News

The Public Health Department published its third monthly Public Health Spotlight on Communicable and Non-Communicable Diseases (NCDs) since the announced changed on August 31, 2022.

From the Desk of Sabrina Turner

The holiday season is upon us! For many of us this is a time of joy and celebration with family and friends. It can also be a time of reflection, goal-setting, and even taking time out to give back.

However, this season can be particularly difficult for many persons within our community. Some are struggling with loss, others are having financial difficulties, while others are on the road of recovery. I make it a point to say “of” because recovery is not a destination, it is an ongoing journey.

Thus, this month’s public health spotlight focuses on building awareness of alcohol misuse during this time of the year. While we lack data when it comes to alcohol use within Cayman’s adult population, the National Drug Council’s Cayman Islands Student Drug Use Survey of 2022 provides us with some eye-opening information about how alcohol is impacting the lives of our youngest citizens.

This should not only give us pause, but it should also challenge us to play closer attention to our teens during the season given how readily available alcohol becomes throughout the month of December.

Additional information on services provided by the NDC and Caribbean Haven are also included as a way to connect you to these agencies.

Our epidemiological corner provides us with not only the latest surveillance data for COVID-19, but also flags the electronic ESAVI form as an important tool to capture events supposedly attributed to vaccination or immunisation.

As we wrap up 2022, I wish you all a wonderful holiday season.

At your service.

The Holidays, Binge Drinking and Recovery

Drinking during the holidays has become so socially acceptable that one would say it is expected. In fact, long before the cultural phenomenon of “wine moms” took hold, publications like Forbes magazine were publishing articles entitled “Ten Reasons to Drink During the Holidays” (2005).

Most people do not understand that the term “binge drinking” has a specific definition. Many assume that a person must drink to the point of making themselves ill to be considered a binge drinker, but that is not in fact the case.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the United States defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks and women consume 4 or more drinks in about two (2) hours.

The social acceptability, and to some degree expectation, around drinking during the holidays makes it a prime time for over-indulgence.

The Cayman Islands 2021 Compendium of Statistics shows an increase between the number of traffic tickets issues by the Royal Cayman Islands Police Service (RCIPS) for driving under the influence (DUI) in 2020 (228 tickets) and 2021 (312 tickets).

As of 30 November 2022, the RCIPS reports 202 arrests made for DUI this year alone, of which 80 incidents (approximately 40%) were detected due to officers responding to a report of a motor vehicle accident.

A 2015 report released by Alcohol Monitoring Systems (AMS) about the drinking behaviour of over 450,000 DUI offenders who were monitored 24/7 for alcohol consumption in the United States individuated that “drinking violations for the monitored group jumped an average of 33 percent between Thanksgiving and New Year’s Day, compared to the average violation rate the rest of the year”.

Alcohol’s impact on our brain chemistry means that it can directly impact our mental health. The brain relies on a delicate balance of chemicals and processes, and given that alcohol is a depressant it can disrupt that balance.

Drinking heavily is associated with symptoms of depression, though it is difficult to separate cause and effect.

Thus the holiday season is one that may prove particularly challenging to persons who are in recovery as they may be particularly vulnerable to social pressures around alcohol consumption.

Persons in recovery are encouraged to focus on their relationships and connections with others as the goal of holiday gatherings, prioritising quality time over the consumption of alcohol.

Caribbean Haven Residential Centre (CHRC) notes that there is a slight drop-off in the number of admissions right before Christmas, with an increase in the number of admissions in January.

CHRC notes that persons who enter treatment during the holidays are often serious about wanting to become sober and improve their lives. CHRC plans events around the holiday season to ensure that residents are able to celebrate with family on special days.

For more information contact Caribbean Haven Residential Centre on 947-9992.

NDC CISDUS Binge Drinking

Binge drinking typically refers to a pattern of drinking which results in a blood alcohol concentration of 0.08% or higher. In adults, this is typically achieved through the consecutive consumption of five or more drinks within 2 hours, however, young people can achieve this BAC on fewer drinks in the same timeframe.

In this survey, binge drinking is defined as the consumption of 5 or more alcoholic beverages in a single outing.

Binge drinking was measured only among students who reported alcohol use during the last 30 days prior to completing the survey (we consider this time frame as current use).

• Among students who reported drinking in the last 30 days (total number = 471), 48.7% of students also reported having participated in binge drinking at least once during the two weeks prior to participating in the survey.

• The prevalence of binge drinking varied by gender, with 51.2% of boys reporting heavy episodic drinking compared to 4.2% of girls.

• Binge drinking among current users was mostly reported by students in higher grades, with more than half of all students in years 11, 12, and 13 (grades 9-12) reporting binge drinking.

Arrive Alive 345

The National Drug Council’s #ArriveAlive345 campaign is the NDC’s annual, extensive, proactive anti-drinking driving campaign aimed at reducing Cayman’s drink driving incidents. #ArriveAlive 345 is made up of three components:

The Purple Ribbon Pledge:

Beginning on November 1st, the NDC’s Purple Ribbon Pledge encourages drivers to sign the pledge to not drink and drive and collect their purple ribbon stickers and keychain to represent their anti-drink driving over the holiday season.

The Designated Driver Campaign:

Starting on December 1st through to December 31st the Designated Driver Cayman has the full support of local bars, restaurants and clubs across Grand Cayman. The concept is simple: anyone who identifies themselves as a designated driver will receive complementary soft drinks at participating establishments.

NYE Purple Ribbon Bus Service:

The New Year’s Eve Purple Ribbon Bus runs on December 31st only and is a free service for residents and visitors. The bus service operates in Grand Cayman and Cayman Brac from 9PM to 4AM, and services all districts within both islands.

Well Aware

Tips for Coping with Stress and Depression during the Holidays:

Acknowledge your feelings.

No, the holidays aren’t always “the most wonderful time of the year”. Sometimes they are hard because of grief, sadness and other pressures. Acknowledge and express your feelings, don’t try to force yourself to “be happy”.

Reach out.

If you feel lonely or isolated reach out to friends, family, and community. Volunteering your time is also a good way to meet new people and feel more connected.

Be realistic.

Very rarely are the holidays “perfect” and far too much time is spent trying to ‘recreate’ a past experience instead of being fully engaged in the present. As families grow and change so will traditions and rituals. Be flexible in your expectations and be present.

Learn to say “NO”.

No is a full sentence. Saying “yes” when you should have said “no” can create resentment, make you feel overwhelmed, and add to feelings of stress. Set healthy boundaries and stick to them.

Seasonal Flu Update

Entering into the winter respiratory season there are signals of a concerning flu season with earlier than usual increase in Influenza cases being reported in the Northern Hemisphere.

Influenza activity In the US is elevated with influenza test positivity currently reported to be 14.7%^[1]. The hospitalization rate in the US was higher in week 45 than every flu season since 2010-2011¹. The CDC estimate that there have been 2,100 deaths from flu so far in this winter season¹. Influenza A(H3N2) is the most frequently reported subtype, however the proportion of Influenza A(H1N1) is increasing slightly (approximately 26% of subtyped Influenza A viruses in most recent week of data)¹. Of Influenza B cases where a lineage has been detected, the Victoria lineage has been identified¹.

The UK has reported a much earlier spike in cases and the influenza hospital and intensive care admission rates are slightly elevated compared to the baseline level of what would be expected for this time of year^[2]. Influenza A virus is contributing most of the cases in the UK with low levels of Influenza B detected. Similarly to the US, the main subtype currently circulating is Influenza A (H3N2), with low numbers of Influenza A (H1N1) detected^[3].

Surveillance from Europe presents a similar picture with the increase in cases starting much earlier in the season and the test positivity from sentinel sites reported to be 13%, which is higher than the epidemic threshold set at 10%^[4], however trends vary by country.

Surveillance of Influenza-Like-Illness (ILI) in the Cayman Islands indicates that the 2022/23 flu season is currently progressing in a similar manner to last year and 2019/2020. The annual flu vaccine is the best tool we have to protect against flu, both to prevent infection and serious outcomes. To date approximately 1,600 individuals have received their Influenza vaccine this season in the Cayman Islands. We encourage individuals to receive both the flu vaccine and the COVID-19 autumn booster concurrently to have the best protection for the winter respiratory season.

Epidemiology Corner

Epidemiological Alert- Regional

Avian influenza

Outbreaks of avian influenza, commonly known as ‘bird flu’, across the Americas and Europe have been reported by the World Organization for Animal Health (WOAH). Currently, the predominant subtype is H5N1 among poultry and other birds [5]. This subtype has remained prevalent in wild birds over the summer, which is unusual as cases typically occur in the winter season.

In the Region of the Americas, cases have been reported to WOAH from Canada, Columbia, Ecuador, Mexico, Peru, United States of America and Venezuela. There are sporadic occasions where avian influenza can cross over to cause human infections. No avian influenza cases have been detected in the Cayman Islands.

COVID-19 surveillance data

November 2022 (data as of 5 December 2022)

Key points

In the Cayman Islands COVID-19 hospitalisations have increased slightly, however the number of people admitted remains in line with recent months. There were 17 COVID-19 hospital admissions during November, which has increased from 10 admissions in October. To note, this includes patients admitted for other reasons and detected as positive for COVID-19 on screening. There has been no increase in the number of patients admitted to ICU and no COVID-19 deaths were reported in November. During the winter months, it is anticipated that COVID-19 transmission in the community will increase alongside other respiratory infections. However, as policy and public behaviour surrounding testing has changed since earlier in the year we will not see the full extent of this in the number of cases detected.

Nearly 1,000 doses of the Autumn COVID-19 booster have been administered, with the highest uptake among 50-69 year olds. We strongly recommend that all those who are eligible receive their Autumn booster for COVID-19 and concurrently receive the influenza vaccine.

ESAVI

Events Supposedly Attributed to Vaccination or Immunization (ESAVI): online reporting for COVID-19 Autumn booster side effects

SARS-CoV2 vaccines licensed in the UK by the Medicines and Healthcare products Regulatory Agency (MRHA) are subject to additional monitoring. This is to allow quick identification of emerging safety information on newly licensed medicines. Healthcare professionals in the UK are asked to report any suspected adverse reactions directly to the MHRA using what is known within the UK as the ‘yellow card system’; which is not a recognized adverse events system in the Cayman Islands.

As we are using UK sourced and licensed vaccines, we inherit a duty to implement these surveillance obligations, but can do so in a manner that is appropriate to our circumstances. The system we use is the PAHO/WHO reporting of Events Supposedly Attributed to Vaccination or Immunization (ESAVI). This surveillance tool is aimed at early detection of any adverse events that may occur following vaccination. By doing so, it’s possible to monitor and classify risks related to a vaccine, the manufacturing process, transportation, storage, administration, and to rule out an association between the event and the vaccine.

This surveillance has been in place since SARS-CoV2 vaccines became available to us during the pandemic with information captured through a paper form. The Public Health Department have updated this approach to now be captured electronically, on the Cayman Islands Health Services Authority (HSA) website or the Ministry of Health’s website. A link to the surveillance form is here: https://forms.office.com/r/wi78Qw5Rwd.

The purpose of introducing digital reporting is to enable real time monitoring of any reactions and create a more robust surveillance system. Nothing has changed in the type of data collected. The form does not collect any information that can be used to identify an individual, therefore all online entries will be anonymous.

To ensure vaccine safety, persons who have received the COVID-19 Autumn booster are encouraged to fill out this form if they experience any adverse events after being vaccinated. While these reactions are suspected to be the result of a recent vaccination, some events may result from other non-vaccine related factors and some reactions are indicative of the body’s normal immune response. By reporting this information, Public Health can monitor for any new side effects or unusual patterns.