Issue #13: October 2, 2014

NEWS

EBOLA – Numbers of infected patients in the West Africa outbreak of Ebola virus disease reached 6,574 on September 29. In Liberia cases are doubling every 15-20 days. Worst-case projections by the CDC suggest 1.4 million could be infected by January 2015 if public health infection control measures fail. In resource poor countries of Africa the mortality rate continues to approach 50%. However, general supportive care would likely improve survival substantially in countries able to provide critical care. Clinicians with experience in West Africa also argue that many lives could be saved even in resource-constrained settings by providing timely intravenous hydration. The first US case of Ebola virus disease was admitted to a Dallas, Texas Hospital on September 30. Improvement opportunity: more timely recognition of suspected cases in the US allowing infection control protections to be initiated earlier. See the CDC website for a detailed hospital preparedness checklist.

IMMUNIZATION DISASTER IN SYRIA – The immunization campaign to control measles and polio in war-torn Syria was interrupted by the deaths of 15 infants after receiving a measles vaccine reported to have been contaminated by atracurium, a neuromuscular blocker. It remains unclear whether this catastrophe was accidental or intentional.

CHIKUNGUNYA – In the US, 1,125 cases have been reported by the end of September. Most of these occurred in travelers returning from endemic areas of the Caribbean, South America, Pacific Islands, or Asia. New York State leads with 259 cases, all acquired after travel to endemic areas. 11 locally acquired cases have been identified in Florida.

ENTEROVIRUS RESPIRATORY DISEASE – An unusual widespread outbreak of respiratory illness associated with enterovirus D68 is occurring in the US. Affecting children, most have a mild upper respiratory infection. A small proportion, especially those with asthma, have a more severe illness. The spectrum of disease and its management are similar to other childhood viral lower respiratory tract infections. A small cluster of children in Colorado also has had a polio-like acute neurological syndrome with limb weakness and inflammatory lesions of the spinal cord or brainstem gray matter. No viral organism has been detected in cerebrospinal fluid, however, nasopharyngeal specimens were positive for enterovirus D68 in 4 of 6 children. The CDC seeks additional information on similar cases.

NEXT GENERATION VENTILATORS FOR DISASTER STOCKPILE – Conventional mechanical ventilators cost as much as $30,000 each. The US Department of Health and Human Services is sponsoring the development of ventilators for public health emergency surges designed to be easier to use without special training, able to support patients of all ages from newborn to elderly, at a cost of less than $4,000 each.

UNNECESSARY PUBLIC HEALTH EMERGENCY DECLARATION? – The declaration of a public health emergency to prevent overdoses and deaths due to opiate addiction in Massachusetts has raised questions whether a governor’s emergency powers are the most appropriate way to solve public health problems. The Massachusetts declaration authorized expanded access to the opiate antagonist naloxone, expanded opiate prescription monitoring, prohibited prescriptions for a hydrocodone medication, and allocated funds for addiction treatment. It is not clear why these interventions could not have been authorized by the normal legislative or administrative rule making process. Emergency powers are usually invoked at the state level, suspending individual civil rights or private business interests to urgently prevent catastrophe associated with infectious disease outbreaks, natural disasters, or acts of terrorism. Overuse of emergency powers may impair their effectiveness when most needed. It may be time to develop clearer and more consistent criteria for state emergency declarations.

EBOLA GENOMIC SURVEILLANCE – Analysis of Ebola virus genomic sequences from 78 patients during the current West Africa outbreak reveals substantial genetic variation as the virus transmits from human to human. Such genetic variation could impact disease pathophysiology, as well as diagnostic and therapeutic tools. Tragically, 5 of the authors of this study became ill and died from Ebola virus disease while serving in public health and research efforts to control the outbreak.

DECLINING FUNDING FOR HOSPITAL PREPAREDNESS – The 10 countries with the highest child mortality worldwide are all in sub-Sarahan Africa. Leading causes in this region include infections (malaria, pneumonia, gastroenteritis), neonatal disorders, nutritional deficiencies, sickle cell disease, congenital anomalies, epilepsy, and asthma. Affordable, lifesaving interventions: exclusive breast feeding through 6 months of age, oral rehydration products, vaccinations, and insecticide treated bed nets.

Edited by: Dr. Bob Kanter