Prescription drug and heroin abuse. Deaths from prescription opioids have quadrupled in the United States since 1999, with more than 16,000 in 2013, according to the Centers for Disease Control and Prevention (CDC). Deaths from heroin overdose rose similarly over that same span. The increase in heroin use has occurred across demographic groups, including women and people with private insurance and higher incomes, according to a July Vital Signs report (see http://1.usa.gov/1dKho6w).
The public health response to both epidemics so far includes expanding access to medication-assisted treatments and improving opioid prescribing practices. This past October, President Obama issued a memorandum directing federal agencies to accelerate efforts toward both goals.
Significant effort will have to come at the state level because of the wide variation in prescribing patterns from state to state, a fact highlighted in a CDC Surveillance Summary published in the October 16 Morbidity and Mortality Weekly Report (http://1.usa.gov/1YdEV2i), the first report to provide comparable current data on controlled-substance use from multiple state prescription drug-monitoring programs. By monitoring such programs, some states, including New York and Tennessee, have reduced the number of patients seeing multiple prescribers for the same drugs, a practice that puts them at risk for overdose.
Serious communicable diseases.
* Measles claimed the life of a Washington State woman in July, the first U.S. measles death since 2003. From January through September 2015, the CDC recorded 189 measles cases (http://1.usa.gov/1hR3aN8); the largest single outbreak was associated with the Disney theme parks in California. State and CDC officials are emphasizing the importance of the measles-mumps-rubella vaccine (better known as the MMR vaccine) in order to prevent further outbreaks.
* Mistrust of vaccines persists among some U.S. parents and antivaccination activists, but the laws in some states are getting stricter. In July California governor Jerry Brown signed a bill eliminating vaccine exemptions for schoolchildren based on parents' personal beliefs, starting in 2016. Research continues to demonstrate the overall safety of crucial vaccines. A study published online this past October in the Journal of Allergy and Clinical Immunology examined more than 25 million vaccine doses over three years (January 2009 through December 2011) to identify cases of postvaccine anaphylaxis; the researchers found just 33 vaccine-associated anaphylaxis cases and no deaths.
* Last year's Ebola outbreak has paused, according to the World Health Organization, although concerns remain. Infections will likely appear again in endemic areas, and surviving victims are experiencing painful, debilitating, and even life-threatening sequelae, such as severe joint pain and meningitis. The virus can linger in the eye, testicles, or central nervous system. Criticism remains over the treatment of patients and providers in the United States at the endemic's peak. For example, nurse Kaci Hickox was illegally detained and quarantined in New Jersey in 2014, despite having no symptoms and a negative blood test (she has filed suit against Governor Chris Christie).
Climate change and health. The phrase "climate change" conjures up images of extreme weather like last winter's massive snowfall in the Northeast or extreme storms such as Hurricane Patricia, the most intense tropical cyclone ever recorded in the Western Hemisphere in terms of barometric pressure. But the phenomenon is also responsible for more direct health effects. Scientific American reported in April that allergy diagnoses have been on the rise, and some allergists are pointing to longer pollen seasons as an exacerbating factor. And changes in vector ecology have led to a rise in diseases around the world, such as yellow fever, according to the World Health Organization (see http://bit.ly/1w4M8Dd). The United States has long been free of yellow fever, but health officials in California confirmed the presence of mosquitoes that carry yellow fever in several Los Angeles-area counties in 2015. And vector-borne diseases such as West Nile virus and Lyme disease remain significant concerns in the United States.-Laura Wallis