Who Archives - Maryn McKenna

Ebola Could Cause Thousands More Deaths — By Ushering In Measles

March 15, 2015 By Maryn Leave a Comment

Women gather in the Guinean village of Meliandou, believed to be Ebola’s ground zero. Jerome Delay/AP

Awareness of Ebola is picking up again in the United States: An American volunteer who was working in Sierra Leone has contracted Ebola and been medevac’d to the National Institutes of Health Clinical Center for Ebola treatment, and 10 more volunteers have been brought back to NIH, Omaha and Atlanta, to be examined at three of the four institutions in the US that have safe units to house them.

It’s a reminder that Ebola still persists in West Africa: In the last period the World Health Organization reported on (the 7 days ending March 8), there were 116 new cases. One bit of good news: None of them were in Liberia, for the second week in a row. But Guinea and Sierra Leone, where this volunteer was infected, continue to struggle.

And in a research paper published as that volunteer was being flown back, there’s a reminder that the Ebola outbreak is creating layers of health risks for those countries. In Science , researchers from NIH and four universities warn that Ebola’s interruption of other health services, such as childhood immunizations, threatens to create secondary epidemics of preventable diseases that would dwarf Ebola’s impact. In particular, they warn that there could be 100,000 additional measles cases, and up to 16,000 additional deaths, if health services are not restored.

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Still Fighting Ebola: A View from Liberia's Front Line

February 16, 2015 By Maryn Leave a Comment

Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia. Jerome Delay/AP

We’ve pretty much signed off on Ebola in the United States — last week, President Obama withdrew the US troops sent to fight the disease — but in Africa, the news on the epidemic has seemed pretty good. The overall number of known cases stands at 22,894, with 9,177 deaths, far below the dire predictions made last fall that the epidemic could sicken millions.

Progress at beating the disease is stalling, though. According to the World Health Organization, the number of new cases has gone back up for two weeks in a row. Sierra Leone, now the outbreak’s epicenter, still has what the WHO calls “widespread transmission,” and on Saturday its government quarantined part of the capital. Guinea has had a spike in cases, and in several areas, mobs have attacked clinics.

The news is best from Liberia, where there were just three new cases last week compared to 65 in Guinea and 76 in Sierra Leone. Liberia was hard-hit, with 8,881 confirmed cases and 3,826 deaths — 300 cases per week at some points. But it also seems to have done the most to curb the disease’s spread: Today, schools that had been closed since last fall are supposed to open again.

Last week, though, I had the opportunity to speak to a front-line Ebola fighter in Liberia, and what he told me underlined how precarious that country’s progress is.

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A New Polio Case in Pakistan and an Unsolved Epidemic

January 21, 2015 By Maryn Leave a Comment

A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi on January 20, 2015. Rizwan Tabassum/AFP/Getty Images

Time to check in on another globe-spanning epidemic. While we were all watching Ebola, polio continues—and as long as it does, it holds the possibility of surging back over the rest of the world.

A quick refresher: Polio has been the target of a very expensive and aggressive multi-national eradication campaign since 1988. By last summer, polio was endemic—that is, transmission from one person to another has never been interrupted—in Afghanistan, Pakistan and Nigeria. Very high rates of vaccination have kept the paralyzing disease from leaking over those countries’ borders to most of the rest of the world—but every once in a while, something slips through, or a country runs out of money and lets its vaccination campaigns lapse.

As a result, last year, there was still polio in seven other countries — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria—and the World Health Organization declared an international emergency.

So, updates: Despite its ongoing civil strife, Syria has not had a polio case in a year. There has been no detection of polio virus in sewage in Israel or the West Bank or Gaza since March. It has been almost 6 months since the last polio case in Nigeria—extremely good news because that country has periodically re-infected other areas of Africa.

But: Pakistan remains a problem.

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

November 13, 2014 By Maryn Leave a Comment

The European Commission’s DG ECHO team (CC), on Flickr

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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Found: Forgotten Vials of Smallpox

July 8, 2014 By Maryn Leave a Comment

Variola, CDC

Headline-making news today from the Centers for Disease Control and Prevention: Workers clearing out an old storage room on the Bethesda, Md. campus of the National Institutes of Health have found a forgotten box of vials that contain smallpox.

Yes, smallpox. The “most terrible of all the ministers of death,” as Thomas Babington Macaulay called it in his 1848 History of England — a disease that was the world’s most dreadful killer, until it was declared eradicated in 1980. A disease caused by a virus that now is supposed to reside in only two highly secure laboratories on the planet, in Russia, and at the CDC.

Smallpox is the only human disease ever successfully eradicated — pursued to elimination by a relentless dragnet that closed nooses of vaccination around every identified case. After the last natural infection, in Somalia in 1977, the World Health Organization launched a second dragnet, scouring lab freezers and storage rooms for any remaining samples of the virus, and consolidating them in Siberia and Atlanta.

Somehow, these six tubes of freeze-dried virus evaded the search. They were found in the storage room of a lab that now belongs to the Food and Drug Administration but was ceded to that agency by NIH in 1972. They may date back to the 1950s.

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A World Cup Visitor: Polio from Africa in Brazil

June 25, 2014 By Maryn Leave a Comment

Gerick Bergsma via Eutrophication & Hypoxia / Flickr

Unnerving news from Brazil, now hosting travelers from all over the world because of the World Cup: The virus that causes polio has been found in sewage in one of the cities where matches are being played.

The World Health Organization, which announced the finding on Monday, says the virus was discovered last week in a sample collected in March at Viracopos International Airport in Campinas, which is about 60 miles outside Sao Paulo, and is where many of the World Cup teams have been landing. The agency said no cases of polio have been identified and there is no evidence the disease has been transmitted.

Genetic sequencing of the virus—the WHO didn’t say, but probably done by the Centers for Disease Control and Prevention in Atlanta—revealed that it was closely related to a poliovirus that recently caused a case of the disease in Equatorial Guinea in West Africa. Humans are polio’s only host; so that probably means the virus was carried into Brazil by a traveler, likely someone who never knew he was harboring it.

Brazil, like most of the rest of the world, continues to vaccinate against polio, even though there have been no cases of polio in Brazil since 1989, and the Americas were declared polio-free in 1991. The high vaccination rate — 95 percent of children nationwide, and higher than that in Sao Paulo State — kept the virus from spreading.

Still: not good.

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World Health Organization Drafting Global Plan on Drug Resistance. Is That Enough?

May 26, 2014 By Maryn Leave a Comment

Image: Nathan Reading (CC), Flickr

The annual World Health Assembly — the meeting of representatives of the 194 countries that belong to the World Health Organization — ended Saturday. Each year, the Assembly defines policy and sets out goals for the coming 12 months in a series of voted-on resolutions. This year it zeroed in on antibiotic resistance, upping the ante on the WHO’s previous efforts to fight the emergence of resistance globally. The biggest initiative: A global action plan that the agency expects to have drafted by next January, in order to have it approved by all the levels of the organization so that it can be voted on next May.
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Polio Declared An International Health Emergency

May 6, 2014 By Maryn Leave a Comment

Image: André Luiz D. Takahashi (CC), Flickr

In a move that is simultaneously discouraging, urgent and deeply unusual, the World Health Organization has declared that the resurgence of polio is a “public health emergency of international concern.” It’s an extraordinary statement, coming less than four months after India — once considered a place where polio might never be vanquished — was declared polio-free after three years without a new case.

That achievement left only Afghanistan, Nigeria and Pakistan as countries where the chain of polio transmission had never been broken. But as the virus persists in those countries, it is also moving out across their borders. Seven other nations that previously had beaten polio — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria — have now been reinfected, and the virus is spreading in communities there.

If the continued existence of polio is news to you, you’re not alone. It’s a largely forgotten disease in the industrialized West; the last United States case occurred in 1979. The WHO, the Centers for Disease Control and Prevention, the fraternal organization Rotary International and a raft of partners have been pressing an international and very expensive eradication campaign since 1988. Every time the world has gotten close, though, polio has flared up again. The WHO once thought it would be able to declare the disease eradicated in 2000; then it set 2005 as a target; then 2008; 2012; 2015; and now, a hoped-for 2018. (Here’s my archive of posts.)

But the past couple of months have thrown even that into doubt. The trigger for the WHO’s action was the discovery that there have been 74 cases of polio so far this year. That seems like a low number, but there were only 417 in all of 2013. And, crucially, winter is considered polio’s “low season” — so for polio to be spreading now rings an alarm bell for the warmer, wetter months when it usually spreads faster and further.

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World Health Organization: Antibiotic Resistance Grave Global Problem

May 5, 2014 By Maryn Leave a Comment

Image: Nathan Reading (CC), Flickr

The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.

The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “It’s clear that rates are very high of resistance among bacteria causing many of the most common serious infections – the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”

But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.

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H7N9 Flu, Year Two: What Is Going On?

February 10, 2014 By Maryn Leave a Comment

Live-poultry market, Shandong, China, 2009. Jonas_in-China (CC), Flickr

Live-poultry market, Shandong, China, 2009. Jonas_in-China, Flickr

Cast your mind back to about this time a year ago. A novel strain of flu, influenza A (H7N9), had emerged in China, in the provinces around Shanghai. International health authorities were deeply concerned, because any new strain of flu bears careful watching — and also because, on the 10th anniversary of the SARS epidemic, no one knew how candid China would be about its cases.

By the time peak season for flu ended in China, there had been 132 cases and 37 deaths from that newest flu strain. But, confounding expectations, the Chinese government was notably open about the new disease’s occurrence, and scientists worldwide were able to ramp up to study it. Still, no one could say whether that flu would be the one to make the always-feared leap to a pandemic strain that might sweep the globe. As with other, earlier, worrisome strains of flu, science could only wait and see whether it might return.

And now it has.
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