September 14, 2014

The Spreading Threat of Ebola – Part III

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the third of a three-part series about the reappearance of the Ebola virus in Africa.

As the Ebola virus continues to spread across Africa, global health organizations are ramping up their efforts in the face of increased concerns over a possible pandemic.

Tom Frieden, director of the Centers for Disease Control and Prevention told CNN recently after returning from West Africa that the epidemic is spreading widely through many countries and “spiraling out of control.”

In response, the World Health Organization convened a summit of experts in Geneva, Switzerland. The National Institutes of Health announced it is fast-tracking its Ebola testing vaccine program.  And the WHO created an Ebola Response Roadmap, which lays out protocols for everything from handling blood samples to travel restrictions and safety guidelines for burial rites.

But even before human trials on a vaccine have begun, the journal Science reported the virus is mutating, a reminder of the challenges the medical community faces in staying ahead of nature’s ability to adapt.

We can blame our collective germ phobia of recent years, which left us awash in cleaning products with powerful antibacterial agents that actually lowered our society’s resistance to microbes.

Medical centers including Orlando Health also are seeing an increase in diseases, including pertussis, that previously were thought to have been all but eradicated with vaccines. The resurgence of these diseases can be blamed, in part, to the failure to vaccinate children, according to Scott Brown, director of infection prevention and control at Orlando Health, who added there is no medical reason why the “vast majority “ of children should not be vaccinated.

“There are a few children who cannot be vaccinated due to allergic reactions, but the vast majority can,” he said. “However, it is now a big worry for hospitals and schools when more and more children do not get vaccinated.”

Children must wait to be vaccinated until they are a year old, he said, making them vulnerable to infection by other children who already contracted the disease.

“As more and more kids don’t get vaccinated and get pertussis, they in turn infect infants who are too young to get the vaccine,” he said. “Those babies can die.” Orlando Health also is seeing more cases of the measles, which virtually had been eradicated 10 years ago, according to Brown.

New challenges also exist in fighting bacterial illnesses, he said. “Bacteria are going to adapt, but we can slow that down if you use antibiotics less. Doctors are now being more careful and give antibiotics less often.

“At Orlando Health, we have taken steps to make sure antibiotics are used appropriately. We track antibiotic use and ask doctors not to use certain ones without the hospital’s permission. We also give continuously updated educational materials to our medical staff.”

Scientists have found antibiotic and antimicrobial agents in our food, water and soil, meaning we all are consuming antibiotics unnecessarily. Antibiotic chemicals are leeching into the environment from waste products. Studies have linked some of these compounds to decreased immune response, endocrine-related conditions and some cancers.

A recent investigation into triclosan was somewhat of an eye opener. Triclosan is a powerful antimicrobial that was originally used in hospital and surgical hand scrubs. Over the years it has found its way into products where they don’t belong, including toothpaste, cutting boards, toys, soaps, clothing, cosmetics, mattresses and insulation, among other place.

According to a 2004 CDC study, 75 percent of participants age six or older had triclosan in their systems. A NIH study in 2013 found triclosan in lakes and streams. Another study suggested a possible association between triclosan resistance and resistance to other antimicrobials, including E-coli and salmonella enterica.

“Thus, widespread use of triclosan may represent a potential public health risk,” the report said.

While each report of Ebola spreading to a new African country raises concerns in other countries, it is somewhat comforting to know health-care centers across the country successful tackle infectious diseases every day by leveraging superior resources and technology.

The Ebola crisis is a reminder of our vulnerability, and it should heighten our awareness about infectious diseases. Dangerous microbes are always in motion. Our efforts to shield the U.S. population from mass epidemics could be defeated if a disease overwhelms our technology and systems.

September 7, 2014

The Spreading Threat of Ebola – Part II

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the second of a three-part series about the reappearance of the Ebola virus in Africa. Part III will address why we should be worried about antibiotic resistance and the pervasive presence of antibiotics in food, cleaning products and the environment.

American missionaries Dr. Kent Brantly and Nancy Writebol were the first human patients with Ebola to ever come to the United States. They have now been deemed cured. But whether their recoveries were due to a U.S. health care system miracle, the experimental drug ZMapp or just plain luck, no one really knows. After all, about half of all Ebola patients in Africa survive as well.

What is clear is that as Ebola continues to spread, and fatalities continue to rise, public concern about contagious illnesses grows. But containing and combating infectious diseases has always been a top priority for hospitals worldwide.

For bacterial illnesses, the health community is challenged by a rise in antibiotic-resistant pathogens. Viral illnesses among the unvaccinated can also be tough to cure. Most treatments for viral illnesses involve boosting the body’s immune system, and researchers are still experimenting with just how to do that.

Scott Brown, director of Infection prevention and control at Orlando Health, which has eight hospitals in Florida, explains how those facilities handle such crises.

“We have internal policies for all kinds of infectious diseases,” Brown said in a recent interview with the J. Robinson Group. “For hemorrhagic fevers, such as Ebola, we follow the guidelines of the CDC’s Healthcare Infection Control Practices Advisory Committee, or HICPAC, which calls for health care workers to wear fluid-impervious gowns, two pairs of gloves and a face shield.”

Orlando Health goes beyond that by adding a respirator and placing patients in airborne isolation rooms, he said. Ebola is not the only thing Brown is worried about. Orlando Health’s Dr. P. Phillips Hospital handled the second MERS case in the United States.

“The Middle East Respiratory Virus, which originated in the Arabian Peninsula, is also very new; we first came across MERS about two years ago,” he said. “There is no treatment per se, so we followed the same measures with the isolation room.”

As for potential Ebola cases, the only precaution being added to Orlando Health’s standard admitting practice of taking a patient’s temperature is a question about their travel history, Brown said. “There is not much else we can do.” If someone was suspect, they would be placed in isolation for further testing. “Then we notify the local Florida Department of Health office, which in turn contacts the CDC, and we would work together to coordinate care.”

Meanwhile, Orlando Health protects against antibiotic resistant infectious diseases every day, Brown said. “We use certain precautions to prevent the spread within the hospitals.” Meanwhile, Orlando Health doctors are trying to use fewer antibiotics in favor of other methods of containment.

“The number of organisms we have seen develop resistance has grown,” Brown said. “We have already seen staph-resistant drugs but now we see many more bacteria, including E. coli, that are antibiotic resistant.”

Brown said Orlando Health uses isolation rooms regularly for tuberculosis patients, given Florida has a high rate of TB, with about 40 new cases a year. “Sometimes it’s immigrant demographics, sometimes TB is a co-infection with HIV,” he said. The isolation rooms are also used for patients with chickenpox.

The possibility of Ebola spreading beyond Africa in a big way is remote but not impossible. As is evidenced by the case of Liberian-American Patrick Sawyer, who flew into Lagos, Nigeria, with the virus, all it takes is one person getting on a plane to spread Ebola to a new country. Approximately a dozen people have been infected in Nigeria since Sawyer arrived; Sawyer himself died from the virus.

It would be impossible to completely control global travel and trade patterns. And within Africa, Ebola cases are expected to continue to rise in the near future. The already frail health-care system in West Africa is overwhelmed, poorly equipped and now, even more understaffed as health-care workers on the front lines succumb to the outbreak.

On Aug. 24, The New York Times reported that 15 nurses died at the government hospital in Sierra Leone, leaving the department with a tiny staff. As frightening as that sounds, many dedicated health-care workers remain, like deputy nurse matron Josephine Finda Sellu. “There is a need for me to be around,” said Sellu, who oversees the Ebola nurses in Sierra Leone. “I am a senior. All the junior nurses look up to me.” If she left, she said, “the whole thing would collapse.”

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