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African Scientist: African Corruption Made Ebola Worse

November 4, 2014 By Maryn Leave a Comment

Since last week, there has been some good news on the Ebola front: a suggestion that the epidemic in Liberia is beginning to slow down, with fewer new cases reported. At the same time, there is a new outbreak in Sierra Leone, in a part of the country that thought it had beaten the disease and then self-quarantined to keep it at bay. So it is probably too soon to hope that the entire international outbreak is on its way to being extinguished.

At the same time, two major international medical meetings happening this week have allowed researchers to discuss the newest reports from the field — but not with equal success. The annual meeting of the American Society of Tropical Medicine and Hygiene, the largest medical society devoted to diseases such as Ebola, lost a significant number of attendees when the conference’s host state, Louisiana, threatened to forcibly quarantine anyone traveling from a country experiencing Ebola, whether or not that person had been exposed. Meanwhile, Vienna, Austria had no such qualms, and so the International Meeting on Emerging Diseases and Surveillance proceeded without any difficulties, allowing physicians and epidemiologists fresh from the Ebola zone to share reports.

It’s from that second meeting that this week’s news comes. Oyewale Tomori, president of the Nigerian Academy of Science and a leader of the World Health Organization’s Ebola response in 1995, used the IMED podium to deliver a stinging critique of the behavior of African governments during the current crisis, charging that internal corruption has crippled the continent’s ability to fight its own disease battles.

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The Grim Future if Ebola Goes Global

October 27, 2014 By Maryn Leave a Comment

Healthcare workers load a man suspected of suffering from the Ebola virus onto an ambulance in Kenema, Sierra Leone, on Sept. 25, 2014. Tanya Bindra/AP

If you listened hard over the weekend to the chatter around the political theater of detaining a nurse returning from the Ebola zone in a tent with no heat or running water, you might have heard a larger concern expressed. It was this: What happens if this kind of punitive detention — which went far beyond what medical authorities recommend — deters aid workers from going to West Africa to help?

As a reminder, the African Ebola epidemic is still roaring in three countries; two others have contained the disease, but it has now leaked to a sixth, Mali. The case count is 10,141, with 4,922 deaths. Last month, the Centers for Disease Control and Prevention estimated that if the epidemic continued on its current course, cases would hit 1.4 million by next January. Last week, Yale researchers said in the journal Lancet Infectious Diseases that even current promises of international aid will not contain the epidemic — so the volunteering of medical personnel such as that nurse becomes even more important.

But what if, because of this weekend’s events, volunteers are discouraged from going to West Africa, for fear of how they will be received on return? Or what if they do go, and their efforts are still not enough?

I wanted to be sure I wasn’t over-imagining what might happen next with Ebola, if it is not contained at its source now. For a fact-check, I turned to Jody Lanard and Peter Sandman, two risk-communication experts who have been involved in most of the big epidemic threats of the past decades. (I met them, I think, in the first run-up of concern over H5N1 avian flu in 2003.)

I hoped they would tell me not to be too worried about Ebola becoming a permanent threat in West Africa. Instead, they told me to be very worried indeed.

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Ebolanoia: The Only Thing We Have to Fear is Ebola Fear Itself

October 22, 2014 By Maryn Leave a Comment

Star5112 / Flickr

It is almost a month now since Thomas Eric Duncan appeared at the emergency room of Texas Health Presbyterian Hospital, was sent home after evaluation, and returned two days later with symptoms of Ebola. On Monday, his family and the health workers who treated him at the hospital were released from quarantine, with none having fallen ill.

But if you’ve been paying any attention to the Ebola news, you’ll know that the story is far from over, with one nurse who took care of him in Dallas now hospitalized at NIH (and upgraded to good condition Tuesday) and the other at Emory University, where the aid workers who fell ill in Africa also received treatment and recovered. Duncan remains the only person who came to the US with Ebola but not already identified and under medical care.

Given our nationwide reaction, though, you might think we have had as many cases as West Africa.

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What Would Keep Ebola from Spreading in the US? Investing in Simple Research Years Ago.

October 13, 2014 By Maryn Leave a Comment

Daliborlev (CC), Flickr

There’s a thing you learn, when you’ve been writing about infectious diseases for a while: People love drama. They’re not so much with detail.

Drama is H5N1 avian flu killing half the people who contract it, and the enormous surge in whooping cough, and the sinister movement of almost-untreatable NDM-1 resistance from South Asia to the West.

Detail is the question of whether health care workers treating pandemic-flu patients should expect viral spread for 3 feet or 6 feet; and why immunity conferred by the current pertussis vaccine fades a few years earlier than expected; and how hospitals can encourage their janitors to clean rooms more thoroughly, when they’ve always treated them as a disposable part of the staff.

All of those details are crucial to controlling those diseases. All of them are also research questions. None of them, guaranteed, have gotten the attention or funding that would answer the questions in a way that equips us to counter the dramatic problems.
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US Will Screen Air Passengers for Signs of Ebola. Will It Work?

October 9, 2014 By Maryn Leave a Comment

Masked customs officers look on in a screening area for international passengers from United flight 998 from Brussels at Newark airport in Newark, N.J., Saturday, Oct. 4, 2014. New Jersey health officials say Ebola has been ruled out as the cause of illness for a man who became sick on a flight from Brussels to the United States. Viorel Florescu / AP Photo / Northjersey.com

If you’ve been following the Ebola story, you may have noticed that the Centers for Disease Control and Prevention announced a move yesterday to try to keep the disease off US soil. At the five US airports that receive most passengers from the three countries where Ebola is circulating, passengers will be singled out on the basis of their travel records; interviewed by means of a questionnaire; and have their temperature taken, to see if they have a fever.

It’s the first attempt to control Ebola at the US border, announced, probably coincidentally, on the same day as the death of the only Ebola patient to make it into the US thus far. Political pressure for the CDC to do something was growing, and some visible step was necessary. But in the public health world, I am hearing some doubt whether it will work. Here are some reasons why.
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Keys to Controlling Ebola in the US: Travel Records and Infection Control

October 1, 2014 By Maryn Leave a Comment

Daliborlev (CC), Flickr

If you’re at all interested in infectious diseases, you’ve probably heard by now that a person traveled to the United States while infected with Ebola, was diagnosed and is now in a hospital in Texas. (I was on a flight without Wi-Fi yesterday from before the press conference was announced to after it concluded. Turning my phone on after arrival was… interesting.)

The Centers for Disease Control and Prevention held a press conference yesterday afternoon (transcript is here), and WIRED’s Greg Miller covered it.

The quick details:

The infected person flew from Liberia to the US on Sept. 19-20 to visit family members who live in Texas.*
He began to develop symptoms on Sept. 24 (important because victims are infectious only after symptoms develop).
He went to an ER in Dallas on Sept. 26 and was given antibiotics and sent home.
Two days later, Sept. 28, he was taken by ambulance to Texas Presbyterian Hospital in Dallas and was admitted on suspicion of Ebola and put in isolation.
The test results confirming the diagnosis came down yesterday, the same day as the announcement.

(*A quick Google will demonstrate that the patient and his family have been named by the Associated Press, with the New York Times using the name and attributing it to AP. Given the unnecessary panic around Ebola at this point, I have conflicting thoughts about whether and how the name should be used, so am passing on using it for now.)

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White House Actions on Antibiotic Resistance: Big Steps, Plus Disappointments

September 22, 2014 By Maryn Leave a Comment

Roman Boed (CC), Flickr

The United States government proposed several important steps last week that, if accomplished, will significantly change how this country attempts to counter the advance of antibiotic resistance, bringing us within reach of the more complete programs which exist in Europe. But as significant as it is, the new program has some perplexing gaps that left experts attending to the issue disappointed.

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Via Farmworkers, Superbugs Find a Route Away from Drug-Using Farms

September 21, 2014 By Maryn Leave a Comment

Pig farms from the air. Image: Maryn McKenna

One of the persistent questions regarding antibiotic use in meat production, and its effect on the health of humans who live far away from production farms, is: How do the resistant bacteria that result get from one place to another? That is: Most people accept by now that using antibiotics in livestock-raising causes drug resistance to emerge in the systems of those animals, in their guts or on their skin. But whether those newly resistant bacteria leave the farm, and how they make the trip, is both fought over and—despite much investigation—still under-researched.

Some studies have shown that bacteria can move off farms in groundwater, on the feet of flies, and via dust on the wind. What is insufficiently explored—because it is difficult to get large meat-production facilities to cooperate—is whether farm workers themselves are serving as a transport vehicle.

A new study just published (and open-access, so anyone can read it) helps to answer that question. It looks at the possibility that workers on large hog farms are carrying away drug-resistant staph or MRSA, and especially a type of resistant staph — known familiarly as “pig MRSA” and more technically as “livestock-associated MRSA” — that emerged on hog farms a decade ago and is directly linked to farm-drug use.

(If you’ve been visiting Superbug the blog for a while, you might remember pig MRSA; the story of its discovery in a Dutch farmer’s daughter 10 years ago also was told for the first time in Superbug the book. If it’s a new concept to you, you might be interested in this archive here.)

The new study finds that hog farmers are carrying multi-drug resistant livestock-associated MRSA away from the farm and — this is the crucial bit — that their bodies are hanging onto those bacteria, in a way that might allow them to spread, for up to 14 days.

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The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It

September 14, 2014 By Maryn Leave a Comment

Daliborlev (CC), Flickr

The Ebola epidemic in Africa has continued to expand since I last wrote about it, and as of a week ago, has accounted for more than 4,200 cases and 2,200 deaths in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. That is extraordinary: Since the virus was discovered, no Ebola outbreak’s toll has risen above several hundred cases. This now truly is a type of epidemic that the world has never seen before. In light of that, several articles were published recently that are very worth reading.

The most arresting is a piece published last week in the journal Eurosurveillance, which is the peer-reviewed publication of the European Centre for Disease Prevention and Control (the EU’s Stockholm-based version of the US CDC). The piece is an attempt to assess mathematically how the epidemic is growing, by using case reports to determine the “reproductive number.” (Note for non-epidemiology geeks: The basic reproductive number — usually shorted to R₀ or “R-nought” — expresses how many cases of disease are likely to be caused by any one infected person. An R₀ of less than 1 means an outbreak will die out; an R₀ of more than 1 means an outbreak can be expected to increase. If you saw the movie Contagion, this is what Kate Winslet stood up and wrote on a whiteboard early in the film.)

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually R_t.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.
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Unseen Suburban Danger: Children Dying of Mosquito-Borne Diseases

September 10, 2014 By Maryn Leave a Comment

James Jordan (CC), Flickr

Every once in a while a scientific paper pops up in my stream that makes me think, not Cool, or Ick, but: Wow, I had no idea. I’ve just read one, published last month in Pediatrics, which definitely falls into the last category. My extreme abbreviation of the findings: On average, more than 100 children and teens each year are made dangerously ill or paralyzed by infections carried by mosquitoes, and two die.

I think of mosquito-borne infections in the United States — that is, primarily West Nile virus, and the much less well-known La Crosse virus and Eastern equine encephalitis virus — as a problem of adults. I had no clue they were so dangerous to children. (And if I didn’t, most of you probably didn’t either.)

Here’s a more detailed breakdown.

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