World Health Organization (WHO): Zika Virus is a Public Health Emergency of International Concern (PHEIC)
The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.
The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology.
The following States Parties provided information on a potential association between microcephaly and/or neurological disorders and Zika virus disease: Brazil, France, United States of America, and El Salvador.
The Committee advised that the recent cluster of microcephaly cases and other neurologic disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC).
Based on this information, the WHO Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016.
Resurgence of a disease that was “eliminated” from the United States in 2000
In medical history, measles was 1st identified as a unique disease by the Persian physician Rhazes in the 9th century when he published the text titled The Book of Smallpox and Measles. Measles is an ancient disease that used to have a profound global impact causing hundreds of thousands of deaths and millions of cases each year. In the 16th century, a measles epidemic caused the deaths of two-thirds of the population of Cuba in one year, and two years later, it killed half the population of Honduras. In the 1850’s, a measles outbreak caused the death of 20% of the population of Hawaii. From 1840-1990, it is estimated that measles has killed approximately 200 million people worldwide.
Global Need for Coordination of Efforts
The International Health Regulations (IHR) is a structural body created to increase Global Health Security and prevent national public health emergencies from becoming global crises. The IHR were first implemented in 1969 focusing on plague, cholera, yellow fever and small pox. Several years later in 1995, the reemergence of plague in India and Ebola in Democratic Republic of Congo (DRC) created the need to revise and update the IHR. This led to the creation of a network of technical collaborations among existing institutions and networks, which would pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance: the Global Outbreak Alert and Response Network (GOARN). Most recently, the GOARN has focused on the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Alert and response operations functions include:
- Event-based surveillance, multi-hazard rapid risk assessment and event-based risk communications
- Critical information and communications platforms for decision support
- Operations and logistics platforms for any WHO response to international public health risks.
The flu season is just beginning
In the United States, the flu season typically spans from December to February. About 25,000 people die each year in the US from flu-related complications. The latest statistics from 2011 indicate 53,826 people died from influenza and pneumonia. The US Centers for Disease Control and Prevention (CDC) has designated December 7-13th as National Influenza Week to emphasize the public health need for flu vaccinations as we enter the peak flu season. Availability of the flu vaccine should be widely accessible, and 7 influenza vaccine manufacturers are projecting around 155 million doses of influenza vaccine will be available this year. The 2014-2015 influenza vaccine will protect against at least 3 strains of flu (trivalent vaccine), and an additional vaccine will be available that will also protect against a 4th strain (quadrivalent vaccine). All of the 2014-2015 influenza vaccines will protect against the following 3 strains:
- A/California/7/2009 (H1N1) pdm09-like virus
- A/Texas/50/2012 (H3N2)-like virus
- B/Massachusetts/2/2012-like virus
The quadrivalent vaccine will also add protection against additional B virus: B/Brisbane/60/2008-like virus.
As the Ebola Epidemic of 2014 continues, some officials are calling upon a centuries-old tactic to combat the disease: medical quarantine. In an effort that began on October 24th, New York and New Jersey state officials instituted a mandatory 21-day quarantine on all medical personnel returning from volunteer efforts to combat the disease in West Africa.
No Standard Protocols
While some states are embracing the idea and implementing quarantines of their own, other state and national officials are denouncing them. Medecins Sans Frontieres (MSF), the main humanitarian group coordinating volunteer efforts in Africa also denounced the quarantines:
There are other ways to adequately address both public anxiety and health imperatives, and the response to Ebola must not be guided primarily by panic in countries not overly affected by the epidemic,” said Sophie Delaunay, executive director of MSF-USA. “Any regulation not based on scientific medical grounds, which would isolate healthy aid workers, will very likely serve as a disincentive to others to combat the epidemic at its source, in West Africa.
International MSF staff members commit to burdensome four-to-six week assignments in the Ebola affected countries. The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place. This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever.
In mid-September, a six-member team from Baylor College of Medicine trained nearly 1,500 healthcare providers and non-medical personnel in the basic facts about Ebola and in the care of people with the disease during four days of training in two Nigerian cities – Lagos, Africa’s most populous city, and Eket, an industrial city in the south. The effort was sponsored by ExxonMobil, which has offices and petroleum operations in the African nation.
Nigeria has had a limited number of cases of the disease in the current outbreak, and the disease has been designated as contained as of early October.
The Baylor training consisted of a presentation for the non-medical public about the disease itself and how best to protect against it. A second, more sophisticated presentation was designed for healthcare providers, describing the best methods to prevent transmission, caring for patients, and protecting against acquiring the infection during care. A third presentation dealt with the appropriate personal protective equipment and how best to put it on and take it off safely.
Dr. Bobby Kapur, physician leader and associate professor of medicine – emergency medicine at Baylor, said it was interesting that Nigeria’s situation was similar to that in the United States. One person traveled from Liberia to Nigeria and then had some contact within the community.
The respiratory virus known as Enterovirus D68 (EVD68) has been sweeping the country this summer, primarily infecting children. So far 691 people in 46 states have been infected. Luckily, enterovirus is typically a summer virus, and it’s season shall soon come to an end.
Children with Asthma may have Worse Outcomes with EVD68
While the signs and symptoms of EVD68 generally mirror that of other respiratory viruses and can include fever, runny nose, sneezing, cough, and body and muscle aches. In some children wheezing and difficulty breathing can develop. The most deadly form of the virus seems to be more widespread in the Midwest. At the peak of the Kansas City-area outbreak their 354-bed hospital was filled, and Children’s Mercy had 100 patients in their pediatric intensive care unit (PICU), three times more than normal for this time of year. Patients usually end up in the PICU due to severe bronchospasms, and often many children affected by the virus suffer from asthma or have had episodes of wheezing in the past. This video describes EVD68 in more depth.
The 1st ever documented case of Ebola in the United States was announced on September 30, 2014 by the Centers for Disease Control & Prevention (CDC) and the Texas Department of State Health Services.
Dallas, We have an Infection
Thomas Eric Duncan, a 42 year old Liberian national, who was traveling to the US for the 1st time to visit family in Dallas arrived in Texas on September 20, 2014. He had traveled to Dallas via flights from Brussels to Washington, DC then to Dallas. Mr. Duncan, initially showed signs of a low-grade fever and abdominal pain beginning on September 24th and was seen at Texas Health Presbyterian Hospital Dallas on September 26th. Although his family had informed the healthcare workers of his recent arrival from Liberia, the hospital personnel decided he did not meet the criteria for Ebola suspicion since he did not have a temperature greater than 101.5 degrees Fahrenheit. He was discharged home. On September 28th, Mr. Duncan’s symptoms worsened, and he was transported by Dallas County EMS back to Presbyterian Hospital and was placed into isolation. On September 30th, lab tests from the State of Texas and the CDC confirmed the patient has Ebola. He is currently in critical condition in the ICU. The C.D.C. has sent a team to Dallas to identify others who may have contracted the illness.
It is important to remember that Ebola does not have respiratory transmission. The disease is only spread through exchange of bodily fluids and is only contagious when symptoms appear. Thus, only those who interacted with Mr. Duncan on or after September 24th are at risk. The Director of the CDC, Dr. Thomas Frieden has stated there is “zero risk of transmission” to fellow passengers on his flights because he was not showing signs of symptoms while traveling.
On Thursday, September 18, President Barrack Obama issued an Executive Order which created a Task Force with the Mission to Combat Antibiotic-Resistant Bacteria in response to this report published by the President’s Advisory Council (PAC) on Science and Technology. The CDC estimates that there are have been over 2 million illnesses and 23,000 deaths from antibiotic-resistant bacteria in the United States.
The PAC report outlines a 5-step plan to combat these specific pathogens:
- Carbapenem-Resistant Enterobacteriacea
- Methicillin-Resistant Staphylococcus aureus
- Ceftriaxone-Resistant Neisseria gonorrhea
- Clostridium difficle
The CDC also includes Extended-Spectrum Beta Lactamase producing Enterobacteriacea, Multi-Drug Resistant Salmonella, and Pseudomonas on its list of pathogens to target.
“Tip of the Iceberg”
Public health officials and physicians are scrambling to keep up with hospital admissions and Emergency Department (ED) visits in 10 states across the country as an epidemic of children presenting with severe respiratory symptoms spreads across the US. Mark Pallansch, the director of CDC’s Division of Viral Diseases has said that these increased hospitalizations could represent, “just the tip of the iceberg in terms of severe cases” and have prompted health officials in Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, and Kentucky to reach out to the CDC for further assistance.