CDC Presents A Patient Tuberculosis Education Series

The Centers for Disease Control and Prevention (CDC) has recently updated and made available a six booklet patient tuberculosis (TB) education series for healthcare providers to utilize with people who have TB disease, as well as those with latent tuberculosis infection (LTBI).

Education is a key element in CDC’s tuberculosis elimination strategy. To that end, this user-friendly series employs an easy-to-understand conversational style, colorful photos and actual patient examples. Topics covered in the six individual booklets are:

Booklet One: Get The Facts About TB Disease – How tuberculosis is transmitted, treatment of TB disease, and how to communicate with family and friends about the disease.

Booklet Two: What You Need To Know About TB Infection  – Definition of TB infection, the Mantoux Tuberculin Skin Test (TST), and why it is important to adhere to prescribed medication in LTBI.

Booklet Three: What You Need To Know About The TB Skin TestFacts about the TST.

Booklet Four: Protect Your Family And Friends From TB: The TB Contact InvestigationIssues relating to protecting others from TB and what to ask healthcare workers during a contact investigation.

Booklet Five: Take Steps To Control TB When You Have HIV – Vital importance of TB testing, and treatment of TB disease and TB infection when a person is HIV positive.

Booklet Six: Staying On Track With TB Medicine – Discussion of TB medications and hints for staying on target with medication regimens.

All of the above booklets are available in English, Spanish, Tagalog and Vietnamese. To access this material, visit


What Is H7N9 and Why is it of Worldwide Concern?

H7N9 is a subtype of influenza A viruses that is sometimes found in birds, but that does not usually affect humans. Many H7 viruses have circulated in poultry for centuries. However, beginning at the end of March 2013, China reported the first new cases of infections spread from birds to people with a new strain of H7N9, which was very different from previously known H7N9 viruses. Although the transmission of the virus to humans has remained sporadic, it has steadily increased to where in May 2017, China reported 688 human infections to the World Health Organization (WHO). This increasing number of human infections has raised serious concerns by WHO and also the federal Centers for Disease Control and Prevention (CDC).

Poultry infected with H7N9 virus do not experience any symptoms or signs of illness, yet they can transmit the virus to humans. To date, most of the reported human cases have experienced severe illness, beginning with high fever and cough, and frequently progressing to pneumonia. About 40% of these reported human cases have died. Although the H7N9 virus continues to have the greatest potential to cause a worldwide pandemic, presently there is no evidence of “sustained” spread of the virus from person to person. Ongoing spread of a virus among humans is necessary for a pandemic (global outbreak) to occur. Health officials are watching the situation closely for this.

Currently there is no publicly available vaccine to protect against H7N9 infection. Most of the H7N9 viruses which have been studied, however, appear to be susceptible to the three influenza antiviral drugs (oral oseltamivir, inhaled zanamivir and intravenous peramivir) that are recommended in the treatment of seasonal influenza.

No H7N9 virus infections of birds or humans have been detected in the United States so far, and at this time, the risk to people in the U.S. is considered to be very low. What about travel to China? Because H7N9 is not spreading easily from person to person, CDC and WHO are not recommending that people delay or cancel trips to China. CDC does advise travelers to China to take some common sense precautions such as not touching birds or other animals, avoiding live poultry markets, and washing hands often. All poultry and poultry products should be fully cooked.

It is always of significant public health concern whenever a new influenza A virus subtype (e.g. H7N9) that infects humans and causes severe illness emerges. For this reason, CDC, together with domestic and international partners such as WHO, continues to closely monitor the situation in China, with the goal of averting the possibility of a worldwide pandemic of H7N9 influenza.

For additional information visit:

Alternative and Complementary Treatments for Managing COPD

With the internet and Google at our fingertips, it’s easy to find all sorts of advice, options and less conventional means of controlling or managing the symptoms of chronic lung diseases. However, many of these solutions are untested or have minimal proof of benefit.

It’s important to get medical and clinical advice before beginning any sort of treatment or therapy to help control your lung disease.

In conjunction with medications typically prescribed, the following options are proven to work, though you should keep in mind that results vary due to severity of disease and lung damage already present:

  1. Pulmonary Rehabilitation is proven to help decrease symptoms, reduce number of exacerbations, improve lung function and, in some cases, help to decrease the amount of oxygen therapy needed.
  2. Breathing exercises/relaxation exercises
  3. Yoga and Tai Chi aim to calm the mind, which helps to calm the body and its responses to stress.
  4. Watch what you eat. Carbohydrates release carbon dioxide, which is already hard to expel with COPD. An excess will increase your breathing rate and make you feel more short of breath.

Here are some unproven therapies:

  1. Acupuncture, Ginseng and XCP paste—check with a doctor trained in Traditional Chinese Medicine before beginning any of these.
  2. Eucalyptus Oil can cause lung irritation and adversely interact with certain medications.
  3. Vitamin D has been proven in some small studies to prevent exacerbations, but requires taking extremely large doses. Instead try to add the foods high in Vitamin D to your diet, such as cheese and egg yolks. Foods fortified with Vitamin D, such as some dairy products, orange juice, cereals, and Omega-3 fatty fish (tuna, salmon and mackerel).

How Did You Sleep Last Night?

Most mornings, the question, “How did you sleep last night?” starts the conversation between my husband and me.  When my kids were teenagers, I was constantly bugging them about how they slept—if only to find a reason for their irritability.

I used to be a great sleeper, but one of the things I have really noticed about getting older is the way that my sleep quality is changing. Sure, there are still mornings when I wake up refreshed and energized, but my sleep has been changing enough that I am starting to experience more and more of those “not-so-great” mornings, too.

So, why is this even worth my time to share?  Because as my good night’s sleep becomes more elusive, I feel the impact more and more.  Of course, I already know that sleep is important.  Everyone knows sleep is important. Forty years ago, my grandma used to tell me that nothing was more important than a good night’s sleep.

Fast forward to 2017, and now there are hundreds of credible authorities who have used research and compiled data to back up the importance of sleep. The Center for Disease Control (CDC) has linked insufficient sleep to many chronic health issues such as diabetes, high blood pressure, obesity, depression and some cancers.   Beyond the health link, they also point out some important public health issues that are caused by people sleeping too little. They have linked lack of sleep to thousands of automobile crashes, industrial accidents and medical errors. On a daily basis, insufficient sleep has been shown to affect concentration, memory and overall performance on daily activities.  I definitely notice a decrease in my ability to focus after I have had a bad night of sleep.

In keeping with our mission at Breathe Pennsylvania to help our community live and breathe better, I will be sharing lots of information about sleep quality, effects of poor sleep, sleep apnea and what can be done about it.

If you have a personal story about sleep and breathing, stay tuned!  I’d love to hear from you as we explore this journey together.

Here’s to a good night’s sleep tonight!

What are the components that make up the flu vaccine?

Although summer is just beginning, the U.S. Food and Drug Administration has already announced the components of the influenza vaccine for the northern hemisphere in the 2017-2018 flu season.

For the trivalent vaccine the components are:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus
  • A/Hong  Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)

 In addition to the above, the quadrivalent vaccine will contain:

  • B/Phuket/3073/2013-like virus (B/Yamagata)

So how are flu vaccine components determined? There are more than 100 national influenza centers located throughout the world. These centers conduct year-round surveillance for influenza, involving testing thousands of influenza virus samples from patients. From these samples, the centers send representative viruses to five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza, which are located in Atlanta, Georgia,United States; London, United Kingdom; Melbourne, Australia; Tokyo, Japan; and Beijing, China. As one of these Collaborating Centers, the Centers for Disease Control and Prevention (CDC) in Atlanta receives and tests thousands of influenza viruses from around the world.

Twice a year, the WHO consults with the directors of the WHO Collaborating Centers and with representatives of key national laboratories and academies. At these meetings, which take place in February for the selection of the upcoming northern hemisphere’s seasonal influenza vaccine and in September for the southern hemisphere’s vaccine, the WHO recommends specific vaccine viruses for inclusion in the vaccines.  Based on the WHO recommendations, each country then makes their own decision about which viruses should be included in influenza vaccines to be licensed in their country.

In the United States, the FDA makes the final decision about vaccine viruses to be included in flu vaccines to be sold. As soon as a decision has been made concerning which viruses should be incorporated into the vaccine, private sector manufacturers begin the process of producing the vaccine. The manufacturing process is time sensitive, as it takes at least six months to produce large quantities of influenza vaccine.  In order for vaccines to be delivered in time for vaccination to begin in the fall, manufacturers may actually begin to grow one or more of the vaccine viruses as early as January, based on their best guess as to what viruses are most likely to be included in the vaccine.

What Is The Best Time To Get A Flu Shot?

In western Pennsylvania, the flu season generally occurs in mid/late October through March. Since it takes approximately two weeks for protective vaccine antibodies to develop, September and early October are considered to be optimal times to receive a flu shot. However, a flu shot may be received at any time, even when the flu illness has actually occurred in the community.

What Is The Best Flu Vaccine Formulation To Receive—Trivalent or Quadrivalent?

In addition to the trivalent and quadrivalent formulations, in recent years a “high dose” flu vaccine has been developed specifically for people 65 years of age and older.

Keep in mind that, as with any health-related issue, it is best to discuss flu immunization with your doctor in making the decision as to which flu vaccine is most suitable for you. For additional information, visit

Chris Harancher, MS, RRT, Named As Director of Sleep Apnea Education

Chris Harancher, MS, RRT, joined the Breathe Pennsylvania staff as the Director of Sleep Apnea Education. Harancher has been involved in respiratory care for 25 years. She started as a Registered Respiratory Therapist with Butler Health System in 1992 after earning her BS degree from Indiana University of PA.

After obtaining her Master’s Degree in Professional Leadership from Carlow University in 2007, she accepted a position in higher education to assist in the development of what is now the Venango College of Clarion University Respiratory Care program.  As the Program Director and former Director of Clinical Education, she has spent the past ten 10 years educating respiratory care and other allied health care students.

Harancher is an active member of the Pennsylvania Society for Respiratory Care (PSRC) and the American Association for Respiratory Care (AARC).

“As a respiratory therapist, I have cared for many patients whose health has been directly or indirectly affected by sleep apnea.  Many patients were either unaware that they had sleep apnea or were not compliant with their treatments,” Harancher said. “In my new role, I am excited to bring together my knowledge and passion for education to make a difference.”

Avoiding Pneumonia—Even in the Summer

Pneumonia can rear its ugly head at any time of the year and for those suffering from chronic lung diseases, it’s best to be cautious all year round. Pneumonia is an infection in one or both lungs, sometimes only a specific section of a lung. It occurs when organisms settle in the air sacs and then grow rapidly, causing the sacs to fill with pus and fluid while the body tries to fight the infection.

People who have COPD are at greater risk of getting pneumonia because excess mucus is being produced and can trap the bacteria or fungus, allowing it to grow. Some symptoms of pneumonia are similar to those of a COPD exacerbation and include:

  • Fever higher than 100.5 degrees or shaking chills
  • Shortness of breath or more rapid breathing
  • Cough with increase in mucus
  • Cough with change in mucus color
  • Increased heartrate
  • Pain in one area of the chest with deep breaths

Call your doctor is you are experiencing one or more of these symptoms. The best ways to avoid pneumonia are:

  • See your doctor regularly, even if you are feeling well
  • Get a flu shot
  • Get a pneumonia vaccine if you’re due to get one
  • Wash your hands
  • Don’t smoke
  • Rest—a tired body is more susceptible to getting sick

It’s possible to stay healthy if you watch for early warning signs of a flare-up and report them right away to your doctor.

Mold: How it Can Affect Your Breathing

How does mold affect us?  Most people have a natural resistance to mold.  However, high levels of certain kinds of molds can cause people to have reactions.  This is especially true for toxic molds.

Different people have different susceptibilities, but most reactions are similar to hay fever:  sneezing, watery eyes, coughing and difficulty with breathing.

Mold is a very small “plant” that grows through the transmission of spores.  These spores are let go and then attach themselves to nearby surfaces and continue to grow as new plants.

Many molds are black, so when people see or talk about “black mold” they may not be seeing the toxic mold known as “stackybotrous.”

Unlike the plants that we are familiar with, molds do not get their energy from the sun.  They give off mycotoxins which help break down the organic material they attach themselves to.  They receive their energy through consumption of these organic materials.  Mold needs two things to live: an organic sub-straight to feed off of and water.  It gets its water from the air through high humidity.  This is why basements – especially those in Western Pennsylvania– tend to have mold, as the humidity there is higher than the rest of the home.

If you suspect that there is mold in your house and you have an asthma condition, the best option – as always – is to test.

The Importance of Getting The Flu Shot

Each flu season, many people debate whether or not they should get a flu shot. However, when we are deciding what is the best thing to do for our children/adolescents with asthma, we need to have a better understanding of the facts and fears we have towards the flu vaccine. Immunization each year is the best way to protect yourself and your children/adolescents with asthma from the flu.

Flu is an infection of the nose, throat, and lungs caused by the influenza virus. Symptoms can be mild to severe, especially in children younger than 5 who have asthma. These children are at a greater risk for complications from the flu such as pneumonia, bronchitis, and ear infections. These complications can lead to a stay in the hospital and even death. In 2017, there were 72 pediatric deaths from flu complications–74% occurred in unvaccinated children ages 6 months to 17 years old.

In 2016-2017, the live attenuated influenza vaccine (LAIV) or the nasal spray was not recommended due to concerns of it effectiveness. Centers for Disease Control and Prevention noted that in 2015-2016, the nasal spray had no protective benefit for children ages 2 to 17 whereas the children who got the flu shot were 63% less likely to get the flu compared to those who weren’t vaccinated. CDC will review this recommendation for 2017-2018.

CDC also recommends that everyone 6 months and older should be vaccinated every year by the end of October. However, you can still get your shot through January or later.

In this past year, the recommendations for people with egg allergies were updated. If you only get hives after exposure to eggs, you can get the flu shot. However, if you have additional symptoms, you can still get the flu shot as long as it is administered and supervised by your doctor who can manage severe allergic conditions. People with egg allergies no longer need to wait 30 minutes after the vaccine has been administered. People who are high risk can also be treated with antiviral drugs. It is most effective if started within 48 hours.

So this October, don’t be the one who “should have, could have, would have” gotten the flu shot. Remember children and adolescents with asthma experience more asthma attacks if they get the flu. To learn more about asthma management, as well as Breathe Pennsylvania’s programs and services, visit us at

Whooping Cough Remains a Public Health Concern

It’s National Infant Immunization Week, which serves as a good reminder for parents and all adults to check with their doctors to make sure that their pertussis vaccination, as well as all recommended immunizations, are up to date.

Pertussis, a highly contagious respiratory disease known as whooping cough, is caused by the bacterium Bordetella pertussis. The disease is usually spread by coughing or sneezing, or when sharing breathing space with someone who has it. The cough can last up to 10 weeks or longer. The disease may cause serious illness, and can even be life-threatening, especially in babies.

Approximately half of the babies who are younger than 1 and have whooping cough need to be hospitalized.

In 2015, 20,762 cases of whooping cough (and 6 deaths) in the United States were reported to the Center for Disease Control and Prevention (CDC). Of this number, 2,709 cases occurred in children younger than 1 year. Worldwide, there are an estimated 16 million cases of pertussis and some 195,000 deaths annually.

There are currently two vaccines for whooping cough, and they are effective against Diphtheria, Tetanus, and Pertussis. DTaP is licensed for children up to 6 years of age. One dose is to be administered at 2, 4, 6, 15-18 months and again at 4-6 years.  Additionally, a single dose of the Tdap vaccine is recommended for people ages 11 through 64.

So why are we still seeing whooping cough in the population when effective vaccines exist? There are several reasons. First, it is thought that there may be a waning vaccine immunity which takes place over time in adults who had been immunized as children. Babies, especially those younger than 6 months of age who have not yet built up vaccine immunity, can be infected by older siblings, parents, or caregivers who might not even know that they have the disease. For this reason, it is very important that pregnant women, healthcare providers and caregivers of children younger than 1 year of age be vaccinated with Tdap.  It is possible that vaccinated children and adults may still contract pertussis, however, the disease is typically much less severe in vaccinated people.

Make sure to get vaccinated, and protect yourselves, your families, and the community from vaccine preventable diseases.

Reference: https://www.cdc/pertussis