- THE EBOLA EPIDEMIC – In late December the CDC reported the worldwide Ebola virus outbreak reached 19,497 cases with 7,588 deaths. Transmission remains active in the west African countries of Liberia, Guinea, and Sierra Leone. Although cases are no longer increasing at an exponential rate throughout the region, local spread remains intense in western areas of Sierra Leone. Isolation and general supportive treatment of Ebola patients, as well as safe burial practices, have improved. However, the attention to Ebola has distracted from prevention and therapy for other diseases such as malaria in west Africa. Ebola infection control efforts have halted outbreaks in the US, Spain, Nigeria, Senegal, and Mali. Ebola virus disease sounds the alarm that poor healthcare infrastructure in developing countries poses a worldwide threat. In industrialized countries public health infrastructure and practices do not match the sophistication of acute care. In the US, national deficiencies in public health leadership led to disruptive panic and politically driven responses.
- CHIKUNGUNYA – In the US, 2,021 cases have been reported by the end of December. Most of these occurred in travelers returning from endemic areas of the Caribbean, South America, Pacific Islands, or Asia. New York State leads with 533 cases, all acquired after travel to endemic areas. 11 locally acquired cases have been identified in Florida.
- PERTUSSIS – After decades of good vaccine control of pertussis in the US, annual rates are now exceeding 20,000. Through August, pertussis cases were up by 30% compared with 2013. The problem appears to be due to a combination of incomplete immunization practices and less effective protection from the current acellular vaccine than previous whole cell vaccines that were also associated with a higher incidence of adverse reactions. Policy options: develop a new whole cell vaccine, modify the acellular vaccine, or adjust immunization schedules for the current acellular vaccine. The currently recommended strategy aims to maximize immunization for individuals likely to have contact with infants who suffer the most life-threatening effects from pertussis.
- ANTIBIOTIC RESISTANT BACTERIA – The uncontrolled use of antibiotics in humans and farm animals, combined with poor sanitation practices has resulted in a dangerous increase in antibiotic resistant bacteria in sewage and water, resulting in colonization of humans. Genetic markers for antibiotic resistance, first detected in India, are now being identified around the world. Infants born with antibiotic resistant bacterial infections accounted for 58,000 deaths in India last year. While practices contributing to antibiotic resistance are most prevalent in developing nations, similar risks occur worldwide. Regardless of source, national boundaries do not prevent the spread.
- DISASTERS AND EVERYDAY CARE OF CHILDREN – Leaders in healthcare organizations, public health, and communities must constantly decide on the allocation of resources for emergencies versus everyday needs. It is worth reflecting on evidence that health and development of children in the US ranks near the bottom of industrialized countries, a disaster by any definition. As a result needs for expensive healthcare, school, juvenile justice, and child protective services are high. Can we do better? It will require a consensus on national priorities and funding that transcends present day polemics. Authors of a policy statement believe the child healthcare system must transition from its old emphasis on treating acute illness and chronic disease management, instead aiming for lifelong optimal health development. However, it is worth remembering that the increase in childhood chronic disease is partly a result of successful acute care in newborns and critically ill and injured children. Good results in local prototype programs would inform efforts in other communities. Costs might be justified if early prevention reduces later costs of special education, law enforcement/juvenile justice, as well as chronic disease management for older children and adults. Evidence to guide resource allocation would be essential. Unfortunately, the recent cancellation of the National Children’s Study does not predict progress toward evidence-based interventions to optimize lifelong health and development. Costs and complexity of scientific design appear to have been limiting factors leading to failure of this important research program.
- DECLINE IN LOCAL HEALTH DEPARTMENT PREPAREDNESS – A survey of local health department preparedness trends in North Carolina during 2010-2012 showed declines in surveillance & investigation, legal preparedness, plans & protocols, communication, and incident command, all at a time of funding cuts and job losses.
- CLINICAL EXPERIENCE WITH EBOLA IN MODERN HOSPITALS – Lacking evidence from clinical trials, clinicians can refer to case reports for preliminary guidance on hospital treatment of Ebola virus disease. Moderately ill patients received aggressive intravenous hydration and titrated electrolyte replacement (especially sodium, potassium, and calcium), convalescent whole blood from Ebola survivors, infusion of an experimental antibody, along with treatment of malaria co-infection. In a severely ill patient, assisted ventilation and antibiotics for gram-negative bacterial co-infection (presumably originating by translocation from the injured intestinal tract) also were necessary.
Edited by: Dr. Bob Kanter