infectious disease

RECENT POSTS

Harvard Poll On Ebola Risk Finds Public Dazed And Very Confused

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

By Richard Knox

Americans are seriously confused about how Ebola spreads. And it’s no wonder.

A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.

Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.

And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.

Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.

In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.

(Courtesy of Harvard School of Public Health)

(Courtesy of Harvard School of Public Health)

The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.

More than a third worry they or someone in their immediate family will get Ebola. Continue reading

Curb Your Hysteria: Talking Rationally To Kids About Ebola Risk

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

By Gene Beresin, MD and Steve Schlozman, MD

On Sept. 30 the first case of Ebola was diagnosed in the United States. The patient, who is currently being treated in Dallas, had recently traveled to Liberia, and was back in this country for a few days before symptoms began.

Understandably, the coverage of this news is pervasive. Although it seemed inevitable that a case in the U.S. would eventually emerge, the story still ignites a fair bit of hand-wringing among just about everyone who has learned of it.

Additionally, our country has experienced some novel infections that have ignited increased concerns in recent weeks. Enterovirus D-68 has made its way across the nation, causing severe cold-like symptoms, and, in some children with conditions such as asthma, the need for hospitalization. There’s also a potentially new contagion on the horizon that appears to cause varying degrees of muscular paralysis, and may or may not be related to Enterovirus D-68.

But, as public health officials are eager to stress, a nuanced and thoughtful approach to these issues has been as necessary as it has been fleeting. Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out that viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.

This raises a critical point:

Ebola, as scary as it is, poses a relatively minor threat to the United States; and the current cases of Enterovirus D-68 are far out-numbered by the RSV and influenza cases we experience on a yearly basis. And the currently unknown contagion that appears to cause paralysis has only happened in a very small population of kids.

So why the massive reaction in the media and among worried parents? Intellectually, at least at this point, all indications point to little danger for our children and ourselves. Why, then, do we get so frightened?

Well, let’s start with this confession: We’re frightened.

Sort of.

We know, intellectually, that the threat is minor. But, when has intellect played a leading role in the emotionally driven process of threat assessment? And, especially with regard to infectious disease, when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying that we should massively worry, or even that we’ll be changing our instructions to our kids or our patients on how to behave with these new bugs dancing around.

What we’re saying is that germs, especially new germs, are scary. We have a long and probably evolutionarily derived tendency to fear disease, and when new ones rear their heads, we get alarmed.

Germs In Hollywood

As a society, we think about germs a lot — and nowhere, perhaps, does that play out more than in Hollywood. The 1954 novella “I am Legend” has been made into no less than three movies (“The Last Man on Earth,” “The Omega Man” and the more recent movie of the same title as the written work). You can rattle off other movies as well — there’s “Dawn of the Dead” (in 1978 and again in 2004), “Outbreak,” “Carriers,” “Contagion,” “The Crazies” (in 1973 and again in 2010),

“Quarantine” (and “Quarantine 2″) and most recently “World War Z.” You get the picture. Continue reading

Mass. Reports First Case Of Cold Virus, E68

Massachusetts has its first confirmed case of a cold virus that has sent hundreds of children to hospitals across the the country.

The case of an 8-year-old girl who was treated at Boston Children’s Hospital and released means Enterovirus 68 is here and spreading, says state epidemiologist Al DeMaria. It is not typically as dangerous as the flu, he says, except in children with asthma.

“Compared to influenza virus, this virus does not cause a lot of serious complications,” DeMaria said. “In fact, the vast majority of children who have asthma attacks get better.”

DeMaria urges children with asthma to take their management medications. He asks everyone to wash their hands often.

– Here’s the full press release from the state Health Department:

The Massachusetts Department of Public Health (DPH) today announced a confirmed case of Enterovirus D68. The patient is a school aged child with a history of asthma who became ill in early September and has since been treated and released from an area hospital. Due to privacy considerations, DPH will not be releasing additional patient information.

“With enterovirus D68 now widespread across the country, this news comes as no surprise,” said DPH Commissioner Cheryl Bartlett, RN. “We have been working closely with pediatric providers and area hospitals to ensure the proper testing was done to identify the virus. For most children, this virus is relatively mild – but for children with asthma or other respiratory illnesses, it can be serious. Parents should contact their pediatrician if their child is experiencing respiratory issues.”DPH State Epidemiologist Dr. Alfred DeMaria underscored the importance of simple, common-sense steps such as hand-washing to reduce the spread of illness. “As with any other respiratory virus, hand washing is the key to reduce spread, use soap and warm water for 20 seconds” said Dr. DeMaria.

Other tips for parents and patients include:
Avoid touching eyes, nose and mouth with unwashed hands
Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the home is sick

Continue reading

Ebola: As Other Doctors Die, Heading Straight Into The Outbreak To Help

Dr. Nahid Bhadelia is in protective gear with Dr. Guillermo Madico at the National Emerging Infectious Diseases Laboratory in Boston, where she directs infection control. This gear is slated to be donated to the Ebola-fighting efforts in Sierra Leone when she goes there in mid-August. (Jackie Ricciardi/BU Photo Services)

Dr. Nahid Bhadelia is in protective gear with Dr. Guillermo Madico at the National Emerging Infectious Diseases Laboratory in Boston, where she directs infection control. This gear is slated to be donated to the Ebola-fighting efforts in Sierra Leone when she goes there in mid-August. (Jackie Ricciardi/BU Photo Services)

If all goes as planned, Dr. Nahid Bhadelia will soon head straight into the heart of the Ebola outbreak that has already killed more than 700 people in western Africa, including at least 50 health care workers. Global and U.S. health authorities announced Thursday that they would ramp up efforts to bring the epidemic under control, but that it would likely take at least three to six months.

Dr. Bhadelia is director of infection control at the National Emerging Infectious Diseases Laboratory in Boston and a hospital epidemiologist at Boston Medical Center. She’s slated to travel to Sierra Leone in mid-August, to share her expertise on infection control and also care directly for Ebola patients. Our conversation, edited:

This is the biggest Ebola outbreak ever, as far as we know. Is it notable in other ways?

This is the first time Ebola has been present in these three countries: Sierra Leone, Guinea and Liberia. Because these countries haven’t seen the infection before, that impacted their ability to recognize and manage the infection early on.

Also, because of the recent travel of the American Patrick Sawyer to Lagos [where he died of Ebola], I think it has raised a lot more concern about transfer of Ebola abroad, which has not been much of an issue in the past.

A lot of the U.S. media coverage has focused on, ‘Could it come here?’ Part of that fear seems to stem from the sense that Ebola, with its hemorrhages and high death rate, is particularly horrible. Is it?

In some ways yes and in others no. Ebola Zaire, the strain we’re seeing right now, is one of the most deadly strains; it’s been shown in the past to have 90 percent mortality when no treatment is given. But in some ways, it’s much harder to transmit at a population level compared to respiratory viruses we’ve been hearing about such as SARS or MERS. It requires close contact with bodily fluids. So, for example, there’s been a lot of concern about travel of folks from the areas impacted to the developed world, and I think the reason it’s less likely to spread is because it’s limited to people who come into contact very closely with the person who’s impacted.

So many health care workers have been getting infected. Do you have a sense of why? Are there practices that might be easily correctable that you could have an impact on?

There are a lot of talented people there in the field already, not just from international organizations but people who’ve been working there a very long time. In Sierra Leone, for example, though they haven’t had Ebola before, they’ve dealt with Lassa fever, another viral disease that causes hemorrhagic fever, at Kenema — one of the places where Dr. Khan, the leading physician who just died of Ebola, worked. That center has dealt with Lassa fever for over 25 years, and there are nurses there who have long experience. The issue is the amount of patients. You have nurses there who were taking care of maybe a dozen Lassa patients and now they have to see 70 Ebola patients. I think the major issue is the fact that the health care system is so overwhelmed.

One of the major ways to alleviate that would be the presence of more personal protective equipment and more sterile medical equipment in general. I know that the PPE — the personal protective equipment — is a major concern because there’s a dearth of it right now in the field.

Also, we understand that the virus can be transmitted from surfaces — so if someone comes into contact with bodily fluids with the virus in them on a surface, that’s another way to get it. The virus can live outside the host for a couple of days. So this contamination of the environment is another important component — and that’s very difficult if you can imagine 70 patients in a small space. Ebola is not hard to kill, so it’s easy to avoid contamination in general. It’s only because of the number of people and poor health infrastructure that it becomes difficult.

Still, it’s so baffling that these leading, incredibly knowledgable doctors are getting infected. How can that happen? Continue reading

A Surprising New View Of Flu: Rethinking The 1918 Pandemic

Giving treatment to influenza patient at the U.S. Naval Hospital. New Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

Giving treatment to influenza patient at the U.S. Naval Hospital. New
Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

By Richard Knox
Guest Contributor

Ever since 1918, the world has wondered why a novel flu virus touched off an explosive pandemic that killed as many as 50 million people – most of them healthy young adults — and whether it could happen again.

Flu researchers today report some surprising news: They say the 1918 virus was no super-bug. Instead, its deadliness had to do with how very different it was from the flu viruses circulating 25 or 30 years before, when the young adults of 1918 were first exposed to the flu.

Indeed, the new study says it’s that first childhood exposure that determines how people will fight off – or fall prey to – every other flu virus they will encounter in a lifetime.

That’s a very different way of looking at flu, both pandemics and regular seasonal outbreaks.

Much of the current emphasis is on the virus itself. Scientists around the world are doing controversial “gain-of-function” experiments – adding and subtracting pieces of genes from flu strains to see what mutations make some viruses so virulent.

Instead of focusing on flu virus itself, authors of a paper published Monday in the Proceedings of the National Academy of Sciences say scientists and public health experts should pay attention to the vulnerabilities of different age groups to any new flu virus – and how those immune gaps might be filled in by targeted vaccine strategies.

“Childhood exposure seems to give kick-ass immunity to that kind of flu virus for many, many decades,” says evolutionary biologist Michael Worobey of the University of Arizona, the paper’s lead author. Continue reading

Flu Or Just Crud? Latest Wrinkle In Flu Tracking: Home Tests

The rapid home flu test distributed by GoViral (Courtesy GoViral)"

The rapid home flu test distributed by GoViral (Courtesy GoViral)

You’re aching, you’re shivering, you’re coughing. You’re definitely, miserably sick, but is this real, potentially serious flu or just some garden-variety winter crud?

Better find out. You pull your handy-dandy virus test kit from the shelf, insert the nasal swab gently into your nostril and twist it around three times to coat it with your (copious) mucus. You swish the swab in liquid and deposit drops of your germy mix on the four wells of the instant test. Ten minutes later — voila. Sure enough, you test positive for an influenza type A. You call your doctor to ask about anti-viral meds, and — as a good citizen of your disease-tracking community — you go online to report your diagnosis to Flu Near You. On its map, you see that you’re not alone: a dozen of your neighbors have the same bug.

Futuristic? Not if you live in the Boston area and are part of a new flu-tracking experiment funded by the National Science Foundation, called GoViral. Run by researchers at Boston Children’s Hospital, the three-year project is just getting under way now, as this year’s flu season takes on steam.

Flu is more than a nuisance. It’s a serious threat — infecting tens of millions of Americans a year and killing an average of 24,000 — and public health types try hard to track and understand it. The CDC monitors reports from doctors’ offices, including lab test results. Google Flu Trends watches online searches for telltale symptoms. Flu Near You, where GoViral is based, already brings together thousands of volunteer sentinels who report online when they have symptoms. Now, GoViral will take testing into the home, where many flu patients hole up rather than seeing the doctor.

“It’s never been done before, to give a lot of people in their homes these tests,” said Dr. Rumi Chunara, GoViral’s lead researcher. “This is the first time that we’re actually crowdsourcing diagnostic samples from people.”

The project breaks new ground in flu tracking, said Dr. Lyn Finelli, who leads flu surveillance and response at the National Center for Immunization and Respiratory Diseases at the CDC: “This is the first time that I know of that anybody has used what we call participatory surveillance,” she said, “where people indicate whether they’re well or ill, and participate in home testing and send the tests in. This is a very novel look at a surveillance system and home testing.”

Dr. Chunara plans to distribute several hundred free flu test kits to Boston-area members of the public who sign up (here) this winter, and expand to encompass more areas next year. The kits include the rapid test, which can only check for four common viruses but gives an instant answer, and also a saliva test that must be sent in to a laboratory and can reliably detect 20 common viruses (though you may be better by the time you get the result.) Continue reading

On New Bird Flu, From A Doctor Who’s Been There: We Need Time

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans.  (Sanofi Pasteur/Flickr)

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans. (Sanofi Pasteur/Flickr)

We wrote earlier this week about the latest avian flu news, concerning a new strain called H7N9 that has killed at least 43 people in Asia. Summary: A probable case of human-to-human transmission has been reported in China, and some flu researchers say they’re going to alter the H7N9 virus in the lab in ways that will make it more dangerous, in order to understand and defend against it better.

I was left a little confused about those highly controversial plans to modify the virus. Very scary. What if it got out? On the other hand, bird flu is scary too. Shouldn’t we do all we can to fight it?

I spoke with Dr. Michael V. Callahan, a Massachusetts General Hospital infectious disease and disaster medicine physician who deploys to large-scale disease outbreaks. He’s the director of a Department of Defense-funded project to predict and defend against dangerous virus mutations. He is also an expert on flu outbreaks and one of the few Americans to have treated H7N9 patients last March in China.

How, I asked, does he see the letters in Science and Nature announcing the researchers’ plans to modify the H7N9 virus?

Dr. Michael V. Callahan outside Harvard Medical School (Photo: Joseph Ferraro, Massachusetts General Hospital)

Dr. Michael V. Callahan at Mass. General Hospital (Photo: Joseph Ferraro, MGH)

“In the right environment, with peer review, these gains of function studies are revealing and will help us home in on those conserved, critical elements of influenza that we might someday be able to use to block [all strains of flu] with one vaccine,” he said.

So how about the suggestion in the letter that the research should begin quickly in hopes of producing something of value by this winter?

“Both unwise and impossible,” he answered. “DARPA [The Defense Advanced Research Projects Agency] has developed the world’s fastest pathogen-to-vaccine capability, capable of 100 million doses in three months. This is the only process that could deliver vaccine by November, the start of flu season.”

“Unfortunately, the vaccine capability is not fully approved by the FDA. The traditional cell and egg based vaccine systems require months to develop a ‘production strain,’ a hybrid of H7N9 and a ‘tame’ strain, which can be placed in cells and eggs. Continue reading

Déja-Vu On Avian Flu: Probable Human-Human Spread, Research Debate

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans.  (Sanofi Pasteur/Flickr)

A worker at Sanofi Pasteur, the world’s larges influenza vaccine manufacturer. Some researchers in the United States have published letters in the journals Nature and Science arguing to create a more virulent strain of the H7N9 avian flu to prepare for its possible spread in humans. (Sanofi Pasteur/Flickr)

This is not my favorite topic, potential bird flu pandemics that could sweep humanity and kill hundreds of millions. But I also worry that a “cry wolf” phenomenon will set in, and then we won’t be prepared when the Big One hits. So let’s just consider, for a moment, the latest anxiety-producing avian flu news, about a strain called H7N9 that has killed at least 43 people in China.

Today brings two news items on this new strain: The BMJ medical journal reports the first case of probable human-to-human spread of H7N9, from a Chinese father who caught it from poultry to his daughter. And avian flu researchers publish a public letter in the prestigious journals Nature and Science saying they must produce “super-strains” of H7N9 — more easily transmitted, more resistant to attack — in order to understand the virus better and prepare to defend against it. (Science reports on some initial responses to the letter: Critics skeptical as flu scientists argue for controversial H7N9 studies.)

Science also offers this helpful round-up of the background, the reason why this all feels like flu déja vu. It’s that this is familiar ground from the last avian flu scare, with the virus H5N1: Continue reading

Worry About New ‘World Threat’ Virus? Specialist: We Just Don’t Know

You may have seen this headline last week: “World Health Organization says new virus may be ‘threat to entire world.‘” And if you’re like me, you may have been surprised by your own ho-hum reaction. Is this a crying-wolf situation? Have we been warned about too many potentially scary viruses over the last few years? Or are we just getting more used to living with viral uncertainty? Here, Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, writes about his own reaction to this latest outbreak in the face of insufficient information.

By Dr. Paul E. Sax
Guest contributor

From one of my close friends — a non-MD — comes this alarming video.

And here’s his email:

Concerned? Terrified? I bet your department is buzzing about this.

Um, not quite — especially since, among the 49 cases in the world (apparently there are five more than the WHO reported), exactly zero have occurred thus far in the United States. As of May 29, 2013, it hasn’t even cracked the front page of the CDC site.

Is MERS-CoV — short for Middle East Respiratory Syndrome Coronavirus — potentially of great concern? Of course. The WHO response seems right, especially with the parallels to SARS.

Coronoviruses (these are not the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)

Coronoviruses (this image is not of the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)

But do we garden-variety infectious disease specialists know how serious it will be on a global basis? Of course not. As with the first SARS cases, the first anthrax cases, the first West Nile cases, the first hantavirus cases, even the first AIDS cases — we really don’t have enough points on the graph yet to make any sort of confident predictions.

And from a practical perspective, the clinical unfamiliarity doesn’t help. If someone walked into our emergency room tomorrow with fever, cough, and respiratory symptoms, would we know how to distinguish MERS-CoV — from the hundreds (OK, thousands) of other causes of similar illnesses?

Initially, not a chance. The denominator of people with these complaints is just too gargantuan. It will probably take someone with a particularly severe respiratory illness, along with the appropriate exposure (“He just returned from a 10-day business trip to Riyadh”) for an astute clinician to make the connection.

So how should we infectious disease doctors, who are supposed to know everything, respond to these emails in the interim? Continue reading

Boston Biolab Clears State Hurdle For Max-Security Work

The National Emerging Infectious Diseases Laboratories, on the BU Medical Campus. Photo by Kalman Zabarsky, courtesy of BU)

The National Emerging Infectious Diseases Laboratories, on the BU Medical Campus. Photo by Kalman Zabarsky, courtesy of BU)

It’s widely referred to as the “needle” — as in NEIDL, the acronym for the National Emerging Infectious Disease Laboratory. It’s a futuristic, seven-story tower near Boston Medical Center in the South End, built to house high-level infectious-disease labs. And its fate has been mired in controversy for years, the kind of struggle you’d expect around a plan to research some of the world’s deadliest pathogens right near a densely populated neighborhood.

BU Today explains: “Construction on the $200 million facility was completed in September 2008, but controversy and litigation have kept much of the building’s 192,000 square feet of laboratory space closed.”

Now, BU Today reports that the NEIDL has just gained a key approval:

The Massachusetts Secretary of Energy and Environmental Affairs has given approval for the lab to conduct research at Biosafety Level 3 (BSL-3) and Biosafety Level 4 (BSL-4). The state agency issued a Massachusetts Environmental Policy Act (MEPA) certificate on Friday, clearing the way for the issuance of final state permits for the project.”

Some background:

As the Globe’s Stepehen Smith wrote in 2010: “South End and Roxbury residents have taken to the streets and the courts to protest the project. While state and federal judges allowed construction on the $200 million project to continue to completion — it includes both a high-security Biosafety Level-4 lab, as well as other research facilities — they mandated further safety reviews before it could open for research.”

WBUR’s Delores Handy took a press tour of the building last year, and officials told her that the NEIDL was probably the safest building in the city, and that the fence around it could stop truck bombs.

NECN’s Peter Howe described “foot-thick reinforced concrete walls, triple microscopic air filtration systems, intensely guarded entrances and exits, doors controlled by iris scanners to allow only authorized scientists and security personnel in to specific floors, and hundreds of surveillance cameras to prevent anyone from trying to sneak deadly biological samples out of the building to create terrorist weapons.”

Critics point out that the building is just off the Southeast Expressway in the densely populated South End. This, they say, is an issue of environmental justice.

But Boston Mayor Thomas Menino told reporters on the tour: “This is about the future. It’s about making sure that we have the tools in our city to do the research and the findings that we need to cure some of these diseases out there.” Continue reading