Large Number of People in the Crosshairs
With a population of more than 177 million people, Nigeria has a larger population than the next two most populous African countries combined (Ethiopia & Egypt). Although the current Ebola crisis has focused on the more than 2,100 cases and 1,100 deaths in Liberia, Sierra Leone, and Guinea, the epidemic has now spread to Nigeria.
Continuing coverage of the Ebola Epidemic affecting West Africa with the potential to spread to a wider region. The 1st article in the series can be found here.
The Fight Ramps Up
The 2014 Ebola outbreak “is moving faster than our efforts to control it..this is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary,” said Margaret Chan, director-general of the World Health Organization (WHO) in response to the continued devastation in Africa where the outbreak has claimed at least 932 lives, including that of Sierra Leone’s leading Ebola expert Dr. Sheikh Umar Khan, and over 1700 cases. The WHO announced on August 6th that it will convene a special panel to deliberate the use of experimental drugs in an attempt to control the outbreak with innovative measures.
The US Centers for Disease Control (CDC) has raised its Emergency Operations Center Response to the Ebola epidemic to a Level One, its highest level of response. Level One has occurred only 2 other times in the CDC’s history: Hurricane Katrina in 2005 and the H1N1 Outbreak in 2009. The CDC has 240 staff members working on the Ebola response and 30 members in the affected regions with more en route.
Many organizations such as US Peace Corps have already evacuated hundreds of volunteers from the most severely affected areas in West Africa. The situation has garnered international concern and the World Health Organization recently announced allocation of $100 million in funds to provide much needed supplies and officials to reverse the disease’s overwhelming tide and plans to send another 50 specialists to West Africa to help control the outbreak. But as efforts are escalated to treat those infected, containment protocols have also been expanded:
– The CDC has issued a Level 3 travel warning (highest level) for US citizens that severely discouraged from all nonessential travel to those countries hardest hit by the virus: Guinea, Sierra Leone and Liberia
– In Sierra Leone the government has announced plans to quarantine the hardest hit regions and to deploy security personnel to assist healthcare workers in their efforts to combat the disease
– Liberia has declared that all non-essential government personnel will be placed on a thirty-day long complusory leave and is making plans to close all schools temporarily
– Meanwhile from Nigeria to New York, vigilance has been increased at airports for passengers arriving from endemic regions with symptoms consistent with the Ebola virus. Dr. Jay Varma, deputy commissioner for disease control at the New York health department has reassured the public that any such affected individual would be briefly quarantined at the airport before being transported to an area hospital for further evaluation.
Though cholera mainly affects children in developing countries, the US is still at risk for outbreaks of this potentially lethal infection following natural disasters or terrorist attacks that disrupt access to clean water and sanitation systems. The manufacture of a safe, rapidly effective oral vaccine will be beneficial for both those in endemic areas and those in non-endemic countries.
Global Burden of Cholera
Official statistics show that global cholera cases are approximately 200,000-500,000 per year. However, current research shows that these reported figures only represent 5-10% of actual cholera cases, and it actually affects 3-5 million people and causes over 100,000 deaths per year.
Children Escaping Violence & Poverty
Over 50,000 undocumented children (UAC) have entered the United States through the Southwestern border in the last 8 months, creating what some a calling a humanitarian crisis. As many as 90,000 children are expected to enter the country by the end of the year.
Many children are being sent to the United States alone without any adult supervision by family members hoping that by entering the United States their children will be spared the harsh realities of gang violence, drug cartels and civil unrest in their home countries. Categorized as Unaccompanied Alien Children (UAC), these children hail mostly from Mexico, Guatemala, El Salvador, Honduras and Ecuador.
Sandflies & Civil War
The Syrian civil war has set the stage for the reemergence of a rare infectious disease. Transmitted through the bite of the sandfly, Leishmaniasis is a parasite that can affect many different parts of the body. The most prevalent form in the Middle East is called Cutaneous Leishmaniasis, which causes disfiguring welts and scarring of the skin. A more lethal variant known as Visceral Leishmaniasis can also damage the spleen and liver.
Since the Syrian conflict began in 2011, the number of Leishmaniasis cases has skyrocketed from 3,000 to over 100,000. Water shortages and poor sanitation have combined to create conditions ripe for the transmission of the disease. To make matters worse, the pentavalent antimonial drugs used to treat Leishmaniasis are becoming increasingly scarce. In times of conflict, Public Health tools such as surveillance, multi-sector response, and international collaboration rapidly diminish states Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine and President of the Sabin Vaccine Institute.
African Mosquito-borne Virus Arriving in Western Hemisphere
Chikungunya virus, an arthropod-borne virus thought to have originated in Central/East Africa with first known human infections reported in Tanzania in 1955, has re-emerged with newly documented cases in the Caribbean and the United States raising concerns of among health officials for a new epidemic. The virus is transmitted to humans through the bite of an infected Aedes aegypti or Aedes albopictus mosquito. Though cases have been documented in countries in Asia and Africa and even Italy in 2007, the previously “tropical” disease is surprising health officials with its capacity for global spread. Also adding to official concerns: the newly reported cases in the Caribbean mark the first instance that the disease has been spread by locally infected mosquitoes among people who have not travelled to endemic areas recently.
CDC Employees Exposed to Deadly Bacteria
On June 19, 2014, the CDC announced that about 75 Atlanta based staff may have been exposed to life Bacillus anthracis, or anthrax, the deadly bacterial spores which were used as weapons of biological terrorism is 2001. The number of exposed staff has since been increased to 84, with 7 at increased risk because they had more direct exposure to the spores.
B.anthracis is a spore-forming, gram positive bacillus, which when inhaled carries a high mortality. The spores can enter the body cutaneously, enterally, via injection or via inhalation. Patients with inhalation anthrax will present with fever, chills, headache, chest pain, cough and difficulty breathing, and will require hospitalization even though they may not appear critically ill. These patients are susceptible to sudden decline and hemodynamic monitoring should be initiated. Chest CT and CXR will show characteristically widened mediastinum and pleural effusions.
Pertussis Epidemic affecting California and much of the US
Another day, another vaccine-preventable illness is on the rise. I described the current measles outbreak in an earlier post , and so that we do not run of out diseases to discuss, a new one has recently captured media attention. So far in 2014, 3,498 cases of Whooping Cough, or Pertussis, have been reported in California – more than all that were reported in 2013, Nationally, 24% more cases have been reported than in January to April 2013. Pertussis outbreaks occur cyclically, peaking every 3-5 years, with the last peak in 2010. A vaccine-preventable disease, Pertussis infection begins as a cold-like illness associated with mild cough and fever. Within 1-2 weeks, however, the severe, characteristic cough begins and can continue for weeks. Infants, however, may not cough, but may suffer from dangerous fits of apnea, or pauses in breathing. In vaccinated children the symptoms’ duration and severity is lessened. The CDC’s website further describes the disease characteristics.
Severe Pandemic in West Africa
A deadly pandemic has been brewing in western Africa since December 2013. This latest outbreak of the deadly Ebola Virus Disease (EVD) began in the Republic of Guinea and then spread to Sierra Leone and Liberia. To date, 344 suspected and confirmed cases of EVD have been reported in Guinea, 112 in Sierra Leone, and 13 in Libera. Since emerging in 1976 in Sudan and Congo, EVD outbreaks have occurred 33 times.
Measles is Back and it’s Entirely Our Fault
If you haven’t heard by now, the measles virus is on the rise in the United States. As of May 23, 2014, 288 cases have been reported in 18 states with 15 distinct outbreaks making up 79% of the reported cases this year.