Liberia: MOH Press Conference On Ebola Outbreak

 @WHO & Partners Ebola Response In Guinea

 

 

# 8417

 

While the planned webcast of the Liberian Ministry of Health’s press conference ran into technical difficulties, the United Nations Mission in Liberia twitter account (@UNMILNews) live-tweeted the key points, which I’ve captured and reproduced below:

My thanks go to the UNMIL social media team for their terrific work in getting the details out on this press conference via twitter.

 

 

LIVE: "We are working around the clock to reach out to the public." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: Out of 7 samples tested, 2 are positive for Ebola virus. - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: Woman w/ #Ebola took taxi from Foya to Firestone Clinic for treatment. - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "This is a preventable disease." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "We need to follow those who have had contact w/ Ebola patients for 21 days." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Traditional practices that could spread this disease need to be avoided." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Avoid eating bats and other bush meat during this period." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Ebola is transmitted from person to person through direct physical contact." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "National taskforce established & working tirelessly for effective response." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Any sudden death or person w/ fever needs to be reported immediately." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Lofa is the epicenter of the epidemic. One case is an epidemic." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Don't travel if you have symptoms. Report to nearest medical facility." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Media: please help us. Help the people to avoid fear, panic and denial." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "We're tracing down, isolating & investigating all who had contact w/ cases." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Incubation period is from 3-21 days." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Not all cases will show all the symptoms." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "@WHO has teams supporting the Government in all affected areas." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Don't get contaminated by doing own investigations. Tell a medical officer." -#Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Media: don't take pictures of suspected patients. Respect confidentiality." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Media: don't expose yourself & widen the net of people we have to monitor." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Out of every 10 people who get the disease, up to 9 of them will die." - #Liberia Ministry of Health Press Conference on #Ebola.

Q&A session is underway. Followers can post questions for the Minister of Health, Chief Medical Officer, WHO, or the Min of Info on #Ebola

LIVE: "Tests require certain technology so for now we are relying on #Guinea." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "The fact that we cannot test for Ebola doesn't mean we don't have labs." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Response will cost approx. $1.2 million over 3 month period." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Don't buy bush meat until outbreak is over -> 42 days after last case." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "The country remains open and business goes on." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Let people remain where they are, be informed, be supported & be treated." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Chief Medical Officer available on-call 24/7 for media." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "Government is taking every step to trace every movement of cases." - #Liberia Ministry of Health Press Conference on #Ebola.

LIVE: "We need to get timely & truthful information out to people not sensation." - #Liberia Ministry of Health Press Conference on #Ebola.

#Liberia Ministry of Health Press Conference on #Ebola coming to a close. We'll be posting the mp3 for download momentarily.

 

(NOTE: I’ll post a link to the MP3 file when it becomes available)

 

Meanwhile, as this press conference proceeded, the issue of the safety of consuming bushmeat was addressed by WHO Spokesperson Gregory Hartl in a series of tweets to UNMIL and @MicatLiberia  (Liberia’s Ministry of Information, Cultural Affairs, and Tourism).

 

An important reminder that bushmeat can be an important vector for a variety  zoonotic diseases, and that just because an outbreak may have been contained in a region, that doesn’t mean the pathogen isn’t still lurking in a local animal reservoir. 

For more on these risks, which is often exacerbated by the exporting or smuggling of  bushmeat (or live animals), you may wish to revisit:

 

Vienna: 5 Smuggled Birds Now Reported Positive For H5N1

WSJ: Nathan Wolfe & Viral Chatter

Bushmeat,`Wild Flavor’ & EIDs

WHO Update & Messaging On Ebola Outbreak

Photo Credit - CDC

 

NOTE: For far more complete coverage of the Ebola outbreak in Western Africa you’ll most certainly want to check in with Crofsblog several times a day, as he is doing a phenomenal job covering breaking events there.

 

# 8417

 

Not unexpectedly, the World Health Organization confirmed yesterday that at least two cases of Ebola infection have been confirmed in Liberia.

 

While obviously a concerning geographic expansion of the outbreak beyond the borders of Guinea, WHO spokesperson Gregory Hartl noted this morning on Twitter that the Liberian cases were all exposed in Guinea, before traveling to that country.

 

 

Excerpts from the WHO announcement follow:

 

Ebola Haemorrhagic Fever, Liberia (Situation as of 30 March 2014)

30 March 2014 – The Ministry of Health (MoH) of Liberia has provided updated details on the suspected and confirmed cases of Ebola Haemorrhagic Fever (EHF) in Liberia.  As of 29 March, seven clinical samples, all from adult patients from Foya district, Lofa County, have been tested by PCR using Ebola Zaire virus primers by the mobile laboratory of the Institut Pasteur (IP) Dakar in Conakry.  Two of those samples have tested positive for the ebolavirus. There have been 2 deaths among the suspected cases; a 35 year old woman who died on 21 March tested positive for ebolavirus while a male patient who died on 27 March tested negative.  Foya remains the only district in Liberia that has reported confirmed or suspected cases of EHF.  As of 26 March, Liberia had 27 contacts under medical follow-up.

In accordance with the International Health Regulations (IHR, 2005), the MoH of Liberia is communicating regularly with WHO and neighbouring countries to help coordinate and harmonise surveillance, prevention and control activities.

Response activities within health care facilities include strengthening infection prevention and control (IPC) at the Foya Hospital, the provision of additional personal preventive equipment (PPE) and medical supplies to support case isolation and clinical management and training for health care workers in IPC. Health care workers are receiving training on EHF; 50 clinicians from 5 hospitals in Montserrado County received training on 27 March. PPE and medical supplies have also been sent to Bong and Nimba Counties which border Guinea.

As this is a rapidly changing situation, the number of reported cases and deaths, contacts under medical observation and the number of laboratory results are subject to change due to enhanced surveillance and contact tracing activities, ongoing laboratory investigations and consolidation of case, contact and laboratory data.

(Continue . . . )

As @WHO notes in their twitter messaging overnight, two of the most recently diagnosed cases in Guinea are healthcare workers, highlighting the need for vigilance in infection control procedures during this outbreak.

 

 

Reports of nosocomial transmission of VHF (Viral Hemorrhagic Fevers) are a reminder that many healthcare facilities – particularly in developing countries – often work with a limited supply of basic disposable infection control supplies like masks, gloves, and gowns.

 

More sophisticated isolation procedures - such as Airborne Infection Isolation Rooms (AIIR) as might be found in the United States and Europe - are a luxury few hospitals in the developing world can afford.

 

Out of necessity, Infection control advice tends to be more basic and mindful of limited resources, such as is provided in the following WHO interim guidance document.

 

Interim Infection Control Recommendations for Care of Patients with Suspected or Confirmed Filovirus (Ebola, Marburg) Haemorrhagic Fever

March 2008

This document provides a summary of infection control recommendations when providing direct and non-direct care to patients with suspected or confirmed Filovirus haemorrhagic fever (HF), including Ebola or Marburg haemorrhagic fevers. These recommendations are interim and will be updated when additional information becomes available.

Download document

Full text
pdf, 282kb

Hong Kong: SFH On H7N9 & Vaccine Timetable

# 8416

 

Tomorrow, March 31st, will be the one-year anniversary of the world’s notification from the Chinese MOH that a new avian flu virus – H7N9 – was spreading and infecting people in China (see  China: Two Deaths From H7N9 Avian Flu). In these past 12 months more than 400 human infections have been recorded – a milestone that took the H5N1 virus roughly 6 years to reach (2003-2008).

 

While the closure of live-markets in many of the larger towns and cities in China seems to have reduced the rate of human infection over the past couple of months, we continue to see scattered cases reported from several provinces in Eastern China. 

 

As avian flu spreads best in cold temperatures, public health officials in China are anxiously awaiting the arrival of summer, which they hope will provide a respite in transmission of the virus.  They are very aware, however, that the virus could easily return next fall.

This morning, we’ve some comments from Hong Kong’s Secretary of Food & Health Dr. Ko Wing-man, on this expected reduction in the H7N9 threat, and on prospects on when a vaccine for humans would be available.

 

You may recall that earlier this month, in Parsing China’s H7N9 Vaccine Headlines, we looked at some dubious Chinese media claims, suggesting that a vaccine was only a couple of months away.  Given that only phase I (animal) trials had been conducted on the vaccine, some of the promises (see Xinhua News H7N9 vaccine may hit market in May) seemed more than a little ambitious.

 

Dr. Ko Wing-man provides a far more plausible timetable, in his remarks which are carried in the following item published overnight by the Hong Kong Government.

 

H7N9 cases to decline: Health chief

March 30, 2014

Secretary for Food & Health Dr Ko Wing-man says the threat from H7N9 will decrease as temperatures rise, but the Government will stay vigilant.

Briefing reporters today, Dr Ko said H7N9 cases have decreased since Mainland authorities adopted preventive measures, and added he hoped the contingency plan for local chicken sales would not have to be activated after Mainland live chicken imports resume in June.

Noting concerns from Ta Kwu Ling residents on the plan, he said the Government will continue to communicate with them and will minimise environmental impacts.

Dr Ko also said the Government will conduct a study in May to formulate a contingency plan for the coming winter, including the use of a new vaccine against H7N9.

"According to our experts, the experts in the Mainland have already obtained the licence for experiment. The earliest possible available time frame would be around the end of the year or early next year. However, as to the application of this new vaccine, it remains to be discussed among the scientists and the authorities."

 

 

While work is being done on an H7N9 vaccine in China, Taiwan, Japan, and the United States - and there are hopes that a suitable one can be created – we’ve seen evidence in the past that effective H7 (and H5) flu vaccines are harder to make than their seasonal cousins.

 

Last May we saw an analysis of some of the problems inherent in creating and deploying an  H7N9 vaccine published in JAMA, penned by CIDRAP’s Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; and Nicholas S. Kelley, PhD.

Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9)

Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; Nicholas S. Kelley, PhD

JAMA. 2013;():1-2. doi:10.1001/jama.2013.6589.

Published online May 9, 2013

Issues such as the correct amount of antigen per shot, the timing or need for a booster shot, the incidence and severity of side effects, and even the need for an adjuvant are usually sorted out during several rounds of clinical (human) testing, something that can take months or even years.

 

Last September (see NIH Begins Phase II Clinical Trials On H7N9 Vaccine Candidates) the NIH released a detailed summary of their plans to test a variety of H7N9 vaccine formulations across two clinical trials - involving as many as 1700 volunteers - who will receive various strength H7N9 vaccines (adjuvanted and non-adjuvanted).

 

When complete, we should have a much better idea of what will be involved in creating a pandemic H7N9 vaccine. Full results, however, are not expected until December of 2014.

 

And assuming no major obstacles are encountered during these clinical trials, there’s several months of vaccine production, fill and finish, shipping, and local distribution to take into account. But the reality is - In a world of 7 billion people- our ability to manufacture and (just as importantly) distribute a pandemic vaccine in  a short amount of time remains severely limited.

 

Realistically, all of this means we are still a long way from having adequate amounts of commercial H7N9 vaccine available to the general public. 

 

Should H7N9 (or any other novel virus) spark a major epidemic or worse – a pandemic – then our first line of defense will be NPIs or Non-Pharmaceutical Interventions.   The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:

 

Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.

NPIs are geared to the virulence and spread of the virus, and may range from simple advice to `wash your hands and cover your coughs’ to mandatory school and business closings.

 

Vaccines would eventually play an important role in the containment of any pandemic, but likely not until the second or third wave of infection. And even then, they would initially only be available to a fraction of the world’s population.

 

Despite having been depicted in movies and TV shows as the panacea for any pandemic, the rapid global rollout of an experimental (and untested) vaccine is something that only really happens in in the minds of Hollywood screenwriters.

Infectious Disease Radio Show Today

 

 

# 8415

 

I’ll be away from my desk for most of the day, as I’m headed for the studios of WTAN radio to spend an hour with Microbiologist and radio host Robert Herriman on his Outbreak News This Week radio show.   Those in the immediate listening area can catch us at noon, EDT today on the Tan Talk Radio Network, but most will probably want to listen online (live, or the archived show which will be posted later in the day).

In addition to Robert and I, Crawford Kilian of Crofsblog will be joining us to discuss current events, flu blogging, and the art of newshounding.

 

To hear the show: 

Listen live Saturday’s from 12 to 1 pm EST on WTAN 1340 AM, WDCF 1350 AM and WZHR 1400 AM in the Clearwater, Lakeland, Zephyrhills and greater Tampa Bay area on the Tan Talk Radio Network,

or online at http://www.tantalk1340.com/

WHO: Ebola an `Outbreak, Definitely Not An Epidemic’

 

# 8414

 

While it may be a Saturday morning, officials at the World Health Organization (and other agencies) are nonetheless at work, dealing with the ongoing outbreak of Ebola Hemorrhagic Fever in Western Africa. 

 

Earlier this week I highlighted some of the WHO’s social media messaging (see WHO Twitter Messaging On Ebola), so this morning we’ve another round, along with a multi-language PSA from the UN Mission in Liberia.

 

First some of the messaging this morning from Gregory Hartl – spokesperson for the WHO – that stresses the regional nature and history of limited community spread of Ebola, and characterizes  it as `an outbreak’ . . . not an epidemic. 

Hartl also clarifies that the suspected cases in Liberia have yet to be lab-confirmed.

 

 

Meanwhile, the UN Mission in Liberia has produced a Public Service Announcement in 5 languages (English, Simple English, Kpelle, Bassa, Loma) on the Ebola Outbreak, for broadcast in that country.  You can listen to any (or all) of these PSAs at the link below:

https://soundcloud.com/un-mission-in-liberia/sets/ebola-public-service

Yesterday the ECDC released an epidemiological update, and as you might expect, they too are calling this an `outbreak’.

 

Epidemiological update: Outbreak of Ebola haemorrhagic fever in Guinea

28 Mar 2014

​Background
An outbreak of Ebola haemorrhagic fever in Guinea, West Africa, with onset in early February 2014 is rapidly evolving. The first cases were reported from the Forested Region of south-eastern Guinea. ECDC published a Rapid Risk Assessment of the outbreak on 23 March at which time 80 cases including 59 deaths (CFR: 74%) had been reported. To date, fifteen cases have tested positive for Ebola virus by PCR. Gene sequencing has demonstrated 98% homology with the Zaire Ebola virus last reported from an outbreak in 2009 in Kasai-Occidental Province of the Democratic Republic of Congo. The case fatality ratios in previously reported outbreaks caused by the Zaire Ebola virus have been high.

Update
On 27 March, fifteen new cases were reported to WHO, of which five were reported from Conakry, eight from Guéckédou district and two from Macenta district. Of the five cases reported from Conakry, four have been laboratory-confirmed and are isolated in a hospital while the fifth fatal case could not be tested. Investigations are underway to identify the source and route of transmission of these patients, record their travel histories before arrival in Conakry and determine their period of infectivity for the purpose of contact tracing. The five cases in Conakry are unlikely to have been infected in the capital. According to a media report quoting the Minister of Health in Guinea, the primary case in the Conakry cluster is an elderly man who developed haemorrhagic fever after visiting Dinguiraye in central Guinea and subsequently died. Four of the man’s brothers who attended his funeral in the central town of Dabola later developed symptoms and tested positive for Ebola on their return to Conakry. The four patients have been placed in an isolation ward in Donka hospital. The elderly man's family has been quarantined.

In summary, as of 27 March, 103 cases (15 laboratory-confirmed and 88 suspected) including 66 deaths (CFR: 64%) have been reported from three districts in south-eastern Guinea, Guéckédou, Macenta and Kissidougou, and from the capital, Conakry. Four of the fatal cases were healthcare workers. All age groups have been affected but most of the cases are adults aged 15-59 years.

As of 27 March, Liberia has reported eight suspected cases, including six deaths, and Sierra Leone has reported six suspected cases, including five deaths. All cases reported from Sierra Leone and Liberia had travel history to the affected districts in Guinea.

Investigations and response activities are ongoing in Guinea, and isolation facilities have been set up in Guéckédou district. WHO and the Global Outbreak Alert and Response Network (GOARN) have deployed experts to support the operational response. Supplies and logistics required for supportive management of patients and all aspects of outbreak control are being mobilised.

Read More
WHO/AFRO outbreak news
ECDC Ebola health topic page
ECDC Ebola and Marburg fact sheet
ECDC Rapid Risk Assessment, 23 March 2014

 

And lastly, Crof over at Crofsblog has been doing a terrific job covering the flow of news out of Guinea and the surrounding areas, and – in addition to following @WHO and the twitter feed #AskEbola - is undoubtedly the best place to go to get the latest updates on this Ebola outbreak

Los Angeles M5.1: Californians Shaken & Hopefully Stirred

 

# 8413

 

Overnight, and as 2014’s National Tsunami Preparedness Week winds down,  the city of Los Angeles was rocked by a moderately strong earthquake (Mag 5.1), causing some minor damage and rattling nerves across a wide swath of Southern California.   Three hours after the quake, the Los Angeles Times was reporting 5.1 earthquake causes damage; some flee from homes.

 

While a far cry from `the big one’, California residents are advised by USGS seismologist Lucy Jones that there is about a 5% chance that this quake could be a foreshock, and that another – larger quake – could occur in the hours or days ahead (Larger L.A. earthquake possible after 5.1 temblor, USGS says).

 

First the Tectonic Summary from the USGS, then I’ll be back with a bit more about earthquake preparedness.

 

Tectonic Summary

A M5.1 earthquake occurred at 9:09PM on March 28, 2014, located 1 mile easy of La Habra, CA, or 4 miles north of Fullerton, CA. The event was felt widely throughout Orange, Los Angeles, Ventura, Riverside, and San Bernardino counties.  It was preceded by two foreshocks, the larger of M3.6 at 8:03pm.  The demonstration earthquake early warning system provided 4 second warning in Pasadena. 

There have been 23 aftershocks as of 10:00PM on March 28, the largest of which was a M3.6 at 9:30PM, and was felt locally near the epicenter. The aftershock sequence may continue for several days to weeks, but will likely decay in frequency and magnitude as time goes by.

The maximum observed instrumental intensity was VII, recorded in the LA Habra and Brea areas, although the ShakeMap shows a wide area of maximum intensity of VI. The maximum reported intensity for the Did You Feel It? map was reported at VI in the epicentral area.

This sequence could be associated with the Puente Hills thrust (PHT).  The PHT is a blind thrust fault that extends from this region to the north and west towards the City of Los Angeles.  It caused the M5.9 1987 Oct. 1 Whittier Narrows earthquake. 

Previously, the M5.4 2008 Chino Hills earthquake occurred in this region.  It caused somewhat stronger shaking in Orange County and across the Los Angeles Basin. 

The moment tensor shows oblique faulting, with a north dipping plane that approximately aligns with the Puente Hills thrust.

 

Last December, in Dr. Lucy Jones: `Imagine America Without Los Angeles’, we looked at a presentation given by Dr. Jones at the  annual meeting of the American Geophysical Union (held this year in San Francisco),  that emphasized that should the `big one’ hit Southern California, we could literally `lose’ Los Angeles.

 

She warned that the damage could be far greater, and last much longer, than most people believe.  While 99 out of 100 modern buildings might remain standing, the (often buried) infrastructure needed to provide water, electricity, internet connectivity, and natural gas – the lifeblood -  to the region could be devastated (see CBS News report).

 

If this sounds like hyperbole, in 2010 (see Revised Risk Of `The Big One’ Along San Andreas Fault) we looked at a study that suggested that Southern California may be more overdue for another major quake than previously thought, and in the following year (see Estimating The Economic Impact Of A San Andreas Quake) we looked at a report from the U.S. Bureau of Labor Statistics that endeavored to gauge the crippling impact that a highly feasible (and long overdue) 7.8 magnitude Southern California earthquake would have on jobs and local businesses.

Download PDF file

A quake of this magnitude, they estimate, could affect  430,000 businesses and 4.5 million workers and deliver a devastating – and prolonged – blow to the local (and national) economy.

 

For a comprehensive guide on how you can prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.  

 

As you’ll notice, Los Angeles recommends having more than just a 72 hour emergency kit.

It isn’t enough to have a kit, and a plan during an earthquake. You need to know what to do to protect life and limb while the shaking is going on.  And for that, we have the ever-growing Great Shakeout Drill (see  NPM13: A Whole Lotta Shakeouts Going On).

 

While there is admittedly a 95% chance that there won’t be a large aftershock to this quake, it only takes being caught unprepared for a single major disaster to ruin your entire day.

 

For more information on emergency preparedness, I would invite you  to visit:

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

And some of my preparedness blogs, including:

When 72 Hours Isn’t Enough

The Gift Of Preparedness: 2013

In An Emergency, Who Has Your Back?

WHO: Updated Ebola Factsheet

Ebola Virus - Credit CDC

 

# 8412

 

My thanks to Gregory Hartl – spokesperson for the World Health Organization – for tweeting the announcement that a new Ebola Factsheet has been published on their website.

While the virus was first identified in 1976, there have been fewer than 3 dozen outbreaks studied, and so doctors and researchers are still learning about these emerging pathogens. 

I’ve only excerpted the first two sections, follow the link to read it in its entirety.

 

Ebola virus disease

Fact sheet N°103
March 2014

---

Key facts

• The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans.
• EVD outbreaks have a case fatality rate of up to 90%.
• EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
• No specific treatment or vaccine is available for use in people or animals.

---

The Ebola virus causes Ebola virus disease (EVD) in humans, with a case fatality rate of up to 90%.

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:

• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV)
• Reston ebolavirus (RESTV)
• Sudan ebolavirus (SUDV)
• Taï Forest ebolavirus (TAFV).

BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Transmission

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

(Continue . . . )

 

For more additional background\ on Ebola, you may wish to revisit some of these earlier blogs:

 

A Brief History Of Ebola 

When Viruses Jump Cages

When Viruses Jump Species

Saudi MOH Announces A New MERS-CoV Case In Jeddah

 

# 8411

 

A brief announcement from the Saudi Ministry of Health this morning informs us of one additional case of MERS Coronavirus infection, this time in a 26-year-old from Jeddah.  As usual, we get very little else in the way of details.

 

Health: recording cases of one virus (Corona) new in Jeddah

05/27/1435

In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus, "Corona" that causes Acquired Middle East respiratory MERS-CoV, Ministry announces the registration of the case of a citizen at the age of 26 years in Jeddah, and receiving treatment in intensive care. God asking him to recover.

 

While the lack of details here make it difficult to match up, I would note that overnight Crof at Crofsblog picked up a report of a male nurse (age not given) from Jeddah, who is suspected of being infected with the virus.

Saudi Arabia: Male nurse hospitalized with suspected MERS

 

 

For more on the status of the emergence of  MERS-CoV, the World Health Organization released an updated summary and literature review yesterday (see WHO: MERS-CoV Summary & Literature Update – March 27th).

PHE: Transmission Of Bovine TB From Felines To Humans - UK

 

 

# 8410

 

Readers with good memories will recall that back in 2010 I wrote a blog called Badgers? We Don’t Need No Stinkin’ Badgers!, that looked at a controversial plan to cull badgers in the UK in an attempt to reduce the wildlife reservoir of Mycobacterium bovis which is the cause of tuberculosis in cattle (known as bovine TB).

 

M. bovis is also capable of infecting humans (mainly through unpasteurized milk), although famers in contact with infected cattle are at risk as well.

 

In fact, of the three type of Tuberculosis bacteria (Mycobacterium bovis, M. avium, and M. tuberculosis – the most prevalent strain in humans), M. bovis has the largest host range – being capable of infecting just about all warm-blooded vertebrates.

 

Last year, a study appeared in the CDC’s EID Journal that attempted to estimate the global burden of M. bovis infection in humans (see Zoonotic Mycobacterium bovis–induced Tuberculosis in Humans), and found that while the number was small (roughly 1 per 100,000 pop.) - it was not insignificant – particularly in areas of the world where unpasteurized milk is still widely consumed.

 

DEFRA calls Bovine TB one of the biggest challenges facing UK cattle industry, and cites the following key facts:

• 5.5 Million – total number of TB tests on cattle in England in 2011.
• 28,000 – approximate number of cattle slaughtered for TB control in England in 2012.
• 3,900 – approximate number of new TB incidents in 2012 (herds where at least one animal tests positive for bovine TB, when the herd had previously been TB free).
• 11.5% of cattle herds in England were under cattle movement restrictions at some point in 2011 (the 2012 statistics will be published once additional quality assurance checks have been completed).
• 23.6% of cattle herds in the South-West were under cattle movement restrictions at some point in 2011 (the 2012 statistics will be published once additional quality assurance checks have been completed).
• £500 million – the amount it has cost the taxpayer to control the disease in England in the last 10 years.
• £1 billion – estimated cost of TB control in England over the next decade without taking further action.
• £34,000 – the average cost of a TB breakdown on a farm, of which around £12,000 falls to the farmer.

 

While many farmers see badgers as the primary source of their bovine TB woes, and blame them for reintroducing the disease into their herds each year, conservation and animal rights groups strongly disagree, and argue that the badger is the victim here.

 

They maintain that cow-to-cow transmission is the primary route of infection, and that badgers usually get the disease from cattle – not the other way around.

 

Four years, and a pilot culling program later, and the controversy still reigns. Recent media coverage has run the gamut from TB strategy about much more than badger culling – Paterson -Farmers Guardian to MPs vote overwhelmingly to halt badger cull in England – The Guardian.

 

Adding a new dynamic to an already complex and contentious debate, yesterday Public Health England released a report on two rare human infections with M. bovis – both associated with an outbreak in cats – which likely became infected via contact (directly or indirectly) with badger setts (dens). 

 

The feline outbreak is described in a letter published in the BMJ’s Veterinary Journal called Mycobacterium bovis infection in cats by Nigel Gibbens, which prompted a full epidemiological investigation.  A brief excerpt:

 

BETWEEN December 2012 and March 2013, a veterinary practice in Newbury (west Berkshire) diagnosed nine cases of Mycobacterium bovis infection in domestic cats. In seven of those cases the diagnosis was confirmed by bacteriological culture. The nine affected cats belonged to different households and six of them resided within a 250 metre radius. The animals presented with mycobacterial disease of variable severity including anorexia, non-healing or discharging infected wounds, evidence of pneumonia and different degrees of lymphadenopathy. The latest information is that six of the cats have been euthanased or have died. The three surviving animals are undergoing treatment and are reported to be responding. At the time of writing, no new cases had been detected in local cats since March 2013.

 

PHE published the following press release on their website yesterday regarding the epidemiological investigation that turned up two probable cases where humans contracted M. bovis from cats.

 

Cases of TB in domestic cats and cat-to-human transmission: risk to public very low

Published 27 March 2014

Two people in England have developed tuberculosis after contact with a domestic cat infected with ‘Mycobacterium bovis’ (‘M. bovis’), Public Health England (PHE) and the Animal Health and Veterinary Laboratories Agency (AHVLA) have announced.’‘M. bovis’ is the bacterium that causes tuberculosis (TB) in cattle (bovine TB) and in other species.

Nine cases of ‘M. bovis’ infection in domestic cats in Berkshire and Hampshire were investigated by AHVLA and PHE during 2013. PHE offered TB screening to 39 people identified as having had contact with the infected cats as a precautionary measure. 24 contacts accepted screening. Following further investigations, a total of 2 cases of active TB and 2 cases of latent TB were identified. Latent TB means they had been exposed to TB at some point but they did not have active disease. Both cases of active TB disease have confirmed infection with ‘M. bovis’ and are responding to treatment.

There have been no further cases of TB in cats reported in Berkshire or Hampshire since March 2013. PHE has assessed the risk of transmission of ‘M. bovis’ from cats to humans as being very low.

Dr Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at PHE, said:

“It’s important to remember that this was a very unusual cluster of TB in domestic cats. ‘M. bovis’ is still uncommon in cats - it mainly affects livestock animals. These are the first documented cases of cat-to-human transmission, and so although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed ‘M. bovis’ infection should be assessed and receive public health advice.”

The findings of the animal health aspects of this investigation are published in The Veterinary Record today, 27 March 2014.

 

Molecular analysis at AHVLA showed that ‘M. bovis’ isolated from the infected cats and the human cases with active TB infection were indistinguishable, which indicates transmission of the bacterium from an infected cat. In the other cases of latent TB infection, it is not possible to confirm whether these were caused by ‘M. bovis’ or the source of their exposure.

 

Transmission of ‘M. bovis’ from infected animals to humans can occur by inhaling or ingesting bacteria shed by the animal or through contamination of unprotected cuts in the skin while handling infected animals or their carcasses.

 

Professor Noel Smith, Head of the Bovine TB Genotyping Group at AHVLA, said:

“Testing of nearby herds revealed a small number of infected cattle with the same strain of ‘M. bovis’ as the cats. However, direct contact of the cats with these cattle was unlikely considering their roaming ranges. The most likely source of infection is infected wildlife, but cat-to-cat transmission cannot be ruled out.”

Cattle herds with confirmed cases of bovine TB in the area have all been placed under movement restrictions to prevent the spread of disease.

 

Local human and animal health professionals are remaining vigilant for the occurrence of any further cases of disease caused by ‘M. bovis’ in humans, cats or any other pet and livestock animal species.

(Continue . . . )

 

The PHE also released a HAIRS Risk Assessment, where they characterized the risk to public health as:

 

A Very low risk of transmission of M. bovis from cats to humans.

 

Although the risk of acquiring TB from a domestic cat in the UK is exceedingly low, and even less likely here in the United States, this report illustrates how animals – both wild and domestic – can carry and transmit zoonotic infections to humans.

 

This intersection of man and other species, and their sharing of viruses (zoonotic transmission), has increasingly been recognized as a driving factor in emerging infectious diseases, and even the creation of pandemics.

 

The age of emerging infectious diseases in humans really began in earnest about 10,000 years ago when humans began to domesticate – and live in close proximity to – other animals (see The Third Epidemiological Transition).

   

Measles probably evolved from canine distemper and/or the Rinderpest virus of cattle. Tuberculosis, which now infects 1/3rd of humanity, likely jumped from domesticated goats and cattle.  And influenza’s all seem to have an origin in waterfowl.

 

Other zoonotic nasties include Babesiosis, Borrelia (Lyme), Nipah, Hendra, Malaria, Hantavirus, Ebola, Leptospirosis, Q-Fever, bird flu . . . the list is long and growing.

 

Roughly 70% of the infectious diseases that afflict man today are believed to have begun in some other species, and new ones (think MERS-CoV, H7N9, H5N1, SFTS, etc. ) continue to show up each year. We live in an amazingly complex and interconnected world, where what happens in a live poultry market in China, a camel stable in Saudi Arabia, or a pig farm in Mexico can ultimately impact the health of people around the world.

 

So we watch these spillovers of diseases from animals to humans – no matter how rare, or small they may be – with considerable interest.

WHO: MERS-CoV Summary & Literature Update – March 27th

Figure 1. Laboratory confirmed cases of MERS‐CoV infection by approximate time of onset, March 2012 through March 2014.

 

 

# 8409

The World Health Organization released a 5-page PDF summary and literature update on the MERS coronavirus today, which seeks to characterize the first 206 reported human cases originating on the Arabian Peninsula.

 

I’ve only excerpted a small portion, follow the link to read it in its entirety.

 

 

Middle East Respiratory Syndrome Coronavirus (MERS‐CoV)      

Summary and literature update  – as of 27 March  2014   

Since April 2012, 206 laboratory confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS‐CoV) have been reported to WHO, including 86 deaths (Figure 1). 

The age and gender distribution of cases vary depending on the presumed type of exposure that led to infection. Primary cases, those who have no history of prior exposure to other human cases, are on average older and a larger percentage of them are men than secondary cases (Table 1). Secondary cases are those who appear likely to have been infected by other humans.

Thus far, the affected countries in the Middle East include Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE), all of which appear to have had primary transmission events from non‐human sources. Other affected countries include France, Germany, Italy and the United Kingdom (UK), in Europe and Tunisia, in North Africa. In these countries, cases have been imported from the Middle East with some secondary transmission (Figure 2). All primary cases have had their exposure to MERS‐CoV in the Middle East.

Since the last update of 20 January 2014, 28 laboratory‐confirmed cases, including 10 deaths, have been reported to WHO.  Countries in which the presumed exposure of these cases occurred are shown in Table 2 below.

It is notable that the cases from Jordan, Kuwait, and one of the cases from UAE appear to have acquired infection in a healthcare setting. Among the 22 cases reported from Saudi Arabia, 19 were in Riyadh, and one appears to have acquired his infection in a health care setting.  Among the four cases that acquired infection in a health care setting, three appear to have had exposure to an unidentified primary case.

Additionally, four of the cases from Riyadh were members of the same household: the index case, a 19‐year‐old male, died as a result of infection with MERS‐CoV, and three presumed secondary cases — a 53‐year‐old male, an 18‐year‐old female and a 22‐year‐old  female—exhibited mild or no symptoms. 

(Continue . . . )

 

MMWR: Heartland Virus Disease — United States, 2012–2013

Lone Star Tick - Credit CDC MMWR

 

 

# 8408

 

In August of 2012, in a New Phlebovirus Discovered In Missouri, I wrote about the CDC’s announcement of a new tick-borne virus detected in two Missouri farmers – living 60 miles apart, and with no epidemiological links - that was dubbed `The Heartland Virus’ (HLV) - named after the Heartland Regional Medical Center in St. Joseph, Mo which alerted the CDC back in 2009 about these cases

 

A 2012 NEJM report (A New Phlebovirus Associated with Severe Febrile Illness in Missouri), described the process that led to the identification of this novel virus:

 

Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus.

<SNIP>

This novel virus (which we called the Heartland virus) is a distinct member of the phlebovirus genus and is most closely related to tickborne phleboviruses, notably the recently isolated SFTSV

 

Phleboviruses are part of the family Bunyaviridae - which includes such nasties as Crimean-Congo hemorrhagic fever, Hantaviruses, and Rift Valley Fever. Bunyaviruses -  are mostly spread via arthropod vectors (ticks, mosquitoes & sand flies), with the exception of Hantaviruses (see Hantaviruses Revisited), which are spread via the feces and urine of rodents.

 

This newly described `Heartland virus’  is genetically similar to another tickborne disease identified in China in 2011 called the SFTS virus (see EID Journal  dispatch Severe Fever with Thrombocytopenia Syndrome Virus, Shandong Province, China Jun 2012).

 

Since then we’ve seen reports of SFTS in Japan and Korea as well (see Japan Announces 4th SFTS Fatality,  Korean CDC On SFTS Cases).  

 

And in September of 2013, we saw a report in the CDC’s EID Journal (Novel Bunyavirus in Domestic and Captive Farmed Animals, Minnesota, USA), where researchers found an unexpectedly high prevalence (10%-18%) of antibodies (using an ELSIA reagent kit developed by China’s CDC) to SFTS in the cattle, goats, sheep, and elk they tested.   

 

Since the Heartland Virus (HLV) and SFTF are antigenically cross reactive, the authors believed `the viruses detected in this region are most likely HLV or close relatives of HLV.’

 

Given the geographical separation of the first two cases in Missouri, and the detection of HLV-like antibodies in farmed animals as far away as Minnesota, one cannot be too surprised to learn that additional human cases of HLV (5 in Missouri, 1 in Tennessee) have now been identified, as is reported today by  the CDC’s MMWR.

 

Notes from the Field: Heartland Virus Disease — United States, 2012–2013

March 28, 2014 / 63(12);270-271

Daniel M. Pastula, MD1, George Turabelidze, MD2, Karen F. Yates, MS2, Timothy F. Jones, MD3, Amy J. Lambert, PhD4, Amanda J. Panella, MPH4, Olga I. Kosoy, MA4, Jason O. Velez4, Marc Fischer, MD4, J. Erin Staples, MD4 (Author affiliations at end of text)

Heartland virus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009 (1). Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. From this work, it was learned that Heartland virus is found in the Lone Star tick (Amblyomma americanum) (Figure) (2). Six additional cases of Heartland virus disease were identified during 2012–2013; four of those patients were hospitalized, including one with comorbidities who died.

(Continue . . . )

 

The CDC’s emailed press release summarizes  the cases:

 

Ongoing investigations have yielded six more cases of Heartland virus disease, bringing to eight the total number of known cases. All of the six case-patients were white men over the age of 50. Their symptoms started in May to September and included fever, fatigue, loss of appetite, headache, nausea, or muscle pain. Four of the six new cases were hospitalized. One patient, who suffered from other health conditions, died. It is not known if Heartland virus was the cause of death or how much it contributed to his death. Five of the six new cases reported tick bites in the days or weeks before they fell ill.

Nearly all of the newly reported cases were discovered through a study conducted by the Missouri Department of Health and Senior Services and CDC who are actively searching for human cases at six Missouri hospitals.

<SNIP>

CDC studies to date have shown Heartland virus is carried by Lone Star ticks, which are primarily found in the southeastern and eastern United States. Additional studies seek to confirm whether ticks can spread the virus to people and to learn what other insects or animals may be involved in the transmission cycle. CDC is also looking for Heartland virus in other parts of the country to understand how widely it may be distributed.

The CDC’s Heartland Virus FAQ (updated yesterday, March 26th), provides the following advice regarding HLV.

How can people reduce the chance of getting infected with Heartland virus?

There is no vaccine or drug to prevent or treat the disease. Preventing bites from ticks and mosquitoes may prevent this and other infections.

• Use insect repellents
• Wear long sleeves and pants
• Avoid bushy and wooded areas
• Perform thorough tick checks after spending time outdoors

Additional information on reducing exposure to ticks is available on the CDC Ticks website.

 

How do I know if I have been infected with Heartland virus?

Currently, no tests are routinely available to tell if a person is infected with Heartland virus. Tests that will help a doctor diagnose Heartland virus infection are being developed. Consult your healthcare provider if you have any symptoms that concern you.

 

What is the treatment for Heartland virus disease?

There is no specific treatment for Heartland virus disease. Antibiotics are not effective against viruses. Supportive therapy can treat some symptoms. Some patients may need to be hospitalized for intravenous fluids, and treatment for pain or fever.

 

What should I do if I think someone might be infected with Heartland virus?

Consult your healthcare provider for proper diagnosis if you have any symptoms that concern you.

Post-Disaster Stress Cardiomyopathy: A Broken-Hearted Malady

Credit Wikipedia

 

# 8407

 

Although once thought to be the figment of a poet’s imagination, doctors now know it is possible to die from a `broken heart’ – from a condition known as Takotsubo cardiomyopathy – or stress induced cardiomyopathy.  Also known as broken heart syndrome, this acute ballooning of the heart ventricles is a well-recognized cause of acute heart failure and dangerous cardiac arrhythmias.

 

Johns Hopkins Medicine has a Frequently Asked Questions about Broken Heart Syndrome, that describes the condition:

 

1. What is “stress cardiomyopathy?”

Stress cardiomyopathy, also referred to as the “broken heart syndrome,” is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding.

2. What are the symptoms of stress cardiomyopathy?

Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.

3. Is stress cardiomyopathy dangerous?

Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.

 

Since this condition is normally associated with the sudden loss of a loved one, or some other form of severe stress, it shouldn’t come as a complete surprise research finds an increased incidence of this syndrome in stress filled post-disaster scenarios. 

 

First a press release from the American College of Cardiology, after which I’ll return with a bit more.

 

 

Clusters of 'broken hearts' may be linked to massive natural disasters

Analysis of US Takotsubo cardiomyopathy cases shows pattern to cue emergency responders

WASHINGTON (March 27, 2014) — Dramatic spikes in cases of Takotsubo cardiomyopathy, also called broken heart syndrome, were found in two states after major natural disasters, suggesting the stress of disasters as a likely trigger, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session. Authors call for greater awareness among emergency department physicians and other first responders.

Takotsubo cardiomyopathy, or broken heart syndrome, is a disorder characterized by a temporary enlargement and weakening of the heart muscle, which is often triggered by extreme physical or emotional stress – for example, being in a car accident or losing a child or spouse. Previous international studies have also linked broken heart syndrome to natural disasters, including the 2004 earthquake in Japan. This is the first U.S. study to examine the geographic distribution of the condition in relation to such catastrophes.

Researchers at the University of Arkansas identified 21,748 patients diagnosed with primary cases of broken heart syndrome in 2011 using a nationwide hospital discharge database. After mapping the cases by state, Vermont and Missouri emerged as having the highest rate of cases, with 380 cases per million residents in Vermont and 169 per million in Missouri. Most states had fewer than 150 cases per million residents. New Hampshire and Hawaii had the lowest rate of the disease that year.

The rate of broken heart cases in Vermont in 2011 was more than double most other states. This was the same year that Tropical Storm Irene pummeled the state with heavy rain and wind, causing the most devastation Vermont has experienced since the Great Flood of 1927. Similarly, researchers found broken heart syndrome at a rate of 169 cases per million in Missouri in 2011, the same year a massive tornado ripped through Joplin, Mo., demolishing neighborhoods and killing at least 158 people.

"Despite the seemingly increasing number of natural disasters we have, there is limited data about how it might affect the heart," said Sadip Pant, M.D., internist at the University of Arkansas for Medical Sciences, and lead investigator of the study. "Our findings suggest two disasters, one in Vermont and one in Missouri, might have been possible triggers for the clustering of Takotsubo cardiomyopathy cases in these regions."

(Continue . . .)

 

We’ve looked at the post-disaster (often stress related) effects on human health previously, including earlier this month in Tulane University: Post-Katrina Heart Attack Rates – Revisited, where heart attack rates remain elevated by 300% in New Orleans six years after that hurricane struck.

 

And just last month, in The Long Term Effects Of A Major Disaster, we looked at the post-tsunami deaths due to stress and displacement that exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami. And last fall - in Sandy 1 Year Later: Coping With The Aftermath - we looked at the lingering psychological effects of New England’s brush with that late season super storm of 2012.

 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). This has been recognized as such a pressing problem that last  August the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:

 

While the psychological impact of a major disaster cannot be completely mitigated, encouraging individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

Which is why FEMA, Ready.gov, along with organizations like the American Red Cross, spend so much time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.The bottom line is that those who follow the advice to Have A Plan, Make A Kit, and Be informed  will be not only be better able to deal with a disaster, they will be better prepared to weather the rigors of a long recovery as well.

 

And that, in turn, could help reduce the risks of a variety of post-disaster health issues.

 

For more on all of this, a few of my (many) blogs on disaster preparedness include:

 

In An Emergency, Who Has Your Back?

When 72 Hours Isn’t Enough

When Evacuation Is The Better Part Of Valor