Category Archives: Pandemics & Infectious Diseases

Zika Virus: Global Health Considerations

Source: Tiaji Salaam-Blyther, Congressional Research Service, CRS Insight, IN10433, April 14, 2016

Zika is a virus that is primarily spread by Aedes mosquitoes—the same mosquitoes that transmit dengue, chikungunya, and yellow fever. Zika transmission has also been documented from mother to child during pregnancy, as well as through sexual intercourse, blood transfusions, and laboratory exposure. Scientists first identified the virus in 1947 among monkeys living in the Ugandan Zika forest. Five years later, human cases were detected in Uganda and Tanzania. The first human cases outside of Africa were diagnosed in the Pacific in 2007 and in Latin America in 2015. From January 1, 2007, to April 7, 2016, Zika has spread to 62 countries and territories (Figure 1), and the World Health Organization (WHO) expects the disease to spread to more countries where Aedes mosquitos reside. Scientists are also exploring whether other vectors can spread the disease. …..

Emerging Infectious Diseases: Preliminary Observations on the Zika Virus Outbreak

Source: Timothy M. Persons, U.S. Government Accountability Office (GAO), Testimony Before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce – House of Representatives, GAO-16-470T, March 2016

From the summary:
While several countries have reported outbreaks of Zika virus disease—which appear to be primarily transmitted to humans by mosquitos—unanswered questions remain regarding the epidemiology and transmission of the disease. Many factors—including a large number of asymptomatic patients and patients with mild symptoms, and a lack of a consistent international case definition of Zika virus disease—complicate understanding of the virus and may hinder responses to the current outbreak. For example, an estimated 80 percent of individuals infected with the Zika virus may not manifest clinical symptoms. As a result, incidence of the infection may be underestimated. Questions also remain regarding the strength of the association between Zika virus infection and two other conditions: microcephaly and Guillain-Barré syndrome.

A lack of validated diagnostic tests, consistent international case definitions, and trend information may also contribute to difficulty in estimating the prevalence of the virus. The United States uses two diagnostic tests for Zika, and according to the U.S. Centers for Disease Control and Prevention (CDC), while there are no commercially-available diagnostic tests for Zika, an antibody-based test for Zika virus was recently authorized for Emergency Use by the U.S. Food and Drug Administration. Diagnosing Zika virus infection is also complicated because it is difficult to differentiate it from other similar diseases, such as dengue or yellow fever. For example, a person previously infected with dengue could be falsely identified as also having been exposed to the Zika virus (and vice-versa). Moreover, the World Health Organization has acknowledged the need for a consistent case definition—that is, a set of uniform criteria to define the disease for public health surveillance and to determine who is included in the count and who is excluded. Additionally, a lack of pattern and trend data has made surveillance challenging.

Because Zika virus disease cannot yet be prevented by drugs or vaccines, vector (mosquito) control remains a critical factor in preventing and mitigating the occurrence of this disease. There are three methods for mosquito control: (1) standing water treatment, (2) insecticides, and (3) emerging technologies. Mosquito control has been achieved in some locations by methods such as reducing or chemically-treating water sources where mosquitoes breed or mature, or by insecticide dispersal. Emerging technologies, including biological control methods—such as infecting mosquitoes with bacteria— genetically-modified mosquitoes, and auto-dissemination traps, show some promise but are still in development and testing phases.

The National Institutes of Health (NIH) and the CDC have identified several high priority areas of research. Research priorities include basic research to understand viral replication, pathogenesis, and transmission, as well as the biology of the mosquito vectors; potential interactions with co-infections such as dengue and yellow fever viruses; linkages between Zika and the birth defect microcephaly; improving diagnostic tests; vaccine development; and novel vector control methods. These efforts are ambitious, and agencies may face challenges in implementing this agenda.

Zika Virus

Source: U.S. Department of Health & Human Services, Centers for Disease Control and Prevention (CDC), 2016

Sections include:
Symptoms, Diagnosis, & Treatment
Most common symptoms are fever, rash, joint pain, or red eyess…

Prevention
No vaccine exists…Prevent Zika by avoiding mosquito bitess…

Transmission
Transmitted to people primarily through the bite of an infected mosquitos…

Zika Virus: Questions and Answers
Answers to the most commonly asked questions regarding Zika virus…

Areas with Zika
Countries and territories with active Zika virus transmission…

For Health Care Providers
Clinical evaluation, disease, diagnostic testing, obstetricians, pediatricianss…

For Pregnant Women
Questions & answers, travel information, microcephaly, avoiding mosquitoss…

Vector Surveillance and Control
Resources for surveillance and control of Aedes aegypti and Aedes albopictus…

Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs

Source: Enrique Casalino, Eugenio Astocondor, Juan Carlos Sanchez, David Enrique Díaz-Santana, Carlos del Aguila, Juan Pablo Carrillo, American Journal of Infection Control, Article In Press, August 12, 2015
(subscription required)

From the abstract:
Background: Personal protective equipment (PPE) for preventing Ebola virus disease (EVD) includes basic PPE (B-PPE) and enhanced PPE (E-PPE). Our aim was to compare conventional training programs (CTPs) and reinforced training programs (RTPs) on the use of B-PPE and E-PPE.

Methods: Four groups were created, designated CTP-B, CTP-E, RTP-B, and RTP-E. All groups received the same theoretical training, followed by 3 practical training sessions.

Results: A total of 120 students were included (30 per group). In all 4 groups, the frequency and number of total errors and critical errors decreased significantly over the course of the training sessions. The RTP was associated with a greater reduction in the number of total errors and critical errors. During the third training session, we noted an error frequency of 7%-43%, a critical error frequency of 3%-40%, 0.3-1.5 total errors, and 0.1-0.8 critical errors per student. The B-PPE groups had the fewest errors and critical errors.

Conclusion: Our results indicate that both training methods improved the student’s proficiency, that B-PPE appears to be easier to use than E-PPE, that the RTP achieved better proficiency for both PPE types, and that a number of students are still potentially at risk for EVD contamination despite the improvements observed during the training.

Highlights
• Despite current recommendations, training courses for Ebola virus disease personal protective equipment (PPE) have not been evaluated to date.
• We evaluated basic and enhanced PPE with conventional and reinforced training programs.
• Critical error frequency was between 3% and 40% at the third training session.
• Basic PPE appears to be easier to use than enhanced PPE.
• The reinforced training program achieved better proficiency for both PPE types.

First Do No Harm: Protecting Patients Through Immunizing Health Care Workers

Source: Rene F. Najera, Dorit Rubinstein Reiss, Health Matrix: Journal of Law-Medicine, Vol. 26, 2015

From the abstract:
To protect vulnerable patients, hospitals increasingly adopt policies requiring health care workers to be vaccinated against influenza. More than twenty states have also enacted statutes or regulations on the topic. A small minority of health care workers oppose the requirement, and several have appealed to our courts of justice.

This article examines the legal issues surrounding influenza mandates for health care workers, including the constitutional framework, federal employment discrimination statutes, and the effect of collective bargaining. It argues that requiring vaccination for health care workers is both ethical and appropriate. While better done via state statute, hospitals have the authority to require vaccination from their workers — and are not, arguably, required to exempt any workers that do not have medical barriers to vaccination.

Ebola and the Law in the United States: A Short Guide to Public Health Authority and Practical Limits

Source: Polly J. Price, Emory University School of Law, Legal Studies Research Paper No. 14-299, December 14, 2014

From the abstract:
This paper provides a brief overview of the various laws and regulatory authority relevant to the control of the Ebola virus in the United States, beginning with the first U.S. Ebola patients treated at Emory University Hospital in Atlanta, Georgia, as a background for broader discussion. Public health law is a general term for the broad array of laws and regulations that apply to control measures for any infectious disease outbreak. The Ebola virus provides an opportunity to survey the many fields of law responsive to the threat of pandemic disease, including the use of emergency health powers and quarantine authority in the United States.

Outbreaks: Protecting Americans from Infectious Diseases

Source: Jeffrey Levi, Laura M. Segal, Dara Alpert Lieberman, Kendra May, Rebecca St. Laurent, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), December 2014

From the summary:
The Outbreaks: Protecting Americans from Infectious Diseases report finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.
Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators. Arkansas has the lowest score at two out of 10.

2009 Flu Pandemic Was 10 Times More Deadly Than Previously Thought

Source: Richard Knox, NPR, November 26, 2013

By the World Health Organization’s official tally, the flu pandemic of 2009-10 killed 18,449 people around the world. Those are deaths of people who had laboratory-confirmed cases of the so-called swine flu.

But a fresh says the real toll was 10 times higher — up to 203,000 deaths. And maybe it was twice that, if you count people who died of things like heart attacks precipitated by the flu. …
Related:
Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study
Source: Lone Simonsen, Peter Spreeuwenberg, Roger Lustig, Robert J. Taylor, Douglas M. Fleming, Madelon Kroneman, Maria D. Van Kerkhove, Anthony W. Mounts, W. John Paget, PlOS Medicine, Volume 10 no. 11, November 26, 2013

Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries….

Association between health care workers’ knowledge of influenza vaccine and vaccine uptake

Source: Oluwatosin Jaiyeoba, Margaret Villers, David E. Soper, Jeffrey Korte, Cassandra D. Salgado, AJIC: American Journal of Infection Control, Article in Press, published online 31 October 2013
(subscription required)

From the abstract:
Immunization is the most effective measure available to prevent influenza and its complications, and health care workers (HCWs) play a pivotal role. We conducted a cross-sectional survey study to determine HCWs knowledge and opinions regarding influenza vaccine and its acceptance at our institution. The most important reason for vaccine uptake was because it required formal declination (33%); physicians were more likely to be vaccinated because of patient care, whereas nurses were more likely to be vaccinated because it required formal declination.

Managing the Human Toll Caused by Seasonal Influenza: New York State’s Mandate to Vaccinate or Mask

Source: Arthur Caplan, Nirav R. Shah, JAMA: Journal of the American Medical Association, Viewpoint, Vol 310, No. 17, November 6, 2013
(subscription required)

…The state of New York it implementing a first-of-its-kind mandate for the use of masks in all unvaccinated health care personnel, both staff and volunteer. The new regulation, which goes into effect with the 2013-2014 flu season, requires unvaccinated health care personnel in regulated settings to wear a surgical mask in areas where patients or residents may be present. These settings include hospitals, nursing homes, diagnostic and treatment centers, home care agencies, and hospices. Under the new regulations, health care facilities are obligated to report the number of personnel who have been vaccinated and must supervise unvaccinated staff to ensure the appropriate use of masks. Personnel who fail to comply will be subject to the same institutional disciplinary procedures imposed on workers who do not follow other infection control procedures. In addition, the state may cite a facility for failure to comply with these regulations if requirements are not met…