Tag: Ebola in the US

Pandora Report 4.1.2016

by spopescu, posted in Pandora Report

Happy Friday! We’re excited to give you some great updates on the world of global health security. Firstly, a recent cluster of what some are calling “rabies” has claimed the lives of 12 individuals. Officials are concerned as transmission seems to be spread through biting and the affected individuals do not appear to be experiencing pain or concern over decaying skin. Just kidding – April Fools’ Day! The zombie apocalypse hasn’t started (that I know of….), but the European Centre for Disease Prevention and Control (ECDC) has issued a warning about Yellow Fever in Angola. The ECDC is stressing the role of vaccination in travelers as a means to prevent the disease from traveling to susceptible populations. Researchers from the University of Sydney’s Charles Perkins Centre recently published their analysis regarding the barriers and facilitators for pathogens to jump species. They reviewed 203 human viruses to look at biological factors that may give us predictors as to which viruses are likely to emerge in human populations.

Mapping the Global Health Security Agenda
Raad Fadaak discusses the Global Health Security Agenda (GHSA) and its set of 11 Action Packages, working to better “prevent, detect, and respond to both human and animal infectious diseases threats.” Fighting an uphill war with organizational and political challenges, the GHSA has won some battles in the fight against global health security threats. In the midst of their MERS outbreak last year, South Korea looked to GHSA “to invest both diplomatic commitment as well as approximately $10 billion US dollars—in addition to graciously hosting the annual GHSA Ministerial High-Level Meeting.” Perhaps a challenging component to getting the GHSA and its Action Packages running smoothly is the vast array of partnerships and projects. Raad uses several wonderful spatial graphics to show timelines, participating countries, commitments, and much more in his analysis of GHSA. “Speaking more generally, it is important to not take the ‘global’ in ‘global health security’ for granted. These maps are a first step in helping to identify and isolate the unique scope and reach of US Governmental activity under GHSA programs – and the production of a specific kind of scalar policy through the GHSA.” In the midst of the Zika outbreak, now will be a telling time to see how the US will meet its commitments to the GHSA through the CDC and USAID.

Medical Rant & Response
Medical experiences tend to be low on the totem pole for “things I’d like to do with my day”. No one enjoys sitting in a busy emergency department waiting area, dealing with miscommunications, or waiting on lab results. Dallas, TX experienced first-hand the serious ramifications of medical frustrations when they had an Ebola patient stroll into their ED and then get discharged a few hours later. What happens when your symptoms are stumping physicians or the delivery of care is delayed? Researchers discuss an experience by a U.S. patient and “responses offered by several experts from various perspectives of the healthcare system.” As you read this article, consider your own healthcare experiences. Take it a step further and consider the global health security implications regarding some of these experiences…

How to (Make Chemical Weapons) Disappear Completely
GMU Biodefense MS student, Greg Mercer, is at it again! In this week’s commentary he’s discussing how chemical weapons are actually destroyed. Incineration and neutralization are the two most common practices employed by the US and Greg is breaking each technique down. Unfortunately, these methods aren’t aways perfect and can easily result in human and environmental damage. “Chemical weapons weren’t always disposed of so carefully, though. The James Martin Center for Nonproliferation Studies (CNS) cites at least 74 instances of the U.S. dumping chemical weapons at sea from 1918 to 1970.”

Ebola: We May have Won the Battle, But We Haven’t Won the War
It’s been two years since the first Ebola cases were identified in Guinea. Since then, you’ve surely read articles upon articles about the outbreak, how it spiraled out of control, and how we should’ve seen it coming. Why read more? History. Plain and simple – if we fail to study this outbreak and learn from all our mistakes, we’re doomed to repeat them. Ranging from infection and prevention control measures (music to my ears) to addressing the needs of Ebola survivors and social mobilization, there’s host of things we can learn. “And even when international partners responded, they often arrived too late. It took about three months from the time the United States announced in September 2014 it would send troops to Liberia to build Ebola treatment units (ETUs) to the time those were built. By then, the epidemic was already waning, and nine out of the eleven centers built never saw a patient.” What about fear? Fear became an issue not just on the ground in West Africa, but also in the U.S. after we started treating imported cases and the initial Dallas, TX case. “But I think we did most poorly when we let fear dictate the quality of the clinical care we provided to patients. ‘What if,’ Dr. Paul Farmer provokingly asked, ‘the fatality rate isn’t the virulence of the disease but the mediocrity of the medical delivery?’ Of course lack of staff, supplies and space, combined with an overwhelming patient load didn’t help.” Coordination, communication, and engagement. You may see these repeated several times whenever you read an after action report about this outbreak, and yet I’m not quite sure we’ve really let it sink in. Zika? Let’s just hope we can learn from the lessons of public health history before another outbreak sneaks up on us again. Update: two more cases have been identified in the now nine person cluster in Guinea. A young woman has died of Ebola in Liberia today, marking their first case in months.

Where Are We With Zika?

Screen Shot 2016-03-31 at 11.11.34 AM US knowledge gaps are the name of the game this week. 1/3 of Americans polled in a recent survey believed that Zika virus can be transmitted from coughing and sneezing. This same survey, conducted by a team from the Harvard T.H Chan School of Public Health and the National Public Health Information Coalition (NPHIC), found that people in households not affected by pregnancy issues held the most misconceptions about the virus. 39% thought that a non-pregnant woman’s illness could pose a threat to future birth defects. Brazil’s Health Ministry reported that the number of confirmed and suspected cases of microcephaly associated with Zika virus in the country have grown to 5,235 cases. The ministry also reported 19 infant deaths related to the virus. Revised estimates and a map released by the CDC now show that a larger percentage of the US population could be exposed to the virus as the mosquito season approaches . The University of Texas Medical Branch, Galveston (UTMB) has developed the first Zika animal model since the recent outbreak. “Several research institutions and companies have vaccine and drug candidates nearly ready to test, but until now a mouse model – a critical stage in preclinical testing – has not been available. The study, published this week in the American Journal of Tropical Medicine and Hygiene (AJTMH), removes a major bottleneck that was delaying treatment screening.” There is also concern regarding the ability for ultrasounds to fully detect brain damage and microcephaly in pregnant women with or exposed to Zika virus. If you’re looking to get your Zika on, attend the Zika Innovation Hack-a-thon April 2-3, 2016! As of March 30, 2016, there were 312 travel-associated Zika cases in the US.

Stories You May Have Missed:

  • Ancient Malaria Roots – researchers from Oregon State University are suggesting that the origins of malaria may have actually begun 100 million years ago. The protozoa genus, Plasmodium, has ancestral forms that may have used different insects during its evolution. “Scientists have argued and disagreed for a long time about how malaria evolved and how old it is,” Poinar said. “I think the fossil evidence shows that modern malaria vectored by mosquitoes is at least 20 million years old, and earlier forms of the disease, carried by biting midges, are at least 100 million years old and probably much older.”
  • Ebola Is No Longer A Public Health Emergency of International Concern – On Tuesday, March 29th, 2016, the WHO Emergency Committee met, noting that since its last meeting, all three countries met criteria for interruption of original transmission chains. The WHO Direct General, Margaret Chan, stated that any trade and travel restrictions initiated during the outbreak should be lifted.
  • Ethiopia Drought Emergency – Ethiopia is currently experiencing the worst drought it’s had in 50 years, causing water and food security issues. As of March 2016, over 10.2 million people need food assistance. Food security issues and poor access to water are severely impacting the agricultural industry as well as human health.

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report 2.5.2016

by spopescu, posted in Pandora Report

Fear of mosquitoes continues to grow as Zika virus joins the list of burdening arbovirus infections. Perhaps the biggest surprise this week wasn’t that imported Zika cases continue to spring up across the US, but rather that the first sexually transmitted case occurred in Dallas, Texas. I’m starting to think Dallas, TX, could use a break from emerging infectious diseases… As influenza season picks up in the US, Avian influenza outbreaks are popping up in Taiwan, South Africa, and Macao. Good news- it’s safe to go back to your favorite burrito bowl! The CDC declared the Chipotle-associated E. coli outbreak over, however, their co-CEO has voiced frustration over delayed reporting. In the interview, he felt that it gave the “mistaken impression that people were still getting sick” and news was “fueled by the sort of unusual and even unorthodox way the CDC has chosen to announce cases.” Before we venture down the biodefense rabbit hole, don’t forget to stay healthy and safe this Super Bowl Sunday. Spikes in cases and flu-related deaths (in those >65 years of age) can jump by 18%  in the home regions of the two teams. Take care to avoid respiratory viruses and food-borne issues while cheering on your favorite team this weekend!

Medical Counter Measures for Children
Having worked in pediatrics, I was thrilled to see the American Academy of Pediatrics publish the updated guidelines. Throughout my work in infection prevention and collaborations with hospital emergency preparedness and local county health departments, it became increasingly evident that in many ways, this is a patient population that is easily forgotten. There is a woefully apparent gap in preparedness methodology to recognize and modify practices to meet the unique needs of children. While many may laugh at the notion that “children aren’t just little adults”, those who have worked in pediatrics can attest to these common misconceptions. Children are not only more susceptible to the devastation of disasters and CBRN attacks, the medical counter measures often do not account for pediatric dosages. The published report discussed their work over the past five years to better address and fill major gaps in preparedness efforts when it comes to medical counter measures (MCM) for children. “Moreover, until recently, there has been a relative lack of pediatric MCM development and procurement; many MCMs were initially developed for use by the military and have been evaluated and tested only in adults.” Some of the recommendations that were made from this report include: “the SNS and other federal, state, and local caches should contain MCMs appropriate for children in quantities at least in proportion to the number of children in he intended population for protection by the cache” and “federal agencies collaborating with industry, academia, and other BARDA partners, should research, develop, and procure pediatric MCMs for all public health emergency, disaster, and terrorism scenarios and report on progress made.” Perhaps one of the most interesting recommendations was that “the federal government should proactively identify anticipated uses of MCMs in children during a public health emergency and, where pediatric FDA-approved indications do not exist, establish a plan to collect sufficient data to support the issuance of a pre-event EUA that includes information such as safety and dosing information and the federal government should use existing entities with pediatric SMEs, such as the PHEMCE, PedsOB IPT, and the DHHS National Advisory Committee on Children and Disasters, and continue to collaborate with private sector partners offering pediatric expertise to provide advice and consultation on pediatric MCMs and MCM distribution planning.” Overall, these recommendations and the push for data collection and clear progress reporting are definitely a step in the right direction.

GMU Open House
Interested in a master’s degree that allows you to focus on bioweapons, global health security, and WMD’s? Check out GMU’s School of Policy, Government, and International Affairs (SPGIA) Open House on Thursday, February 25th at 6:30pm, at our Arlington Campus in Founders Hall, room 126. Representatives from our Biodefense program will be there to answer all your questions. Better yet, check out our Biodefense Course Sampler on Wednesday, March 2nd, at 7pm (Arlington Campus, Founders Hall, room 502). Dr. Gregory Koblentz,  director of the Biodefense graduate program, will be presenting “Biosecurity as a Wicked Problem”. Come check out our curriculum and get a taste of the amazing topics we get to research!

From Anthrax to Zikam6502e1f
Researchers at the University of Greenwich are finding a potential cancer-fighting strategy using the anthrax toxin. Lead scientist, Dr. Simon Richardson, is working with his team to convert the anthrax toxin into a delivery tool for medications.“This is the first time a disarmed toxin has been used to deliver gene-modulating drugs directly to a specific compartment within the cell. We’ve achieved this without the use of so called helper molecules, such as large positively charged molecules like poly(L-lysine). This is important as while these positively charged molecules, known as polycations, can condense DNA and protect it from attack by enzymes before it reaches the target, they are also known to be toxic, break cell membranes and are sent quickly to the liver to be removed from the body. In this study we demonstrate that using disarmed toxins without a polycation is effective, at a cellular level.” In the world of Zika virus….On Monday, the WHO Zika virus team met and announced that the outbreak should now be considered a public health emergency of international concern. Dr. Margaret Chan, WHO director general, stated, “I am now declaring that the recent cluster of microcephaly and other neurological abnormalities reported in Latin America following a similar cluster in French Polynesia in 2014 constitutes a public health emergency of international concern.” Given the level of uncertainty regarding the disease, many feel this was a justified classification of the outbreak. The first case of sexual transmission within the US also occurred in Dallas, Texas. The patient became sick after having sexual contact with an individual who became symptomatic upon return from Venezuela. Chile and Washington DC have just confirmed their first three cases this week. Mexico’s Health Ministry is trying to downplay the Zika impact on tourism, however as the outbreak unfolds, it will be interesting to see long-term tourism repercussions within the affected countries. The state of Florida is ramping up their mosquito elimination, control, and education efforts to combat the growing epidemic, as it is one of the mosquito-heavy states within the US. Governor Rick Scott recently declared a health emergency in four Florida counties. If you’re on the lookout for educational tools, there are several helpful CDC informational posters regarding mosquito bite prevention.

US Military and the Global Health Security Agenda
In effort to protect military members and support global public health, the DoD (specifically, the Military Health System in coordination with the Defense Health Agency’s Armed Forces Health Surveillance Branch) developed the 2014 Global Health Security Agenda (GHSA). The GHSA established a five-year plan with specific agenda items, targets, and milestones that would incorporate its 31 partner countries. The DoD’s Global Emerging Infections Surveillance and Response System (GEIS) will also support these efforts through their biosurveillance practices in over 70 countries. The international work is as varied as the challenges one might see in global biosurveillance. The Armed Forces Health Surveillance Branch (AFHSB) “leveraged existing febrile and vector-borne infection control efforts in Liberia to support the recent Ebola outbreak response. The Liberian Institute for Biomedical Research served as a central hub for Ebola diagnostic testing with the help of the Naval Medical Research Unit-3 in Cairo, Egypt and two Maryland-based facilities, the Naval Medical Research Center in Silver Spring and the U.S. Army Medical Research Institute of Infectious Diseases in Frederick.” Surveillance efforts will also look at antimicrobial resistance and the development of additional research laboratories to work in coordination with host-nations and certain regional networks. You can also read Cheryl Pellerin’s work on DoD Biosurveillance and the role it plays in maintaining global public health efforts. Pellerin reports on the duties of the GEIS and the US Army Medical Research Institute of Infectious Disease (USAMRIID) in not only global health security, but also protecting US military personnel from infections while abroad.

Norovirus Outbreak in Kansas
There are few things that will make a food-borne disease epidemiologist (or infection preventionist for that matter) as frustrated as a norovirus outbreak. It hits quickly, is highly infectious, and tends to leave you with stories from case-control interviews that will make you either laugh, cry, or need some fresh air. A Kansas City suburb is currently experiencing a 400 person outbreak of gastroenteritis associated with the New Theatre Restaurant. Initial lab reports have confirmed norovirus as the culprit. The Vice President of the restaurant said that three employees have also been confirmed as norovirus cases. To date, the almost 400 people who reported symptoms are said to have eaten at the restaurant between January 15 to present. Norovirus is a pretty unpleasant gastroenteritis (you’ve probably heard it called the “cruise ship bug”) as it has a low infectious dose (estimates put it as low as 18 viral particles, while 5 billion can be shed in each gram of feces during peak shedding). Norovirus outbreaks tend to spring up quickly and infect high volumes of people, making it difficult for public health officials to jump ahead of the outbreak. Perhaps one of the biggest components to stopping the spread of infection is good hand hygiene, environmental cleaning, and staying home when sick.

TB Transmission on Airplanes
We’ve all been there – you’re seated next to someone with a nasty cough or cold and you just know you’re going to get sick. But what happens if you’re on a plane and there’s a person a few rows away that has tuberculosis (TB)? The European Centre for Disease Prevention and Control (ECDC) reviewed evidence of TB transmission on airplanes to update their Risk Assessment Guidelines. Of all the records/studies reviewed, 7/21 showed some evidence for potential in-flight (all flights lasted more than 8 hours) TB transmission, while only one presented evidence for transmission in this environment. The interesting component is that this low transmission risk is considered only for in-flight, as they excluded transmission on the ground since the before and after flight ventilation system is not in full-function mode. The one study that did show transmission risk involved six passengers that were in the same section as the index case, of which, four were seated within two rows. After their review, they found that the risk for TB transmission on airplanes is “very low”. They noted that “the updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contact tracing and risk assessment.”

Stories You May Have Missed:

  • Resistant HIV – A recent study published in The Lancet discusses drug resistance after virological failure with the first-line HIV medication, tenofovir-containing ART (antiretroviral  therapy). This treatment is used as both a prevention and pre-exposure prophylaxis (PrEP). Researchers found “drug resistance in a high proportion of patients after virological failure on a tenofovir-containing first-line regimen across low-income and middle-income regions”. This study highlights the growing need for surveillance of microbial drug resistance.
  • Active Monitoring of Returning Travelers – Ebola Surveillance – The CDC’s MMWR for the week of January 29, 2016, discussed NYC monitoring of returned travelers from October 2014-April 2015. Monitoring of returned travelers from Ebola-affected countries was one strategy the US employed to prevent imported cases. This report reviews the 2,407 travelers that returned from affected countries, of which no cases were detected. The NYC Department of Health and Mental Hygiene (DOHMH)’s active monitoring system proved successful, however it was very taxing on resources and reinforces the need to minimize duplication and enhanced cooperation. Speaking of Ebola, investigators from the University of Texas Medical Branch at Galveston, Vanderbilt University, the Scripps Research Institutem and Integral Molecular Inc., have performed research to establish that “antibodies in the blood of people who have survived a strain of the Ebola virus can kill various types of Ebola.” Further work will now seek to understand immune response to the virus and how we can modify treatments and potential vaccines to be more effective.
  • DoD BioChem Defense – take a glimpse into the global biosurveillance and defense efforts within the DoD Chemical and Biological Defense Program (CBDP). Working within several joint programs and striving to get ahead of outbreaks and attacks with early warning systems, this program faces the challenges of monitoring biochem threats on an international scale.

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report 9.25.2015

by spopescu, posted in News, Pandora Report

You didn’t think a Papal visit would slow us down, did you? Even in the event of a zombie apocalypse, we GMU Biodefense folks would still find a way to get out the weekly report – perhaps pigeon carrier? Until that happens, don’t forget to check us out on Twitter! This week saw a lot of great focus on collaborations to fight public health threats like antimicrobial resistance and epidemics. Schools in Chicago were closed for concerns over Legionnaires’ disease, yours truly provided a piece on Ebola infection prevention, and we have a wonderful opportunity to contribute to World Medical & Health Policy regarding women’s health on a global stage.

Learned Lessons from Ebola in the US
Sylvia Burwell, Secretary of Health & Human Services, discusses the clinical complexity and reality that “our clinical approach to treating Ebola in a hospital setting posed different challenges.” Several key US health experts weighed in on the pivotal first patient, Thomas Duncan, to unknowingly bring Ebola to the US. The implications for healthcare and preparedness sent a tidal wave of response across US hospitals. Dr. Tom Frieden, director of the Centers for Diseases Control and Prevention (CDC), also highlights three main lessons from not only the cases in Dallas, but also the Ebola epidemic as a whole. He points to the necessity of a strong surveillance and response system, need for rapid international aid, and better infection control in hospitals….which segues beautifully into our next story.

The Infection Prevention Angle of the 2014 Ebola Crisis
Reports and analyses from a range of responders to the crisis have been trickling out for several months now, but there’s a constant in all of them – infection control. Given my background and experiences in this field, I wanted to take our readers down the rabbit hole of what exactly it was like to be an Infection Preventionist during this time. A hopeful start to a series of pieces on this subject, it will give you a taste of not only the daily struggles, but the brevity of what potential Ebola patients meant for US healthcare preparedness.

Partnerships to Support Antibiotic Development
564px-Penicillin_Past,_Present_and_Future-_the_Development_and_Production_of_Penicillin,_England,_1943_D16963The ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Biomedical Advanced Research and Development Authority (BARDA) is part of a larger initiative to use Other Transaction Authority (OTA – flexible advanced research and development funding instruments) to start developing business relationships between government and private industry. The relationships are mutually beneficial, allowing both parties to invest and develop products for biodefense and the growing threat of antibiotic resistance. Given the slowing of new antibiotic development, this joint agreement comes at a pivotal time for antimicrobial resistance efforts.

Three Chicago-area Schools Close in Response to Legionnaires’ Disease Concerns
Three schools in the Illinois U-46 district were shut down on Wednesday and Thursday after cooling tower test results showed “higher than normal levels of Legionella bacteria”. The OSHA recommended threshold is no higher than 1,000 CFU/ml (colony-forming units per milliliter) and with the outbreak among residents of the Illinois Veteran’s Home, it’s not surprising to see many water towers being frequently tested, etc. The important thing to note is that Legionella pneumophila infections are a result of the intensity of the exposure and the immune status of the exposed person. Legionella can’t be totally eradicated from the water supply and a majority cooling towers will contain some amount of growth.

Call for Papers – Women’s Health in Global Perspective
Papers sought for a special issue and workshop of World Medical & Health Policy on “Women’s Health in Global Perspective,” to contribute to understanding and improve policy related to women’s health and wellbeing.  Forces ranging from the economic to the climactic have human repercussions whose genesis and solutions demand consideration of their global context.  A wealth of recent research and inquiry has considered the particular plight of women, who often suffer disproportionately from lack of education, compromised nutrition, poverty, violence and lack of job opportunities and personal freedom.  The Workshop on Women’s Health in Global Perspective will consider the broad ranging social determinants of health on a global scale that importantly influence health outcomes for women everywhere, which in turn has implications for economic, political and social development.
Abstract submission deadline (250 words): October 16, 2015 
Contact: Bonnie Stabile, Deputy Editor, bstabile@gmu.edu
Notification of selected abstracts: November 13, 2015
Workshop March 3rd, 2016
Completed papers due: March 11, 2016

Stories You May Have Missed:

  • Personal Microbial Cloud – researchers found that a person’s microbiome form a cloud around them, allowing scientists to identify a specific person just by sampling their microbial cloud. Food for thought: would this be our microbial cloud version of a fingerprint?
  • C. Difficile Drug Success – Researchers at Stanford University School of Medicine were successful in their ability to get rid of the deadly gastrointestinal toxin via a drug that didn’t focus on the organism, Clostridium difficile, but rather the toxin itself. C. difficile is responsible for 250,000 hospitalizations and 15,000 deaths per year while costing the US more than $4 billion in healthcare expenses. Yay for successful treatments!
  • EC, EU, and WHO Work To Better Share Private Drug Data – The European Commission, European Medicines Agency, and World Health Organization are working to “step up coordination” on EU medicines regarding safety, quality, and efficacy of new drug candidates. The first step in solving a problem is recognizing you have one, right? The new focus on global public health threats is one we can all appreciate!
  • WHO Makes Changes to Southern Hemisphere Flu Vaccine – The WHO committee recommended changes for two of the three trivalent influenza vaccines for the Southern Hemisphere next year due to changes in the circulating viral strains. They suggested using H1N1, H3N2 an A/Hong Hong/4801/2014-like virus, and for influenza B, the Brisbane/60/2008-like virus. In the quadrivalent vaccine, they recommended adding the influenza B Yamagata lineage component, with the A/H1N1 strain staying.

Ebola 2014: The Infection Preventionist Perspective

by spopescu, posted in News, Pandora Report, Uncategorized

By Saskia Popescu

Unlike many infectious diseases, especially ones with a relatively small number of occurrences, the Ebola outbreak that started in 2014 received a sensational amount of attention. While many in public health keep tabs on outbreaks (thanks ProMed!), it’s not uncommon for the rest of society to remain blissfully unaware unless the bug comes knocking on their front door. I’ve been captivated with Ebola (now called Ebola Virus Disease, or EVD) since a young age after Richard Preston’s sensational book, The Hot Zone got passed to me during a family vacation. The first whispers and later emails of the surging cases in West Africa were pretty astounding in early 2014. Usually these outbreaks occur in small blips and then die off a few weeks or months later. I was working in Infection Prevention & Control at a pediatric hospital at the time and, like many, didn’t think too much about the outbreak pertaining to the US and even if it did, our infection control practices should be able to handle an organism that required Contact/Droplet isolation. I put some updates in our monthly newsletter and continued to watch as West Africa became overwhelmed with EVD.

Like many public health issues, no one really starts hitting the panic button until a disease shows up and you’re scrambling (and trust me, most of the time, you find out retrospectively) to do damage control. The IP (infection prevention) world started to get worried in late July when Emory University Hospital accepted and began treatment the first two EVD patients transported into the US from their field assignments in West Africa. Questions about isolation and practices were asked, but again, no one really worried too much since these patients were flown directly to Emory due to their special infectious disease isolation unit. Suddenly, on September 30th, 2014 a media storm announced that a patient being treated at Texas Health Presbyterian Hospital in Dallas, Texas, was positive for EVD. I can personally tell you, this is when the proverbial crap hit the fan for just about every healthcare facility and IP in the US. A visiting your emergency department, being sent home, and then coming back with a highly infectious disease that few physicians know well enough to suspect, let alone diagnose or treat, is pretty much the equivalent of an IP nightmare. So what could we do?

First, I should say that every hospital with an IP team (most of them have at least one IP) experienced a massive level of panic, anxiety, and stress dedicated to avoiding this, so please, give them a pat on the back. I am fortunate that my IP team consists of not only enthusiastic, ridiculously talented and intelligent people, but they know how to respond to crisis in the flip of a switch. We quickly pulled together a committee to encompass all people that would play a role in the preparedness and response of an EVD patient. Fortunately, by this time, Emory had released an extremely helpful document that discussed their experiences and lessons learned. We met our committee (now filled with people from environmental services, facilities, nursing, medical staff, infectious disease, emergency preparedness, the emergency department, and many others) with this document and everything else the Centers for Disease Control and Prevention (CDC) had on EVD response. For many, the difficulty laid in where do we put this patient, what designated staff will care for them, and what will we do with the waste? You pretty much need to have a specific process for both your emergency department if there is a suspected case, but also a designated wing you can move patients out of and move this potential EVD patient into. Without going too much into detail, one of the trickier components became the PPE (personal protective equipment) and waste process of a potential patient. CDC PPE recommendations were changing almost daily (or at least that’s how it felt). Information was changing so rapidly it was a constant cycle of checking their website, talking with peers, and attempting to update instructional handouts and training tools for staff incase we happened to get a potential patient. Historically, EVD PPE recommendations came from outbreaks in Africa with little access to the equipment and capabilities we’re used to in the US. The ability to intubate a patient or insert a central line opened up a Pandora’s box of potential transmission scenarios, leading to difficulty in establishing a solid PPE process. Acquiring the PPE was another struggle. Our materials management team worked tirelessly to find the ever changing products we would need to not only have PPE kits in our emergency department and urgent cares, but also to sustain care for a patient for several days. The sustainability was a huge concern as staff were changing in and out of PPE every 45 minutes due to heat exhaustion and CO2 build-up from the N-95 masks. Once we were able to obtain the PPE, and this was a constantly changing cycle to follow CDC recommendations, training went into effect. One of the greatest struggles was training enough staff to have a proficient understanding of an extremely complex (and dangerous) process. The unique part about EVD PPE practices is that you utilize a buddy system with a checklist – something healthcare workers are not used to and something we had to remind them of (don’t try and memorize this)! We did several drills involving patients projecting a mixture of chocolate syrup and glitterbug to not only prepare healthcare staff, but also show their cross contamination when doffing the PPE.

Courtesy of USA Today
Courtesy of USA Today

The PPE struggles were one small piece of this EVD pie. Many IP’s could probably write a novel about the struggles and random problems that came up during this time. Our ridiculously long days were filled with preparedness meetings, educational trainings, hospital-wide communication, worried calls from people and staff (the comical relief of people calling to ask for an EVD vaccine but refusing to get their flu shot showcases the ridiculousness of what we experienced), educating physicians on signs and symptoms, identifying routes for patient transportation, and coordinating surveillance mechanisms like electronic mandatory travel history (from the affected countries) questions and alerts in the intake process of patients from the emergency department or urgent cares. The simple truth is that the US became so panicked and so obsessed with a disease no one really worried about a few months before, the amount of preparedness that was initiated simply couldn’t be maintained for an extended period of time. Emergency departments and hospitals are comprised of some of the most hardworking and intelligent people you’ll ever meet, but I can honestly say, something like what happened in Dallas could’ve happened in any hospital. Healthcare is an imperfect system and while we struggle to make it better and more robust, it always comes down to overworked staff and communication gaps. My experiences as an IP during the EVD 2014 outbreak, while exhausting, were truly eye opening to the ability of our healthcare infrastructure to respond to such an event. It revealed a lot of gaps in our practices and the state of our preparedness, but overall, it highlighted the growing need for better disease surveillance, preparedness, and attention to biosecurity.

 

Pandora Report 10.4.14

by juliadhomstad, posted in Pandora Report

This week the round up includes Russian bird flu, pregnancy and flu, ISIS threats to British troops, and of course, an Ebola update.

Have a great weekend, don’t forget your flu shot, and keep smart about your news!

Russia Reports First Cases of Deadly Bird Flu in Two Years

Domestic chicken, geese, and ducks in the Altai Krai region of Russia, near the border of Kazakhstan, were found to be infected with the H5N1 serotype of bird flu. These are the first cases of the highly pathogenic flu in this area in nearly two years.

Reuters—“The latest outbreaks in Russia, which led to the death or culling of 344 birds, were thought to have come from wild birds. “Probably, hunted ducks and geese trophies had been placed in backyards where mortality occurred later in domestic birds,” the farm ministry said in its report.”

Why is Flu Virus Higher Risk for Pregnant Women? 

While HHS continues to prepare for pandemic flu, which could kill 60 million people, researchers at Stanford University have looked at the effects flu has on pregnant women. A pregnant woman’s immune system is strongly suppressed, but researchers say this alone cannot explain vulnerability to influenza. Researchers looked at the proportion and behavior of natural killer cells and T cells, which in the presence of flu increased and changed in function. These findings offer a possible treatment path—changing inflammatory response rather than just fighting replication of the virus.

Star Tribune—“Women who get the flu while pregnant have a much higher risk of hospitalization and death and are four times more likely to deliver a premature baby. During the 1918 epidemic, in fact, the death rate among pregnant women was at least 28 times that of the general population.”

ISIS Threatens to Gas British Troops in Iraq: Soldiers Ordered to Carry Chemical Suits

British Special Forces training Kurdish Peshmerga fighters and identifying RAF bombing targets in Northern Iraq have started carrying chemical protection suits. Intelligence sources warned that ISIS fighters may have stolen poison gas from Syrian forces who withheld the agents from destruction. ISIS is thought to have stolen sarin and chlorine gases when they raided a Syrian Air Force base two months ago.

The Mirror—“The [British] soldiers now carry nuclear and biological warfare protection and respirators. All vehicles are being fitted with gas detectors and an RAF Regiment trained in chemical warfare is on standby to fly to the region.”

This Week in Ebola

Oh, Ebola. The big story this week is that the virus arrived on American shores, with the first confirmed case in Dallas and potential cases of Ebola in the DC area being ruled out, the CDC is using contact modeling to help track potential cases in Texas. Arrival in the U.S. has caused an absolute avalanche of news stories and opinion pieces throughout the media. They have ranged from fear mongering about an epidemic in the U.S. and how quarantines would be ineffective, to why you shouldn’t worry about Ebola as a bioweapon. We saw the White House urging calm (and making awesome infographics) and medical facilities saying the average American citizen has nothing to worry about. Meanwhile, there were reports that Ebola poses a greater risk than SARS and AIDS and Louis Farrakhan tweeted that Ebola is a bioweapon against Africans. Use of hyperbole and misinformation do a disservice to those trying to responsibly inform Americans. We saw a case of a doctor in Liberia who quarantined herself in order to keep others safe and another Liberian doctor who seems to have effectively treated Ebola using HIV drugs. And, of course, the biggest problem was that Ebola could affect the cocoa trade. Oh wait, no, that’s what we in “the biz” call a #champagneproblem.

Stories You May Have Missed

 

Image Credit: Pregnant In The City