fever outbreak. Yellow fever and Zika are carried by the same Aedes aegypti mosquito, which can also transmit dengue and chikungunya.

“If yellow fever is introduced into South Florida, and I suppose it will be, you’re not going to see the same explosive outbreak we did with Zika,” said Justin Stoler, an assistant professor of geography at the University of Miamiwho has done global health research with a focus on mosquito-borne illnesses. “There hasn’t been prior exposure, but we’ve kept mosquito populations down, which is a good thing.”

Broward County began its first truck spraying of the year April 30 to kill infant mosquitoes that are expected to multiply as the region’s heavy rains increase, said Anh Ton, who oversees Broward’s mosquito control efforts.

South Florida’s rainy season runs from May 15 to Oct. 15, according to the National Weather Service. The truck spraying is designed to kill mosquito larva in standing water, as opposed to aerial spraying that targets adult mosquitoes.

The Aedes aegypti doesn’t travel far from where it is bred. The mosquito, one of more than 40 types in South Florida, gravitates to urban areas and can breed in as little as a bottle cap full of standing water. It bites during the daytime and not just at dusk and dawn, officials said.

Yellow fever and Zika

Yellow fever is a rare disease in the United States, with only one reported case between 2004 and 2016, according to the Centers for Disease Control.

Devastating outbreaks killed thousands in Philadelphia in 1793, in Memphis, Tenn., in 1878 and in New Orleans throughout the 19th century, among other places.

It wasn’t until 1900 that the Yellow Fever Commission formed by the U.S. military proved that the disease was spread by mosquitoes, which led to practices such as fumigation and the covering of open water cisterns where the mosquitoes bred. The last U.S. outbreak occurred in New Orleans in 1905.

Zika wasn’t on anyone’s radar when it struck. The CDC didn’t track Zika cases until the virus exploded on the scene in 2016. Infections spiked in Miami-Dade’s Wynwood neighborhood, which caused the CDC to issue a travel warning for a U.S. city for the first time ever.

Most of the reported Zika cases came from travel abroad, especially in Brazil where there was a massive outbreak, but local transmissions also surfaced in 2016: 287 cases in Miami-Dade, five in Palm Beach and one in Broward, according to the state health department.

The Zika virus is still out there. Although there is no vaccine for Zika, the number of cases has reduced dramatically in the past two years as South Florida counties increased mosquito-control efforts and more people were protected because of previous exposure to the virus.

Florida recorded 1,469 Zika cases in 2016, with 298 infected locally. The state numbers dropped to 265 cases in 2017, with only two locally transmitted. There have only been 30 cases and no local transmissions so far this year.

Travel hub in South Florida

South Florida is susceptible to such diseases not only because of its climate and mosquitoes, but because it is a major hub attracting visitors from throughout the Americas for education, tourism, business and commerce, said Bindu S. Mayi, an associate professor of microbiology at Nova Southeastern University.

That’s why a World Health Organization report in April identified Miami as one of the global cities susceptible to the spread of yellow fever because the United States doesn’t require people arriving from abroad to be vaccinated against the disease. Infected travelers arriving in South Florida could be bitten by mosquitoes here, which could then spread the disease through bites to other people.

“It was inevitable we would get these diseases,” Mayi said. “It’s remarkable how well we responded.”

The proliferation of a disease can be worse if it is new to an area, because there is no natural immunity, she said.

“These flare-ups happen, especially when you have a large chunk of population that has never seen this virus,” Mayi said. “There is nothing initially stopping the body from hosting the virus.”

Most people in the U.S. haven’t been vaccinated for yellow fever because it is so uncommon. With the recent Brazil outbreak and efforts there to vaccinate large portions of the population, the available supply in the U.S. is limited and the sole U.S. manufacturer doesn’t expect to have more available until the end of the year.

The vaccine is being recommended for people traveling to areas known to have yellow fever. It is not recommended for everyone. The vaccine could cause worse problems for infants under nine months old, adults older than 60 and people with compromised immune systems.

A factor that could limit South Florida’s exposure to yellow fever from travelers is the size of the outbreak in Brazil. The number of cases there in recent years has been a few thousand, while Zika infected hundreds of thousands there. That means there’s a much smaller pool of people with the potential for bringing the virus to the U.S., said Larry Bush, an affiliate professor of clinical biomedical sciences at Florida Atlantic University.

Dr. Lyle Petersen, the CDC’s director of diseases transmitted through insect bites, also said there was low risk of a yellow fever outbreak in Florida.

“We learned with Zika, thousands of people came to the United States with Zika virus which is carried by the same mosquito — the Aedes aegypti mosquito — and only saw very limited transmission down in parts of southern Texas and in the Miami area,” Petersen said in a March teleconference.

That’s still not a guarantee against the disease.

“The fact that the [Aedes aegypti] mosquito is widespread in the country, all you need is a person infected with the virus to be the source of the virus,” Bush said. “Mosquito control and mosquito bite prevention with repellent is really crucial. We can’t overdo it.”

What is yellow fever?

Symptoms

Most people infected with yellow fever virus have no illness or only mild illness.

Symptoms, which usually take three to six days to appear, include the sudden onset of fever, chills, a severe headache, back pain, general body aches, nausea, vomiting, fatigue and weakness.

About 15 percent of cases are more severe. After a brief remission of up to a day, these individuals can experience high fevers, jaundice, internal bleeding and eventually shock and multiple organ failure.

Treatment

There is no specific treatment. Rest, fluids and use of pain relievers and other medications to reduce fever may relieve some symptoms. Hospitalization is recommended to provide supportive care and observation.

Certain medications should be avoided. Those include aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, which could increase risk of bleeding.

Patients should avoid mosquito exposure for up to five days after the onset of fever to avoid spreading the disease to uninfected mosquitoes.

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PRESS RELEASE: UNITEDHEALTHCARE’S VALUE-BASED CARE PROGRAM FOR KNEE, HIP AND SPINE PROCEDURES DEMONSTRATES IMPROVED HEALTH OUTCOMES AND REDUCE COSTS

• Bundled payment program achieved a 22 percent reduction in hospital readmissions and 17 percent fewer complications for people undergoing knee- and hip-replacement surgeries
• Total savings for participating employers of nearly $18 million, an average of $18,000 per procedure, while individuals saved more than $3,000 per procedure
• Program has added additional financial incentives for employees and has been expanded to 46 participating health care facilities, each recognized for high-quality care

MINNETONKA, Minn.–(BUSINESS WIRE)–UnitedHealthcare’s value-based care program for knee, hip and spine procedures has demonstrated fewer hospital readmissions and complications following surgery, while generating total savings of nearly $18 million for participating employers.

The Spine and Joint Solution helped reduce hospital readmissions by 22 percent and led to 17 percent fewer complications for joint replacement surgeries, as compared to nonparticipating facilities. For spine surgeries, hospital readmissions were reduced by 10 percent, and there were 3.4 percent fewer complications, as compared to nonparticipating facilities.

Since the program’s introduction, participating employers have realized an average savings of $18,000 per operation when compared with median costs in the same metropolitan area. Eligible employees saved more than $3,000 in out-of-pocket costs per procedure when accessing a participating facility rather than another in-network medical facility, with incentives such as cash, gift cards, additional vacation days for recovery, and health savings account (HSA) contributions.

The program’s bundled payment method reimburses health care providers and facilities for a defined episode of care, such as knee or hip replacement, under a single fee or payment. This is a shift away from the traditional fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care.

The Spine and Joint Solution has expanded nationwide to 46 participating health care facilities, with more than 115 employers enrolled and 3 million employees. The program, available to companies of any size with self-funded health plans, provides employees with access to surgeons and facilities that qualify as UnitedHealthcare Centers of Excellence and accept bundled case rates for knee and hip replacement, spinal fusion and spinal disc repair. All participating health care facilities have been independently evaluated for providing quality patient care and better outcomes.

“This program is one example of the ways we are reshaping how health care is delivered, helping enhance care coordination, improve outcomes and deliver greater value,” said Sam Ho, M.D., chief medical officer of UnitedHealthcare. “The initial results and nationwide expansion demonstrate the value of this program to health care providers, employers and their employees, helping to improve health outcomes and make care more affordable for more people.”

Musculoskeletal procedures are becoming more common due to an aging population and higher obesity rates. Moreover, these procedures are expensive, and costs and outcomes vary widely among care providers.

“Working with UnitedHealthcare on this program has furthered our efforts to treat the whole person, providing patients with access to comprehensive, coordinated care,” said Mark Carley, vice president of managed care and payor relations, Centura Health, which has participated in the Spine and Joint Solution since 2016. “Employers are seeking new ways to enhance employee health and reduce costs. By effectively coordinating patient care among the primary care provider, the surgeon, hospital and health plan, we can improve postoperative care, reduce readmissions, and enhance outcomes and the patient experience, leading to healthier communities.”

The Spine and Joint Solution was developed in collaboration with Optum, a UnitedHealth Group (NYSE: UNH) company.

UnitedHealthcare Value-Based Care Portfolio Continues to Grow

Value-based care models have made tremendous gains in adoption across America’s health care system over the last few years. UnitedHealthcare’s care provider reimbursements that are tied to a variety of value-based care arrangements have nearly tripled in the last three years to $64 billion annually, and are expected to reach $75 billion by the end of 2020.

To date, more than 15 million people, or nearly one in every three people enrolled in UnitedHealthcare benefit plans, currently access care from providers in value-based care relationships.

UnitedHealth Group (NYSE: UNH) recently announced advancements in the company’s collaboration with individual doctors, health systems and governments as the use of bundled payment models expands in traditional fee-for-service Medicare. UnitedHealth Group aims to offer data and analytics, technology and care coordination to support the bundled payment models of health care providers, including those participating in the Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement Advanced (BPCI Advanced) program when BPCI Advanced launches later this year.

For more information about Value-Based Care, visit www.uhc.com/valuebasedcare.

About UnitedHealthcare
UnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. In the United States, UnitedHealthcare offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1.2 million physicians and care professionals, and 6,500 hospitals and other care facilities nationwide. The company also provides health benefits and delivers care to people through owned and operated health care facilities in South America. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visit UnitedHealthcare at www.uhc.com or follow @UHC on Twitter.

 

 

PRESS RELEASE:CIGNA NAMED TO CORPORATE RESPONSIBILITY MAGAZINE’S 100 BEST CORPORATE CITIZENS LIST FOR FOURTH CONSECUTIVE YEAR

Cigna is the only global health service company to appear on 2018 ranking

BLOOMFIELD, Conn., 09 May, 2018 – Cigna (NYSE:CI) has been named to the 2018 Corporate Responsibility Magazine (CR Magazine) 100 Best Corporate Citizens List  for the fourth consecutive year. The list ranks the environmental, social and governance (ESG) performance of the 1,000 largest publicly traded companies in the United States. Cigna is the only global health service company to appear on the 2018 list.

“Being an active and engaged corporate citizen is at the heart of what we do,” said Mary Engvall, director of corporate responsibility and civic affairs. “We are honored to receive this recognition and inspired to continue our work through Cigna Connects, our approach to corporate responsibility, and help improve the health, well-being, environmental sustainability and inclusive business for our global community.”

Through Cigna Connects , we identify, engage, convene and activate stakeholders who, together, can make powerful connections to positively impact the health of people, communities and the environment. Cigna’s 2017 work is focused in three key areas: Health and Well-being, Environmental Sustainability and Inclusive Business. To view a full list of Cigna’s corporate responsibility work and learn more about Cigna Connects, click here  to visit the latest report.

The 100 Best Corporate Citizens List is based on 260 ESG data points gleaned from publicly available information in seven categories: environment, climate change, employee relations, human rights, governance, finance, and philanthropy and community support.

“CR Magazine is proud to present the only ESG ranking list that doesn’t rely on self-reporting,” said Dave Armon, publisher of CR Magazine. “Each year, the 100 Best Corporate Citizens ranking measures the success of the Brands Taking Stands movement by celebrating the most successful, most transparent companies that report on their responsible practices. We congratulate those honored on this year’s list for their commitment to corporate responsibility.”

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in over 30 countries and jurisdictions, and has more than 95 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit https://www.cigna.com . For more information about Cigna’s proposed acquisition of Express Scripts, please visit http://www.makinghealthcaresimple.com .