Maryn McKenna

Journalist and Author

Holiday Travel? Get Vaccinated First, or Bring Home Something Unexpected

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Angelo DeSantis (CC), Flickr

Angelo DeSantis (CC), Flickr

Happy holidays, constant readers. If you’re like many people, you may be preparing to take a trip, maybe for a break from winter, maybe just to see family. As you’re getting ready, making sure to decant the toiletries and pack the presents unwrapped, here’s one thing not to forget: your vaccinations.

Really, this is important. Last January, according to an account recently published by the Centers for Disease Control and Prevention, four unvaccinated people were infected with measles by a never-found fifth person during a single 4-hour window at an airport gate somewhere in the US.

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To Slow Down Drug Resistance in Health Care, Buy an Antibiotic-Free Turkey for Thanksgiving

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Organic turkey poults, Lance Cheung, USDA. CC on Flickr

Organic turkey poults, Lance Cheung, USDA. USDA/Flickr

I thought it might be time to switch away from Ebola and catch up with other disease problems that continue to occur in the world. (If you miss Ebolanoia, though, I’m still collecting instances at my Tumblr. The latest: Indian authorities have force-quarantined in an airport a man who returned from West Africa with a clean bill of health and negative blood tests. They say they will not allow him to leave until his semen tests negative for Ebolavirus. Yes, they are insisting on samples.)

So: How can healthcare workers contribute to slowing down antibiotic resistance? A healthcare nonprofit suggests they commit to buying an antibiotic-free turkey for Thanksgiving.

If it feels like the problem in one sphere, medicine, doesn’t have much to do with the other, agriculture, then you are the perfect target for this pledge. (Even if you don’t actually work in health care.)

Here’s the backdrop to the campaign, created by Health Care Without Harm,the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative, and the Pediatric Infectious Disease Society (PIDS):

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Ebola Here and There: Knowing When It Is And Isn't Over

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It may have skipped your notice, but the United States is now Ebola-free. Dr. Craig Spencer was released from treatment in New York City Tuesday; that day also marked the end of the watch period for Kaci Hickox, the nurse force-quarantined in New Jersey and then allowed to go home to a remote town on the Maine border. The two nurses who treated deceased patient Thomas Duncan, Amber Vinson and Nina Pham, were both released from treatment two weeks ago. The health care workers who were sickened in Africa and came home for treatment have all gone home.

There are some things to note in these events. The first is that the Ebolanoia over the possibility of the disease spreading in the United States  is now clearly shown to have been an over-reaction. No one got sick because Spencer went around New York City in the days before he developed symptoms. No one got sick, either, from contact with Kaci Hickox — and, an important point, she never developed symptoms herself. Her quarantine was self-evidently unnecessary. The only people to have contracted Ebola in the United States are the two nurses who were in close face-to-face contact with Duncan when he was floridly ill, and while the hospital that treated him, and the Centers for Disease Control and Prevention, were working out the best protective protocols.

So we really could calm down now. (Have you noticed how the chatter has died down? Especially since the election?) But we also shouldn’t forget that Ebola continues in West Africa, and could return to the US at any time.

Here’s an example of the continuing challenges: the West African country of Mali.

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

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Daliborlev (CC), FLickr

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?

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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.

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

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Daliborlev (CC), FLickr

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

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Daliborlev (CC), FLickr

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 Rt.) 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

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James Jordan (CC), Flickr

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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CDC Director on Ebola: 'The Window of Opportunity Really Is Closing'

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I said last month that I was going to try to stay out of Ebola news because so much is being written about it elsewhere. Since then, the African outbreak — now really an epidemic, since it is in multiple countries —  has ballooned to 3,000 cases, and the World Health Organization has predicted it may take 6 months or more to bring it under control.

Something caught my attention today though that felt worth highlighting. Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, gave a lengthy press conference immediately after returning to the US from a visit to the Ebola zone. Frieden has shown in the past that he knows how to be outspoken in a very strategic way; yet even so, the urgency of his language, and his call for an immediate, comprehensive global response, was striking.

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Ebola in Africa and the U.S.: A Curation

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I’ve stayed out of the Ebola news so far, for a couple of reasons. First, as longtime readers know, I’m writing a book; I’m in the last 6 months of it and the work is intense and involves a lot of travel. I’m not always available at the exact moment news breaks. Second, I try to explore things here that readers may not have heard about elsewhere. The Ebola outbreak has been building in West Africa for a while, but when it was revealed at the end of last week that two American aid workers had caught the disease — and that they were being transported back to the US for treatment — the news and the reaction to it instantly filled every channel. Over the weekend, so much misinformation and outrage got pumped out that it feels as though there’s no way to cut through the noise.

But I have a few thoughts. Start with this: No, I don’t think the two aid workers who are being returned to the US pose any risk at all to the average American, or even the average Atlanta resident. Here’s my marker on that: I’m an Atlanta resident. I live less than 2 miles from the CDC and Emory University (the aid workers are being treated in a special unit housed at Emory on behalf of the CDC; the two institutions are next door to each other). My entire neighborhood and a good part of my various friendship circles are CDC employees, Emory healthcare workers, or both.

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